13, 14 To date, the measurement of craving has been highly uneven-there are no field-wide (or drug-specific) standard instruments for craving assessment. But despite the development of several psychometrically validated multi-item craving instruments, craving continues to be assessed most commonly with single-item ratings in both clinical and research settings. The clinical utility of drug craving is governed, in part, by the psychometric adequacy of craving measures.
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We will start, however, with a discussion of the measurement of craving, as we believe that a full consideration of selected assessment issues will set the stage for a more informative review of related clinical topics. The paper will be both descriptive and prescriptive, with recommendations informed by the current state of the science on craving.
Thus, this paper will review the relevance of craving across a broader array of clinical domains including diagnosis, prognostic utility, craving as an outcome measure, and the potential value of craving as a direct target of intervention. 9– 12 Though this is an important concern, we believe the potential clinical utility of craving extends beyond this somewhat narrow question.
Although there have been several reviews covering the basic science and theory of craving 5 or the clinical relevance of certain features of craving for select drugs of abuse, 6– 8 there have been no comprehensive examinations of the overall clinical significance of craving across substance-use disorders.Īn issue that has received considerable attention in the clinical realm is the extent to which craving is or is not related to drug use and relapse. It often intrudes into their daily lives, at times dominating their thoughts and generating considerable distress. For these people, craving is a very real phenomenon. a The significance of craving is considerably less controversial among those who are addicted. Over the past 50 years, approximately 10,000 articles have been published on craving-more than 60% of these have appeared in just the past 10 years. 1– 4 These disputes have occurred in the context of a voluminous and rapidly expanding literature on craving. Craving disputes have erupted over the definition of the word craving, the measurement of craving, the function of craving in addiction, and the utility of craving for understanding addictive processes.
Over the past 40 years, drug craving has been a highly lively and, at times, contentious topic. We conclude that craving has considerable utility for diagnosis and as a clinical outcome, and that findings from future research will likely expand the clinical potential of the craving construct in the domains of prognosis and craving as a treatment target. The paper is both descriptive and prescriptive, informed by the current state of the science on craving with recommendations for the definition of craving, assessment practices, future research, and clinical applications. The paper then considers the relevance of craving across a broad array of clinical domains, including diagnosis, prognostic utility, craving as an outcome measure, and the potential value of craving as a direct target of intervention. This paper presents an overview of measurement issues of particular relevance to a consideration of use of craving in clinical settings. Although drug craving has received considerable research attention over the past several decades, to date there has been no systematic review of the general clinical significance of craving.
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