What Is Craving? Models and Implications for Treatment - alcohol craving

Alcohol Research & Health, Fall, 1999 by Raymond F. Anton

The evaluation of craving during clinical treatment also can help clinicians manage their clients' treatment in several ways. First, "craving" is a useful concept for bridging our understanding of addiction and what we know about actual drinking behavior--that is, craving influences drinking behavior and is a central feature of addiction. A discussion of the patient's craving therefore can facilitate therapeutic discussions between treatment provider and client.

Second, the results of repeated evaluation and monitoring of craving may influence treatment decisions. For example, treatment approaches that include craving management may be appropriate for patients reporting a considerable amount of urges for--or thoughts of--drinking, particularly for patients who have difficulty resisting such urges. Such treatment approaches include cognitive-behavioral therapy or anticraving medications (e.g., naltrexone). For clients who continue to experience persistent craving despite receiving some craving management therapy, alternative treatment approaches or more intensive care should be considered. For example, clients taking naltrexone who still experience some degree of craving--either during or immediately after treatment--may require extended therapy. Alternatively, once additional anticraving medications (e.g., acamprosate) become available, combination therapy with several medications may be appropriate for some patients who experience severe craving.

Third, clinicians can teach clients to monitor themselves for the presence of various craving phenomena and thereby assist in their own long-term care. For those patients, the recognition of craving could serve as an early warning sign of relapse that can prompt the use of preventive measures before drinking actually occurs.

In clinical practice, the assessment of craving can be difficult, however, because some clients may deny experiencing it. For those patients, the clinician should inquire about urges, desires, and, most importantly, thoughts of drinking, because many clients express craving only by reporting thoughts or images of drinking situations. [2] Finally, when making treatment decisions, treatment providers must consider the presence of psychiatric conditions that may influence craving.

NEW HORIZONS AND UNRESOLVED QUESTIONS

New technological tools have opened up new roads for enhancing understanding of the mechanisms underlying craving and AOD dependence. For example, the development of animal models, coupled with a focus on analyzing cellular networks in the brain (Pierce et al. 1998), should help identify and fit together increasingly small pieces of the puzzle. Analyses that integrate neurochemistry, neuroanatomy and, perhaps, genetic vulnerability also have enormous potential to advance current understanding of craving. Furthermore, application of the latest brain-imaging techniques in humans will begin the process of translating results obtained in basic science laboratories to clinical settings (George et al. 1999). Such analyses already have begun to unravel the neuroanatomic basis of craving in cocaine addicts (Grant et al. 1996). In alcoholics, such studies are only just beginning; however, the results could take researchers and clinicians to the next level of investigation and understanding.