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Multiple ambiguities in the measurement of drug craving

2015; Wiley; Volume: 110; Issue: 2 Linguagem: Inglês

10.1111/add.12726

1360-0443

Scott J. Moeller, Anna B. Konova, Rita Z. Goldstein,

Hormonal and reproductive studies

AddictionVolume 110, Issue 2 p. 205-206 Commentaries on Wilson & SayetteFree Access Multiple ambiguities in the measurement of drug craving Scott J. Moeller, Scott J. Moeller Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USASearch for more papers by this authorAnna B. Konova, Anna B. Konova Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USASearch for more papers by this authorRita Z. Goldstein, Rita Z. Goldstein rita.goldstein@mssm.edu Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USASearch for more papers by this author Scott J. Moeller, Scott J. Moeller Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USASearch for more papers by this authorAnna B. Konova, Anna B. Konova Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USASearch for more papers by this authorRita Z. Goldstein, Rita Z. Goldstein rita.goldstein@mssm.edu Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USASearch for more papers by this author First published: 19 January 2015 https://doi.org/10.1111/add.12726Citations: 7AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Craving is a core feature of all addictive disorders, exemplified by its inclusion in the new DSM-5 1. However, investigating the neurobiology of craving is fraught with ambiguity. Craving is an inherently subjective human experience, replete with cognitive, emotional, interoceptive, metacognitive and physiological components that are difficult, if not impossible, to capture fully in animal studies. Thus, the neurobiology of craving has been examined principally via human neuroimaging studies. These studies have revealed that a diffuse network of brain regions is reliably engaged by drug-related cues (for reviews, see 2-6). Here, Wilson & Sayette raise the intriguing possibility that these studies, rather than probing the neural correlates of clinically relevant craving, could be unintentionally measuring low-level desire 7. In support, they point to neuroimaging studies of nicotine users in which craving probes often fail to elicit endorsement of even the scales' mid-points. Furthermore, many of these studies have allowed ad-libitum smoking prior to cue exposure, promoting satiation that can minimize or obscure subjective and neural craving responses. The authors conclude that consideration of 'urge intensity' in imaging studies could help to clarify the neurobiological basis of overpowering, clinically relevant craving. We agree that refinement of the craving concept is vital to advancing the clinical neuroscience of drug addiction, and we raise the following additional caveats for consideration. First, it will be important to disentangle the multi-faceted construct of craving from the effects of deprivation or withdrawal. For nicotine, which is consumed in well-defined patterns that maintain relatively consistent bodily levels of nicotine, deprivation might correspond directly with craving. In contrast, for stimulants that are often consumed in binge cycles (e.g., cocaine, methamphetamine), the link between craving and deprivation could be more tenuous. In our work, cocaine-addicted individuals reported the highest levels of cocaine 'wanting', a proxy of craving, when recalling a time that they were already 'under the influence' of the drug (versus the contexts of 'right now' or 'in general') 8; that is, craving was highest when deprivation was ostensibly lowest. Moreover, individuals with more recent cocaine use (i.e. cocaine-positive versus cocaine-negative urine screens) rated cocaine pictures as being more affectively pleasant 9 and chose more of them for viewing (versus pleasant pictures) on tasks of simulated drug choice 10. In direct support, others have shown that priming doses of cocaine in cocaine-addicted individuals increased craving 11 and subsequent choice for cocaine over money 12. Secondly, it will be important to integrate craving measures more effectively with imaging measures. This consideration can help to maximize applicability across multiple addictions and enable more precise investigation of the underlying craving construct. The approach of assessing differences in neural activation between addicted subgroups (e.g. stratified by craving level, recency of use, etc.) is susceptible to numerous confounds that could drive observed differences. As we suggested above, craving may overlap with withdrawal, depending on the population under study. A potentially improved strategy is to exploit, in a participant-specific manner, the variability in craving intensity within the experimental paradigm itself. This approach, by increasing temporal proximity between the measured craving and the neuroimaging data, could provide more accurate tracking of their association. For example, one could have participants indicate, on a trial-by-trial basis, their craving level upon exposure to a drug cue or by making a drug-related decision. This latter design, based on behavioral response (choice), could also help to address obstacles of impaired insight/self-awareness 13, which in an important subgroup of addicted individuals may impede the effective assessment of online craving and subjective drug–cue reactivity 14, 15. Importantly, these types of designs would enable parametric correlation of trial-by-trial responses with the associated neural signals for each individual. One could compare how low-level desire and clinically relevant craving may diverge in neural location and magnitude and across groups of addicted individuals. Such parametric designs are the standard in research on non-pathological food cravings 16. They are also amenable to sophisticated, more sensitive analytical approaches (e.g. multi-voxel pattern analysis 17). Of clinical relevance, these designs could be used potentially for interventional purposes (e.g. training individuals to reduce craving or drug-biased responding). In sum, we agree that the neurobiology of craving, despite being a long-standing focus of intense basic and clinical investigation, remains unclear. Disambiguating the neurobiological basis of drug craving could fundamentally advance our understanding of drug addiction and its treatment-resistant nature. Declaration of interests None declared. Acknowledgements This work was supported by grants from the National Institute on Drug Abuse (to R.Z.G.: 1R01DA023579, R21DA034954; to S.J.M.: 1F32DA030017-01). References 1 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th edn. Arlington, VA: American Psychiatric Publishing; 2013. CrossrefGoogle Scholar 2 Chase H. W., Eickhoff S. B., Laird A. R., Hogarth L. 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CrossrefPubMedWeb of Science®Google Scholar Citing Literature Volume110, Issue2February 2015Pages 205-206 ReferencesRelatedInformation