What can hunger teach us about drug craving? A comparative analysis of the two constructs

doi:10.1016/0146-6402(92)90006-A

Advances in Behaviour Research and Therapy

Volume 14, Issue 3, 1992, Pages 141-167

Advances in Behaviou...

https://doi.org/10.1016/0146-6402(92)90006-A Get rights and content

Abstract

While few deny the prevalence of craving among drug-dependent individuals, many theorists have suggested that craving has outlived its usefulness as a meaningful psychological construct. The prevailing notion is that craving reflects an underlying biologic need, but the empirical support for this appears weak. To examine this concern, we review a similar psychological construct: hunger. An intuitive view is that hunger reflects the need to eat due to energy depletion. In this paper, we outline conceptual expectations of the constructs of craving and hunger, and review evidence suggesting that neither craving nor hunger (1) is a simple reflection of underlying biologic need, (2) has reliable physiological correlates or controls, (3) is strongly linked to affective state, or (4) reliably predicts consumption (food or drug). Rather than abandon the study of a compelling psychological construct, researchers ought to re-examine their expectations of craving, and re-focus their attempts to understand the role of craving in drug use. A review of the hunger literature also suggests several fruitful lines for investigation of craving.

References (128)

D.B. Abrams et al.
Reactivity to smoking cues and relapse: Two studies of discriminant validity
Behaviour Research and Therapy
(1988)
L.L. Birch et al.
Conditioned meal initiation in young children
Appetite
(1989)
R.C. Bolles
Historical note on the term “appetite”
Appetite
(1980)
A. Brummer et al.
An attempt to demonstrate reliable salivary increases in the hungry state
Appetite
(1981)
C.M. Christensen et al.
Anticipatory salivary flow to the sight of different foods
Appetite
(1984)
N.L. Cooney et al.
Salivation to drinking cues in alcohol abusers: toward the validation of a physiological measure of craving
Addictive Behaviors
(1984)
C.E. Cornell et al.
Stimulus-induced eating when satiated
Physiology and Behavior
(1989)
J.M. De Castro
Macronutrient relationships with meal patterns and mood in the spontaneous feeding behavior of humans
Physiology and Behavior
(1987)
J.M. De Castro
Circadian rhythms of the spontaneous meal pattern, macronutrient intake, and mood of humans
Physiology and Behavior
(1987)
J.M. De Castro
Social facilitation of duration and size but not rate of the spontaneous meal intake of humans
Physiology and Behavior
(1990)

J.M. De Castro et al.

Subjective hunger relationships with meal patterns in the spontaneous feeding behavior of humans: evidence for a causal connection

Physiology and Behavior

(1988)

J.M. De Castro et al.

A microregulatory analysis of spontaneous human feeding patterns

Physiology and Behavior

(1985)

J.M. De Castro et al.

Spontaneous human meal patterns are related to preprandial factors regardless of natural environmental constraints

Physiology and Behavior

(1986)

J.J. Franchina et al.

Effects of deprivation on salivary flow in the apparent absence of food stimuli

Appetite

(1988)

R. Hodgson et al.

Alcohol dependence and the priming effect

Behaviour Research and Therapy

(1979)

M.E. Jarvik et al.

Potentiation of cigarette craving and satisfaction by two types of meals

Addictive Behaviors

(1989)

L.T. Kozlowski et al.

“Cravings” are ambiguous: ask about urges or desires

Addictive Behaviors

(1989)

R. Larson et al.

Bulimia: disturbed patterns of solitude

Addictive Behaviors

(1985)

M.R. Lowe et al.

Restraint, disinhibition, hunger and negative affect eating

Addictive Behaviors

(1988)

A.M. Ludwig

Pavlov's “bells” and alcohol craving

Addictive Behaviors

(1986)

R. Mattes

Hunger ratings are not a valid proxy measure of reported food intake in humans

Appetite

(1990)

R. Niaura et al.

Responses to smoking-related stimuli and early relapse to smoking

Addictive Behaviors

(1989)

H.J. Rankin et al.

The concept of craving and its measurement

Behaviour Research and Therapy

(1979)

P.J. Rogers et al.

Breakdown of dietary restraint following mere exposure to food stimuli: interrelationships between restraint, hunger, salivation, and food intake

Addictive Behaviors

(1989)

B.J. Rolls et al.

The specificity of satiety: the influence of foods of different macronutrient content on the development of satiety

Physiology and Behavior

(1988)

B.J. Rolls et al.

Sensory specific satiety in man

Physiology and Behavior

(1981)

B.J. Rolls et al.

Pleasantness changes and food intake in a varied four course meal

Appetite

(1984)

J.E. Rose et al.

Sensory blockade of smoking satisfaction

Pharmacology Biochemistry and Behavior

(1985)

J.L. Saumet et al.

Heat loss and anticipatory finger vasoconstriction induced by smoking of a single cigarette

Physiology and Behavior

(1985)

J.E. Sherman et al.

Urges/craving to smoke: preliminary results from withdrawing and continuing smokers

Advances in Behaviour Research and Therapy

(1986)

S. Shiffman

A cluster-analytic classification of smoking relapse episodes

Addictive Behaviors

(1986)

H.J. Alban Davies et al.

Metabolic response to low- and very-low calorie diets

American Journal of Clinical Nutrition

(1989)

T.B. Baker et al.

The motivation to use drugs: a psychobiological analysis of urges

K.E. Bauman et al.

The relationship between the consequences adolescents expect from smoking and their behavior: a factor analysis with panel data

Journal of Applied Social Psychology

(1984)

R.C. Bolles

A functionalistic approach to feeding

D.A. Booth

Hunger and satiety as conditioned reflexes

T.H. Brandon et al.

The process of smoking relapse

S.A. Brown

Expectancies versus background in the prediction of college drinking patterns

Journal of Consulting and Clinical Psychology

(1985)

H. Bruch

Eating disorders

(1973)

R. Bunker

Stress and nicotine intake: underlying mechanisms and processes

(1990)

W.B. Cannon et al.

An explanation of hunger

American Journal of Physiology

(1912)

A.R. Childress et al.

Classically conditioned responses in opioid and cocaine dependence: A role in relapse?

A.R. Childress et al.

Mood states can elicit conditioned withdrawal and craving in opiate abuse patients

S. Cohen

The chemical brain: The neurochemistry of addictive disorders

(1988)

M.L. Cooper et al.

Coping, expectancies, and alcohol abuse: a test of social learning formulations

Journal of Abnormal Psychology

(1988)

R. Coronas et al.

Modified total fasting and obesity: results of a multicentric study

International Journal of Obesity

(1982)

L.M. Eriksen et al.

Conditioned abstinence in alcoholics: a controlled experiment

International Journal of the Addictions

(1984)

R.M. Gilbert et al.

Early effects of quitting smoking

Psychopharmacology

(1982)

F.B. Glaser

Psychologic vs. pharmacologic heroin dependence

New England Journal of Medicine

(1974)

M.S. Goldman et al.

Expectancy theory: thinking about drinking

Cited by (53)

Craving and opioid use disorder: A scoping review
2019, Drug and Alcohol Dependence
Citation Excerpt :
The report resulting from that meeting acknowledged the importance of craving as it related to alcohol use, but ultimately recommended that the term ‘craving’ be eliminated from the scientific literature due to confusion arising from its various ‘everyday connotations’ (Supplementary Materials, Appendix A). Since that time there has been continued debate regarding the clinical utility of the concept of craving as it relates to substance use disorders (Kassel and Shiffman, 1992; Kozlowski and Wilkinson, 1987; Pickens and Johanson, 1992; Sayette et al., 2000; Tiffany and Wray, 2009, 2012). However, despite these challenges, drug craving remains a salient and important patient-reported experience as reflected by a survey at a recent public meeting hosted by the Food and Drug Administration (FDA) in collaboration with the National Institute of Drug Abuse (NIDA) (see meeting slides located at Food and Drug Administration, 2018a).
The subjective experience of drug craving is a prominent and common clinical phenomenon for many individuals diagnosed with opioid use disorder (OUD), and could be a valuable clinical endpoint in medication development studies. The purpose of this scoping review is to provide an overview and critical analysis of opioid craving assessments located in the published literature examining OUD.
Studies were identified through a search of PubMed, Embase, and PsychInfo databases and included for review if opioid craving was the focus and participants were diagnosed with or in treatment for OUD.
Fifteen opioid craving assessment instruments were identified across the 87 studies included for review. The most common were the Visual Analog Scale (VAS, 41 studies), Desires for Drug Questionnaire (DDQ, 12 studies), Heroin Craving Questionnaire (HCQ, 10 studies), and Obsessive-Compulsive Drug Use Scale (OCDUS, 10 studies). Craving assessments varied considerably in their format, content, time frame, and underlying subscales, and only 6 of 15 had been psychometrically evaluated.
This review identified a variety of opioid craving assessments, but few had been evaluated for their psychometric properties making it difficult to ascertain whether craving is being assessed optimally in studies of OUD. Thus, the development of a reliable and valid opioid craving assessment would be worthwhile and could be guided by recently published Food and Drug Administration Clinical Outcome Assessment (COA) guidelines. Importantly, a COA focused on opioid craving could be a valuable addition to research studies designed to evaluate novel treatments for OUD.
Implications of Psychological Engineering: Commentary on De Houwer, Hughes, and Barnes-Holmes
2017, Journal of Applied Research in Memory and Cognition
Neuroscience of drug craving for addiction medicine: From circuits to therapies
2016, Progress in Brain Research
Citation Excerpt :
Substance use disorder as a brain disease is characterized by persistent drug-seeking and drug-taking behaviors despite significant negative consequences in physical, emotional, social, and occupational aspects of the individual's life (Shariatirad et al., 2013; Volkow et al., 2011). Drug craving is considered by many researchers to be one of the main driving forces of drug-taking behaviors (Anton, 1999; Kassel and Shiffman, 1992; Robinson and Berridge, 1993). In spite of growing interest in craving which led to its consideration as one of the criteria for substance use disorders in DSM-5, there is a lack of consensuses about its definition (Sayette et al., 2000) and underlying causes (Drummond, 2001).
Drug craving is a dynamic neurocognitive emotional–motivational response to a wide range of cues, from internal to external environments and from drug-related to stressful or affective events. The subjective feeling of craving, as an appetitive or compulsive state, could be considered a part of this multidimensional process, with modules in different levels of consciousness and embodiment. The neural correspondence of this dynamic and complex phenomenon may be productively investigated in relation to regional, small-scale networks, large-scale networks, and brain states. Within cognitive neuroscience, this approach has provided a long list of neural and cognitive targets for craving modulations with different cognitive, electrical, or pharmacological interventions. There are new opportunities to integrate different approaches for carving management from environmental, behavioral, psychosocial, cognitive, and neural perspectives. By using cognitive neuroscience models that treat drug craving as a dynamic and multidimensional process, these approaches may yield more effective interventions for addiction medicine.
Cue-reactivity in experienced electronic cigarette users: Novel stimulus videos and a pilot fMRI study
2016, Brain Research Bulletin
Citation Excerpt :
The study of craving has been a major theme in addiction research across drug types (Robinson and Berridge, 1993; Tiffany, 1990). In cigarette smoking more specifically, exposure to implicit and explicit cigarette cues produces neural, physiological, and cognitive responses that lead to increased desire to smoke (i.e., urges or craving) and subsequent smoking behavior (Abrams et al., 1988; Droungas et al., 1995; Due et al., 2002; Franklin et al., 2007; Janes et al., 2010; McBride et al., 2006; McClernon et al., 2005)–though craving and using do not always go hand-in-hand (Kassel and Shiffman, 1992; Shiffman, 2000; Tiffany, 1990). Given some of the unique characteristics of e-cigarette use compared to cigarette smoking noted above (e.g., more variable nicotine delivery, ability to use more frequently throughout the day, etc.), it is unclear to what extent craving, and more specifically cue-induced craving, play a role in e-cigarette use.
Some individuals who try electronic cigarettes (e-cigarettes) continue to use long-term. Previous research has investigated the safety of e-cigarettes and their potential for use in smoking cessation, but comparatively little research has explored chronic or habitual e-cigarette use. In particular, the relationship between e-cigarette cues and craving is unknown. We sought to bridge this gap by developing a novel set of e-cigarette (salient) and electronic toothbrush (neutral) videos for use in cue-reactivity paradigms. Additionally, we demonstrate the utility of this approach in a pilot fMRI study of 7 experienced e-cigarette users. Participants were scanned while viewing the cue videos before and after 10 min use of their own e-cigarettes (producing an 11.7 ng/ml increase in plasma nicotine concentration). A significant session (pre- and post-use) by video type (salient and neutral) interaction was exhibited in many sensorimotor areas commonly activated in other cue-reactivity paradigms. We did not detect significant cue-related activity in other brain regions notable in the craving literature. Possible reasons for this discrepancy are discussed, including the importance of matching cue stimuli to participants' experiences.
Smoking, food, and alcohol cues on subsequent behavior: A qualitative systematic review
2015, Clinical Psychology Review
Citation Excerpt :
Moreover, target acquisition (e.g. breaking down and buying that pack of cigarettes) may occur dynamically over the course of several hours, potentially started by exposure to cues, but produced by slowly draining self-control resources until the person lacks the strength to resist. Many addictive processes are similar across substance and behavioral domains (Kassel & Shiffman, 1992; Köpetz et al., 2013; Pelchat, 2009; Tang, Fellows, Small, & Dagher, 2012), suggesting potential utility in examining the effect of cues on behavior across multiple targets. In the current review, we chose to evaluate behavioral responses to smoking, alcohol and food cues due to the ubquitiousness of these behaviors in Western society; 18% of US adults smoke, 52% of US adults report regular alcohol consumption, and two-thirds of adults are overweight or obese (Schiller, Lucas, & Peregoy, 2012).
Although craving is a frequent phenomenon in addictive behaviors, and laboratory paradigms have robustly established that presentation of cues can elicit self-reported craving responses, extant work has not established whether cue exposure influences subsequent behavior. We systematically review extant literature assessing the effects of cue exposure to smoking, food, and alcohol cues on behavioral outcomes framed by three questions: (1) Is there value in distinguishing between the effects of cue exposure on behavior from the responses to cues (e.g., self-reported craving) predicting behavior?; (2) What are the effect of cues on behavior beyond lapse, such as broadly considering both target-syntonic (e.g., do cigarette cues predict smoking-related behaviors) and target-dystonic behaviors (e.g., do cigarette cues predict other outcomes besides smoking)?; (3) What are the lessons to be learned from examining cue exposure studies across smoking, food and alcohol domains? Evidence generally indicates an effect of cue exposure on both target-syntonic and target-dystonic behavior, and that self-report cue-reactivity predicts immediate target-syntonic outcomes. Effects of smoking, food and alcohol cues on behavior are compared to elucidate generalizations about the effects of cue exposure as well as methodological differences that may serve the study of craving in the future.
Ambivalence about smoking and cue-elicited neural activity in quitting-motivated smokers faced with an opportunity to smoke
2013, Addictive Behaviors
Citation Excerpt :
The authors proposed that overweight women may have avoided the high-calorie images because of their ambivalence about eating such food, and that this avoidance appeared to be relatively non-effortful (e.g., automatically shifting their gaze from the food cues; see also Werthmann et al., 2011). Given the phenomenological and neurobiological similarities between cue-elicited craving for food and addictive substances (Kassel & Shiffman, 1992; Volkow & Wise, 2005), highly ambivalent smokers might exhibit a pattern of neural responses to cigarette cues that is similar to those observed in overweight individuals presented with food stimuli. That is, compared to those with low levels of smoking ambivalence, participants with elevated smoking ambivalence may exhibit dampened activation of reward-related brain regions during cue exposure insofar as they approach such stimuli in a guarded manner; at the same time, smoking ambivalence may be unrelated to activity in conflict- and control-related regions if the processes that result in attenuation of reward-related responses are largely automatic or non-demanding.
Many cigarette smokers appear to experience ambivalence about smoking, defined as the simultaneous co-occurrence of a strong desire to smoke and a strong wish to quit smoking. Research suggests that this ambivalence about smoking affects how smokers respond to cigarette-related stimuli, but many important questions remain about precisely how smoking ambivalence influences cognitive and affective processing during cigarette cue exposure. We used functional magnetic resonance imaging (fMRI) to address this knowledge gap by examining the relation between self-reported ambivalence about smoking and cue-reactivity in quitting-motivated smokers presented with an opportunity to smoke. Eighty-two quitting-motivated cigarette smokers completed a measure assessing their ambivalence about smoking. Subsequently, participants initiated an attempt to quit smoking and underwent an fMRI session, during which they were asked to hold and view a cigarette. Consistent with hypotheses, results indicated that self-reported smoking ambivalence was negatively correlated with cigarette-related activation in brain areas linked to reward-related processing, motivation, and attention (i.e., rostral anterior cingulate and medial prefrontal cortex, caudate nucleus, visual cortex). Self-reported ambivalence was not, however, correlated with activation in brain regions related to conflict processing. This pattern of results is discussed with respect to the process of change for those attempting to quit smoking.

View all citing articles on Scopus

View full text