A critique of contemporary urge and craving research: Methodological, psychometric, and theoretical issues

Abstract

Contemporary theories of drug urges assume that these states are central to the maintenance of drug administration in addicts and are responsible for the high rate of relapse frequently encountered when addicts attempt abstinence. Most urge theories share the assumption that urges and cravings are subjective states that are manifest behaviorally as concordant changes in overt behavior (e.g., drug pursuit and consumption), verbal reports of urges, and particular constellations of somatovisceral responses. Urge research has been impeded by inadequate development of questionnaires for assessing verbal report of urges, limitations of laboratory-based urge-induction procedures, selection and interpretation of relevant psychophysiological measures, and reluctance to critically examine the assumption that urges are necessary for drug use. Examples of research from the author's laboratory illustrating how these issues might be addressed are presented. In addition, a recent cognitive model (Tiffany, 1990) is described that assumes that the processes that control drug use in the addict operate independently of those supporting drug urges. This approach, which draws on the strong parallels between various descriptions of automatic and nonautomatic cognitive processing and some key characteristics of drug-use behavior and drug urges, offers a distinct alternative to current models of drug urges.