Pm. Monti et al., Toward bridging the gap between biological, psychobiological and psychosocial models of alcohol craving, ADDICTION, 95(8), 2000, pp. S229-S236
Citations number
36
Categorie Soggetti
Public Health & Health Care Science","Clinical Psycology & Psychiatry
Urge to drink ("craving") has been a central focus of many theories and tre
atments, but some researchers question the importance of urges during recov
ery. Several studies assessed reactions to the presence of beverage alcohol
(cue-reactivity) or to simulated high-risk situations (role plays). Higher
urges in response to role plays predicted more drinking during the 6 month
s after treatment. However, urges in response to beverage cues were inconsi
stently predictive of outcome while measures of awareness or attention to c
ues predicted less drinking. Urge to drink might re? ect a conflict between
motivation to drink and awareness of danger. Whether urges predict increas
ed risk of drinking should be a function of factors that affect motivation
to drink, awareness of risk and effectiveness of coping. Cue-reactivity ass
essment has recently been used to bridge the gap between psychosocial and b
iomedical approaches in several ways: (1) salivation to cues predicts incre
ased drinking independent of urge or attention, showing the value of includ
ing both physiological and psychosocial measures; (2) naltrexone has been s
hown to decrease cue-elicited urge to drink, illustrating the value of this
assessment methodology for medications evaluation and (3) pre-pulse inhibi
tion of startle response is being used to investigate the role of dopaminer
gic pathways in cue-elicited urge. Thus, this laboratory based program of r
esearch has the potential to add to knowledge of both biomedical and psycho
social mechanisms involved in urge and relapse, leading to greater integrat
ion of models.