Craving research: future directions

Many prospective clinical studies have concluded that craving does not reli ably predict relapse and that the concept is of little or no clinical utili ty. Contrary to earlier more simplistic clinical models of addiction, more recent models do not require that craving be present for relapse to occur. New approaches to study human craving may enhance its predictive validity a nd yield more knowledge of its nature, course, behavioural sequelae and reg ulatory function in alcohol/drug consumption. These approaches include empi rical research that focuses on: (1) the elucidation of the domains of cravi ng (i.e. subjective experience, physiological responses, behavioural sequel ae and their inter-relationships); (2) the temporal dynamics of craving (i. e. its course over minutes or days, as well as its natural history over the course of a drinking career); (3) the factors that may mediate/moderate/de termine the development and resolution of craving; (4) studies of the predi ctive validity of craving measures; and (5) the development of valid method s of measuring the different domains of craving. The conclusions are that f uture craving research should: (1) incorporate more sophisticated general t heories of behaviour (conditioning, cognitive social learning, neurobiologi cal, and genetic); (2) apply more sophisticated and standardized measuremen t methods and experimental paradigms, including studies in which alcohol is made available to human subjects; and (3) effective development of new pha rmacological and behavioural therapies for relapse prevention depend on gre ater understanding of the nature and measurement of craving.