Theories of drug craving, ancient and modern

This paper reviews the principal theoretical models of drug craving and pro vides some directions for future research. The main models are classified b roadly into three categories: (1) phenomenological models; based on clinica l observation and description; these have been influential in classificatio n systems of addictive disorders and in the development of pharmacological therapies; (2) conditioning models: based on conditioning theory; these hav e been influential in the development of cue exposure treatments; (3) cogni tive theories; based on cognitive social learning theory: these have been i nfluential in the development of cognitive therapies of addiction. Ir is co ncluded that no one specific theory provides a complete explanation of the phenomenon of craving. However, theories of craving grounded in general the ories of human behaviour offer greatest promise, and generate more specific and testable research hypotheses. Theories that do not require craving to be present for relapse to occur have more empirical support than those that provide simplistic causal explanations. The cue-reactivity model shows pro mise in the exploration of the relationship between craving and relapse. Ho wever, further attention to the phenomenology of craving could help to advi se the future measurement and study of drug craving, particularly in the co ntext of research in which drugs are available to human subjects, with adeq uate ethical safeguards. There is a need for further study of the temporal dynamics of craving and consensus in the field on the most appropriate meth ods of measurement. Finally, new psychotherapies such as cue exposure and p harmacotherapies that aim to attenuate drinking behaviour, such as naltrexo ne and acamprosate, provide opportunities to improve understanding of the n ature and significance of craving. However, the relatively uncritical assum ption that craving is the underlying basis of addiction and represents the most appropriate target for treatment is challenged.