Rohsenow Damaris J, Martin Rosemarie A, Eaton Cheryl A, Monti Peter M
Providence Veterans Affairs Medical Center, Brown University's Center for Alcohol and Addiction Studies, Providence, RI 02903, USA.
J Stud Alcohol Drugs. 2007 Sep;68(5):641-8. doi: 10.15288/jsad.2007.68.641.
Whether craving (urge to use) actually predicts drug-use outcomes has had little investigation despite its central role in theories. Pretreatment predictors of within-treatment cocaine urges were investigated, and the urge reports were used as predictors of treatment attrition and outcome while controlling for correlated variables. In addition, urge to use in the patients' first relapse situations was compared with urge reports in the same patients' close-call situations without relapse.
Cocaine-dependent patients (N = 163) in residential treatment were assessed during the first week of treatment for pretreatment substance use and for urge to use cocaine in simulated high-risk situations. Substance use was assessed at follow-up with urine-confirmed self-reports (n = 119 at 3 months, n = 114 at 6 months). Mood and urge ratings just before relapse and in close calls without relapse were assessed.
Urge to use cocaine was unrelated to demographics, other substance use, years used, or cocaine-use frequency in the past 6 months but was higher for those who spent more on cocaine before treatment or reported more negative cocaine consequences. Urge did not predict treatment attrition but significantly predicted the amount spent on cocaine during the first 3 months even after covarying the pretreatment amount spent on cocaine. Urge ratings, not mood, were higher just before a relapse than a close call.
Urge to use cocaine predicts early drug-use outcomes and is not simply accounted for by the pretreatment quantity of cocaine use. Thus urge is a valid treatment target.
尽管渴望（使用冲动）在理论中具有核心作用，但实际上它是否能预测药物使用结果却鲜有研究。本研究调查了治疗期间可卡因冲动的治疗前预测因素，并在控制相关变量的同时，将冲动报告用作治疗中断和结果的预测因素。此外，还比较了患者首次复发时的使用冲动与同一患者未复发的险些复发情况时的冲动报告。
对住院治疗的可卡因依赖患者（N = 163）在治疗的第一周进行评估，以了解治疗前的物质使用情况以及在模拟高风险情况下使用可卡因的冲动。随访时通过尿液确认的自我报告评估物质使用情况（3个月时n = 119，6个月时n = 114）。评估复发前和未复发的险些复发情况时的情绪和冲动评分。
使用可卡因的冲动与人口统计学、其他物质使用、使用年限或过去6个月内的可卡因使用频率无关，但对于治疗前在可卡因上花费更多或报告有更多负面可卡因后果的人来说，冲动更高。冲动并不能预测治疗中断，但即使在对治疗前在可卡因上的花费进行协变量调整后，仍能显著预测前3个月内在可卡因上的花费。复发前的冲动评分高于险些复发情况时的冲动评分，而非情绪评分。
使用可卡因的冲动可预测早期药物使用结果，且不能简单地用治疗前可卡因使用量来解释。因此，冲动是一个有效的治疗靶点。
