Department of Psychology, University "Vita-Salute San Raffaele", Milan, Italy; Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy.
Drug Alcohol Depend. 2020 Jul 1;212:108002. doi: 10.1016/j.drugalcdep.2020.108002. Epub 2020 Apr 26.
It is still unclear whether craving should be considered a key risk factor for substance-use behaviors (SUB) among treatment-seeking individuals with alcohol (AUD) and other drugs use disorders. Therefore, this study aims at clarifying this topic using a meta-analytic approach.
Cohen's d was computed as effect size (ES) measure. Heterogeneity of ESs was computed using the Q statistic and I index. The analyses also evaluated the impact assessment length on ESs. Furthermore, proximal effects of craving on SUB were compared to distal ones. The diagnoses of specific substance use disorders (SUDs), together with assessment instruments and research design were considered as additional moderators.
Thirty-six independent studies were included for a total of 4868 treatment-seeking individuals with SUDs. Patients who used substances showed slightly higher levels of craving than abstinent ones. The heterogeneity of results was large and significant. The length of period of assessment was positively related to ESs. The analyses highlighted no differences between pooled ESs of proximal and distal impacts of craving on SUB. The diagnoses of SUDs were significant moderators. Considering AUD, assessment instruments and research design were additional moderators.
Craving is a modest time-dependent proximal and distal risk factor for SUB among individuals with SUDs. Both the frequency of craving episodes and a heightened reactivity to craving cues are largely associated to SUB among individuals with AUD. Future studies should evaluate the mediating and moderating roles of self-regulatory mechanisms on the relationship between craving and SUB.
对于寻求治疗的酒精（AUD）和其他药物使用障碍患者，是否应将渴望视为物质使用行为（SUB）的关键风险因素仍不清楚。因此，本研究旨在使用荟萃分析方法阐明这一主题。
采用 Cohen's d 作为效应量（ES）指标。采用 Q 统计量和 I 指数计算 ES 的异质性。分析还评估了渴望对 SUB 的近因和远因的影响。将特定物质使用障碍（SUD）的诊断以及评估工具和研究设计视为附加的调节因素。
共有 36 项独立研究纳入了总计 4868 名有 SUD 的寻求治疗的个体，其中使用物质的患者比禁欲患者表现出稍高的渴望水平。结果的异质性很大且显著。评估期长度与 ES 呈正相关。分析表明，渴望对 SUB 的近因和远因的聚合 ES 之间没有差异。SUD 的诊断是显著的调节因素。考虑到 AUD，评估工具和研究设计是其他调节因素。
在有 SUD 的个体中，渴望是一种适度的、随时间变化的 SUB 的近因和远因风险因素。渴望发作的频率和对渴望线索的反应性增加与 AUD 个体的 SUB 高度相关。未来的研究应评估自我调节机制在渴望和 SUB 之间关系中的中介和调节作用。
