Singleton E G, Gorelick D A
Behavior Therapy Treatment Research Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21224, USA.
Recent Dev Alcohol. 1998;14:177-95. doi: 10.1007/0-306-47148-5_8.
Craving for alcohol is frequently given as a reason for drinking and is often used as a surrogate measure in studies of alcoholism and its treatment. Despite this wide use, there is little consensus on what craving for alcohol means, the best way to measure it, what mechanism accounts for the urge to drink, or what is its true relationship to alcohol use. This chapter reviews theoretical and measurement issues about the possible mechanisms involved in craving for alcohol and the clinical implications of evidence supporting them. Until recently, most instruments for assessing craving assumed it was a univariate construct and usually contained only one or a few items. Several multi-item and multidimensional rating instruments have now been developed that offer the promise of more useful assessment of clinically relevant behavior. Most models of craving have assumed that a consistent and positive relationship exists between craving and drinking. The incentive sensitization model and the cognitive theory of drug use and drug urges may account better than the older models for the frequent clinical observation of a dissociation between craving and drinking. However, no single model or theory of craving accounts for the wide variation in findings reviewed here, suggesting that multiple mechanisms may be involved. A comprehensive, multidisciplinary approach is necessary to elucidate the nature of craving for alcohol and its implications for pharmacological and psychosocial treatment of alcoholism.
对酒精的渴望常常被视为饮酒的一个理由，并且在酒精中毒及其治疗的研究中常被用作替代指标。尽管其应用广泛，但对于酒精渴望意味着什么、测量它的最佳方法、导致饮酒冲动的机制是什么，或者它与酒精使用的真实关系是什么，几乎没有达成共识。本章回顾了关于酒精渴望可能涉及的机制以及支持这些机制的证据的临床意义的理论和测量问题。直到最近，大多数评估渴望的工具都假定它是一个单变量结构，通常只包含一个或几个项目。现在已经开发出了几种多项目和多维度的评分工具，有望对临床相关行为进行更有用的评估。大多数渴望模型都假定渴望与饮酒之间存在一致的正相关关系。与旧模型相比，动机敏感化模型以及药物使用和药物冲动的认知理论可能能更好地解释渴望与饮酒之间分离这一常见临床现象。然而，没有单一的渴望模型或理论能够解释这里所综述的研究结果中的广泛差异，这表明可能涉及多种机制。需要一种全面的、多学科的方法来阐明酒精渴望的本质及其对酒精中毒药物治疗和心理社会治疗的意义。
