Michael A. Sayette

The measurement of drug craving.

This paper reviews theoretical and methodological issues in the measurement of drug craving, with an emphasis on self-report assessment. Despite the important role that craving plays in many research and clinical settings, the way in which the construct is conceptualized and measured rarely receives sufficient attention. Issues pertinent to conceptualizing craving are identified. Because there is no single perfect measure of craving, it is essential that researchers understand the limitations of each measure. Measurement performance concerns that affect the validity of different measures are reviewed. Non-verbal assessment methods are also reviewed. Research factors that may help determine the optimal measures for a given study are highlighted. It is concluded that advances in assessment will proceed only when combined with additional research and a better theoretical understanding of craving.

Meta-awareness, perceptual decoupling and the wandering mind

Mind wandering (i.e. engaging in cognitions unrelated to the current demands of the external environment) reflects the cyclic activity of two core processes: the capacity to disengage attention from perception (known as perceptual decoupling) and the ability to take explicit note of the current contents of consciousness (known as meta-awareness). Research on perceptual decoupling demonstrates that mental events that arise without any external precedent (known as stimulus independent thoughts) often interfere with the online processing of sensory information. Findings regarding meta-awareness reveal that the mind is only intermittently aware of engaging in mind wandering. These basic aspects of mind wandering are considered with respect to the activity of the default network, the role of executive processes, the contributions of meta-awareness and the functionality of mind wandering.

Prefrontal responses to drug cues: a neurocognitive analysis

The construct of craving has been central to addiction research for more than 50 years. Only recently have investigators begun to apply functional neuroimaging techniques to the study of drug cue reactivity, and a small but growing number of studies implicate a distributed system of brain regions in the pathogenesis of craving. The internal consistency of this burgeoning literature has thus far been disappointing, however, leaving open the question of which brain regions contribute to craving. Here we review neuroimaging studies of cue-elicited craving in the context of a framework drawn from behavioral research indicating that perceived drug use opportunity significantly affects responses to the presentation of drug cues. Using this framework provides a way to reconcile discrepant findings among brain-imaging studies of cue-elicited craving.

Attentional Bias Predicts Outcome in Smoking Cessation

Most attempts to quit smoking end in failure, with many quitters relapsing in the first few days. Responses to smoking-related cues may precipitate relapse. A modified emotional Stroop task-which measures the extent to which smoking-related words disrupt performance on a reaction time (RT) task-was used to index the distracting effects of smoking-related cues. Smokers (N = 158) randomized to a high-dose nicotine patch (35 mg) or placebo patch completed the Stroop task on the 1st day of a quit attempt. Smokers using an active patch exhibited less attentional bias, making fewer errors on smoking-related words. Smokers who showed greater attentional bias (slowed RT on the first block of smoking words) were significantly more likely to lapse in the short-term, even when controlling for self-reported urges at the test session. Attentional bias measures may tap an important component of dependence.

An appraisal-disruption model of alcohol's effects on stress responses in social drinkers.

This article reviews the effects of alcohol on stress responses among social drinkers. Despite considerable research, the relationship between alcohol and stress has remained unclear. An appraisal-disruption model of alcohols effects on stress responses is proposed, which attempts to integrate many divergent findings. According to this model, alcohol disrupts initial appraisal of stressful information by constraining the spread of activation of associated information previously established in long-term memory. The conditions under which such disruption is likely to occur are outlined. Evidence relevant to each of the models propositions is considered. It is concluded that the appraisal-disruption model provides a framework for integrating many of the findings from past investigations. Theoretical issues pertinent to the model are addressed.

Cue-Provoked Craving and Nicotine Replacement Therapy in Smoking Cessation.

Cue exposure paradigms have been used to examine reactivity to smoking cues. However, it is not known whether cue-provoked craving is associated with smoking cessation outcomes or whether cue reactivity can be attenuated by nicotine replacement therapy (NRT) in clinical samples. Cue-provoked craving ratings and reaction time responses were measured on the 1st day of abstinence among 158 smokers who had been randomized to high-dose nicotine (35 mg) or placebo patch. The nicotine patch reduced overall levels of craving but did not attenuate cue-provoked craving increases or reaction time responses. Cue-provoked craving predicted relapse among participants on the nicotine patch but not among those on placebo. In summary, NRT users could benefit from treatment that attenuates cue-provoked craving.

A Review of the Effects of Perceived Drug Use Opportunity on Self-Reported Urge

Although persons addicted to drugs reliably report experiencing cravings or urges during drug cue exposure, less is known about factors that may moderate this effect. This article reviews cue exposure studies with people who smoke, are dependent on alcohol, or are addicted to cocaine or opiates. Perceived drug use opportunity is found to affect urge ratings. Specifically, people who are addicted to substances and who perceive an opportunity to consume their drug of choice report higher urges than do those who do not anticipate being able to use the drug. This factor was proposed to explain why those in treatment for substance dependence report urges that are about half the strength of those in nontreatment settings. The impact of perceived drug use opportunity on urge is considered from a variety of perspectives, including conditioning theories, a cognitive appraisal framework, and motivated reasoning theory. Conceptual and methodological implications of perceived drug use opportunity are addressed.

Instructed smoking expectancy modulates cue-elicited neural activity: A preliminary study

In recent years, research applying functional neuroimaging to the study of cue-elicited drug craving has emerged. This research has begun to identify a distributed system of brain activity during drug craving. A review of this literature suggested that expectations regarding the opportunity to use a drug affected the pattern of neural responses elicited by drug cues. Using functional magnetic resonance imaging (fMRI), we examined the effects of smoking expectancy on the neural response to neutral (e.g., roll of tape) and smoking-related (a cigarette) stimuli in male cigarette smokers deprived of nicotine for 8 hr. As predicted, several brain regions (e.g., the anterior cingulate cortex) exhibited differential activation during cigarette versus neutral cue exposure. Moreover, we found that subregions of the prefrontal cortex (i.e., ventromedial, ventrolateral, and dorsolateral prefrontal cortices) showed cue-elicited activation that was modulated by smoking expectancy. These results highlight the importance of perceived drug use opportunity in the neurobiological response to drug cues.

A PSYCHOMETRIC EVALUATION OF THE FACIAL ACTION CODING SYSTEM FOR ASSESSING SPONTANEOUS EXPRESSION

The Facial Action Coding System (FACS) (Ekman & Friesen, 1978) is a comprehensive and widely used method of objectively describing facial activity. Little is known, however, about inter-observer reliability in coding the occurrence, intensity, and timing of individual FACS action units. The present study evaluated the reliability of these measures. Observational data came from three independent laboratory studies designed to elicit a wide range of spontaneous expressions of emotion. Emotion challenges included olfactory stimulation, social stress, and cues related to nicotine craving. Facial behavior was video-recorded and independently scored by two FACS-certified coders. Overall, we found good to excellent reliability for the occurrence, intensity, and timing of individual action units and for corresponding measures of more global emotion-specified combinations.

Effects of smoking opportunity on attentional bias in smokers.

The emotional Stroop task was used to examine the influence of opportunity to smoke on attentional bias to smoking-related stimuli. At the outset of the study, 92 nicotine-deprived smokers were told that they (a) would, (b) would not, or (c) might be able to smoke during the experiment. Next, participants completed an emotional Stroop task, in which they were presented with smoking-related or -unrelated words in an unblocked format. Smokers demonstrated interference to the smoking words, relative to matched neutral words, F(1, 87) = 18.0, p < .0001. Moreover, smoking opportunity affected the degree of interference, F(2, 87) = 4.35, p < .02, with participants who had been told they would be able to smoke during the study showing the most interference. The results suggest that smoking opportunity affects the salience of smoking-related stimuli among nicotine-deprived smokers.