Stephen T. Tiffany

Evaluation of the brief questionnaire of smoking urges (QSU-brief) in laboratory and clinical settings

A brief, 10-item version of the Questionnaire of Smoking Urges (QSU; Tiffany & Drobes, British Journal of Addiction 86:1467-1476, 1991) was administered to 221 active cigarette smokers in a laboratory setting (Study 1) and to 112 smokers enrolled in a comprehensive smoking cessation program (Study 2). In the laboratory setting, craving to smoke was evaluated in response to neutral and smoking-related stimuli. In the clinical setting, craving was assessed prior to cessation and again during treatment. Factor analyses revealed that a two-factor solution best described the item structure of the QSU-Brief across conditions. Factor 1 items reflected a strong desire and intention to smoke, with smoking perceived as rewarding for active smokers. Factor 2 items represented an anticipation of relief from negative affect with an urgent desire to smoke. The findings were consistent with the expressions of craving found in the 32-item version of the QSU (Tiffany & Drobes, 1991). Regression analyses demonstrated stronger baseline mood intensity and self-reported tendency to smoke to achieve pleasurable effects and to experience the desire to smoke when cigarettes are unavailable were predictive of general levels of craving report in active smokers in the laboratory and clinical setting. The findings supported a multidimensional conceptualization of craving to smoke and demonstrated the utility of a brief multidimensional measure of craving.

A cognitive model of drug urges and drug-use behavior: role of automatic and nonautomatic processes.

Contemporary urge models assume that urges are necessary but not sufficient for the production of drug use in ongoing addicts, are responsible for the initiation of relapse in abstinent addicts, and can be indexed across 3 classes of behavior: verbal report, overt behavior, and somatovisceral response. A review of available data does not provide strong support for these assumptions. An alternative cognitive model of drug use and drug urges is proposed that hypothesizes that drug use in the addict is controlled by automatized action schemata. Urges are conceptualized as responses supported by nonautomatic cognitive processes activated in parallel with drug-use action schemata either in support of the schema or in support of attempts to block the execution of the schema. The implications of this model for the assessment of urge responding and drug-use behavior are presented.

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.

The development of a cocaine craving questionnaire

Two versions of a 45-item questionnaire on cocaine craving were administered to 225 cocaine users. The Now version asked about current craving for cocaine, and the General version asked about average craving over the preceding week. Factor analyses showed that a four-factor solution best described the item structure for both versions of the questionnaire. Higher-order analyses indicated that each version was permeated by a single second-order factor. Factor scales derived for each primary and second-order factor had moderate to high reliabilities. Examination of item content, correlations of factors across versions, and external correlates of the factors suggested that both versions were represented by the same hierarchical factor structure. The theoretical and clinical implications of the results from these craving instruments are discussed.

Are adolescent smokers dependent on nicotine? A review of the evidence

This paper reviews the empirical literature on adolescent nicotine dependence, withdrawal, and their associated features. Data documenting nicotine dependence scores, diagnoses, and individual features among adolescents are reviewed in detail and compared to observations based on adult smokers. These data are derived from a broad variety of sources, including national surveys, school-based surveys, and smoking cessation studies. Overall, results indicate that one to three out of five adolescent smokers is dependent on nicotine, with some adolescent groups clearly at higher risk for dependence (those who are incarcerated, in vocational schools, daily smokers, and/or heavy smokers). Across studies, data consistently indicate that a large majority (two-thirds or more) of adolescent smokers report experiencing withdrawal symptoms during attempts to quit or reduce their smoking. Craving or strong desire to smoke was the most commonly reported withdrawal symptom in every study reviewed. Although analyses of concurrent validity generally support the dependence and withdrawal findings among adolescents, data on the predictive validity of measures used are needed. Moreover, studies of adolescent tobacco withdrawal rely almost exclusively on retrospective self-report data. Recommendations for enhancing methodology and advancing our understanding of adolescent nicotine dependence and withdrawal are offered.

Is craving the source of compulsive drug use

Compulsive drug use, which is typically portrayed as a defining quality of addictive behavior, has been described as a pattern of drug consumption that is stimulus bound, stereotyped, difficult to regulate and identified by a loss of control over intake. It is widely assumed that compulsive drug use is caused by drug craving. This assumption is supported by numerous findings of a general correspondence between measures of craving and drug-use behavior. A more focussed analysis of the available data, however, reveals that craving and drug use are not coupled to the degree required by the hypothesis that craving is the source of all drug use in the addict. As an alternative to this craving-based view, compulsive drug use could be characterized as a form of automatized behavior. Automatic performance is assumed to develop over the course of repeated practice of motor and cognitive skills. Automatized behavior, like compulsive drug use, tends to be stimulus bound, stereotyped, effortless, difficult to control and regulated largely outside of awareness. The formulation of drug compulsion as a manifestation of automaticity rather than craving allows addiction researchers to apply methods and measures derived from cognitive sciences to investigate the fundamental organization of compulsive drug-use behavior.

Challenges in the manipulation, assessment and interpretation of craving relevant variables

The nature of drug craving and its role in the addictive process is a contentious issue in the addiction sciences. There are numerous disputes regarding the definition, assessment, manipulation and interpretation of craving, and progress toward resolving the enigmas of craving confronts numerous conceptual and methodological challenges. Greater attention to certain fundamental principles of measurement and manipulation should generate immediate and substantial improvements in efforts to understand and control alcohol craving. This paper provides suggestions for enhancing the measurement of self-reported alcohol craving and improving the manipulation of alcohol craving under controlled laboratory conditions. With regard to measurement, single-item scales commonly employed in craving research tend to be handicapped by limited reliability and validity. Multi-item craving scales are more likely to provide the accuracy required to accurately discriminate between different levels of craving across individuals or across different settings. Conceptual and practical considerations for the selection of multi-item craving instruments are discussed. With regard to the manipulation of alcohol craving in the laboratory, recent meta-analyses suggest that alcohol craving effects in such research may be relatively weaker than craving effects found in similar research with other addicts. Therefore, laboratory-based investigations into the nature of alcohol craving should utilize procedures and assessments that are particularly sensitive to the detection of alcohol craving. This paper offers methodological recommendations for enhancing the magnitude of alcohol craving effects generated in laboratory research.

The use of a dual-task procedure for the assessment of cognitive effort associated with cigarette craving

Two experiments used a dual-task procedure to investigate Tiffany’s (1990) proposal that drug craving should disrupt activities that demand nonautomatic cognitive processing. The primary task required smokers to imagine sentences that incorporated urge or no-urge descriptors. During imagery, the subjects also responded to a secondary reaction time (RT) task. Additional dependent variables collected during the imagery manipulation included craving report, mood report, heart rate (HR), and skin conductance levels (SCL). In study 1, imagery of urge sentences produced slower probe RTs and increases in HR and SCL, greater urge and negative mood reports, and lower positive mood ratings. This same pattern of results was replicated in the second study, which utilized sentence types more closely matched on no-urge content. These results support Tiffany’s (1990) cognitive processing theory and suggest an innovative approach to the investigation of drug craving.

A critique of contemporary urge and craving research: Methodological, psychometric, and theoretical issues

Abstract Contemporary theories of drug urges assume that these states are central to the maintenance of drug administration in addicts and are responsible for the high rate of relapse frequently encountered when addicts attempt abstinence. Most urge theories share the assumption that urges and cravings are subjective states that are manifest behaviorally as concordant changes in overt behavior (e.g., drug pursuit and consumption), verbal reports of urges, and particular constellations of somatovisceral responses. Urge research has been impeded by inadequate development of questionnaires for assessing verbal report of urges, limitations of laboratory-based urge-induction procedures, selection and interpretation of relevant psychophysiological measures, and reluctance to critically examine the assumption that urges are necessary for drug use. Examples of research from the authors laboratory illustrating how these issues might be addressed are presented. In addition, a recent cognitive model ( Tiffany, 1990 ) is described that assumes that the processes that control drug use in the addict operate independently of those supporting drug urges. This approach, which draws on the strong parallels between various descriptions of automatic and nonautomatic cognitive processing and some key characteristics of drug-use behavior and drug urges, offers a distinct alternative to current models of drug urges.

The production of smoking urges through an imagery manipulation : psychophysiological and verbal manifestations

This study examined physiological (heart rate, skin conductance, and finger temperature) responses and self-reported urges elicited by an imagery procedure designed to produce smoking urges. Sixty-six cigarette smokers were instructed to imagine vividly four audiotaped imagery scripts; two of the scripts contained explicit descriptions of smoking urge situations (urge scripts) while the other two were devoid of explicit urge content (neutral scripts). Physiological responses were monitored throughout each imagery trial and subjects rated the vividness of their image and intensity of their urge to smoke at the termination of each trial. Subjects reported significantly stronger urges to urge scripts than to neutral scripts. Urge scripts also produced increases in heart rate and higher tonic skin conductance levels than neutral scripts. These results suggest that the imagery procedure may have considerable potential in the study of the structure and function of drug urges. The theoretical implications of the data are discussed.