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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.

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 alcohol's 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 model's 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.

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 taskwhich 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.Keywords attentional bias; emotional Stroop; relapse; smoking cessation Most attempts to quit smoking end in failure. Less than 5% of smokers trying to quit on their own maintain abstinence for 12 months (Hughes et al., 1992;Ward, Klesges, Zbikowski, Bliss, & Garvey, 1997). In smoking-cessation clinics, typically only 20-25% of smokers are abstinent at 6 months, and fewer are abstinent at 12 months. Relapse to smoking is rapid as well as common, with many relapses occurring in the first few days (Garvey, Bliss, Hitchcock, Heinold, & Rosner, 1992;Hughes et al., 1992). Medications such as nicotine replacement and bupropion improve outcomes (Jorenby et al., 1999; Silagy, Mant, Fowler, & Lancaster, 2000), but even with treatment, the majority of cessation efforts end in failure. Therefore, it is important to understand the psychological processes that cause the rapid relapse to smoking in the first few days, so that more effective relapse-prevention interventions can be developed.It is unclear what psychological processes underlie early lapses to smoking. Nicotine withdrawal in acute abstinence has been suggested as a critical process enhancing motivation to smoke and lapses to smoking, but it has been hard to demonstrate a strong link between severity of withdrawal and outcome in smoking cessation (Hughes, Higgins, & Hatsukami, 1990;Patten & Martin 1996). Many theories of drug addiction assume that responses to drugrelated cues are critical in maintaining drug use (e.g., Niaura et al., 1988;Robinson & Berridge, 1993;Siegel, 1983;Stewart, de Wit, & Eikelbloom, 1984;Wikler, 1948). Research on the details of initial lapse episodes (e.g., Shiffman, Paty, Gnys, Kassel, & Hickcox, 1996) suggests that environmental stimuli and events play a substantial role in precipitating initial lapses, and when such a lapse occurs, complete relapse is nearly certain to follow: 85-90% of lapses lead NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript to relapse (e.g., Kenford et al., 1994). There have also been reports of associations between measures of cue reactivity and clinical outcome (Abrams, Monti, Carey, Pinto...

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.

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.

This research examines the effects of manipulations designed to induce an urge to smoke on cognitive resources. Two cue-exposure experiments were conducted in which current smokers' reported urge to smoke and cognitive resources, as measured by a secondary reaction time (RT) probe, were assessed. In each study, subjects came to the laboratory twice, once while deprived of smoking for 12 hr and once when they were nondeprived. During each session, subjects were exposed to both smoking and control cues. Results indicated that experimental manipulations designed to elicit a strong urge to smoke led to an increase in self-reported urge to smoke and a decrease of available cognitive resources, as measured by RT. In addition, these 2 measures were significantly correlated. These data, in conjunction with previous findings using alcohol-dependent subjects (M. A. Sayette et al., 1994), lend support to the validity of RT as an objective measure of the effects of cue exposure on cognitive resources.

Aims-This research examined the performance of a broad range of measures posited to relate to smoking craving.Design-Heavy smokers and tobacco chippers, who were either deprived of smoking or not for 7 hours, were exposed to both smoking (a lit cigarette) and control cues.Participants-Smokers not currently interested in trying to quit smoking (n = 127) were recruited. Heavy smokers (n = 67) averaged smoking at least 21 cigarettes/day and tobacco chippers (n = 60) averaged 1-5 cigarettes on at least 2 days/week.Measurements-Measures included urge rating scales and magnitude estimations, a rating of affective valence, a behavioral choice task that assessed perceived reinforcement value of smoking, several smoking-related judgement tasks and a measure of cognitive resource allocation.Findings-Results indicated that both deprivation state and smoker type tended to affect responses across these measurement domains.Conclusions-Findings support the use of several novel measures of craving-related processes in smokers.