Should craving be a diagnostic measure?

Although most drug and alcohol addicts blame their inability to quit using their drug of choice on craving, the concept is not a criterion for any diagnoses of substance abuse or dependence in the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV).

New research indicates that maybe it should be, at least for alcohol abuse and dependence, because it?s as good a predictor of problem drinking as most of the criteria currently used, said National Institute on Drug Abuse intramural researcher David Newlin, PhD. He bases his opinion on an analysis of data from more than 3,500 participants in the National Longitudinal Alcohol Epidemiology Survey (NLAES). The survey participants represented the subset of the survey?s 42,862 participants who reported a lifetime history of craving alcohol. Items on the NLAES consisted of a moderate craving question asking, 'Have you ever felt a strong desire or urge to drink?' and an extreme craving question asking, 'Have you ever wanted a drink so badly that you couldn?t think of anything else?'

The moderate craving question was a significant and independent predictor of DSM-IV alcohol dependence and only four DSM-IV items were stronger predictors, Newlin and his colleagues found.

Also, survey participants who admitted to having an alcohol dependence or abuse diagnosis and who also answered yes to the moderate craving item had twice as many alcohol-related symptoms as those who didn?t report craving?20.7 symptoms compared with 9.5 symptoms.

'Craving for alcohol should be a sufficient, but not necessary criteria for alcohol dependence in DSM-V,' concluded Newlin.

?Beth Azar