其他摘要 | Drug Use Disorders (DUD) is a chronic and relapsing brain disease. Craving is a significant factor in the continued drug use and relapse of addicts. Craving refers to the subj ective experience of wanting to use drugs, which includes cognitive, emotional, and internal sensations. It is influenced by factors such as the severity of addiction, type of substance, and internal and external states like negative emotions and stress. Previous research has explored the triggers, motivations, and physiological characteristics of craving from the perspectives of classical conditioning, cognitive processing, decision-making, and neurobiology. However, there has been limited systematic exploration of the experience of craving. The cognitive-emotional theory proposes that craving is an emotionally charged cognitive process involving the imagination of substance use, intrusive thoughts, and a sense of urgency to use the substance. The Craving Experience Questionnaire (CEQ), developed based on this theory, has preliminarily explored the psychological characteristics of craving in tobacco and alcohol dependence. As drugs are highly addictive substances that cause more severe and persistent damage to the central nervous system and the brain compared to tobacco and alcohol, previous studies and clinical reports have also shown that drug addicts experience more intense and persistent physical sensations related to drug use.
Therefore, the main purpose of this study is to explore the characteristics of craving experience in drug addicts and further investigate the influence of individual traits such as emotion regulation ability and impulsivity on craving experience. Additionally, the stu即examines the predictive role of emotional and stress states on craving. This article includes two studies. Study 1 explores the psychological experiential characteristics and internal and external triggers of drug addicts, consisting of two experiments. The aim of Experiment 1 is to preliminarily explore the dimensions and triggers of craving experience in drug addicts. Based on the results of Experiment 1 and the CEQ, which is grounded in the cognitive-emotional theory, Experiment 2 constructs an interview questionnaire suitable for capturing the craving experience characteristics of drug addicts. After conducting interviews using this questionnaire, latent profile analysis is employed to describe the heterogeneity of craving experience in the population and its relationship with the severity of addiction. Study 2 assesses craving experience using the questionnaire and examines its relationship with gender, substance type, impulsivity, and emotion regulation ability. Ecological momentary assessment is used to evaluate the predictive role of emotions, stress, and common craving triggers identified in Experiment 1 on craving during the drug deprivation period (in a compulsory isolation environment) and the drug availability period (in daily life).
Experiment 1 recruited 174 individuals with drug addiction in compulsory isolation for in-depth interviews. The results showed that: (1) Craving triggers originate from internal and external sources. Internal triggers include emotions, sleep, stress, and other factors, while external triggers include drug-related environments, drug-related cues, interpersonal relationships, and others. (2) The experience of craving includes four aspects: urgency to seek drugs, drug-related imagery, intrusive thoughts, and negative physiological experiences. The dimension of negative physiological experiences was not previously included in the CES. Additionally, individuals with drug addiction have rich multi-sensory imagery, including visual, olfactory, gustatory, auditory, and tactile imaginations. The physiological experience is a prominent craving experiential characteristic in individuals with drug addiction. Based on these results, the craving psychological experiential characteristics interview questionnaire for individuals with drug addiction was developed by adding the dimension of physiological experiences (previously missing) and questions related to multi一sensory imagery, as well as optimizing other dimensions. The craving experience includes two dimensions: intensity and frequency, with each dimension consisting of four sub-dimensions: urgency, imagery, intrusiveness, and absence (negative physiological experiences).
Experiment 2 used the developed questionnaire to interview 262 individuals with addiction about their craving experiences. To ensure that the questionnaire adequately reflects the aforementioned dimensions, exploratory structural equation modeling was conducted, and the questionnaire demonstrated good structural validity. The chi-square values for the intensity and frequency questionnaires were 178.503 and 173.235, respectively, with SRMR values of 0.024 and 0.020, CFI values of 0.970 and 0.972, TLI values of 0.941 and 0.945, and RMSEA values of 0.085 and 0.083.Reliability analysis showed that the Cronbach's a values for the intensity and frequency sub-questionnaires were 0.94 and 0.95, respectively, indicating good reliability. Based on the good validity and reliability of the questionnaire, latent profile analysis was used to classify the craving multidimensional characteristics of individuals in drug rehabilitation into five subgroups: moderate craving group, imagery craving group, urgency craving group, absence craving group, and low craving group. Comparative analysis was conducted on the gender, substance type, addiction severity, duration of drug use, impulsivity, emotion regulation efficacy, anxiety, and depression levels of these five groups. Significant differences were found in the age (p<0.05) duration of drug use(p<0.05), number of detoxifications (p<0.01), addiction severity (p<0.001), and impulsivity (p=0.057), while no significant differences were found in the other measures.
Study 2 employed ecological momentary assessment to explore the influence of sleep, emotions, and stress on craving. The study included 47 participants in drug deprivation (compulsory isolation) and collected data on sleep, emotions, stress, and craving over a period of 14 days. Using generalized estimating equations, a regression model was established with the intensity of craving as the dependent variable and the
other measures as independent variables. The results showed that negative emotions
had a significant predictive effect on craving (}=0.480, p<0.001), while no significant effects were found for sleep, stress, and other characteristics. Additionally, to enhance ecological validity, a mobile intelligent platform was developed to collect real-time and dynamic psychological data in daily life. The platform integrated psychological assessment, physiological monitoring, and psychological intervention, supporting personalized tasks, data storage, and export functions. It facilitated subjective assessment of craving and emotions, as well as objective measurement of stress and sleep. The platform aimed to capture internal and external craving triggers in the daily lives of individuals in drug rehabilitation. However, due to the limitations of high vigilance among individuals in drug rehabilitation, dispersed living locations, and concerns about potential punishment for truthful reporting, data was collected from only 7 participants. The findings revealed that craving in daily life was accompanied by unstable sleep patterns and smoking behavior.
In summary, the results of this study indicate that the psychological experience of craving in individuals with drug addiction can be categorized into dimensions of urgency, imagery, intrusiveness, and absence. The craving experience can be classified into five subtypes: moderate craving, imagery craving, urgency craving, absence craving, and low craving. The differences in craving experience types may be influenced by factors such as impulsivity and duration of drug use. Furthermore, negative emotions in daily life are an important predictor of craving. This research provides a possibility for assessing various types of craving experiences and can serve as a basis for further development of a drug craving experience scale. Additionally, the development of a mobile intelligent platform lays the foundation for subsequent craving monitoring, assessment, and self-management. Exploring the internal psychological processes and external triggers of craving is crucial for providing effective targets for personalized interventions and reducing the risk of relapse. Future research can expand the monitoring of physiological indicators and conduct multidimensional comprehensive assessments of the psychological, physiological, and behavioral characteristics of craving. Moreover, increasing the sample size and establishing predictive models for craving based on the craving psychological characteristics of different populations can be pursued. |
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