Craving as an Indicator of Psychopharmacotherapy Efficiency

Article excerpt

Summary - Craving represents an important diagnostic criterion in diagnosing addiction. Over the recent years there is a growing interest regarding the phenomenon of craving. It is defined as a strong need for drinking of alcohol or intensive thinking about alcohol, surfacing at an attempt to stop drinking or to control drinking of alcohol and is accompanied with the feeling of compulsion to take alcohol. There are many models explaining the concept of craving and they are complementing each other. This psychological phenomenon has its biological point of reference. Also, there is a growing number of studies in which specific areas of the brain and the various neurotransmitting systems which could play a role in developing of this phenomenon are examined. The similarity between craving and other neurotic and stress related disorders is also being described. Particular emphasis is put on the connection between the obsessive-compulsive disorder and craving, where there are recurring, permanent and compulsive thinking about alcohol during the initial abstinence, as well as in the various (most often stressful) situations in the circumstances of longer abstinence.

Treatment should be complex and should certainly include psychopharmacotherapy, (naltrexon, acamprosat, antidepressants and anxiolytics), psychotherapeutical approach (cognitive- behavioural) and social support (out of hospital program - clubs of treated alcoholics). The research included 30 patients who had completed their treatment in hospital and continued to be treated as out-patients during the year of 2005. The subjects have fulfilled the OCDS Questionnaire at the beginning and again after four weeks of taking naltrexon. The results obtained indicate the efficiency of psychopharmacotherapy and can also be used as further indicators for following-up of treatment and relapse prevention. (Alcoholism 2006;42:53-60)

Key words: Craving; Psychopharmacotherapy; Alcohol addiction

INTRODUCTION

Craving is defined as a strong need for drinking or as intensive thinking about alcohol, which occurs at the attempt to stop taking alcohol or to control drinking and is often accompanied with the feeling of compulsion to take alcohol. MKB10 includes craving as one of the important diagnostic criteria for diagnosing the addiction to alcohol.

For the first time, some fifty years ago, Jellinek recognized craving as the central component of alcoholism, and over the last ten or so years, the interest for that concept grew.1 It should be understood as a multifactorial phenomenon and there are many models complementing each other.

Conditional craving model: Any sign connected with drinking of alcohol, after it has been repeated together with drinking, becomes conditional stimulus, i.e., it has the same psychological effect as the drinking of alcohol itself. If drinking does not happen craving develops or it acts by means of strengthening the sensation of alcoholic comfort.2

Cognitive craving model: Alcohol and alcohol-related signs include various cognitive processes, such as expectations connected with sensation of comfort produced by alcohol and a person's belief in the own capability to solve the problem and abstinence.3,4

Neuroadaptive craving model: Neuroadaptation, i.e. permanent brain function adaptation to the presence of alcohol is the central component in developing the alcohol dependency.5,6 It manifests itself as tolerance, abstinence syndrome or rewarding memory. The rewarding memory stands for an unconscious process which appears depending on the chemical changes in the brain cells. It intensifies the attention paid to external factors connected with consumption of alcohol or with very drinking of alcohol. In the circumstances of neuroadaptation, changes occur in the neurotransmitting systems as well. Therefore, GABA and glutamate play the leading role in abstinence syndrome, while the credit for developing the rewarding memory goes to dopamine, GABA, glutamate and endogenous opiates, and finally serotonin plays its part in the development of stress, depressiveanxious conditions and impulsiveness. …