Validity of the DSM-5 craving criterion for alcohol, tobacco, cannabis, cocaine, heroin, and non-prescription use of prescription painkillers (opioids)

Toward the classification of social media use disorder: Clinical characterization and proposed diagnostic criteria

Empirical studies and theoretical models highlight that problematic use of social media can lead to significant functional impairments in several domains, such as social, relational, occupational, and psychological functioning, as well as physical health. However, social media use disorder is not currently recognized as an official disorder in major diagnostic systems, limiting comparability among studies, precise prevalence estimation, and ad-hoc preventive and treatment program development. The present work aims to classify social media use disorder as a pathological condition sharing main mechanisms and maladaptive patterns with addictive behaviors. We discuss diagnostic criteria for social media use disorder by integrating peculiar features of this maladaptive behavior with criteria for substance use disorders and behavioral addictions from major diagnostic systems (i.e., DSM-5 and ICD-11). Moreover, we address some controversies related to the classification of social media use disorder as a behavioral addiction and highlight literature findings indicating social media use disorder shares main alterations in mechanisms and processes characterizing addiction (i.e., maladaptive activation of reward systems and impairment of inhibitory control mechanisms). Despite the lack of studies including clinical populations and the need for future research to validate the proposed criteria and refine knowledge of the mechanisms underlying this condition, our work provides a structured framework for classifying and identifying social media use disorder.

Momentary mindfulness versus distraction coping messages to reduce cannabis craving among young adults: A microrandomized trial

OBJECTIVE

Rates of problematic cannabis use among young adults are high and increasing. Craving for cannabis varies throughout the day and is an important risk factor for cannabis use, yet no studies to date have tested interventions offered at the moment craving is experienced in the natural environment.

METHOD

This study used an efficient and innovative microrandomized trial design to test two distinct types of coping messages (mindfulness strategy vs. distraction strategy) offering brief coping strategies when moderate to severe craving was reported via ecological momentary assessment (EMA).

RESULTS

Young adults who regularly use cannabis (N = 53) were readily engaged in this 4-week intervention, and EMA completion was high throughout, demonstrating excellent feasibility of this approach. However, results indicated that coping messages did not reduce craving at the next EMA relative to control (thank you) messages, with no significant change in efficacy over time. Furthermore, exploratory analyses found that neither mindfulness nor distraction resulted in reduced craving relative to the control message.

CONCLUSIONS

Despite this outcome, this method of testing digital interventions targeting momentary risks for substance use such as craving holds promise for rapidly and efficiently screening a wide variety of intervention strategies for inclusion in future just-in-time adaptive interventions. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Opioid use and abuse in adolescents and young adults; dealing with science, laws and ethics: Charming the COBRAS

The subject of substance use disorders in the pediatric population remains a disturbing conundrum for clinicians, researchers and society in general. Many of our youth are at risk of being damaged and even killed by drug addictions that result from the collision of rapidly developing as well as vulnerable central nervous systems encountering the current global drug addiction crisis. A major motif of this chemical calamity is opioid use disorder in adolescents and young adults that was stimulated by the 19th century identification of such highly addictive drugs as morphine, heroin and a non-opiate, cocaine. This analysis focuses on the pervasive presence of opioid drugs such as heroin and fentanyl that has become a major tragedy in the 21st century arising from an overall substance use and misuse phenomenon rampant in global society. Themes covered in this article include the history of addictive drugs in humans, diagnostic terms in use, the role of neurobiology in drug addiction, and current psychopharmacologic approaches to opioid overdose as well as addiction. Our youth are continuously confronted by dangers of high-risk behaviors including death and injury from opioid use disorders due to their central nervous system neuroplasticity as well as the widespread availability of these harmful chemicals. Healthcare professionals should actively assist our youth who unknowingly and even innocently encounter this deadly menace in the 21st century.

Problematic pornography use and novel patterns of escalating use: A cross-sectional network analysis with two independent samples

Modern internet pornography allows users to harness sexual novelty in numerous ways, which can be used to overcome desensitisation through increasing volume of use (quantitative tolerance), progressing to more stimulating genres (qualitative escalation), skipping between stimuli (tab-jumping), delaying orgasm ('edging'), and engaging in pornographic binges. However, existing research has not yet evaluated how these potentially reciprocal consumption patterns relate to problematic pornography use (PPU). To this end, we recruited two independent samples of male pornography users (N1 = 1,356, Mage = 36.86, SD = 11.26; N2 = 944, Mage = 38.69, SD = 12.26) and examined the relationships between these behavioural dimensions and self-reported difficulties in controlling one's pornography use. Data were analysed through the network analysis approach (using Gaussian graphical models). As hypothesised, i) quantitative tolerance was centrally placed within the overall network, and ii) acted as a statistical bridge node between other patterns of pornography use (e.g., pornographic binges), and all measured facets of PPU. Our results are consistent with other emerging literature suggesting that tolerance, pornographic binges, tab-jumping, and edging behaviours as relevant features ofPPU, and that upscaling overall usage may connect broader patterns of use with problematic engagement. Clinical and theoretical implications, as well as future research directions, are discussed.

An Adaptation and Validation of Cocaine Craving Questionnaire for Malaysians Who Use Amphetamine-Type Stimulants

Introduction

Cases of amphetamine-type stimulants (ATS) use have been increasing over the past decade. Cravings are considered a causal factor for recurrent relapses in ATS use cases. The absence of questionnaires measuring cravings for ATS in the local population necessitates the creation of one, especially considering the rising number of cases.

Objective

This study aimed to adapt and validate the Cocaine Cravings Questionnaire into a questionnaire suitable for measuring cravings for ATS in the local population.

Methodology

The original questionnaire was adapted by substituting "cocaine" with "ATS". The process involved a back-to-back translation, followed by a round of face and content validation. The participants included people who use drugs (PWUD) with a history of ATS use recruited from rehabilitation centers in Malaysia. A set of questionnaires consisting of demographic items and the adapted ATS Cravings Questionnaire (ATS-CQ) were given.

Results

This cross-sectional study recruited a total of 205 PWUD, mostly single men, with a mean age of 33.32 (s.d.=13.14). The mean age of ATS initiation was 22.89 (s.d.=9.39), with a median duration of ATS use of 60 months (IQR=24.00, 120.00). The adapted questionnaire received a good score for content validation. Unlike the original, this adapted version was found to have only three factors showing good internal consistency, ranging from 0.707 to 0.918 for all three factors. Test-retest reliability also showed good results, with an interclass correlation coefficient of 0.875 (95% CI=0.835, 0.905).

Conclusion

The translated ATS-CQ has been finalized and deemed valid and reliable for use among Malaysian substance users to measure ATS cravings.

Moroccan version of the short Tobacco Craving Questionnaire (MTCQ-12)

INTRODUCTION

Craving is a key clinical dimension in the assessment and management of substance use disorders. It is also a recognized predictor of relapse in addictology. To date, no scale for measuring tobacco craving is available to Moroccan clinicians. This work proposes a cross-cultural validation of the Tobacco Craving Questionnaire (TCQ) in its short version.

METHODS

This work consists of the creation of a translated version according to a rigorous methodology and the evaluation of its psychometric properties in a statistical study.

RESULTS

The validation study was done on a sample of 130 smokers with a majority of men (95%). It showed a high acceptability and homogeneity with a Cronbach's alpha coefficient of 0.82. The four scale factors showed a high discriminant validity. Finally, the scale showed high reproducibility with an inter-observer stability of 0.95 and 0.94 between tests and retests.

CONCLUSION

The Moroccan version of the TCQ-12 scale shows good validity indices for measuring craving in Moroccan smokers and also shows that it measures independently the four clinical dimensions of the scale.

Evidence-Based Assessment of Substance Use Disorder

The current review describes updated information on the evidence-based assessment of substance use disorder. We offer an overview of the state of the science for substance-related assessment targets, instruments (screening, diagnosis, outcome and treatment monitoring, and psychosocial functioning and wellbeing) and processes (relational and technical) as well as recommendations for each of these three components. We encourage assessors to reflect on their own biases, beliefs, and values, including how those relate to people that use substances, and to view the individual as a whole person. It is important to consider a person's profile of symptoms and functioning inclusive of strengths, comorbidities, and social and cultural determinants. Collaborating with the patient to select the assessment target that best fits their goals and integration of assessment information in a holistic manner is critical. We conclude by providing recommendations for assessment targets, instruments, and processes as well as recommendations for comprehensive substance use disorder assessment, and describe future directions for research.

Effectiveness of Reducing Craving in Alcohol Use Disorder Using a Serious Game (SALIENCE): Randomized Controlled Trial

BACKGROUND

Alcohol use disorder (AUD) has become a major global health problem. Therapy for this condition is still a great challenge. Recently, it has become increasingly evident that computer-based training is a valuable addition to the treatment of addictive disorders.

OBJECTIVE

This study aims to evaluate the web-based serious game SALIENCE (Stop Alcohol in Everyday Life-New Choices and Evaluations) as an add-on therapy for AUD. It combines the cue-exposure therapy approach with elements of decision-making training, enhanced by interactive panoramic images. The effects of SALIENCE training on levels of craving, attention, and cognitive bias are investigated.

METHODS

In a randomized controlled trial, 62 participants with AUD undergoing 3 weeks of an extended alcohol detoxification program were randomly allocated to an intervention and a control group. A total of 49 individuals (mean age 44.04 y; 17/49, 35% female) completed all sessions and were included in the analysis. Only pretreatment data were available from the other 13 patients. Participants answered questionnaires related to alcohol consumption and craving and completed neuropsychological tasks at the beginning of the study and 2 weeks later to evaluate levels of attention and cognitive biases. During the 2-week period, 27 of the participants additionally performed the SALIENCE training for 30 minutes 3 times a week, for a total of 6 sessions.

RESULTS

We observed a significant decrease in craving in both groups: the control group (mean 15.59, SD 8.02 on the first examination day vs mean 13.18, SD 8.38 on the second examination day) and the intervention group (mean 15.19, SD 6.71 on the first examination day vs mean 13.30, SD 8.47 on the second examination day; F1,47=4.31; P=.04), whereas the interaction effect was not statistically significant (F1,47=0.06; P=.80). Results of the multiple linear regression controlling for individual differences between participants indicated a significantly greater decrease in craving (β=4.12; t36=2.34; P=.03) with the SALIENCE intervention. Participants with lower drinking in negative situations reduced their craving (β=.38; t36=3.01; P=.005) more than people with higher drinking in negative situations.

CONCLUSIONS

The general effectiveness of SALIENCE training as an add-on therapy in reducing alcohol craving was not confirmed. Nevertheless, taking into account individual differences (gender, duration of dependence, stress, anxiety, and drinking behavior in different situations), it was shown that SALIENCE training resulted in a larger reduction in craving than without. Notably, individuals who rarely consume alcohol due to negative affect profited the most from SALIENCE training. In addition to the beneficial effect of SALIENCE training, these findings highlight the relevance of individualized therapy for AUD, adapted to personal circumstances such as drinking motivation.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03765476; https://clinicaltrials.gov/show/NCT03765476.

The fear in desire: linking desire thinking and fear of missing out in the social media context

According to the Elaborated Intrusion Theory of Desire, desire thinking and an associated deficit are fundamental factors to the emergence of craving. In the special case of problematic social networking sites (SNS) use, this experienced deficit could be constituted of an online-specific fear of missing out (FoMO). To test the interaction of these cognitions and their influence on problematic SNS use, we tested a serial mediation model on a sample of N = 193 individuals who use SNS (73% female, M_age = 28.3, SD = 9.29). We found that desire thinking predicted FoMO and both variables were only significant predictors of problematic SNS use when considered in interplay with craving. Ad hoc analyses revealed that the verbal subcomponent of desire thinking is more strongly associated with FoMO than imaginal prefiguration. Our results highlight that neither desire thinking nor FoMO are inherently dysfunctional but become problematic when they increase craving for potentially problematic SNS use.

Desire and craving measured using behavioral ratings and brain network topology differ significantly among moderate to heavy alcohol consumers

BACKGROUND

"Craving" is a central concept in alcohol research, but the semantic interpretation of craving as a concept varies. Multiple studies that have investigated differences in operational definitions of craving have demonstrated a lack of agreement among them. This study investigated whether moderate to heavy drinkers would rate craving and "desire" for alcohol similarly and explored potential neurobiological differences underpinning feelings of craving and desire.

METHODS

Thirty-nine individuals who consumed an average of at least 7 drinks/week for females and 14 drinks/week for males were studied across 3-day periods of their typical alcohol consumption and imposed abstinence. Ratings of desire and craving for alcohol were collected approximately every three hours during waking periods across the two experimental periods (n = 35, 17 males). At the end of each period, participants underwent functional MRI scanning during neutral and alcohol image viewing (n = 39, 17 males) followed by ratings of desire and craving for alcohol (n = 32, 16 males). Survey responses were analyzed using 2-level nested hierarchical modeling, image ratings were compared using a hierarchical mixed-effects regression, and brain networks constructed from fMRI data were assessed with a two-part mixed-effect regression (α = 0.05 in all analyses).

RESULTS

Ratings of desire and craving differed significantly from one another in the survey data and in the ratings collected during image viewing. The strength of the desire experience was higher overall than craving, but the fluctuations over time were similar. Results for desire and craving differed on brain network attributes associated with distributed processing and those regional specific within the default mode network. Significant associations were found between ratings of desire and connection strength and between ratings of craving and connection probability.

CONCLUSIONS

These results demonstrate that the difference between ratings of craving for alcohol and desire for alcohol is not trivial. The different ratings and their association with alcohol consumption or abstinence experiences may have significant biological and clinical implications.

The centrality of craving in network analysis of five substance use disorders

BACKGROUND AND AIMS

Among the 11 current diagnostic criteria, craving is a potential central marker for understanding and for treatment of Substance Use Disorders (SUD). Our objective was to explore craving centrality across SUD based on the study of symptom interactions in cross-sectional network analyses of DSM-5 SUD diagnostic criteria. We hypothesized the centrality of "Craving" in SUD across substance types.

DESIGN

Participants from the ADDICTAQUI clinical cohort with regular use (2 times per week threshold for a substance) and at least one DSM-5 SUD.

SETTING

Outpatient substance use treatment services in Bordeaux, France.

PARTICIPANTS

The sample of 1359 participants, had a mean age of 39 years old and 67% were males. The prevalence of SUD over the time course of the study was: 93% for alcohol, 98% for opioids, 94% for cocaine, 94% for cannabis and 91% tobacco.

MEASUREMENTS

Construction of a Symptom Network Model conducted on the DSM-5 SUD criteria evaluated over the past 12 months for Alcohol-, Cocaine-, Tobacco-, Opioid- and Cannabis Use disorder.

FINDINGS

The only symptom that consistently remained in terms of centrality was "Craving" [3.96 - 6.17] (z-scores), indicating that it exhibits a high degree of connections in the entire symptom network regardless of the substance.

CONCLUSION

Identifying craving as central in SUD symptoms network confirms the role of craving as a marker of addiction. This constitutes a major avenue in the understanding of the mechanisms of addiction, with implications to ameliorate diagnostic validity and clarify treatment targets.

Construct validity of DSM-5 cannabis use disorder diagnosis and severity levels in adults with problematic substance use

The DSM-5 definition of cannabis use disorder (CUD) differs from DSM-IV by combining abuse and dependence criteria (without the legal criterion) and including withdrawal and craving criteria. Information on construct validity of the DSM-5 CUD diagnosis and severity levels is lacking. This study examines the associations between DSM-5 CUD and severity classification and a set of concurrent validators. Adults with problematic substance use were recruited from two settings: a research setting in an urban medical center and a suburban inpatient addiction treatment program. Participants who reported past-year cannabis use (n = 392) were included in this study and completed a semi-structured, clinician-administered diagnostic interview. Regression models estimated the associations between binary DSM-5 CUD and severity levels with a set of validators, including cannabis use variables, psychopathology, and functional impairment. DSM-5 CUD and all severity levels were associated with cannabis use validators, including number of days used, self-reporting that cannabis use was a major problem, and greater cannabis craving. DSM-5 CUD and severe CUD were associated with other psychiatric disorders and social impairment. Findings add information about the validity of DSM-5 CUD diagnosis and severity levels, with severe CUD receiving the strongest support from its association with validators across all domains, as distinct from the mild and moderate CUD measures that were associated with cannabis-specific validators alone. Severe CUD is likely to require more intensive treatment to bolster physical, psychiatric, and social functioning, whereas the mild and moderate severity thresholds provide useful information for identifying less severe disorders for prevention and brief intervention.

Validity of the DSM-5 tobacco use disorder diagnostics in adults with problematic substance use

BACKGROUND

DSM-5 tobacco use disorder (TUD) nosology differs from DSM-IV nicotine dependence (ND) by including craving and DSM-IV abuse criteria, a lower threshold (≥ 2 criteria), and severity levels (mild; moderate; severe). We assessed concurrent and prospective validity of the DSM-5 TUD diagnosis and severity and compared validity with DSM-IV ND diagnosis.

METHODS

The sample included U.S. adults with current problematic substance use and past year cigarette smoking (N = 396). Baseline assessment collected information on DSM-IV ND and DSM-5 TUD criteria, smoking-related variables, and psychopathology. Over the following 90 days, electronic daily assessments queried smoking and cigarette craving. Variables expected to be related to TUD were validators: cigarette consumption, cigarette craving scale, Fagerström Test for Nicotine Dependence, and psychiatric disorders. Regression models estimated the association of each validator with DSM-5 TUD and severity levels, and differential association between DSM-5 TUD and DSM-IV ND diagnoses.

RESULTS

DSM-5 TUD and DSM-IV ND were associated with most baseline validators (p-values < 0.05), with significantly stronger associations with DSM-5 TUD for number of days smoked (p = 0.023) and cigarette craving scale (p = 0.007). Baseline DSM-5 TUD and DSM-IV ND predicted smoking and craving on any given day during follow-up, with stronger associations for DSM-5 TUD (association difference [95% CI%]: any smoking, 0.53 [0.27, 0.77]; number of cigarettes smoked, 1.36 [0.89, 1.78]; craving scale, 0.19 [0.09, 0.28]). Validators were associated with TUD severity in a dose-dependent manner.

CONCLUSION

DSM-5 TUD diagnostic measures as operationalized here demonstrated concurrent and prospective validity. Inclusion of new criteria, particularly craving, improved validity and clinical relevance.