Cocaine Craving As a Predictor of Treatment Attrition and Outcomes After Residential Treatment for Cocaine Dependence *‪.‬

CRAVING, WHICH WE WILL REFER TO as urge to use, is a concept that is central to some models of relapse in addiction research (e.g., Baker et al. 1987b; Ludwig and Stark, 1974; Marlatt, 1978), although not to others (see Rohsenow and Monti, 2001). The term "urge" is being used because dictionaries and colloquial use define craving as a strong desire or longing, whereas terms such as "urge" or "desire" permit assessment of a full range of the state and decrease ambiguity (Kozlowski et al., 1989; Kozlowski and Wilkinson, 1987). In addition to the definition above, craving has variously been described as a cognitive correlate of a subclinical conditioned withdrawal syndrome (Ludwig and Stark, 1974) or of classically conditioned responses (Baker et al., 1987a); as anticipation of the reinforcing effects of alcohol (Marlatt, 1978); as a drug-acquisitive motivational state (Baker et al., 1987b); as a concern about resuming drinking or drug use (Baker et al., 1987a); as an irresistible urge to use that compels drug-seeking behavior (Halikas et al., 1991); as a state of hyperarousal similar to anxiety and depression (Hore, 1974); or as a mixture of intense desire to use, intention to use, and expected consequences of use (Tiffany and Drobes, 1991; Tiffany et al., 1993). However, the core of the definition is a subjective state of wanting or desire to use (Kozlowski et al., 1989). Other aspects of various definitions refer to theorized determinants (e.g., withdrawal or expectancies), consequences (e.g., intentions), or correlates (e.g., arousal) of urges to use rather than being synonymous with urge (Monti et al., 2004; Rohsenow et al., 1990). Interest in the urge to use drugs has been based on the assumption that these urges indicate the likelihood that the individual will use in the future (Baker et al., 1987a,b). In general, it has been assumed that the stronger the urge to use that a patient with a substance-use disorder has in a given situation, the higher the probability that he or she will use. Of particular clinical interest is the role of urges to use as a predictor of future use among currently abstinent patients who have sought treatment, when urges may occur despite the intention to remain abstinent, as we have investigated with alcoholics (Monti et al., 2000). For this reason, urges studied in nonabstinent users are not included because they are not clinically relevant to the predictive value of urges while abstinent during treatment.