Phenomenology of addictive craving: recognition and clinical utility

Abstract

Addiction with its “craving” is a major health problem, world wide. It is useful toknow features of addictive “craving” to distinguish it from desire. These include its instrumentalfocus, its intensity, its imperative nature, its urgency, its salience, and its sense of necessity. Associated emotions include anticipated joy; anger, dysphoria, and fear, in deprivation; and desperation. Associated executive dysfunctions include distortions, rationalizations, preoccupations, ego syntonicity, poor judgment, loss of volition, and lack insight. Differences from other desires for drugs include those desired for pleasure, for social function, and for medical or psychiatric need. Addiction “craving” needs to be distinguished from medical need, psychological dependence, and physical dependence. The biology of addictive “craving” drives itas a motivational force unto itself. The risks of developing addiction include past addiction, developmental factors, social factors, psychological factors, impulsivity, constitutional factors. But addiction requires that the patient reach a threshold of quantity and frequency in use. Someclinical considerations include a patient’s reluctance to disclose “craving,” the resort to illegitimate sources, the need for sound monitoring when medically prescribed