A cognitive processing model of alcohol craving and compulsive alcohol use

Many addiction theories assume that craving plays a central role in the acquisition and maintenance of drug dependence. For example, craving is often depicted as the subjective experience of the motivational state directly responsible for all drinking in the alcoholic. Craving has two prominent features that must be explained by any viable model of craving. First, craving tends to be highly situationally specific, readily triggered by stimuli previously associated with drug use. Secondly, craving can persist well beyond the cessation of drinking in an alcoholic. Conventional theories typically address craving's cue specificity and persistence by invoking concepts of classical conditioning. These theories fall into two classes: those that emphasize withdrawal and those that focus on the positive-incentive properties of drugs. Both types of theories assume that craving processes are represented by the concomitant activation of craving report, drug-seeking and drug use, and specific patterns of autonomic responses. However, research fails to find more than modest relationships across these putative manifestations of craving. The cognitive processing model, described in this paper, offers a different view of craving's form and function and proposes that drug use can operate independently of the processes controlling craving. According to this model, addictive drug use is regulated by automatic cognitive processes, while craving represents the activation of non-automatic processes. These non-automatic processes are activated to either aid in completing interrupted drug use or block automatic drug-use sequences. From this perspective, craving is neither irrelevant nor central to the alcoholic's drug use, but rather serves as a cognitive marker of processes that, only in some instance, may be associated with alcohol seeking and use. The research and treatment implications of this model's assumptions regarding drug use and craving processes are discussed.