- Rely on proxy measures
- Avoids self-reporting bias and any communication challenges 
- Less dependent on the conscious experience of craving and may capture
unconscious craving impulses instead 
- However, can be challenging to implement in clinical practice and
may reflect more than just craving 

Observational Tools

- Can be limited by the ceiling and floor effects (the scale has artificial limitations at either extreme)
- This may prevent distinguishing true differences in craving between patients 
- Includes single-item scales and multi-item scales 


Self Reported Tools 

- Recently, ecological momentary assessments (EMA) have been used to assess cravings 
- EMA involves the patient recording real-time assessments of
craving using mobile technology 
- EMA has the potential to enhance the understanding of craving, particularly in regard to temporal fluctuations, and treatment dosing

Ecological momentary assessments 

- Measures of craving can be divided into observational and self-reported 
- Ecological momentary assessments (EMA) is a newer approach to assess cravings 


Rutgers University

- Craving/addiction neuroadaptive theories 
- Cycle of addiction 
- Reward and Anti-Reward pathways 
- Craving Assessment Tools

Neurobiology of Craving in Opioid Use Disorder 

Kakko J, Alho H, Baldacchino A, Molina R, Nava FA and Shaya G
 2019) Craving in Opioid Use Disorder: From Neurobiology to Clinical Practice.Front. Psychiatry 10:592. doi: 10.3389/fpsyt.2019.00592

Craving in Opioid Use Disorder: From Neurobiology to Clinical Practice

- Theories include opponent, inhibitory control, reward deficiency, incentive sensitization, aberrant learning, and anti-reward theory 

Neuroadaptive Theories in Addiction/Craving

3 key drivers that underlie neurobiological changes associated with opioid dependence 

1. Drug liking
2. Withdrawal and negative affect
3. Craving and negative affect 

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