Is craving the source of compulsive drug use?

Abstract

Compulsive drug use, which is typically portrayed as a defining quality of addictive behavior, has been described as a pattern of drug consumption that is stimulus bound, stereotyped, difficult to regulate and identified by a loss of control over intake. It is widely assumed that compulsive drug use is caused by drug craving. This assumption is supported by numerous findings of a general correspondence between measures of craving and drug-use behavior. A more focussed analysis of the available data, however, reveals that craving and drug use are not coupled to the degree required by the hypothesis that craving is the source of all drug use in the addict. As an alternative to this craving-based view, compulsive drug use could be characterized as a form of automatized behavior. Automatic performance is assumed to develop over the course of repeated practice of motor and cognitive skills. Automatized behavior, like compulsive drug use, tends to be stimulus bound, stereotyped, effortless, difficult to control and regulated largely outside of awareness. The formulation of drug compulsion as a manifestation of automaticity rather than craving allows addiction researchers to apply methods and measures derived from cognitive sciences to investigate the fundamental organization of compulsive drug-use behavior.