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Craving Inertia and Substance Use Disorders

Photo of Upturned Human Hand Portrait View in a gesture of craving.

A small but recent study focusing on the measurement of craving intensity and its long-term impact on recovery from substance use disorders provides keen insight into the mechanism of addiction.

The study involves a large team of researchers from the University of Bordeaux in France. They focused on measuring the changes in craving intensity, craving inertia, and craving variability in the first 14 days of treatment for substance use disorders (SUDs).

The measurements were taken for four years, from 2009 to 2013, at an outpatient treatment facility in Bordeaux, France. Five-year follow-ups began in 2014 and continued through 2018. The patients ranged in age from 18 to 65. Their disorders included tobacco use disorder, cannabis use disorder, alcohol use disorder, and opiate use disorder.

These SUDs all have different treatment protocols, so it’s curious whether the results can be blended like this. The number of people tracked for the duration was 39. Given gender differences, age differences, SUD differences, and very different treatment plans, it’s asking a lot to get something statistically significant.

Here is how the initial 14-day data was collected:

Following a training session, each participant received a personal digital assistant (PDA) to carry for 14 days, programmed to administer four electronic surveys per day, between 8:00 am and 11:00 pm.

Participants were compensated based on the number of surveys completed. After the first 14 days, participants were assessed using the Addiction Severity Index (ASI) every six months. For this study, researchers looked at those with assessments more than five years out from the initial 14 days of treatment.

At the five-year mark, “abstinence” was defined as zero incidences in the previous 30 days of using the primary substance initially treated for. A single day of substance use in the previous 30 days was considered “long term substance use,” regardless of the length of any periods of abstinence in the intervening five years.

It’s interesting that half of the group (n=20) had used the substance they were treated for within the past 30 days, and half had not (n=19). I think that’s a pretty important finding right there. Here is one of the other findings of significance: “The long-term substance use group had a slower decrease of craving [in the first 14 days] compared to the abstinence group.” 

Here are the exact measurements of cravings in the first 14 days of treatment compared with substance use five years later. Again, roughly half the patients ended up in each group:

  • Craving inertia (AR1) for Abstinence group mean = 0.22 (SD = 0.22) vs. Substance Use group mean = 0.03 (SD = 0.29)
  • Craving variability (SD) for Abstinence group mean = 1.43 (SD = 0.51) vs. Substance Use group mean = 1.19 (SD = 0.66)
  • Craving instability (rMSSD) for Abstinence group mean = 1.75 (SD = 0.73) vs. Substance Use group mean = 1.61 (SD = 0.92)

The researchers conclude that the intensity of cravings felt in the first 14 days is not an indicator of who will achieve abstinence at year five, but craving inertia is definitely a predictor. Craving inertia is measured by comparing the strength of cravings at the time of measurement with the previous measurement, which researchers say is a tendency for cravings “to persist from one moment to the other.”

As to why lower craving inertia is strongly correlated with long-term substance abuse, researchers say: 

This result suggests that, for this long-term substance use group, craving intensity at treatment initiation was more variable from moment-to-moment in daily life, while exhibiting an overall slower decrease. One hypothesis is that this lower craving inertia may reflect the persistence of reactivity to cues…

This “persistence of reactivity to cues” limits the improvement in the intensity and duration of cravings found in the abstinence group. The researchers see clearly that craving inertia is a strong predictor of relapse. 

I am deeply curious how craving inertia correlates with the type of SUD. Are all the patients with high craving inertia associated with one SUD? The authors of the paper acknowledge the small sample size and the difficulty of generating statistically significant conclusions from the results. But their work does point to the benefits of thorough assessment upon intake into a treatment program and paying for good data in follow-ups.

Tomorrow, I’ll take a look at another recent study on predicting relapse in recovery from SUDs, which also suffers from a small sample size. Stay tuned.

Written by Steve O’Keefe. First published January 27, 2025.

Sources:

“Craving changes in first 14 days of addiction treatment: an outcome predictor of 5 years substance use status?,” Translational Psychiatry, December 18, 2024.

Image Copyright: steafpong.

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