Subjective dimensions of heroin urges: influence of heroin-related and affectively negative stimuli.

Thirty-five male drug-free heroin addicts rated their affect, craving, and withdrawal in response to boring, anxiety-eliciting, and heroin stimuli. Results revealed that: (a) heroin cues were more effective than boring or anxiety-eliciting cues in prompting self-reports of craving or withdrawal; (b) heroin cues produced an affective state characterized by self-reported low-pleasure and high anxiety/tension; (c) craving was not correlated with any particular affective state, but rather was associated with a variety of negative affects--anxiety, depression, fatigue, anger; (d) the coherence (intercorrelations) of affective, craving, and withdrawal measures was greatest when addicts made their self-ratings immediately after exposure to drug stimuli; and (e) while addicts routinely reported craving without withdrawal sickness, they virtually never reported withdrawal sickness without reporting craving. These results suggested that the potential for negative reinforcement subserved stimulus elicited craving and that craving involved cognitive appraisal processes (attributions, expectations).

Conditioned responses to a videotape showing heroin-related stimuli.

Heroin addicts on 0 or 2 mg of methadone and finishing a 14-day detoxification program, and control subjects were shown a videotape of heroin-related stimuli. Psychological questionnaires were completed before and after the videotape, while physiological responses were monitored during viewing. It was found that the experimental subjects had an increased level of anxiety, depression, and subjective level of craving following the stimulus presentation, with the controls showing no similar change in these measures. In addition, the experimental group had significant increases in heart rate and galvanic skin response compared with controls. The results present some of the first objective evidence of conditioned abstinence occurring in addicts exposed to stimuli closely related to those found in the natural environment.

Craving in heroin addicts maintained on the opiate antagonist naltrexone.

The level of heroin craving was monitored in patiens receiving naltrexone on a regular basis. Meetings and interviews conducted twice weekly attested to a pattern of craving reduction in most but not all the addicts. It was also found that it usually took 3 to 5 weeks for this effect to occur. The possible relationship between drug craving and participation in the naltrexone program is discussed.