The enigma of craving.

Craving is considered to play an important role in the persistence of drug use and relapse of drug use. Very few studies have looked into the subjective experience of this phenomena. This study attempts to study craving comprehensively as described by the subjects. In the present study 30 patients of heroin dependence syndrome were assessed (using a semi-structured questionnaire) for the subjective experience of craving and its various dimensions. All subjects reported having experienced craving. Majority of subjects (90%) described craving as a strong desire to use the substance. About 77% reported that intensity of craving could vary while others described it as a strong urge. Majority (83.3%) reported that only heroin or other opiates could satisfy the craving they experienced for heroin. During craving, thoughts of using the drug by all means would preoccupy their mind. Withdrawal symptoms (70.0%), increased respiration (56.7%) and palpitation (53.3%) were the common physical symptoms and anger (83.3%), tension (63.3%), anxiety (50.0%) were the common emotions experienced during craving. Craving was described as difficult to control and resulted in consumption of heroin on an average of 76.7% occasions. All subjects reported multiple cues that induced craving. Frequency of craving decreased with increase in length of period of abstinence. After being abstinent for 3 months, 90% subjects did not experience craving or experienced it once in a day. Socio-cultural factors do not appear to have prominent influence on subjective experience of craving.