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Heroin Addiction and Related Clinical Problems: 2020, 22, N5 (pages: 5 - 11)

Can the Psychopathology Specific to Substance Use Disorder Distinguish between Reward and Relief Craving?

Maremmani A.G.I., Pallucchini A., Manni C., Cipollone G., Della Rocca F., Salarpi G., Perugi G., and Maremmani I.

Summary: Introduction: Substance Use Disorder is, probably, the most common comorbid psychiatric condition in adult patients with Attention Deficit Hyperactive Disorder. As reported by many A-ADHD patients, the use of stimulants can be viewed as a response to ADHD symptoms, by at least temporarily alleviating or suppressing them, in line with the Self-Medication Hypothesis theorized by Khantzian. This theory is supported by the fact that Cocaine Use Disorder (CUD) patients with Adult ADHD (CUD/A-ADHD) can show a reduction in the use of cocaine, a decrease in craving symptoms, and an improvement in social functioning, reaching higher levels of executive functionality, if treated with stimulants for ADHD. The V.P. Dole Research Group at the Santa Chiara University Hospital of the University of Pisa, Italy, has shed light on the possible definition of a specific psychopathy dimension in SUD, suggesting the trait- rather than the state-dependent nature of the five psychopathological dimensions introduced to supersede SUD. Methods: In the present study we compared, at treatment entry, the psychopathological typology and the severity of symptoms affecting 24 CUD patients without a Dual Disorder and 120 CUD/A-ADHD patients, while assuming that CUD patients are motivated prevalently by a craving for reward and CUD/A-ADHD patients by a craving for relief. Results: The general indexes of psychopathology were more severe in CUD/A-ADHD than in CUD patients, and the same trend was observed regarding the five psychopathological dimensions. In CUD patients the Worthlessness/Being Trapped (W/BT) dimension, which should be a proxy for reward craving, acquired greater importance, especially when its severity was inversely correlated with that of the Violence/Suicide (V/S) dimension. In CUD/A-ADHD patients, on the other hand, their psychopathology was distinguished by the highest level of V/S severity and the lowest level of W/BT severity. Conclusions: The five SCL-90 psychopathological dimensions can differentiate reward from relief craving, while recognizing that both types of motivation mark out addictive disorders, though these do differ in severity and treatment outcome. Making this distinction allows further proof of the five dimensions' specificity in separating types of addiction psychopathology.