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Heroin Addiction and Related Clinical Problems: 2016, 18, 1 (pages: 9 - 18)

Addictive Behaviours in Heroin Use Disorder Patients. Correlation with Heroin-Craving Patients' Self-Evaluation

Maremmani A.G.I., Rovai L., Bacciardi S., Bertoni S., Massimetti E., Gazzarrini D., Rugani F., Pallucchini A., and Maremmani I.

Summary: Introduction: Repeated exposure to heroin leads to addictive behaviours that focus on obtaining that drug by any means and taking the drug under adverse psychosocial and medical conditions. Currently, in the DSM-5, craving is recognized as an important diagnostic criterion for the diagnosis of Substance Use Disorder. Nevertheless, there is still no consensus on the behavioural covariates of craving, or evidence of which behaviours are considered by patients to be related to their craving, and which are not so considered. The aim of this study is to look at correlations between addictive behaviours and the self-evaluation by patients of their heroin craving. Methods: 114 heroin use disorder patients were evaluated, at treatment entry, on the presence and severity of 13 kinds of addictive behaviour. Correlations between these addictive behaviours and the presence and severity of heroin craving in the self-evaluation of patients were calculated at multivariate levels. Results: The most prominent craving scenario is the following: patients think about injecting heroin most of the day (OR=10.32); they get their fix with something else that they think will ‘work', if they have all that is needed for a fix except heroin itself (OR=6.13); they don't even think about saving any heroin if they have some, even if they don't know whether any will be available a day later (OR=5.13). Craving is recognized as very strong if they think about injecting heroin most of the day, if they get their fix with something else that they think will ‘work', if they have all that is needed for a fix except heroin itself, if they go there in any case, if their imaginary friend will give them heroin for free in a place that is very difficult to get access to. Conversely, among behaviours that are independent of the self-evaluation of craving, those distinguished by the greatest medical impact are needle exchanges and use/relapses that are cue-induced. Conclusions: Patients fail to recognize some addictive behaviours as signs of heroin craving. Of these behaviours, those displaying the greatest medical impact are needle exchanges and use/relapses that are cue-induced.