Initial validation of two opiate craving questionnaires

Abstract

In the present study, the factor structure, internal consistency, and the concurrent validity of two heroin craving questionnaires are examined. The Desires for Drug Questionnaire (DDQ) measures three factors: desire and intention, negative reinforcement, and control. The Obsessive Compulsive Drug Use Scale (OCDUS) also measures three factors: thoughts about heroin and interference, desire and control, and resistance to thoughts and intention. Subjects were 102 Dutch patients who were currently in treatment for drug dependency. All proposed scales have good reliability and concurrent validity. Implementation of these instruments in both clinical and research field is advocated.

Introduction

One of the most characteristic experiences in addiction is craving. Craving mainly refers to the desire or urge to experience the effect of a previously experienced psychoactive substance (UNDCP/WHO, 1992). In the past years, several theoretical models of craving have been developed, studied, and reviewed (e.g. Franken et al., 1998, Kozlowski & Wilkinson, 1987, Pickens & Johanson, 1992, Rankin et al., 1979). Studies show that craving can be regarded as an important mediator of continued substance use and relapse after abstinence Anton et al., 1996, Kosten, 1992. Notwithstanding the fact that craving plays a major role in addictive behaviors, findings of the studies that address the relation between craving and other aspects of addiction such as loss of control and relapse after abstinence are inconclusive. One cause of this indistinctness may be difficulties in the measurement of craving. Still, there are several issues that are subjects of debate. One of these issues is the dimensionality of craving. Craving can be measured as an unidimensional or multidimensional concept. The unidimensional approach has been criticized by Tiffany (1997). Besides psychometric problems with single-item questionnaires, Tiffany's critique includes the difficulty of a single item to capture the various dimensions that the various theories of craving hypothesize (Tiffany, Singleton, Haertzen, & Henningfield, 1993). Furthermore, one item may not adequately represent the semantic categories that drug users may use to describe their craving (Tiffany et al., 1993). Another issue that is subject of debate is the time frame of craving. Craving can be understood as a general desire to use the drug of choice (craving within a longer time frame, e.g. a week; general craving) or as an instant desire, triggered by internal or external cues (instant craving). For example, studies have shown that craving measured over the past week is a better predictor of attentional bias for drug cues than instant craving, triggered by drug cues Franken et al., 2000, Franken et al., 2000. In contrast to the field of alcohol research, there are no reliable instruments available for assessing craving in opiate users (see also Anton & Drobes, 1998). In the present study, two alcohol craving questionnaires for both general and instant craving assessment were adapted to measure heroin craving: the Obsessive Compulsive Drinking Scale (OCDS; Anton, Moak, & Latham, 1995) and the shortened 14-item version of the Desires for Alcohol Questionnaire (DAQ; Love, James, & Willner, 1998). The resulting instruments, the Obsessive Compulsive Drug Use Scale (OCDUS), and the Desires for Drug Questionnaire (DDQ) were translated into Dutch and adapted for heroin use. The OCDUS measures general craving (within a time frame of a week) and the DDQ measures instant craving (now).

The OCDS is derived from the Yale–Brown Obsessive Compulsive Scale (Y-BOCS). There are many similarities between obsessive compulsive disorders (OCD) and substance dependence. The basic similarity is the occurrence of frequently recurring thoughts that cannot be stopped and the disabling occurrence of compulsive behavior. Furthermore, drug craving, a major feature of drug dependency, has been associated with obsessive thoughts. Modell, Glaser, Cyr, and Mountz (1992) modified the Y-BOCS Goodman et al., 1989, Goodman et al., 1989 to assess obsessive and compulsive characteristics of alcohol abuse and alcohol dependence, the Y-BOCS-HD. A self-report questionnaire version of this instrument, the OCDS was found to be related to alcohol craving and was able to differentiate between social drinkers and alcoholics (Anton, Moak, & Latham, 1995). In a recent validation study the authors concluded that the OCDS is a reliable and valid self-rating instrument for the measurement of dimensions of alcohol dependence that might best be described as the cognitive correlate of craving (Anton et al., 1996). Furthermore, the authors found the OCDS to be sensitive to measure the severity of alcohol dependence and changes in drinking patterns. The OCDS is recently translated into Dutch (Schippers et al., 1997). The Dutch OCDS has shown to be a valid, reliable, and easy-to-administer instrument for cognitive aspects of alcohol craving in Dutch speaking patients.

The DAQ Clark et al., submitted, Love et al., 1998 is derived from the Alcohol Craving Questionnaire (ACQ) (Tiffany, 1997). The DAQ is a selection of the ACQ items and is rephrased in positive wordings. In a recent validation study of these two alcohol craving questionnaires, the DAQ was found to have clear psychometric advantages over the ACQ (Love et al., 1998). In a cue reactivity study of Schultze and Jones (1999), these authors found the DAQ to be a sensitive measure of subjective cue reactivity.

In the present study, we investigate the psychometric properties of both the OCDUS and the DDQ in a population of heroin-dependent patients in treatment. First, the factor structure of these questionnaires was examined and compared with the original questionnaires. To measure the concurrent validity, a Visual-Analog Craving Scale (VAS) rating the subject's current craving level for heroin was used for comparison with the two new craving instruments. The hypothesis is that the scales of the DDQ, as instrument for instant (now) craving assessment, is more correlated with the VAS than the scales of the OCDUS. Furthermore, the internal consistency, and test–retest stability was studied in a subsample of 18 persons. The overall aim was to establish two reliable drug-craving scales that can be used for both research and clinical purposes.