Indian Journal of Psychiatry, 2002,44(2)138-143 THE ENIGMA OF CRAVING ANJU DHAWAN, RAMESH KUMAR, SEEMA YADAV & B.M.TRIPATHI ABSTRACT 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 ofcraving 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. Keywords: Craving, Heroin, Dependence, Subjective experience Craving for drugs is considered by many drug addicts and treating clinicians to play an important role in the persistence of drug use and relapse of drug use. However, the term craving has several meanings attached to it and has been used by different researchers in different ways (Kozlowski and Wilkinsons, 1987). Many researchers (Mello, 1978; Hughes, 1987; Kassel and Shiftman, 1992) have expressed concern against the use of craving as an explanation of addiction. Even a WHO panel (Jellinek et al., 1955) had concluded that the term craving, with its everyday connotations, should not be used in scientific literature, although they agreed about the existence of craving. Despite many problems, the term craving continued to find a place in the field of substance abuse (Ludwig and Stark, 1974; Robinson and Berridge, 1993; Halikas, 1997; Lowman et al., 2000). In one of the attempts to operationalise the definition of craving, a group of experts, in a meeting 'Informal Expert Group Meeting on the Craving Mechanism' sponsored by UNDCP & WHO (1992), have defined craving as" the desire for the previously experienced effects of a psychoactive substance". It has also found a 138