Toward a Triadic Approach to Craving in Addictive Disorders: The Metacognitive Hub Model
(2019) Harvard Review of Psychiatry — Vol. 27, n° 5, p. 326-331 (2019)
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- Abstract
- Craving is a key factor in substance-related and behavioral addictions, as illustrated by its recent inclusion as a diagnosis criterion in the most recent, fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. It globally refers to the subjective motivational state facilitating the emergence of addiction-related obsessive thoughts and compulsive approach behaviors, despite repeated efforts to stop the addictive behavior. Reduced craving may produce a cascade of downstream benefits, ultimately preventing relapse, but its underlying mechanisms remain uncertain. We present a conceptual, experimental, and clinical approach of craving that aligns it with the triadic model — a recently developed prominent model of addictive disorders. Our central assumption is that craving should not be considered as a unitary process but rather as the emerging consequence of the interplay between three subcomponents, namely (1) cognitive craving (or “obsessive craving”) related to cognitive abilities (e.g., executive functions), (2) automatic craving, linked to cue reactivity and implicit processes (e.g., attentional biases), and (3) physiological craving (or “relief craving”), corresponding to bodily perceptions and related to withdrawal symptoms. We relate these three components to the systems proposed by the triadic model and suggest that metacognitive abilities may constitute a mechanism bridging the three subcomponents. This approach offers an innovative and integrative conceptual framework to explore the interactions between craving and other key processes involved in addictive disorders.
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Valentin Flaudias, Heeren, A., Georges Brousse, & Maurage, P. (2019). Toward a Triadic Approach to Craving in Addictive Disorders: The Metacognitive Hub Model. Harvard Review of Psychiatry, 27(5), 326-331. https://doi.org/10.1097/HRP.0000000000000225 (Original work published 2019)