Behavioral economic analysis of cue-elicited craving for alcohol.

AIMS Craving as a motivational determinant of drug use remains controversial because of ambiguous empirical findings. A behavioral economic approach may clarify the nature of craving, theorizing that subjective craving functionally reflects an acute increase in a drug's value. The current study tested this hypothesis via a multidimensional assessment of alcohol demand over the course of an alcohol cue reactivity procedure. DESIGN One-way within-subjects design. SETTING Human laboratory environment. PARTICIPANTS Heavy drinkers (n = 92) underwent exposures to neutral (water) cues followed by personalized alcohol cues. ASSESSMENTS Participants were assessed for craving, alcohol demand, affect, and salivation following each exposure. FINDINGS Alcohol versus neutral cues significantly increased craving and multiple behavioral economic measures of the relative value of alcohol, including alcohol consumption under conditions of zero cost (intensity), maximum expenditure on alcohol (O(max)), persistence in drinking to higher prices (breakpoint) and proportionate price insensitivity (normalized P(max)). Craving was significantly correlated with demand measures at levels ranging from 0.21-0.43. CONCLUSIONS These findings support the potential utility of a behavioral economic approach to understanding the role of environmental stimuli in alcohol-related decision making. Specifically, they suggest that the behavioral economic indices of demand may provide complementary motivational information that is related to though not entirely redundant with measures of subjective craving.