Advances in the treatment of craving for alcohol and tobacco

This chapter reviews advances in contemporary science-based approaches to the treatment of craving for alcohol and tobacco. Treatment for craving can be broadly divided into cognitive-behavioral and pharmacotherapeutic interventions, each with strengths and weaknesses and specific areas where improvement is necessary. Cognitive-behavioral approaches to addictive behavior have inherently incorporated craving as a treatment target because of their heavy emphasis on situational factors and coping with high-risk situations, which could include acute craving. The most common pharmacological approach for craving for alcohol is naltrexone, whereas the most common approach for craving for nicotine is nicotine replacement therapy (NRT). It is suggested that that forms of NRT with swifter routes of administration appear to be effective in acutely tamping down cravings. It is found that oral naltrexone dosing results in somewhat variable levels of plasma naltrexone, which may influence its effects clinically and the applicability of more standardized laboratory studies. It is suggested that enhanced compliance and stability of administration are important priorities for improving the pharmacotherapy of alcohol craving. It is emphasized that a transdisciplinary approach will enable to develop both a fully integrated science of craving and maximally efficacious treatments. © 2007 Elsevier B.V. All rights reserved.