Cocaine craving as a predictor of treatment attrition and outcomes after residential treatment for cocaine dependence

Objective: Whether craving (urge to use) actually predicts drug-use outcomes has had little investigation despite its central role in theories. Pretreatment predictors of within-treatment cocaine urges were investigated, and the urge reports were used as predictors of treatment attrition and outcome while controlling for correlated variables. In addition, urge to use in the patients' first relapse situations was compared with urge reports in the same patients' close-call situations without relapse. Method: Cocaine-dependent patients (N = 163) in residential treatment were assessed during the first week of treatment for pretreatment substance use and for urge to use cocaine in simulated high-risk situations. Substance use was assessed at follow-up with urine-confirmed self-reports (n = 119 at 3 months, n = 114 at 6 months). Mood and urge ratings just before relapse and in close calls without relapse were assessed. Results: Urge to use cocaine was unrelated to demographics, other substance use, years used, or cocaine-use frequency in the past 6 months but was higher for those who spent more on cocaine before treatment or reported more negative cocaine consequences. Urge did not predict treatment attrition but significantly predicted the amount spent on cocaine during the first 3 months even after covarying the pretreatment amount spent on cocaine. Urge ratings, not mood, were higher just before a relapse than a close call. Conclusions: Urge to use cocaine predicts early drug-use outcomes and is not simply accounted for by the pretreatment quantity of cocaine use. Thus urge is a valid treatment target.