Atención y craving o ganas compulsivas. Avances en su conceptualización y su implicación en la prevención de recaídas

Autores/as

  • Jesús Blasco Unidad de Conductas Adictivas Departamento de Salud de Gandía, Agencia Valenciana de Salud. Enviar correspondencia a: Jesús Blasco Gallego. Centro de Salud de Corea. Unidad de Conductas Adictivas. C./ Benissuai 22, 46700 Gandia, Valencia (España) Tel: +34 96 2959736. Facsimile: +34 96 2959709.
  • José Martínez-Raga Unidad de Conductas Adictivas Departamento de Salud de Gandía, Agencia Valenciana de Salud. Departamento de Fisiología, Farmacología y Toxicología, Universidad CEU Cardenal Herrera, Valencia.
  • Emelia Carrasco Práctica privada, Valencia.
  • Javier Didia-Attas Hospital Italiano de Buenos Aires.

DOI:

https://doi.org/10.20882/adicciones.259

Palabras clave:

craving, atención, atención selectiva, prevención de recaídas, mindfulness

Resumen

El craving, ganas compulsivas, deseo intenso o compulsión irrefrenable a consumir es uno de los síntomas centrales en el síndrome de dependencia y de gran importancia en las recaídas al abuso de alcohol u otras drogas. El presente trabajo revisa la relación entre la atención, los procesos atencionales y el fenómeno del craving. Se abordan los diferentes elementos integrantes de la atención y en particular de la relevancia de la atención selectiva sobre el craving y las etapas iniciales de la recaída. Se revisan las estrategias psicológicas eficaces frente al craving, en especial en el modelo cognitivo conductual de la recaída y en la terapia de prevención de recaídas. Finalmente, se discuten las características de la denominada terapia atencional, basada en el “mindfulness” o “atención consciente” y su potencial utilidad en el abordaje de los trastornos adictivos en general y en el craving en concreto.

Biografía del autor/a

Jesús Blasco, Unidad de Conductas Adictivas Departamento de Salud de Gandía, Agencia Valenciana de Salud. Enviar correspondencia a: Jesús Blasco Gallego. Centro de Salud de Corea. Unidad de Conductas Adictivas. C./ Benissuai 22, 46700 Gandia, Valencia (España) Tel: +34 96 2959736. Facsimile: +34 96 2959709.

Citas

Kozlowski LT, Wilkinson A. Use and misuse of the concept of craving by alcohol, tobacco, and drug researchers. Br J Addict 1987; 82: 31-6.

Organización Mundial de la Salud. Décima revisión de la Clasificación Internacional de Enfermedades (CIE-10). Trastornos Mentales y del Comportamiento. Descripciones Clínicas y Pautas para el Diagnóstico.

Madrid: Ed Meditor; 1992.

Grace A. The tonic/phasic model of dopamine system regulation and its implications for understanding alcohol and psychostimulant craving. Addiction 2000; 95 Supl2: 119-28.

Koob G, Le Moal M. Drug abuse: Hedonic homeostatic dysregulation. Science 1997; 278: 52-8.

Robinson TE, Berridge KC. The neural basis of drug craving: an incentive-sensitization theory of addiction. Brain Res Rev 1993; 18: 247-91.

Lowman C, Hunt W, Litten R, Drummond C. Research perspectives on alcohol craving: an overview. Addiction 2000; 95 Supl 2: 45-54.

Littleton J. Can craving be modelled in animals? The relapse prevention perspective. Addiction 2000; 95 Supl 2: 83-90.

Larimer ME, Palmer RS, Marlatt A. Relapse prevention. An overview of Marlatt’s cognitive-behavioral model. Alcohol Res Health 1999; 23: 151-60.

Niaura R. Cognitive social learning and related perspectives on drug craving. Addiction 2000; 95 Supl 2: 155-63.

Baker T, Morse E, Sherman J. The motivation to use drugs: A psychobiological analysis of urges. The Nebraska Symposium on Motivation: Alcohol Use and Abuse. Lincoln. NE: University of Nebraska Press; 1987. p. 257-323.

May J, Andrade J, Panabokke N, Kavanagh D. Images of desire: cognitive models of craving. Memory 2004; 12: 447-61.

Tiffany ST, Conklin CA. A cognitive processing model of alcohol craving and compulsive alcohol use. Addiction 2000; 95 Supl 2: 145-53.

Marlatt GA, Gordon JR, editores. Relapse prevention: Maintenance strategies in addictive behavior change. New York: Guildford; 1985.

Litman G, Stapleton J, Rawson N, Oppenheimer A, Peleg M, Jackson P. Situations related to alcoholism relapse. Br. J Addict 1983; 78: 381-9.

Merikle EP. The subjective experience of craving: an exploratory analysis. Subst Use Misuse 1999; 34: 1101-5.

Tiffany ST. A cognitive model of drug urges and druguse behavior: Role of automatic and non-automatic processes. Psychol Rev 1990; 97: 147-68.

Tiffany ST. The role of cognitive factors in reactivity to drug cues. En: Drummond DC, Tiffany ST, Glautier SP, Remington B, editores. Addictive Behavior: Cue Exposure Theory and Practice. Chichester, England:

John Wiley; 1995. p. 137-65.

Ramos J, Tejero A, Trujols J. ¿Craving como elemento central o como epifenómeno en las conductas adictivas? Una revisión de la propuesta de Tiffany. Adicciones 1998; 10: 217-21.

Boring EG. A History of Experimental Psychology. New York: Appleton-Century Crofts; 1950.

Broadbent DE. Perception and Communication. London: Pergamon Press; 1958.

Kahneman D. Attention and Effort. Englewood Cliffts: Prentice-Hall; 1973.

Phaf RH, Van der Heijden AH, Hudson PT. SLAM: A connectionist model for attention in visual selection tasks. Cognit Psychol 1990; 22: 273-341.

Raz A, Buhle J. Typologies of attentional networks. Nat Rev Neurosci 2006; 7: 367-79.

Allport DA. Selection for attention: Some behavioral and neurophysiological considerations on attention and action. En: Heuer H, Sanders AF, editores. Issues on Perception and Action. Hillsdale, NJ: Erlbaum; 1987. p. 395-420.

Estevez-Gonzalez A, Garcia-Sanchez C, Junque C. Atención: una función cerebral compleja. Rev Neurol 1997; 25: 1989-97.

James W. The Principles of Psychology. New York: Dover; 1890.

Pashler HE. The Psychology of Attention. Cambridge, MA: The MIT Press; 1997.

Posner MI. Attention: the mechanisms of consciousness. Proc Natl Acad Sci USA 1994; 91: 7398-403.

Van der Heijden AH, Bem S. Successive approximations to an adequate model of attention. Conscious Cogn 1997; 6: 413-28.

Parasuraman R, Davies DR, editores. Varieties of Attention. Orlando: Academic Press; 1984.

Baars BJ. Some essential differences between consciousness and attention, perception, and working memory. Conscious Cogn 1997; 6: 363-71.

Norman DA, Shallice T. Attention to action. Willed and automatic control of behavior. En: Davison RJ, Schwartz GE, Shapiro D, editores. Consciouness and Self-regulation (Vol. 4). New York: Plenum Press; 1986.

p. 1-18.

Reason J. Lapses of attention in everyday life. En: Parasuraman R, Davies DR editores. Varieties of Attention. New York: Academic Press; 1984. p. 515-50.

LaBerge D. Attentional control: brief and prolonged. Psychol Res 2002; 66: 220-33.

Johnston WA, Dark VJ. Selective attention. Ann Rev Psychol 1986; 37: 43-75.

Logan GD. Attention, automaticy and the ability to stop a speeded choice response. En: Long J, Baddeley A, editores. Attention and performance, IX. Hillsdale, NJ: Erlbaum; 1981. p. 205-22.

Courtney SM. Attention and cognitive control as emergent properties of information representation in working memory. Cogn Affect Behav Neurosci 2004; 4:501-16.

Szymura B, Neka E. Visual selective attention and personality: An experimental verification of three models of extraversión. Pers Individ Dif 1998; 25: 713-29.

Posner MI, Rothbart MK. Attention, self-regulation and consciousness. Philos Trans R Soc Lond B Biol Sci 1998; 353: 1915-27.

Marcel AJ. Conscious and unconscious perception: Experiments on visual masking and word recognition. Cognit Psychol 1983; 15: 197-237.

Myers GL, Fisk AD. Training consistent task components: application of automatic and controlled processing theory to industrial task training. Hum Factors 1987; 29: 255-68.

Vecera SP, Rizzo M. Spatial attention: normal processes and their breakdown. Neurol Clin 2003; 21: 575-607.

Bargh JA, Ferguson MJ. Beyond behaviorism: on the automaticity of higher mental processes. Psychol Bull 2000; 126: 925-45.

Schneider W, Pimm-Smith M, Worden M. Neurobiology of attention and automaticity. Curr Opin Neurobiol 1994; 4: 177-82.

Naveh-Benjamin M. Coding of spatial location information: An automatic process? J Exp Psychol Learn Mem Cogn 1987; 13: 595-605.

Zbrodroff NJ, Logan CD. On the autonomy of mental processes: A case study of arithmetic. J Exp Psychol Gen 1986; 115: 118-30.

Duncan J. Consistent and varied training in the theory of automatic and controlled información processing. Cognition 1986; 23: 279-84.

Schneider W, Fisk AD. Automatic category search and its transfer. J Exp Psychol Learn Mem Cogn 1984; 10: 1-15.

Shiffrin RM, Dumais ST. The development of automatism. En: Anderson JR, editor. Cognitive skills and their acquisition. Hillsdale, NJ: Erlbaum; 1981. p. 111-40.

Houghton G, Tipper SP. Inhibitory mechanisms of neural and cognitive control: applications to selective attention and sequential action. Brain Cogn 1996; 30: 20-43.

Tipper SP, Cranston M. Selective attention and priming: inhibitory and facilitatory effects of ignored primes. Q J Exp Psychol A 1985; 37: 591-611.

Wanigaratne S. Psychology of addiction. Psychiatry 2006; 5: 455-60.

Witkiewitz K, Marlatt GA. Relapse prevention for alcohol and drug problems: that was Zen, this is Tao. Am Psychol 2004; 59: 224-35.

Brownell KD, Marlatt GA, Lichtenstein E, Wilson GT. Understanding and preventing relapse. Am Psychol 1986; 41: 765-82.

Marlatt GA, Witkiewitz K. Relapse prevention for alcohol and drug problems. En: Marlatt GA, Donovan DM, editores. Relapse Prevention, Second edition, Maintenance Strategies in the Treatment of Addictive

Behaviors. New York: The Guildford Press; 2005. p. 1-44.

Marlatt GA. Alcohol, the magic elixir: Stress, expectancy, and the transformation of emotional states. En: Gottheil E, Druly KA, Pashko S, Weinstein SP, editores. Stress and Addiction. New York: Brunner/Mazel; 1987. p. 302-22.

Ryan F. Detected, selected, and sometimes neglected: Cognitive processing of cues in addiction. Exp Clin Psychopharmacol 2002; 10: 67-76.

Amato L, Davoli M, Perucci CA, Ferri M, Faggiano F, Mattick RP. An overview of systematic reviews of the effectiveness of opiate maintenance therapies: available evidence to inform clinical practice and research. J

Subst Abuse Treat 2005; 28: 321-9.

Fiellin DA, Pantalon MV, Chawarski MC, Moore BA, Sullivan LE, O’Connor PG, et al. Counseling plus buprenorphine-naloxone maintenance therapy for opioid dependence. N Engl J Med 2006; 355: 365-74.

van den Brink W, Haasen C. Evidenced-based treatment of opioid-dependent patients. Can J Psychiatry 2006; 51: 635-46.

Kirchmayer U, Davoli M, Verster A. Naltrexone maintenance treatment for opioid dependence. Cochrane Database Syst Rev 2006; CD001333.

Sofuoglu M, Kosten TR. Emerging pharmacological strategies in the fight against cocaine addiction. Expert Opin Emerg Drugs 2006; 11: 91-8.

Vocci FJ, Acri J, Elkashef A. Medication development for addictive disorders: The state of the science. Am J Psychiatry 2005; 162: 1432-40.

Martinez Raga J, Knecht C, Cepeda S. Modafinil: A useful medication for cocaine addiction? Review of the evidence from neuropharmacological, experimental and clinical studies. CDAR 2008; 1: 213-21.

West SL. Pharmacological treatment of alcohol dependence. JAMA 1999; 281: 1318-25.

Kleber HD, Weiss RD, Anton RF Jr, George TP, Greenfield SF, Kosten TR, et al. Treatment of patients with substance use disorders, second edition. American Psychiatric Association. Am J Psychiatry 2007; 164 Supl

: 5-123.

Cahill K, Stead LF, Lancaster T. Nicotine receptor partial agonists for smoking cessation. Cochrane Database Syst Rev 2007; CD006103.

Lancaster T, Stead L, Cahill K. An update on therapeutics for tobacco dependence. Expert Opin Pharmacother 2008; 9: 15-22.

Timko C, Finney JW, Moos RH. The 8-year course of alcohol abuse: gender differences in social context and coping. Alcohol Clin Exp Res 2005; 29: 612-21.

Cutler RB, Fishbain DA. Are alcoholism treatments effective? The Project MATCH data. BMC Public Health 2005; 5: 75.

Dutra L, Stathopoulou G, Basden SL, Leyro TM, Powers MB, Otto MW. A meta-analytic review of psychosocial interventions for substance use disorders. Am J Psychiatry 2008; 165: 179-87.

Irvin JE, Bowers CA, Dunn ME, Wang MC. Efficacy of relapse prevention: A meta-analytic review. J Consult Clin Psychol 1999; 67: 563-70.

Descargas

Publicado

2008-12-01

Número

Sección

Originales