An instrument for visual cue associated craving of HEroin (IV-CACHE): A preliminary functional neuroimaging-based study of validity and reliability

Abstract

Background: Craving is the subjective experience of desire for specific drugs. Lack of reliability and untested construct validity are limiting factors for the existing questionnaires to assess craving. Aim: The aim of the study was to design and test the validity and reliability of an instrument to assess visual cue-induced craving for heroin dependence. Materials and Methods: In the first stage of the study, a set of forty images (twenty each of heroin and neutral cues-) were captured and validated by expert consensus. Thirty male participants with heroin dependence rated their cue-induced craving on a six-point Likert scale while viewing this image-set. In the next stage, putative construct validity was examined using a pilot cue-reactivity functional magnetic resonance imaging paradigm with ten additional heroin-dependent patients. Results: Cronbach's alpha for the instrument for visual cue-associated craving of HEroin (IV-CACHE) was 0.9, suggestive of high internal consistency. There were modest and significant correlations of IV-CACHE with the drug desire questionnaire (r = 0.43), and obsessive-compulsive drug use scale (r = 0.37), supporting concurrent validity. Patients with heroin dependence exhibited cue reactivity in the left fusiform area, right lingual gyrus, right precuneus region, right inferior frontal, inferior temporal gyri, and middle occipital gyri. The activated brain areas were largely aligned to the underlying neurobiological substrates of craving but might also have depicted nondrug-specific factors (aberrant face processing and attentional bias). Conclusion: The present cue-task is a promising tool for the examination of cue-related craving for heroin in the Indian setting.