Abstract

Craving is a core feature of heroin use disorder. Craving for heroin is a conscious cognitive process. Recently, implicit (i.e., an implicit attitude toward heroin use) cognitive processes have been thought to be precursors of cravings. This study aimed to explore the associations of craving and implicit attitude toward heroin use with the level of heroin use disorder and adherence to methadone maintenance treatment (MMT). This study recruited 213 intravenous heroin users (196 males and 17 females) from MMT clinics of two hospitals. The mean age of participants was 42.3 years. They provided details of their severity of heroin use disorder and craving for heroin via questionnaires and also completed a computerized test to assess implicit attitude toward heroin use. The relationships between implicit attitude, craving, age, heroin use disorder, and MMT adherence were examined using path analysis. Craving was positively related to heroin use disorder (beta = 0.4). Implicit attitude directly and indirectly positively contributed to heroin use disorder (betas: 0.1 and 0.3). Craving was positively related to MMT adherence (beta: 0.2), whereas implicit attitude had an indirect effect on MMT adherence (beta: 0.03). Age was negatively associated with craving but was not associated with implicit attitude toward heroin. Methadone dosage was negatively associated with craving. Craving is significantly associated with the levels of heroin use disorder and MMT adherence. Meanwhile, craving mediates the relationship between implicit attitude and heroin use disorder, as well as MMT adherence. Implicit attitude also contributes to the level of heroin use disorder directly. For reducing craving, adequate dosage may be necessary.

摘要

渴望是海洛因使用障碍的核心特征。对海洛因的渴望是一个有意识的认知过程。最近，内隐的（即对海洛因使用的内隐态度）认知过程被认为是渴望的前兆。本研究旨在探讨对海洛因使用的渴望和内隐态度与海洛因使用障碍水平和美沙酮维持治疗 (MMT) 依从性之间的关联。该研究从两家医院的 MMT 诊所招募了 213 名静脉注射海洛因使用者（196 名男性和 17 名女性）。参与者的平均年龄为 42.3 岁。他们通过问卷提供了海洛因使用障碍的严重程度和对海洛因的渴望的详细信息，并完成了一项计算机测试，以评估对海洛因使用的内隐态度。内隐态度、渴望、年龄、海洛因使用障碍、并使用路径分析检查 MMT 的依从性。渴望与海洛因使用障碍呈正相关（β = 0.4）。内隐态度对海洛因使用障碍有直接和间接的积极影响（β：0.1 和 0.3）。渴望与 MMT 依从性呈正相关（β：0.2），而内隐态度对 MMT 依从性有间接影响（β：0.03）。年龄与渴望呈负相关，但与对海洛因的内隐态度无关。美沙酮剂量与渴望呈负相关。渴望与海洛因使用障碍和 MMT 依从性水平显着相关。同时，渴望在内隐态度与海洛因使用障碍以及 MMT 依从性之间起中介作用。内隐态度也会直接影响海洛因使用障碍的程度。为了减少渴望，