Importance Craving, which is a strong desire for drugs, is a new DSM-5 diagnostic criterion for substance use disorders (SUDs), which are the most prevalent, costly, and deadly forms of psychopathology. Despite decades of research, the roles of drug cues and craving in drug use and relapse remain controversial. Objective To assess whether 4 types of drug cue and craving indicators, including cue exposure, physiological cue reactivity, cue-induced craving, and self-reported craving (without cue exposure), are prospectively associated with drug use and relapse. Data Sources Google Scholar was searched for published studies from inception through December 31, 2018. In addition, backward and forward searches were performed on included articles to identify additional articles. Study Selection Included studies reported a prospective statistic that linked cue and craving indicators at time 1 to drug use or relapse at time 2, in humans. Data Extraction and Synthesis The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. Study characteristics and statistics were extracted and/or coded by 1 of the 2 authors and then checked by the other. Statistical analyses were performed from May to July 2021. Main Outcomes and Measures Random-effects models were used to calculate prospective odds ratios (ORs) representing the association between cue and craving indicators and subsequent drug use/relapse. Results A total of 18 205 records were identified, and 237 studies were included. Across 656 statistics, representing 51 788 human participants (21 216 with confirmed SUDs), a significant prospective association of all cue and craving indicators with drug use/relapse was found (OR, 2.05; 95% CI, 1.94-2.15), such that a 1-unit increase in cue and craving indicators was associated with more than double the odds of future drug use or relapse. A Rosenthal fail-safe analysis revealed that 180 092 null studies would need to be published to nullify this finding. Trim-and-fill analysis brought the adjusted effect size to an OR of 1.31 (95% CI, 1.25-1.38). Moderator analyses showed that some of the strongest associations were found for cue-induced craving, real cues or images, drug use outcome, same-day time lag, studies using ecological momentary assessment, and male participants. Conclusions and Relevance Findings from this systematic review and meta-analysis suggest that drug cue and craving indicators play significant roles in drug use and relapse outcomes and are an important mechanism underlying SUDs. Clinically, these results support incorporating craving assessment across stages of treatment, as early as primary care.

中文翻译：

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药物线索和渴望与药物使用和复发的关联：系统评价和荟萃分析。

重要性 渴望是对药物的强烈渴望，是物质使用障碍 (SUD) 的新 DSM-5 诊断标准，物质使用障碍是最普遍、最昂贵和致命的精神病理学形式。尽管进行了数十年的研究，药物线索和渴望在药物使用和复吸中的作用仍然存在争议。目的 评估 4 种类型的药物线索和渴望指标，包括线索暴露、生理线索反应性、线索诱发的渴望和自我报告的渴望（无线索暴露）是否与吸毒和复吸前瞻性相关。数据来源 Google 学术搜索从开始到 2018 年 12 月 31 日已发表的研究。此外，对包含的文章进行了向后和向前搜索以识别其他文章。研究选择 纳入的研究报告了一项前瞻性统计数据，该统计数据将时间 1 的提示和渴望指标与时间 2 的吸毒或复发联系起来，在人类中。数据提取和综合遵循系统评价和荟萃分析 (PRISMA) 指南的首选报告项目。研究特征和统计数据由 2 位作者中的一位提取和/或编码，然后由另一位作者检查。统计分析于 2021 年 5 月至 2021 年 7 月进行。主要结果和测量随机效应模型用于计算前瞻性比值比 (ORs)，代表线索和渴望指标与随后的药物使用/复发之间的关联。结果 共鉴定出 18 205 条记录，纳入 237 项研究。在 656 项统计数据中，代表 51 788 名人类参与者（21 216 名已确认 SUD），发现所有线索和渴望指标与药物使用/复发之间存在显着的前瞻性关联（OR，2.05；95% CI，1.94-2.15），因此线索和渴望指标增加 1 个单位与两倍以上相关未来吸毒或复发的几率。Rosenthal 故障安全分析表明，需要发表 180 092 项无效研究才能使这一发现无效。修剪和填充分析使调整后的效果大小达到 1.31（95% CI，1.25-1.38）的 OR。主持人分析表明，一些最强的关联被发现与线索诱导的渴望、真实线索或图像、药物使用结果、同一天的时间滞后、使用生态瞬时评估的研究和男性参与者有关。该系统评价和荟萃分析的结论和相关发现表明，药物提示和渴望指标在药物使用和复吸结果中发挥着重要作用，并且是 SUD 的重要机制。在临床上，这些结果支持早在初级保健阶段就将渴望评估纳入治疗的各个阶段。