The explication of craving in alcoholism: A grounded theory study

Abstract

Alcoholism has been defined as a chronic progressive disease, the essence of which is manifest in the individual's attachment to alcohol and the importance that alcohol assumes in his or her life. Craving is one of four phenomenon commonly reported by alcoholics as a significant source of discomfort. As a central feature of the medical model of alcoholism, craving could be viewed as a symptom of alcoholism. Because of its association with both relapse and loss of control, craving has quality of life implications, potential diagnostic value as a window into disease, and may be a prognostic indicator of treatment outcome. The purpose of this study was to explicate the process of craving during the early recovery period. The research questions guiding this study are: What is the process of craving within the context of alcoholism? What is the relationship between craving and drinking behavior? Grounded theory methodology facilitated the discovery process. The sample consisted of 14 informants, recruited from individuals seeking medical care at the Southern Arizona VA Health Care System. Inclusion criteria include: age 18 or older; English-speaking; self-identification of alcoholism; self-report of craving; and sufficient memory of events for adequate recall and description. Following participant screening, data collection consisted of: written informed consent; elicitation of demographic data for background information; and assessment of craving through an hour-long audiotaped interview. Debriefing followed each interview, and informants were provided with information regarding community resources that could be contacted for additional support. Audiotapes were transcribed by a skilled transcriptionist, with accuracy verified by both the researcher and the Dissertation Chairman. Participant pseudonyms provided the protection of privacy. Data analysis consisted of open coding, category formation, identification of core variables, and theoretical coding. As an initial phase in a program of research, the outcome of this research was the development of a formal theory of craving, in recognition of potential applicability to other conditions in which craving is inherent, such as other addictive behaviors (gambling), addictive diseases (cocaine, heroin, nicotine), and medical conditions (obesity, eating disorders). The eventual goal is the investigation of interventions within a chronic disease framework.