Psychopathological dissection of addiction pattern in cigarette smokers compared to other substances: preliminary results of a psychometric scale on craving

Craving is one of the most problematic features of substance use and addiction disorders, which constitute one of the most difficult-to-solve challenges of modern healthcare systems. However, the management of these disorders greatly differs across different countries, reflecting the uncertainty regarding this field; while it is true that addiction disorders form a category per se, the rate of co- morbidity with psychiatric diseases is extremely high [1]. It is now well recog- nized that what induces craving – apart from the neurochemical pathways - in some instances is psychological distress [2]. We therefore decided to try to interpret craving as a psychopathological phenomenon rather than a neurobio- logical one; to do so, we developed and ad hoc instrument which we named CRA- SEQ, which stands for Craving – Subjective Experience Questionnaire; its purpose is dissecting addiction from a psychopathological perspective. Grounded in six key domains identified through extensive literature review and empirical evi- dence, our questionnaire aims to provide a nuanced understanding of addiction and craving. It is also modeled after existing questionnaires that serve to recognize the craving pattern, such as Craving Type Questionnaire (CTQ) [3]. We recruited cohort of 132 patients from various facilities across Tuscany, including addiction-specific treatment centers and mental health support ser- vices. These patients underwent assessment using our newly developed psy- chometric instrument. The questionnaire encompasses six domains: depression, obsession, salience alterations, anxiety, reward, and impulsivity. Among the participants, 61 reported cigarette smoking as their primary substance of abuse, while the remaining 61 reported other forms of addiction, including cocaine, cannabis, opioids, alcohol, or benzodiazepines. Smokers were recruited from the Anti-Smoking Center, while other participants were recruited from addiction clinics and toxicology units. Preliminary analysis revealed intriguing findings regarding the psychopatho- logical profiles of participants. Smokers tended to score lower in domains traditionally associated with more severe psychopathology, such as depression, obsession, and salience alterations, compared to participants with other sub- stance dependencies. However, their scores in domains related to anxiety, reward, and impulsivity were comparable to those of the more "classical” drugs group. This suggests a distinctive pattern of craving among smokers, character- ized by differential engagement of specific psychopathological domains. The observed pattern of lower scores in certain psychopathological domains among smokers raises questions about the underlying mechanisms of craving in nicotine addiction. It is possible that smokers exhibit a unique profile of psychological distress, potentially influenced by factors specific to nicotine dependence. More- over, the similarity in scores between smokers and those with other substance de- pendencies in domains such as anxiety, reward, and impulsivity underscores the complex nature of addiction and craving, transcending specific substances. The sample from this preliminary analysis is not heterogenous enough: for instance, it lacks patients affected by gambling disorder and heroin use disorder. The sample size allowed only for inter-group confrontations, while the objective is to recruit a cohort large enough to allow the validation of the CRA-SEQ. Nevertheless, our, preliminary findings suggest that our questionnaire holds promise as a valuable tool for dissecting the psychopathological underpinnings of addiction and craving.