Craving across addictions: Application of the CASBAS in non-problematic, risky, and pathological usage groups

Background: Craving, i.e. intense urges to engage in a behavior, apply importantly to substance-related and behavioral addictions. Its relevance is demonstrated in associations with diminished control over behavioral engagement, treatment outcomes, relapses, and neurobiological alterations. Various craving assessments for specific addictions exist, however a unitary trans-addiction craving scale assessing the core features of craving is yet missing. With the Craving Assessment Scale for Behavioral Addictions and Substance Use Disorders (CASBAS) we created a scale that assesses three core features of craving across different addictions: obsessive, reward/relief, and physiological craving. We will present the validation and factor-structure of the CASBAS together with data showing the relevance of each craving dimension for different types of behavioral addictions and usage pattern (i.e., non-problematic, risky, pathological use). 
Method: In sample 1 (N=2,073) the CASBAS modified for gambling, gaming, pornography use, online buying/shopping, social network use, as well as for alcohol, cannabis, nicotine, and caffeine use was administered and validated within an online survey. In sample 2 (N=868), assessed in a multi-center DFG-funded addiction research unit (FOR2974), individuals with non-problematic, risky, and pathological engagement in gaming, pornography use, online buying/shopping, or social network use were identified with clinical interviews. Using multivariate analyses of variance, differences between usage patterns in the expression of craving features measured with the CASBAS were specified.
Results: The three-factorial structure of the CASBAS was confirmed. Overall and factor scores were associated with symptom severity, impulsivity, and compulsivity across all addictions. Group-comparisons in sample 2 revealed that craving is lowest in non-problematic and highest in pathological use. This pattern could be shown for almost all craving facets and all types of behavioral addictions. The effect size of the three craving facets in differentiating between non-problematic, risky and pathological use types differed across addictive behaviors. In problematic pornography use, reward/relief craving as well as physiological craving was high in all three use groups and significant differences between non-problematic and pathological pornography use were only identified in obsessive craving.
Conclusion: The CASBAS is a valid tool for consistent assessment of three core features of craving across different addictions. The relevance of specific craving features might differ across addictions. For example, the natural need to engage in sexual activities has to be considered when investigating craving for pornography use. These cravings could be natural cravings and less associated with symptoms of problematic pornography use. Identifying levels of craving that indicate a pathological use would be of interest for future research.