Methods of assessing craving to gamble: a narrative review

Although the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) does not explicitly list craving as a diagnostic criterion for pathological gambling, theories of disordered gambling and research on relapse precipitants suggest that cravings--among other factors--provoke and maintain episodes of gambling. Assessment of craving to gamble is complicated by questions regarding (a) the emotional, cognitive, behavioral, and physiological components of such craving; (b) the degree to which craving is viewed as an acute and fluctuating experience or as a relatively stable preoccupation with or inclination to gamble; (c) the threshold separating mild desire from pathological craving to gamble; and (d) the degree to which disordered gamblers are aware of, and able to report on, their experience of craving. Our literature search revealed various self-report methods that could be used to assess craving to gamble, including single-item rating scales, multi-item questionnaires, and application of the think-aloud procedure. In addition, psychophysiological reactivity (e.g., heart rate, brain activation) to gambling-related stimuli and reaction time (RT) tasks (e.g., gambling Stroop, Lexical Salience Task) may serve as proxy measures of subjective craving to gamble. Although researchers have assessed elements of reliability and validity of many measures, most require additional evaluation to examine their predictive and construct validity and their utility across different modes of gambling. The field would also benefit from further research to develop and evaluate additional self-report and proxy measures.