Physical sensations of craving in binge drinking and severe alcohol use disorder: A phenomenological approach

Craving is a key concept in addictive disorders. However, despite seminal results identifying the pivotal role of its physical component, craving remains conceptualized as being centrally underpinned by psychological and cognitive processes. To explore the phenomenological dimension of physical craving in addiction, we measured self-reported body sensations of craving among individuals with subclinical (binge drinking, BD) or clinical (severe alcohol use disorder, SAUD) alcohol use disorders.

We used a body mapping technique, allowing for the free report of the bodily counterparts of psychological phenomena, among 76 binge drinkers and 97 recently detoxified patients with SAUD. We measured the taxonomy, localization, intensity, and pleasantness of the craving bodily sensations.

Physical sensations of craving were reported (1) for individuals with BD habits, mostly in the shoulders/thorax (53.95%), mouth (47.37%), and forehead (31.58%), in the form of palpitations, dryness, and tension; (2) for patients with SAUD, most often and with the highest average intensity in the hands (31.96%), forehead (24.74%), and shoulders/thorax (22.68%), in the form of tremors, perspiration, and palpitations. In BD, craving sensations were described as slightly unpleasant to pleasant. Conversely, in SAUD patients, craving was perceived as slightly to very unpleasant.

These findings bring forth a novel perspective of the bodily mechanisms involved in craving. They support a dissociation between subclinical and clinical populations of excessive alcohol drinkers, as body sensations related to craving might generate alcohol consumption through positive reinforcement (to extend positive sensations) for subclinical populations and through negative reinforcement (to alleviate unpleasant body sensations) for clinical populations. More widely, we highlight the need to add perceived bodily sensations to the predominantly and exclusively cognitive focus that characterizes the craving research field, since craving is also underpinned by physical sensations.