الفهرس 
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Abstract
Substance use disorders (SUDs) are global public health problem associated with
craving, which may cause distress and may lead to relapse. It is considered as one of the
barriers to effective treatment of substance use. Cognitive factors have recently gained a lot
of interest as there is growing evidence that they are responsible for the persistence of
craving and drug use even after treatment. These cognitive factors include desire thinking,
metacognition about desire thinking, substance use believes, and craving believes. As soon
as the dysfunctional believes of drug users are activated, the individual experiences a selfserving
way of thinking that exacerbates craving.
Aim of the study:
This study aims to identify the cognitive factors associated with craving, and to
investigate their ability to predict craving among clients with substance use disorders.
This study followed a descriptive design. It was conducted at the outpatient clinic for
clients with SUD at El-Maamoura Hospital for Psychiatric Medicine in Alexandria. The
sample of study consisted of 180 outpatient male clients with SUD who have no comorbidity
with other psychiatric disorders and able to read and write.
Tools used to collect the data of the present study:
Six tools used to collect the data;
Tool I: The General Craving Scale (GCS):
The GCS is a modified version of the Penn Alcohol Craving Scale (PACS) developed
by Flannery et al., (1999) (Flannery et al., 1999). The GCS includes 5 self-report items valid
to measure the duration, frequency and intensity of craving.
Tool II: The Desire Thinking Questionnaire (DTQ):
The Desire Thinking Questionnaire (DTQ) is a self-report instrument that assesses
the cognitive process of desire thinking developed by Caselli & Spada, (2011). It consists of
10 items with two subscales; verbal perseveration and imaginal prefiguration.
Tool III: Metacognitions about Desire Thinking Questionnaire (MDTQ):
This scale was developed by Caselli & Spada, (2013) to measure metacognitions about
desire thinking. It is composed of 18 items with three subscales; Positive Metacognitions
about Desire Thinking, Negative Metacognitions about Desire Thinking and Thought
Control about Desire Thinking.
Tool IV: Beliefs about Substance Use Scale (BSU):
The Beliefs about Substance Use scale (BSU) is a 20-item self-report measure, which
was developed by Wright et al, (1993) dysfunctional beliefs about substance use. The final
version of the BSU contains 4 subscales; Self-efficacy, outcome expectancies, attributions
of causality, and decision-making processes.
Tool V: Craving beliefs questionnaire (CBQ)
The Craving beliefs questionnaire (CBQ) is a 20-item scale which measures beliefs
about substance craving developed by Wright (1993). The final version of the CBQ contains
3 subscales; will power, compulsive behavior and negative coping.
Tool VI: Socio-demographic and clinical data structured interview schedule:
The tool was developed by the researcher and composed of two parts that elicit sociodemographic
data and the clinical data for clients with SUDs.
The following are the main results yielded by the study:
A- Socio demographic characteristics:-
- Age of the studied subjects ranged from 18 to 52 years old where 62.8 % were in the
age group ranging from 25 to less than 40 years old.
- Nearly half of the studied subjects (48.3%) were single, 40.6% were married and
11.1% were separated\divorced. Regarding occupation, 49.4% of the studied subjects
were laborer/ craft worker, 28.9% were unemployed, and 17.8% of them worked as
clerk.
- The majority of studied subjects (80%) did not have enough income, 45% of them
lived with their parents or a relative, and 35.6% of them lived with their wives, while
19.4% of the studied subjects lived alone.
- The studied subjects (37.8%) had a primary or preparatory school, 27.2% were able
to read and write. 21.7 % had secondary education and 13.3% of them had a university
degree.
B- Clinical characteristics
- The majority of the studied subjects (77.8%) reported that they used 4 or more
substances. The largest percent of the studied subjects (77.2%) were using Cannabis,
71.7% of them were using lyrica-lyrolin, 66.7% were using cigarettes and heroin,
52% were using Tramadol, and 42.2% were using Epitril, while 40% were using
alcohol.
- The studied subjects’ age at the beginning of substance use ranged from 12 to 33 years
with a mean age of 20.34±4.808 years, where 50% of the studied subjects started use
at an age of onset less than 18 years.
- In relation to the duration of substance use of the studied subjects, it ranged from 1
to 33 years with mean of 12.71±6.766 years, where 14.4% were less than 5 years of
duration of substance use.
- Regarding the main reason for starting substance use according to the studied
subjects’ opinion, more than two thirds of the studied subjects stated that peer pressure
is the main cause for starting substance use (73.3%), while, 55.6% mentioned that
they used substance to forget bad memories, 53.3% stated that it was to increase selfesteem
and 53.3% for curiosity, 43.3% stated that it was to make relationships, 33.3%
stated that it was for feeling loneliness.
- A large percent of the studied subjects (72.8%) did seek medical help. Among those
61.8% sought medical help for 2-3 times with range from 1 to 15 times with a mean
of 2.38±2.457 times.
- In relation to the reason for seeking treatment, about 67.8% of the studied subjects
with substance use stated that the need for change is the cause for seeking treatment,
while 53.3% of them reported that the cause of seeking treatment is social pressure.
51.7% reported preventing further losses, 50.0% reported remorse and 41.7%
reported loss of health as reason for seeking treatments.
D- Description of craving and cognitive factors
- More than two thirds of the studied subjects (62.3%) had high level of craving,
(36.7%) of the studied subjects had moderate level of craving.
- Most of the studied subjects (88.9%) reported high level of desire thinking with a
total mean of 34.64±4.44. The mean percent score illustrates that the mean
(85.25±15.82) on the Verbal perseveration desire thinking is higher than that of
imaginal prefiguration (79.03±17.81) and total desire thinking (82.14±14.80).
- Most of the studied subjects (92.8%) reported high thought control about desire
thinking and 91.1% reported high negative metacognition about desire thinking,
while only 45.6% of them reported high positive metacognition about desire thinking.
- More than two thirds of the studied subjects (70.0%) obtained high craving beliefs,
while (28.9%) of the studied subjects obtained moderate craving beliefs with a mean
score of 105.52±16.09 and a mean percent score was 71.26±13.41.
- The studied subjects who were substance users had high beliefs about substance use,
40.0%, while 52.2% of them had moderate beliefs about substance use, with a mean
score of 91.461±17.161 and a mean percentage score of 59.55±14.30.
E- Relationship between craving and cognitive factors.
- There was a moderate significant positive correlation (r=.433, p> 0.000) between
craving and total desire thinking and also with its subscales (Verbal perseveration
and Imaginal prefiguration), where, (r=.362, p> 0.000), and r=.398, p> 0.000
respectively.
- There was a highly significant positive correlation (r=.430, p> 0.000), between
craving and positive metacognition about desire thinking, negative metacognition
about desire thinking and need for thought control, where (r=.252, p= 0.001), (r=.462,
p> 0.000), and (r=.334, p> 0.000) respectively.
- It was also found that there is a highly significant positive correlation (r=.465, p
>0.000) between beliefs about substance use and craving.
- There is a significantly positive correlation (r=.512, p> 0.000) between craving and
craving beliefs.
F-Regression
- In predicting craving, the regression analysis revealed that in this model, 45.6% of
the variance of craving can be explained by the regression on desire thinking, NCDT,
PMDT and NMDT, SUD belief and Craving belief. It is found that craving was
significantly associated only with desire thinking, NMDT, SUD belief, craving belief
where (β =.382, t = 4.796, P<.001), (β = .316, t =2.092, P=.038), (β =.064, t = 2.725,
P=.007), (β =.103, t = 4.326, P<.001) respectively followed by insignificance
association with each of PMDT and NCDT, where (β = -.013, t = -.188, P=.851), (β
= .220, t =.967, P=.335). A closer inspection of the final equation reveals that desire
thinking, NMDT, SUD belief and craving belief were the only significant predictors
of craving. The equation will be Craving = -17.580+ (.382 DT +.316 NMDT+.064
SUD belief+.103 Craving belief). Beta for DT is the highest (=.382) indicating that
DT is the strongest independent predictor of craving.