Desire thinking and craving across the continuum of problem drinking

Desire thinking has been conceptualized as a conscious and voluntary cognitive process prefiguring images, information and memories about positive target-related experience. In the last few years, desire thinking has been found to be closely involved in addictive behaviours (substance and behavioural addictions).
Research in this field has investigated the role of desire thinking in increasing craving experience and leading to problematic behaviours (such as binge drinking and gambling). So far, studies on desire thinking have focused especially on drinking behaviour. Preliminary evidence is also emerging in the field of behavioural addictions. The first aim of this thesis was to investigate desire thinking across addictive behaviours, through a systematic review of existing studies (first study of the present thesis). The ten included studies highlighted a significant relationship between desire thinking and addictive behaviour in all conditions (alcohol use, nicotine use, gambling, problematic internet use), even though the nature of studies were mostly cross-sectional. The second and the third studies of my thesis aimed to explore longitudinally, in clinical and non- clinical populations, the involvement of desire thinking in increasing craving experience (supporting previous data) and assessing its impact (over and above craving) in leading to binge drinking and alcohol abuse/relapse (adding new findings in the field of alcohol problems and therapies). Findings showed that desire thinking predicted craving and binge drinking in both samples and predict relapse at follow ups in people with severe alcohol use disorder. Furthermore, the components of desire thinking were found to be differently implicated in alcohol problems (imaginal prefiguration predicts craving levels at follow-up and verbal perseveration were found to be the predictor of binge drinking frequency at follow-up.
As a whole, the results of the studies reported in this thesis will provide support for the central role of desire thinking in increasing craving experience and leading to alcohol use (over and above the level of craving). In other words, engaging in desire thinking gradually leads to an escalation of craving increasing the salience of using alcohol as a means of attaining control. According with this view, therapies should aim at helping patients reducing their desire thinking and mental activities related to imagining how to reach and use their desired target.