Toward a Triadic Approach to Craving in Addictive Disorders: The Metacognitive Hub Model
Résumé
Craving constitutes a key factor in substance-related and behavioural addictions, as illustrated by its recent inclusion as a diagnosis criterion in the DSM 5. Here, we propose to renew the conceptual, experimental, and clinical approach of craving, by integrating this concept in a recently developed model of addictive disorders, namely the triadic model. Our main assumption is that craving should not be considered as a unitary process but rather as the result of interactions between three subcomponents, namely: (1) cognitive craving related to cognitive abilities (centrally executive functions); (2) reward craving, linked to cue-reactivity and implicit processes (centrally attentional biases); (3) physiological craving, corresponding to the bodily perceptions and related to withdrawal symptoms. We relate these three components to the systems proposed by the triadic model, and postulate that metacognitive abilities constitute an underlying hub between the three subcomponents, leading to an integrated model. This offers an innovative conceptual framework to explore the interactions between craving and other key processes involved in addictive disorders, initiating major fundamental and clinical avenues.