[Similarities and differences between pathological gambling and substance dependance: A clarification]

Measuring craving: A systematic review and mapping of assessment instruments. What about sexual craving?

BACKGROUND AND AIMS

Craving is central in the definition of addictive disorders because of its diagnostic and prognostic value. Its measurement is essential in clinical practice. Previous reviews provided a better overview of existing instruments; however, they do not consider emerging substances and behaviors such as sexual addictions. Our objectives were threefold: (1) to provide a systematic review of craving assessment instruments and their psychometric characteristics within a transdiagnostic approach, (2) to highlight and map their conceptual relationships and (3) to identify potential sexual craving assessment instruments.

METHODS

The review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. The PubMed, Embase, PsychInfo and Cochrane/Central databases were searched for publications that met the following inclusion criterion: validation studies of craving assessment instruments, regardless of target substance or behavior. The original search identified 4561 references and included 147 articles. Each selected study was a peer-reviewed publication.

RESULTS

This review provides a synthesis of the psychometric properties of 36 original instruments and identified 93 variations of these instruments (e.g. translations). We were able to highlight five transdiagnostic families of instruments, each corresponding to a conceptual model. Only one instrument for assessing craving in the domain of compulsive sexual behavior, focused on pornography use, has been identified: the Pornography Craving Questionnaire.

CONCLUSION

This review mapped all craving assessment instruments from a transdiagnostic perspective, finding 36 original instruments and 93 variations. The evolution of instruments to measure craving mirrors the evolution of the concept of craving which has progressively integrated cognitive, conditioning and sensory dimensions, and attests to the importance of the context of assessment. Development of an instrument to measure 'sexual craving' is needed and could be based on the data from our review.

[Problematic Internet use among teenagers in Sfax, Tunisia]

Use of the Internet in Tunisian society and especially among teenagers has increased in recent years. While the use of Internet is primarily intended for research and communication, the Internet has also become an important part of teenager's life. Most people use the Internet in healthy and productive ways. However, some teenagers develop a problematic use of the Internet, which is a condition also known by the term of "Internet addiction". In Tunisia, the literature does not report data on problematic Internet use prevalence among Tunisian teenagers.

PURPOSE

The aim of this study was to determine the prevalence of problematic Internet use among teenagers, in the urban area of Sfax.

METHODS

This transversal study was carried out between the 15th January and the 15th February 2009. Participants were 600, first to third grade secondary school students, aged 14 to 20. They were recruited from seven secondary schools randomly selected in the urban area in Sfax City. The self-administered Young's 8-item questionnaire was used in this survey. Participants who scored five or more can be considered problematic Internet users. Finally, 587 valid data samples were collected, 263 (44%) males and 324 (56%) females. Eighty-five percent of the participants were in the 15-17 age range. The mean age was 16 years (±1.26).

RESULTS

The prevalence of problematic Internet use was 18.05% (total of 587 students). The sex-ratio was 0.75. The problematic Internet use was not correlated with sex. The average time of Internet use per day among problematic Internet users was 4.5hours (±2.84) against 1.02hours (±1.56) among non problematic Internet users (P=0.000).

DISCUSSION

In this study, the prevalence of problematic Internet use was higher than that reported in previous studies. Two facts can explain this: first, the use of the only self-administered questionnaire does not distinguish between a simple abuse and a problematic Internet use. A psychiatric examination is essential to support the diagnosis of problematic Internet use. Second, this study was conducted exclusively in an urban area where access to the Internet is easier than in rural areas. This study was not representative of teenagers in Sfax. The gender difference was consistent with the findings of prior research, as was the average time of Internet use per day among problematic Internet users.

CONCLUSION

This study shows that problematic Internet use is frequent in our teenage population. A preventive outreach for youths, their families and health professionals is needed to limit the extension of this problem among young people. The existence of misuse of the Internet should not lead to avoiding this media. Reflections on how to moderate the relationship with the Internet are necessary; especially since Internet becomes an essential medium of information and communication. The current lack of Internet education in school curricula is also a shortage to fulfil.