Abstract :
[en] The incentive sensitization theory posits that prolonged substance use sensitizes the brain’s motivational systems, making drug-related cues highly salient. These cues automatically capture attention, trigger approach tendencies, and activate implicit affective associations, contributing to subjective craving, maintenance of consumption and relapse. Although several implicit measures exist—such as behavioral economic and psychophysiological indicators for motivational aspects, and tasks like the IAT or addiction-Stroop for cognitive processes— a spontaneous measure of cognitions in response to drug cues in real-time is lacking. To address this gap, we developed a novel paradigm combining a think-aloud procedure (TAP) with a 360° VR environment. Participants were immersed in an alcohol-relevant (bar terrace, N = 42) or neutral (hair salon, N = 28) setting, with no mention of alcohol, or craving prior to the task, enabling the naturalistic assessment of craving-related spontaneous cognitions (CRCs). An initial pilot phase aimed to assess whether the neutral environment group exhibited significantly fewer craving-related cognitions (CRCs) compared to the alcohol group. This hypothesis was supported by the data (p < 0.001). Given these results, subsequent testing focused on the alcohol group (N = 42). Correlational analyses (adjusted) explored the relationship between CRC-related variables (the number of CRCs and the median intensity to which these elicited craving, rated on a scale from 1 to 7) and classical craving/ consumption measures (VAS scale, OCDS, AUDIT). Results revealed medium-to-large correlations for number of CRCs and craving-related measures (Kendall’s tau ranging from 0.20 to 0.49, adjusted p-values ranging from 0.09 to 0.0001). In terms of the median intensity of craving elicited by each CRCs, all correlations were significant (Kendall’s tau all > 0.40, with all p-values < 0.05). These preliminary findings support the use of TAP as a spontaneous and meaningful measure of automatic cognitive processes linked to craving. The combination of a TAP and a 360° VR environment provides a novel and naturalistic approach for assessing cognitive responses to drug cues, free from explicit references to alcohol or craving.
