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ISSN: 0095-2990 (print), 1097-9891 (electronic)
Am J Drug Alcohol Abuse, Early Online: 1–8
! 2015 Informa Healthcare USA, Inc. DOI: 10.3109/00952990.2015.1043210
Validation of the cocaine versions of the Obsessive Compulsive Drug
Use Scale and the Desires for Drug Questionnaire
Marien Lievaart, MSc1, Fatos Erciyes, MSc1, Frederik M. van der Veen, PhD1, Ben J. M. van de Wetering, MD, PhD2,
Peter Muris, PhD3, and Ingmar H. A. Franken, PhD1
1
Institute of Psychology, Erasmus University Rotterdam, Rotterdam, the Netherlands, 2Antes Mental Health Care, Rotterdam, the Netherlands, and
Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands
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3
Abstract
Keywords
Background: The Obsessive Compulsive Drug Use Scale (OCDUS) and the Desires for Drug
Questionnaire (DDQ) are two frequently used drug craving questionnaires. Although both
heroin and cocaine versions of the questionnaires exist, only the heroin versions have been
psychometrically evaluated. The present study was conducted to evaluate the psychometric
qualities of the cocaine versions of the OCDUS (OCDUS-C) and DDQ (DDQ-C). Methods: Cocainedependent inpatients (n ¼ 101) completed both scales as well as a Visual Analogue Craving
Scale (VACS), an alternative, one-item index for assessing momentary craving. We examined the
reliability (internal consistency), construct validity (factor structure), and concurrent validity
(correlations among both questionnaires, the VACS, and indicators of severity of dependence).
A subsample also completed the OCDUS-C and DDQ-C for a second time, one week after the
initial administration to obtain a preliminary investigation of the test-retest reliability. Results:
In general, both questionnaires displayed good internal consistency, test-retest reliability, and
concurrent validity. Further, the construct validity of both the DDQ and OCDUS was
demonstrated by means of confirmatory factor analyses showing the expected three-factor
models. Conclusion: Our results indicate that the OCDUS and DDQ for cocaine are both easy to
administer and reliable instruments to assist the clinical practitioner or researcher to measure
craving in cocaine dependent subjects. Moreover, the factor structure for the cocaine versions
were similar to the heroin versions, indicating the OCDUS and the DDQ can be reliably used to
measure craving for both substances, enabling a direct comparison between heroin and
cocaine craving.
Cocaine dependency, drug craving
questionnaires, psychometric properties,
OCDUS, DDQ, craving
Introduction
Craving has been described as the subjective experience of a
desire or urge to use substances (1). In recent addiction
theories craving plays an important role (2–7). Importantly,
craving is considered as a hallmark in the maintenance of
substance abuse, being a prominent precursor of relapse. The
significance of craving in addictive behavior is also
recognized by classification systems, which now include it
as one of the criteria defining substance use disorders (8).
Finally, craving is often used as an outcome measure in
treatment studies (9,10), pointing to the centrality of craving
in addiction. Hence, reliable, valid, and easy-to-administer
measures of craving are important for treatment and research
purposes.
Although originally viewed as a unidimensional construct,
the conviction is growing that craving consists of multiple
Address correspondence to Marien Lievaart, Institute of Psychology,
Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam,
The Netherlands. E-mail: lievaart@fsw.eur.nl.
History
Received 18 December 2014
Revised 11 March 2015
Accepted 30 March 2015
Published online 20 May 2015
dimensions (11,12). For example, Tiffany, Singleton,
Haertzen and Henningfield (13) criticized the one-dimensional approach, and argued that a single-item questionnaire is
not sufficient to assess all features of craving. Moreover, these
authors argued that drug users categorize their subjective
experiences into various semantic categories that cannot be
measured by a single item. Support for this line of reasoning
was found by Skinner and Aubin (14) who reviewed 18
theories on craving as formulated over the past 60 years. Their
conclusion was that it is impossible to describe the complex
construct of craving in terms of one unidimensional factor.
Another aspect under discussion is the time frame of
craving (11). A distinction can be made between general
craving which refers to a chronic desire for the drug over a
longer time period, and instant or reactive craving which
pertains to acute desire for the drug and thus occurs within a
fairly short timeframe. Differences in the assessment of the
time frame of craving may have important repercussions for
the prognosis of the course of the addiction. For example,
Franken and colleagues (15,16) showed that craving measured
over a longer time period (i.e. 1 week) appeared a better
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2
M. Lievaart et al.
predictor of attentional bias for drug cues as compared to
reactive craving measured instantly after being triggered by
drug cues.
Recently, two questionnaires have been developed for
measuring craving from a multidimensional perspective
within the context of heroin dependence: the Obsessive
Compulsive Drug Use Scale (OCDUS) intends to measure
general craving for heroin during a longer time period (‘‘the
past week’’), while the Desires for Drug Questionnaire (DDQ)
intends to assess instant (‘‘now, at this moment’’) craving for
this drug (11). In essence both questionnaires are modifications
of scales that have been used for measuring alcohol craving,
namely the Obsessive Compulsive Drinking Scale (OCDS
(17,18)) and the shortened version of the Desires for Alcohol
Questionnaire (DAQ (19)). The OCDUS and the DDQ were
both subjected to a psychometric evaluation in a clinical
population of 102 heroin-dependent inpatients and exploratory
factor analyses revealed a multiple-factor structure for both
questionnaires (11). In short, the data showed that the OCDUS
consisted of three factors of general craving for this drug:
Heroin thoughts and interference, Desire and control, and
Resistance to thoughts and intention. A similar conclusion was
reached for the DDQ which appeared to contain three factors of
instant craving: Desire and intention, Negative reinforcement,
and Control. It was found that all OCDUS and DDQ subscales
displayed good reliability and concurrent validity as established via correlations with an alternative index of craving (11).
As the OCDUS and DDQ are suitable and psychometrically sound instruments for measuring various aspects of
heroin craving in heroin-dependent individuals, we wondered
whether these scales could also be employed within the
context of another prevalent type of drug problem, namely
cocaine dependency. Thus, we constructed cocaine versions
of these questionnaires in which the word ‘‘heroin’’ was
replaced by ‘‘cocaine’’ and tested their psychometric properties. Although we are aware of the fact that there are
already a number of cocaine craving questionnaires available
(13,20–24), we thought that this enterprise would still be
valuable. Importantly, the availability of the cocaine versions
of the OCDUS and DDQ enables researchers and clinicians to
make a direct comparison between the various components of
craving across different types of drug dependency (i.e. heroin
versus cocaine). This seems particularly relevant as there are
quite a number of patients who are both heroin- and cocainedependent (25). It could, for example, guide the clinician to
determine which drug the patients at time of the assessment
craves most for and allow researchers to examine the extent to
which craving for cocaine in polydrug users affects selfreported heroin craving and vice versa. Further, the OCDUS
and DDQ both are short-to-administer measures of cocaine
craving. Other multidimensional questionnaires of craving,
such as the Cocaine Craving Questionnaire (CCQ; (13)) or the
33-item Questionnaire of Cocaine Use (QCU; (22)), are more
time-consuming and thus less useful for those clinicians
and researchers who want to measure craving repeatedly,
whereas brief measures, such as the shortened version of the
CCQ or visual analogue scales, often measure a single
construct and thus have lost their multidimensionality (26).
Hence, the OCDUS and DDQ are both multidimensional,
short-to-administer measures of cocaine craving that may be
Am J Drug Alcohol Abuse, Early Online: 1–8
valuable adjuncts to currently available measures. Although
both versions are already quite frequently used to measure
craving for cocaine in laboratory settings (15,27–32), no
research report can be found that has subjected the cocaine
versions of the OCDUS and DDQ to a thorough psychometric
evaluation.
The present study was conducted to evaluate the psychometric qualities of the cocaine versions of the OCDUS
(OCDUS-C) and DDQ (DDQ-C). A clinical population of
cocaine-dependent inpatients (N ¼ 101) completed both
scales as well as the Visual Analogue Craving Scale
(VACS), an alternative, one-item index for assessing momentary craving. This enabled us to examine the reliability
(internal consistency), construct validity (factor structure),
and concurrent validity (correlations among both questionnaires, the VACS and indicators of severity of dependence). A
subsample of 18 inpatients also completed the OCDUS-C and
DDQ-C for a second time, one week after the initial
administration, so that we could additionally perform a
preliminary investigation of test-retest reliability. We
expected the OCDUS-C and the DDQ-C to be reliable
scales (both in terms of internal consistency and test-retest
reliability). Further, it was predicted that OCDUS-C scores
(the general craving measure) would be somewhat more
stable than the DDQ-C (the instant craving measure). Finally,
moderate relationships were expected among OCDUS-C and
DDQ-C scales (respectively a general and an instant measure
of craving) and indicators of severity of dependence, and it
was also hypothesized that the links between the DDQ-C
scales and the VACS (which both tap instant, momentary
craving) would be more substantial than those between the
OCDUS-C and the VACS.
Method
Participants
The study sample consisted of 101 (77.2% male) cocainedependent inpatients, who were receiving treatment in
addiction clinics in the Netherlands. The mean age of the
study sample was 43.3 years (SD ¼ 11.4; range 20–70).
Inclusion criteria were: (a) absence of a psychiatric condition
(delirium, psychotic symptoms) that impairs understanding of
the items in the questionnaires, (b) sufficient knowledge of
the Dutch language, and (c) being in treatment for at least one
week. Although individuals were eligible for inclusion
regardless of the type or number of drugs being abused and
polydrug use was apparent, all participants were in treatment
as a result of cocaine dependency or cocaine abuse as
assessed by a multidisciplinary team of mental health
professionals following psychological and psychiatric evaluation. Thirty-two patients (31.7%) received antidepressants,
36 patients (35.6%) benzodiazepines, 49 patients (48.5%)
methadone, 28 patients (27.7%) antipsychotics, 3 patients
(3.0%) acamprosate, and 1 patient (1.0%) was given naltrexone. All these drugs were used on prescription. On average
patients had spent 320.7 Euros (SD ¼ 794.4; range 0–5000) on
drugs in the month before being admitted. The mean number
of days since patients last used cocaine was 136.8
(SD ¼ 431.1; range 0–3600), while 60.6% of the patients
had last used cocaine during the past 14 days.
DOI: 10.3109/00952990.2015.1043210
Ethics
This study was conducted according to the rules of the
Helsinki Declaration on informed consent and confidentiality
and according to the rules of our Institutional Ethical Review
Board. Participants were informed about the study after which
they gave written informed consent. Participation was based
on a voluntary basis and participants were free to refrain from
participation at any point in time.
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Assessment
The OCDUS-C intends to measure the person’s level of
craving for cocaine during the past week. As noted in the
introduction, the scale is an adaption of the OCDUS for
heroine craving (11): as compared to the original version, only
the word ‘‘heroin’’ was replaced by the word ‘‘cocaine’’. The
OCDUS-C consists of 12 items that are thought to represent
three factors: ‘‘Cocaine thoughts and interference’’ which
contains six items (e.g. ‘‘How much of your time when you
are not using is occupied by ideas, thoughts, impulses, or
images related to cocaine use?’’), ‘‘Desire and control’’
which consists of four items (e.g. ‘‘If you do not use, how
often do you feel the urge or drive to use cocaine?’’), and
‘‘Resistance to thoughts and intention’’ which includes two
items (e.g. ‘‘How much of an effort do you make to resist
these thoughts related to cocaine or try to disregard or turn
your attention away from these thoughts?’’). Respondents are
asked to indicate to what extent each of the items applies to
them on a 5-point Likert scale. Scores of individual items are
combined to produce a total score for each subscale.
The DDQ-C measures craving for cocaine at the present
moment and is a variant of the DDQ that has been employed
to assess instant craving in heroin dependent individuals (11).
Differences between both versions are minimal: only the word
‘‘heroin’’ was replaced by the word ‘‘cocaine’’. The DDQ-C
consists of 13 items that intend to assess three components of
instant craving: ‘‘Desire and intention’’ which contains seven
items (e.g. ‘‘My desire to use cocaine now seems overwhelming’’), ‘‘Negative reinforcement’’ which consists of
four items (e.g. ‘‘Using cocaine now would make me feel less
tense’’), and ‘‘Control’’ which is composed of two items (e.g.
‘‘If I started using cocaine now I would be able to stop’’).
Subjects have to indicate for each item how much they agree
with that statement using a 7-point Likert scale ranging from
1 ¼ ‘‘not at all’’ to 7 ¼ ‘‘completely’’. Scores on individual
items can be summed to yield total subscale scores.
The Visual Analogue Craving Scale (VACS) consists of a
100-mm long line that asks participants to indicate how much
craving they experience at that moment, and thus can best be
regarded as an index of acute drug craving. The line has a
label of ‘‘not at all’’ on the left end, and a label of
‘‘extremely’’ on the right end, and thus yields a single score
ranging between 0 and 100.
Procedure
Participants first provided the following demographical
information: gender, age, and education. In addition, they
were asked to indicate at what age they had started to use
alcohol, cocaine and other drugs. The participants also
Validations of cocaine versions of ODDUS and DDQ
3
reported how many years and how many days during the
month before admittance they had used various substances.
Furthermore, participants were asked how much money they
had spent on alcohol and drugs in the month before
admittance. Finally, participants indicated which prescribed
medications they were currently taking. Next, the OCDUS-C
and DDQ-C were administered in a counterbalanced order.
Thus, one half of the participants first received the OCDUS-C
and then was given the DDQ-C, while the other half of
participants received the instruments in the reversed order. Inbetween the two questionnaires, the VACS was administered.
In a subgroup of 18 subjects, the assessment of the OCDUS-C
and DDQ-C was repeated after one week in order to evaluate
the test-retest reliability of these measures.
Statistical analysis
Confirmatory factor analyses were conducted by means of
AMOS 18 (33) to examine the fit of the a priori three-factor
models of the OCDUS-C and the DDQ-C, which would
provide evidence of the construct validity of these questionnaires. Moreover, fit indices of the three-factor models were
compared with fit indices of single factor, unidimensional
models. Listwise deletion was used for each questionnaire,
which resulted in n ¼ 97 for the sample used to examine the
OCDUS-cocaine and n ¼ 96 for the sample used to examine
the DDQ-cocaine. Given that the 2 statistic is considered as
too strict and often results in the rejection of well-fitting
models (34), we looked primarily at fit indices that are less
problematic in this regard, namely the comparative fit index
(CFI) and the root mean square error of approximation
(RMSEA). We used the following cut-offs to define good fit
(34): the CFI should be larger than 0.95, whereas the RMSEA
should be less than 0.05. CFI values between 0.90 and 0.95
are considered as indicative for a reasonable fit, and the same
is true for RMSEA values between 0.05 and 0.10. Internal
consistency coefficients of the OCDUS-C and DDQ-C
subscales factors were estimated by computing Cronbach’s
alphas. Test-retest reliability was determined by calculating
intra-class correlation (ICC) coefficients. The correlations
among the OCDUS-C, DDQ-C, and the VACS were
investigated by means of Pearson’s r.
Results
Reliability of the OCDUS-C and the DDQ-C
The internal consistency of the OCDUS-C scales was
sufficient to good, with Cronbach’s alphas of 0.89 for
‘‘Cocaine thoughts and interference’’, 0.83 for ‘‘Desire and
control’’, and 0.67 for ‘‘Resistance to thoughts and intention’’
(see Table 1). The internal consistencies of the DDQ-C scales
were all good, with Cronbach’s alphas being 0.88, 0.81, and
0.71 for ‘‘Desire and intention’’, ‘‘Negative reinforcement’’,
and ‘‘Control’’, respectively.
To test the test-retest reliability of various OCDUS-C and
DDQ-C scales, ICCs were computed for the subgroup of 18
inpatients who were tested twice, one week apart. As shown
in Table 1, significant correlations were found for most
OCDUS-C and DDQ-C scales. An exception was the
‘‘control’’ scale of the DDQ-C for which the r of 0.35 was
4
M. Lievaart et al.
Am J Drug Alcohol Abuse, Early Online: 1–8
Table 1. Cronbach’s alphas (a) and test-retest reliability correlations (ICCs) of the OCDUS-C and DDQ-C scales.
a
OCDUS-C Thoughts
OCDUS-C Desire
OCDUS-C Resistance
DDQ-C Desire
DDQ-C Negative Reinforcement
DDQ-C Control
0.89
0.83
0.67
0.88
0.81
0.71
Total sample
(n ¼ 97) Baseline
M (SD)
13.19
9.14
4.68
20.04
12.04
6.88
(5.98)
(4.25)
(2.39)
(12.36)
(7.69)
(4.33)
Retest sample
(n ¼ 18) Baseline
M (SD)
14.00
8.89
4.44
18.44
13.11
5.83
(7.90)
(4.99)
(2.66)
(12.11)
(9.83)
(4.42)
Retest sample
(n ¼ 18) Retest
M (SD)
13.28
8.39
3.78
15.06
11.94
4.78
ICC
(7.37)
(5.09)
(2.16)
(10.97)
(8.57)
(4.11)
0.90*
0.92*
0.63*
0.66*
0.90*
0.35
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OCDUS-C, Obsessive Compulsive Drug Use Scale cocaine version; DDQ-C, Desires for Drug Questionnaire cocaine version;
OCDUS-C Thoughts, Thoughts and interference; OCDUS-C Desire, Desire and control; OCDUS-C Resistance, Resistance to
thoughts and intention; DDQ-C Desire, Desire and Intention; DDQ-C Negative Reinforcement, Negative reinforcement; DDQ-C
Control, Control. *p50.05.
Table 2. Descriptive statistics and standardized factor loadings for the items of the OCDUS and the corresponding factor they belong to.
Cocaine thoughts and interference
(1) How much of your time when you are not using is occupied by ideas, thoughts, impulses, or images
related to cocaine use?
(2) How frequently do these thoughts related to cocaine occur?
(3) How much do these thoughts related to cocaine interfere with your social or work functioning?
(4) How much distress or disturbance do these thoughts related to cocaine cause?
(6) How successful are you in stopping or diverting these thoughts related to cocaine?
(9) How much does the urge to use cocaine interfere with your social life or occupational activities?
Desire and control
(7) If you do not use, how much time of the day do you feel the urge or drive to use cocaine?
(8) If you do not use, how often do you feel the urge or drive to use cocaine?
(11) How strong was the drive to use cocaine in the past week?
(12) How much control do you have over your cocaine use in the past week?
Resistance to thoughts and intention
(5) How much of an effort do you make to resist these thoughts related to cocaine or try to disregard or
turn your attention away from these thoughts?
(10) How much of an effort do you make to resist the use of cocaine?
only marginally significant (p ¼ 0.08). To test whether there
were differences between the baseline and retest scores of the
OCDUS-C and DDQ-C scales, paired samples t-tests were
carried out. There were no significant differences between the
mean scores at the baseline and the retest assessment, all ts
51.5, and all ps 40.14. Finally, the OCDUS-C scores
appeared somewhat more stable than the DDQ-C scores,
which was in line with our expectation.
Mean
SD
Loading
13.19
2.34
5.98
1.24
0.68
2.29
1.95
2.23
2.28
2.09
9.14
2.36
2.35
2.39
2.09
4.68
2.24
1.09
1.25
1.30
1.18
1.33
4.25
1.33
1.24
1.39
1.27
2.39
1.29
0.75
0.81
0.83
0.70
0.79
2.43
1.46
0.67
0.77
0.83
0.78
0.60
0.80
to be clearly better [ 2 ¼ 85.31, RMSEA ¼ 0.088, and
CFI ¼ 0.94].
In Table 3 the standardized factor loadings of the DDQ-C
items on their hypothesized factors are shown. The confirmatory factor analysis performed on this scale yielded a reasonable fit for the hypothesized three factor model [ 2 ¼ 98.85,
RMSEA ¼ 0.08, and CFI ¼ 0.93] in contrast to the unidimensional factor model [ 2 ¼ 195.04, RMSEA ¼ 0.15,
and CFI ¼ 0.75] that yielded an inadequate fit.
Construct validity of the OCDUS-C and DDQ-C
A structural model using AMOS with all 12 OCDUS-C items
as indicators of a single latent factor was tested. The
unidimensional model demonstrated an inadequate fit for
the observed data [ 2 ¼ 178.85, RMSEA ¼ 0.16, and
CFI ¼ 0.81]. Table 2 presents the standardized factor loadings
of various OCDUS-C items on the hypothesized three-factor
model. Although the confirmatory factor analysis performed
on this scale yielded a slightly better fit than the unidimensional model, it did not yield an acceptable fit for the
hypothesized
three
factor
model,
[ 2 ¼ 140.31,
RMSEA ¼ 0.14, and CFI ¼ 0.86]. Inspection of the modification indices suggested to allow correlated errors between
item 3 and item 9, and between item 3 and item 4.
The goodness-of-fit indices for this adjusted model proved
Concurrent validity of the OCDUS-C and DDQ-C
Table 4 presents the correlations among the OCDUS-C and
DDQ-C subscales, and the VACS. The DDQ-C ‘‘Desire and
Intention’’ scale had moderate to strong positive correlations
with all OCDUS-C scales (Thoughts and interference,
r ¼ 0.70, Desire and control, r ¼ 0.79, and Resistance to
thoughts and intention, r ¼ 0.45). The DDQ-C ‘‘Negative
Reinforcement’’ scale was associated with all OCDUS-C
scales as well (Thoughts and interference, r ¼ 0.40, Desire
and control, r ¼ 0.40, and Resistance to thoughts and
intention, r ¼ 0.21). The DDQ-C ‘‘Control’’ scale on the
other hand was only weakly positively related to the OCDUSC ‘‘Desire and control’’ scale and was not significantly
associated with the other two scales of the OCDUS-C.
5
Validations of cocaine versions of ODDUS and DDQ
DOI: 10.3109/00952990.2015.1043210
Table 3. Descriptive statistics and standardized factor loadings for the items of the DDQ and the corresponding factor they
belong to.
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Desire and intention
(1) Using cocaine would be satisfying now
(2) I would consider using cocaine now
(4) I would do almost anything to use cocaine now
(6) My desire to use cocaine now seems overwhelming
(9) I want cocaine so much I can almost taste it
(12) Using cocaine would be pleasant now
(13) I am going to use cocaine as soon as I possibly can
Negative reinforcement
(5) I would feel less worried about my daily problems if I used cocaine now
(8) I would feel as if all the bad things in my life had disappeared if I used cocaine now
(10) Using cocaine now would make me feel less tense
(11) Even major problems in my life would bother me if I used cocaine now
Control
(3) If I started using cocaine now I would be able to stop.
(7) I could easily limit how much cocaine I would use if I used now.
Mean
SD
20.04
3.31
3.40
1.96
2.43
1.98
3.72
3.18
12.01
2.95
3.11
3.04
2.88
6.88
3.53
3.35
12.36
2.49
2.55
1.75
2.15
1.88
2.68
2.64
7.69
2.49
2.44
2.34
2.38
4.33
2.48
2.45
Loading
0.78
0.74
0.59
0.71
0.65
0.73
0.79
0.69
0.67
0.77
0.78
0.64
0.90
Table 4. Correlations between the subscales of the OCDUS and DDQ, and the VACS using Pearson’s r.
OCDUS-C Thoughts
OCDUS-C Desire
OCDUS-C Resistance
DDQ-C Desire
DDQ-C Negative Reinforcement
DDQ-C Control
VACS
OCDUS-C
Thoughts
OCDUS-C
Desire
OCDUS-C
Resistance
DDQ-C
Desire
DDQ-C Negative
Reinforcement
DDQ-C Control
VACS
–
0.77**
0.37**
0.70**
0.40**
0.07
0.60**
–
0.46**
0.79**
0.40**
0.20*
0.66**
–
0.45**
0.21*
0.18
0.27**
–
0.49**
0.31**
0.69**
–
0.22*
0.36**
–
0.17
–
VACS, Visual Analogue Craving Scale; OCDUS-C, Obsessive Compulsive Drug Use Scale cocaine version; DDQ-C, Desires for Drug Questionnaire
cocaine version; OCDUS-C Thoughts, Thoughts and interference; OCDUS-C Desire, Desire and control; OCDUS-C Resistance, Resistance to
thoughts and intention; DDQ-C Desire, Desire and Intention; DDQ-C Negative Reinforcement, Negative reinforcement; DDQ-C Control, Control.
*p50.05, **p50.01.
Moreover, we can see from Table 4 that the OCDUS-C
‘‘Resistance to thoughts and intention’’ scale showed less
strong, albeit significant correlations with the DDQ-C than
the OCDUS-C ‘‘Thoughts and interference’’ and ‘‘Desire and
control’’ scales. Finally, all scales of the OCDUS-cocaine and
the DDQ-cocaine, except for the DDQ-cocaine ‘‘Control’’
scale, were significant positively associated with the VACS.
The strongest correlations were between the VACS and the
Desire scales of both the OCDUS-cocaine and the DDQcocaine, indicating strong concurrent validity. Contrary to our
expectation, the correlations between the DDQ-C scales and
the VACS were not stronger than the correlations between the
OCDUS-C scales and the VACS.
Table 5 presents the correlations among the VACS,
OCDUS-C, and DDQ-C subscales with several indicators of
the severity of dependence (i.e. the number of days cocaine
was used in the month before admittance, the amount of
money spent on drugs in the month before admittance, and the
number of days since patients last used cocaine). As can be
seen from Table 5, all scales, except for the DDQ-Control
subscale, were positively associated with the number of days
patients used cocaine in the month before admittance.
Moreover, the OCDUS-C ‘‘Thoughts and interference’’
scale and the DDQ-C ‘‘Negative Reinforcement’’ scale were
positively associated with the amount of money spent on
drugs in the month before admittance. Finally, the VACS
scale, all scales of the OCDUS-C, and the DDQ-C ‘‘Desire
and Intention’’ scale were negatively associated with the
number of days since patients last used cocaine.
Discussion
The main aim of this study was to explore the psychometric
properties of the cocaine versions of the OCDUS-cocaine and
the DDQ-cocaine in a sample of cocaine dependent
inpatients. On the whole, results indicate adequate psychometric properties.
In general, both questionnaires displayed good internal
consistency and test-retest reliability. The internal consistency
was adequate with alpha coefficients all above 0.70, with the
exception of the OCDUS ‘‘Resistance to thoughts and
intention’’ scale with a ¼ 0.67. The somewhat lower reliability for this scale was hardly surprising given that this scale
only consists of two items and thus can still be considered as
sufficient. Furthermore, the ICC values indicated acceptable
to excellent test-retest reliabilities for all scales of the OCDUS
and DDQ, with the exception of the DDQ ‘‘Control’’ scale
that showed poor test-retest reliability. Moreover, as expected,
somewhat lower test-retest stability was found for the DDQ-C
that measures instant craving compared to the OCDUS-C that
6
M. Lievaart et al.
Am J Drug Alcohol Abuse, Early Online: 1–8
Table 5. Correlations among the VACS and subscales of the OCDUS and DDQ with several indicators of severity of dependence using Pearson’s r.
OCDUS-C OCDUS-C OCDUS-C
Thoughts
Desire
Resistance
Number of days cocaine used in month before admittance
Amount of money spent on drugs in month before admittance
Number of days last used cocaine
0.44**
0.24*
0.20*
0.48**
0.10
0.21*
0.40**
0.12
0.20*
DDQ-C
Desire
0.54**
0.15
0.25*
DDQ-C
Negative
DDQ-C
Reinforcement Control
0.26*
0.21*
0.13
0.15
0.11
0.14
VACS
0.38**
0.12
0.23*
Am J Drug Alcohol Abuse Downloaded from informahealthcare.com by Erasmus MC on 05/26/15
For personal use only.
VACS, Visual Analogue Craving Scale; OCDUS-C, Obsessive Compulsive Drug Use Scale cocaine version; DDQ-C, Desires for Drug Questionnaire
cocaine version; OCDUS-C Thoughts, Thoughts and interference; OCDUS-C Desire, Desire and control; OCDUS-C Resistance, Resistance to
thoughts and intention; DDQ-C Desire, Desire and Intention; DDQ-C Negative Reinforcement, Negative reinforcement; DDQ-C Control, Control.
*p50.05, **p50.01.
measures general craving. Further, substantial correlations
among DDQ and OCDUS scales as well as between both
questionnaires and a Visual Analogue Craving Scale and
indicators of severity of dependence (number of days patients
used cocaine in the month before admittance, money spent on
drugs, and number of days patients last used cocaine) were
found, which provides support for the concurrent validity of
both measures. Interestingly, of the DDQ-C only the DDQ-C
‘‘Negative Reinforcement’’ scale was positively associated
with the amount of money spent on drugs in the month before
admittance, whereas only the DDQ-C ‘‘Desire and Intention’’
scale was negatively associated with the number of days since
patients last used cocaine. Although these findings require
replication, they seem to underscore the multidimensional
nature of craving. The finding that specific subscales of the
DDQ-C and OCDUS-C were associated with the amount of
money spent on drugs, whereas other subscales and the VACS
scale were not, could be taken as a further demonstration of
the superiority of a multidimensional craving questionnaire.
Finally, our results concur with previous studies showing both
the OCDUS-C and DDQ-C demonstrate concurrent validity,
which has previously been shown through associations with
impulsivity (27), attentional bias for cocaine cues (15),
cocaine use 3 months after treatment (28), reductions in grey
matter volume in the orbitofrontal cortex (indicating lack of
top-down control) (29), cue reactivity (30), and larger
amplitudes on ERP waves (P3/LPP) for cocaine-related
stimuli (31,32).
The DDQ-cocaine factor ‘‘control’’ was the only factor
that did not correlate significantly with the VACS and with
the number of days patients used cocaine in the month before
admittance. As the DDQ-cocaine factor ‘‘control’’ is also the
only factor that produced poor test-retest reliability, it may be
that cocaine dependent inpatients have difficulties determining how much they are in control over their craving. Another
possibility is that the lower test-retest-reliability on this scale
reflects a shift in attitude toward control over craving as a
result of treatment effects.
Finally, confirmatory factor analyses showed that the a
priori proposed factors derived from the heroin versions of
the OCDUS and the DDQ (11) fitted the data reasonably well
(as discussed in more detail below), indicating adequate
construct validity.
For the DDQ-cocaine exactly the same factor structure as
for the DDQ-heroin (11) was found. Where the DAQ (19)
distinguishes four factors: ‘‘Negative and positive reinforcement’’, ‘‘Strong desires and intentions to use alcohol’’,
‘‘Control’’, and ‘‘Mild desires to use alcohol’’, both the
DDQ-heroin and the DDQ-cocaine discern the three factors of
‘‘desire and intention’’, ‘‘negative reinforcement’’, and
‘‘control’’. For the OCDUS-cocaine also a similar factor
structure was obtained as for the OCDUS-heroin (9). Where
the OCDS (17) distinguishes two factors, ‘‘Obsessions’’ and
‘‘Compulsions’’, both the OCDUS-heroin and the OCDUScocaine consist of three factors, namely: ‘‘Thoughts and
interference’’, ‘‘Desire and control’’, and Resistance to
thoughts and intention’’. Consequently, it seems that in
cocaine- and heroin-dependent inpatients either acute substance craving or general craving can be measured using a
similar set of items. Moreover, the results indicate that both
versions of the OCDUS and the DDQ can be reliably used to
measure craving for both substances, enabling direct comparison of heroin and cocaine craving. This is particularly
relevant since many clinical patients are both heroin- and
cocaine-dependent (25).
With regard to the usefulness and the validity of some
factors of the OCDUS (i.e. Resistance to thoughts and
intention) and the DDQ (i.e. Control), there is still some
debate. Some authors assume that these factors are residual
factors, instead of important factors on their own. Franken and
colleagues (11) advised to refrain from using the third factor
of the OCDUS until further research on its validation, given
the low internal consistency and the aberration from the
original scale (OCDS) which contains only two factors (17).
Indeed, in most studies the factor ‘‘Resistance to thoughts and
intention’’ of the OCDUS and the factor ‘‘Control’’ of the
DDQ are discarded from the analyses (29,35), whereas the
other two factors of the OCDUS (i.e. Thought and interference and Desire and control) and the DDQ (i.e. Desire and
intention and Negative reinforcement) are frequently used. In
this study, we found some indications that the ‘‘Resistance to
thoughts and intention’’ scale of the OCDUS-C and the
‘‘Control’’ scale of the DDQ-C showed less strong psychometric properties (internal consistency, test-retest reliability,
and concurrent validity). Hence, careful use of these subscales
is suggested until further validation.
Finally, it is also noteworthy that the correlations of the
VACS with the factors of the DDQ-cocaine were not stronger
than the correlations of the VACS with the factors of the
OCDUS. This is in contrast with our expectation but in line
with the validation study of the OCDUS for heroin of Franken
et al. (11), which also showed that the VACS correlated more
strongly with the OCDUS than with the DDQ. Tiffany et al.
(13) have emphasized that there is a strong link of general and
DOI: 10.3109/00952990.2015.1043210
instant craving, and this indeed seemed to be the case in the
present sample of cocaine-dependent inpatients.
Am J Drug Alcohol Abuse Downloaded from informahealthcare.com by Erasmus MC on 05/26/15
For personal use only.
Limitations and recommendations for future
research
A limitation of this study might be the stringent inclusion
criteria, which only permitted DSM-IV diagnosed cocainedependent inpatients that were currently undergoing treatment.
As individuals in treatment constitute a selective segment of
the most severe subset of the cocaine using population, these
results may not be generalizable to populations with less severe
use histories. In the future it might be of general interest to also
administer the OCDUS-C and DDQ-C to clinical outpatients
and cocaine users that do not have a diagnosis of cocaine
dependency. By doing so, more can be learned about drug
craving across these populations. Another limitation of this
study is that most of our participants were polydrug users and
we did not administer both cocaine and heroin versions to the
participants. Hence, we cannot assure that cocaine craving was
measured in isolation from craving for other drugs of abuse.
We recommend to include both the heroin and cocaine versions
of the OCDUS and DDQ in future studies in order to examine
the extent to which craving for cocaine in polydrug users
affects self-reported heroin craving and vice versa. Moreover,
predictive validity was not investigated in this study.
Interestingly, a recent study conducted by Smith et al. (36)
showed a significant difference in cocaine craving using the
OCDUS-C between recreational cocaine users and stimulantdependent individuals, whereby stimulant-dependent individuals reported considerable more craving for cocaine, indicating
that the OCDUS-C has some predictive validity. Future
research, however, should investigate the predictive validity
in terms of sensitivity and specificity to further support the
practical value of these instruments. Finally, the most significant limitation of the current study is the relatively small
sample size, especially for the test-retest reliability. A more
extensive investigation of this psychometric aspect is
recommended.
In spite of these limitations, our results indicate that the
OCDUS and DDQ for cocaine are both easy to administer and
reliable instruments to assist the clinical practitioner or
researcher in the field to measure cocaine craving from a
multidimensional perspective. Moreover, the factor structure
for the cocaine versions were similar to the heroin versions,
indicating the OCDUS and the DDQ can be reliably used to
measure craving for both substances, enabling direct comparison of heroin craving and cocaine craving. To conclude,
both questionnaires seem useful when researchers or clinicians want to compare heroin craving with cocaine craving
using the same measure. This could, for example, guide the
clinician to determine which drug the patients at time of
assessment craves the most for, and allows researchers to
examine the extent to which craving for cocaine in polydrug
users affects self-reported heroin craving and vice versa. More
generally, as the same factor structure for cocaine was found
as for heroin, our results seem to indicate that the OCDUS
and DDQ can be adapted to measure craving for other
substances of abuse without losing its validity. Finally, as
these measures take little time to complete and are able to
Validations of cocaine versions of ODDUS and DDQ
7
measure craving from a multi-dimensional perspective, both
the OCDUS-C and DDQ-C seem to have their value when
clinicians and researchers want to measure cocaine craving
from a multidimensional perspective combined with a need
for brevity (e.g. to minimally burden the patient or for
feasibility for multiple assessments).
Declaration of interest
The authors report no conflicts of interest. The authors alone
are responsible for the content and writing of this paper.
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