Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-06-23T21:17:22Z No. of bitstreams: 1 SimoneReginaDeCarvalho_DISSERT.pdf: 2186853 bytes, checksum: 826bb3bb54b140e9bbf4a4bd298cdfcb (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2016-06-28T20:46:25Z (GMT) No. of bitstreams: 1 SimoneReginaDeCarvalho_DISSERT.pdf: 2186853 bytes, checksum: 826bb3bb54b140e9bbf4a4bd298cdfcb (MD5) / Made available in DSpace on 2016-06-28T20:46:25Z (GMT). No. of bitstreams: 1 SimoneReginaDeCarvalho_DISSERT.pdf: 2186853 bytes, checksum: 826bb3bb54b140e9bbf4a4bd298cdfcb (MD5) Previous issue date: 2015-11-16 / O estudo tem por objetivo analisar o efeito do topiramato sobre o craving em usu?rios de crack. Trata-se de um ensaio cl?nico aberto tipo crossover envolvendo usu?rios do Centro de Aten??o Psicossocial ?lcool e drogas (CAPSad) do munic?pio de Parnamirim/RN, aprovado pelo CEP CAAE: 38710614.1.0000.5537, respeitada a Resolu??o N? 466/2012/CNS. O estudo resultou em dois artigos cient?ficos, um ensaio te?rico e uma revis?o integrativa. No ensaio te?rico de Hinds, Chaves e Cypress, os contextos enfocam desde a problem?tica do uso individual ?s pol?ticas de enfrentamento deste consumo no Brasil, ressaltando que a situa??o de complexidade do fen?meno requerendo estrat?gias de enfrentamento a partir da aten??o integral ao usu?rio, fam?lia e sociedade. A revis?o integrativa captura, dentre os 902 registros trilingui recuperados, oito estudos apresentaram esquemas terap?uticos com efeitos positivos para o craving da coca?na, a partir do uso de nove drogas diferentes. N?o houveram resultados para o craving do crack. Os resultados da amostra do presente estudo foi composta predominantemente por usu?rios do sexo masculino, adultos e solteiros, totalizando 30 sujeitos que atenderam aos crit?rios de inclus?o: adultos, idade a partir de 18 anos, diagn?stico do Manual Diagn?stico e Estat?stico de Transtornos Mentais (DSM-IV) para coca?na/crack; capacidade cognitiva preservada; assiduidade ao servi?o, participar de, no m?nimo, tr?s consultas nos 12 meses anteriores ? coleta dos dados; e aceitar o acompanhamento ao tratamento proposto. Os dados foram coletados no per?odo de dezembro de 2014 a julho de 2015 e analisados por meio de estat?stica descritiva com o suporte do Statistical Package for Social Science (SPSS), atrav?s dos instrumentos: 1) Alcoohol, Smoking, and Substance Involvement Screening Test (ASSIST), aponta, entre outros resultados, que apenas 14% fizeram uso do crack/coca?na semanalmente durante o tratamento, enquanto 83% passaram a fazer uso diariamente ou semanalmente ap?s o per?odo de washout; 2) Escala de Impulsividade de Barratt, com uma m?dia de 80,23 e 77,47 com e sem o tratamento medicamentoso, respectivamente. Uma an?lise a partir do teste t de Student mostram que n?o h? diferen?a significativa na impulsividade com ou sem o uso do medicamento; e 3) Cocaine Craving Questionnaire-Brief (CCQ-Brief), indicando que o n?mero de usu?rios com n?vel de intensidade do craving ? expressivamente maior sem o tratamento medicamentoso (86%) do que com o tratamento (33%). A an?lise entre o craving e a grau de impulsividade mostram que h? uma baixa correla??o (Pearson) entre essas duas vari?veis com medicamento (0,282986) e sem (0,154614), demonstrando que a impulsividade tem baixainflu?ncia sobre o resultado do tratamento medicamentoso. Conclui-se que o topiramato produz efeito positivo para redu??o do craving em usu?rios de crack e que o seu uso constitui estrat?gia relevante para a efic?cia no tratamento de usu?rios de crack. / The study aims to analyze the effects of topiramato on the craving of crack users. It is an open crossover clinical trial involving users from the Psychosocial Care Center for Alcohol and Drugs (CAPSad) in city of Parnamirim, RN, approved by the CEP CAAE: 38710614.1.0000.5537, respecting the norms of the resolution n. 466/2012/CNS. The study produced preliminary two scientific papers: a theoretical essay and an integrative review, as a way of seeking the state of art. The first paper was based in the theoretical framework of Hinds, Chaves and Cypress, which focuses different contexts, from the issues of individual use to the coping policies in Brazil, highlighting that the situation and the complexity of the phenome requires coping strategies for the full attention to the user, family and society. As a result of the integrative review, among the 902 retrieved records, eight of them presented therapeutic schemes with positive effects for the craving of cocaine. They used nine different drugs. It is important to spot out that there was no result for the craving of crack. The data collection was conducted from December 2014 to July 2015 and has as sample predominantly single males. The sample was composed of 30 subjects who met the inclusion criteria: adults, age from 18 years, diagnosis of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) for cocaine/crack; cognitive capacity preserved; attendance to the service, participated at least three visits in the 12 months prior to data collection; and accepted to be monitored in the proposed treatment. Data was analyzed using descriptive statistics from the Statistical Package of Support for Social Sciences (SPSS) on the instruments: 1) Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), pointing out, among other results, that only 14% used crack/cocaine weekly during treatment, while 83% used daily or weekly after the washout period; 2) Barratt Impulsiveness Scale, with an average of 80.23 and 77.47 with and without drug treatment, respectively. An analysis from the Student t test show no significant differences in impulsivity with or without the drug; and 3) Cocaine-Craving Questionnaire-Brief (CCK-B), indicating that the number of users with craving intensity level is significantly higher without drug treatment (86%) than with treatment (33%). The analysis between craving and level of impulsivity showed that there is a low correlation (Pearson) between these two variables during treatment and after the washout, demonstrating that impulsivity has low influence on the outcome of drug therapy. As conclusion, it was noted that the topiramate produces positive effect on reducing the craving for crack users and their use is a relevant strategy for efficacy in the treatment of crack users.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-10-11T22:03:58Z No. of bitstreams: 1 AnnaCeciliaQueirozDeMedeiros_TESE.pdf: 45581366 bytes, checksum: 6a53c3c232a3cb541ff48b1bde7d604f (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-02-20T18:22:04Z (GMT) No. of bitstreams: 1 AnnaCeciliaQueirozDeMedeiros_TESE.pdf: 45581366 bytes, checksum: 6a53c3c232a3cb541ff48b1bde7d604f (MD5) / Made available in DSpace on 2017-02-20T18:22:05Z (GMT). No. of bitstreams: 1 AnnaCeciliaQueirozDeMedeiros_TESE.pdf: 45581366 bytes, checksum: 6a53c3c232a3cb541ff48b1bde7d604f (MD5) Previous issue date: 2016-04-29 / O craving por alimentos pode ser definido como um desejo intenso de comer um tipo de alimento em particular. Trata-se de um comportamento bastante comum na popula??o em geral. O presente trabalho se prop?s a investigar o comportamento de craving por alimentos em popula??o brasileira, validando question?rios para este fim, al?m de pesquisar a rela??o do craving por alimentos com o estado de cromo no organismo. Como resultado, foi realizada a tradu??o, adapta??o cultural e valida??o dos Food Cravings Questionnaire (State e Trait), da vers?o reduzida do dos Food Cravings Questionnaire-Trait e do Attitudes to Chocolate Questionnaire (ACQ), al?m do desenvolvimento e valida??o da vers?o brasileira do Food Craving Inventory. Foram identificadas influ?ncias do est?gio de vida, sexo, adiposidade corporal e restri??o diet?tica na ocorr?ncia do craving por alimentos. Tamb?m foi encontrado que os indiv?duos com n?veis mais baixos de cromo plasm?tico apresentam maior craving por alimentos doces, o que foi concomitante a maior frequ?ncia de consumo deste tipo de comida e maior adiposidade corporal.

Stress and limbic iritability in depression and alcohol dependency Denisa Jasová Abstract Depressive disorders and alcohol dependency recently present epidemiologically most significant psychiatric disorders. According to current research both diseases are multifactorial, mainly represented by genetic and environmental conditions. Several recent research studies are mainly focused on social factors related to stress and traumatic events such as neglect, deprivation, verbal, emotional, physical and sexual abuse, bullying and others. Important feature of these pathological conditions present disbalance between excitatory and inhibitory systems. In this context in affective disorders as well as in alcohol dependency these inhibitory deficits are represented by increased sensitivity and excitability of the limbic system called limbic irritability. Several studies suggested that these pathological changes may be described using the kindling model that potentially may explain limbic changes similar to temporal lobe epilepsy which may produce affective, cognitive and psychosensory symptoms but without typical changes that occur in neurologically diagnosed epilepsy. Following these findings significant correlations between depression and limbic irritability and between limbic irritability and alcohol craving have...

O jogo patológico se caracteriza pela perda do controle de apostar em jogos de azar e pelo comportamento persistente apesar dos prejuízos causados. Uma das características centrais do comportamento de jogadores patológicos é a fissura de jogar para evitar estados emocionais desfavoráveis e sintomas de ansiedade e de depressão estão significativamente associados à intensidade da fissura em jogadores patológicos. Assim, é possível que o tratamento da depressão e da ansiedade esteja associado indiretamente à melhora do comportamento de jogar, através da redução da fissura. Sabemos que a saúde mental pode ser influenciada positivamente pela prática de atividade física. Diversos estudos sugerem que a prática de exercícios tem efeito positivo sobre o humor, se associa à redução da ansiedade e da depressão, possibilitando melhor controle do estresse. O objetivo principal deste trabalho foi examinar o impacto de um programa de atividade física sobre a sintomatologia ansiosa e depressiva e sobre a fissura por jogo em uma amostra de 33 jogadores patológicos em início de tratamento ambulatorial. Adicionalmente, analisamos a associação entre a fissura e níveis dos hormônios relacionados ao estresse. O tratamento consistiu em terapia cognitivocomportamental ou psicoterapia psicodinâmica em grupo e tratamento psiquiátrico das comorbidades associadas. O programa de atividade física variou de 4 a 8 semanas e consistiu em 8 sessões de 50 minutos cada de exercícios aeróbios de intensidade moderada (60-75% da freqüência cardíaca máxima). A fissura durante o exercício foi avaliada imediatamente antes e depois de cada sessão de atividade física. Também foi avaliada a fissura por jogo nas 24 horas anteriores e nos 7 dias anteriores. Os pacientes foram investigados no início e ao final do programa de atividade física quanto a comportamento de jogo, intensidade de sintomas depressivos e ansiosos e níveis plasmáticos dos hormônios adrenocorticotrófico (ACTH), cortisol e prolactina. Os resultados mostram que houve redução significativa da fissura por jogo após cada sessão de atividade física e ao final da intervenção. Houve melhora nos sintomas de ansiedade, depressão e do comportamento de jogo. A redução da fissura por jogo durante o exercício físico se relaciona com a redução da fissura e da ansiedade ao final do programa, mas não à sintomatologia depressiva. Ainda, se associa à variação da prolactina, mas não à variação de cortisol e ACTH / Pathological gambling is characterized by loss of control over gambling and this behavior persists despite losses caused by this activity. One of the central features of the behavior of pathological gamblers is craving for gambling in order to avoid adverse emotional states, and symptoms of anxiety and depression are significantly associated with the intensity of craving among pathological gamblers. Thus, it is possible that the treatment of depression and anxiety is indirectly associated with improvement of gambling behavior by reducing the craving. We know that mental health can be positively influenced by physical activity. Several studies suggest that exercise has a positive effect on mood, is associated with reduced anxiety and depression, enabling better control of stress. The main objective of this study was to examine the impact of a program of physical activity on depressive and anxiety symptoms and the craving for gambling in a sample of 33 pathological gamblers in early outpatient treatment. Additionally, we analyzed the association between craving and levels of hormones related to stress. The treatment consisted of cognitive-behavioral or psychodynamic therapy group and treatment of psychiatric comorbidities. The physical activity program included 8 sessions ranging from 4 to 8 weeks. The proposed activity consisted of 50 minute sessions, aiming at 60-75% of maximum heart rate. Craving during exercise was assessed immediately before and after each session. We also analyzed the gambling craving in the previous 24 hour and 7 day period. Patients were investigated at the beginning and at the end of the program of physical activity regarding gambling behavior, intensity of depressive and anxiety symptoms, and plasma levels of adrenocorticotropic hormone (ACTH), cortisol and prolactin. The results show a significant reduction in gambling craving following each session of physical activity and at the end of the program. There was improvement in symptoms of anxiety, depression, and gambling behavior. The reduction in craving after each session is associated with the reduction of craving and anxiety at the end of the program but not with depressive symptomatology. Still, craving reduction is associated with variation in prolactin levels, but not in cortisol and ACTH levels

Stress and limbic iritability in depression and alcohol dependency Denisa Jasová Abstract Depressive disorders and alcohol dependency recently present epidemiologically most significant psychiatric disorders. According to current research both diseases are multifactorial, mainly represented by genetic and environmental conditions. Several recent research studies are mainly focused on social factors related to stress and traumatic events such as neglect, deprivation, verbal, emotional, physical and sexual abuse, bullying and others. Important feature of these pathological conditions present disbalance between excitatory and inhibitory systems. In this context in affective disorders as well as in alcohol dependency these inhibitory deficits are represented by increased sensitivity and excitability of the limbic system called limbic irritability. Several studies suggested that these pathological changes may be described using the kindling model that potentially may explain limbic changes similar to temporal lobe epilepsy which may produce affective, cognitive and psychosensory symptoms but without typical changes that occur in neurologically diagnosed epilepsy. Following these findings significant correlations between depression and limbic irritability and between limbic irritability and alcohol craving have...

Purpose: Food cravings are common, more prevalent in the obese, and may differ in those who pursue surgical treatment for obesity. Food craving tools are most often validated in non-clinical, non-obese samples. Methods: In this retrospective study, 227 bariatric surgery candidates at a large medical center completed the Food Cravings Questionnaire-Trait (FCQ-T). The aim was to explore the factor structure of the FCQ-T. Results: Principal components analysis with varimax rotation revealed a seven-factor structure that explained 70.89 % of the variance. The seven factors were: (1) preoccupation with food, (2) emotional triggers, (3) environmental cues, (4) loss of control, (5) relief from negative emotions, (6) guilt, and (7) physiological response. The preoccupation with food factor accounted for 49.46 % of the variance in responses. Conclusions: Unlike other populations, food cravings in bariatric surgery candidates appear to be related most to preoccupations with food.

Rationale: Evidence indicates that drug-paired stimuli can evoke drug-craving leading to drug-seeking and repeated relapse periods can influence drug-seeking behaviors. Objectives: The present study examined (1) the effect of an interaction between repeated deprivation cycles and excitatory conditioning stimuli (CS+) on ethanol (EtOH)-seeking; (2) the effects of EtOH-paired cue-exposure in a non-drug-paired environment on subsequent conditioning in a drug-paired environment; and (3) the temporal effects of conditioned cues on subsequent EtOH-seeking. Methods: Adult female alcohol-preferring (P) rats were exposed to three conditioned odor cues; CS+ associated with EtOH self-administration, CS− associated with the absence of EtOH (extinction training), and a neutral stimulus (CS0) presented in a neutral non-drug-paired environment. The rats underwent four deprivation cycles or were non-deprived, following extinction they were maintained in a home cage for an EtOH-free period, and then exposed to no cue, CS+, CS−, or CS0 to assess the effect of the conditioned cues on EtOH-seeking behavior. Results: Repeated deprivations enhanced and prolonged the duration of CS+ effects on EtOH-seeking. Presentation of the CS− in a non-drug-paired environment blocked the ability of a CS+ to enhance EtOH-seeking in a drug-paired environment. Presentation of the CS+ or CS− in a non-drug-paired environment 2 or 4 h earlier significantly altered EtOH-seeking. Conclusion: Results indicated an interaction between repeated deprivation cycles and CS+ resulted in a potentiation of CS+ evoked EtOH-seeking. In addition, a CS− may have therapeutic potential by providing prophylactic protection against relapse behavior in the presence of cues in the drug-using environment.

The prevalence of tobacco smoking among persons with recurrent pain is approximately twice that observed in the general population. Smoking has been associated with the development and exacerbation of several chronically painful conditions. Conversely, there is both experimental and cross-sectional evidence that pain is a potent motivator of smoking. A recent study provided the first evidence that laboratory-induced pain could elicit increased craving and produce shorter latencies to smoke (Ditre & Brandon, 2008). To further elucidate interrelations between pain and smoking, and to identify potential targets for intervention, the current study tested whether several constructs derived from social-cognitive theory influence the causal pathway between pain and increased motivation to smoke. Smokers (N = 132) were randomly assigned to one of four conditions in this 2 X 2 between-subjects experimental design. Results indicated that manipulations designed to (a) challenge smoking-related outcome expectancies for pain reduction, and (b) enhance pain-related coping, each produced decreased urge ratings and increased latencies to smoke, relative to controls.

Introduction : Le cannabis est une des substances psychotropes les plus utilisées à l’échelle mondiale et sa consommation peut être décrite sur un continuum, allant de l’usage récréatif jusqu’au trouble de l’usage. De ce fait, la recherche s’intéresse de plus en plus à des interventions efficaces, particulièrement pour la gestion du besoin impérieux de consommer une substance (ou craving). De nombreuses études ont en effet montré que le craving était très souvent associé à la consommation de substances, incluant le cannabis. L’activité physique (AP) est souvent mentionnée comme une stratégie potentielle de réhabilitation dans le cadre d’une consommation de substance. Parmi les concepts émergents dans le domaine de l’activité physique, on peut citer l’utilisation des affects. Un affect étant globalement une sensation de plaisir ou de déplaisir dont on pourrait se servir pour guider l’intensité de séances d’exercice physique dans le but de maximiser son appréciation. Enfin, récemment, un faisceau de preuves a suggéré que l’exercice physique pourrait stimuler les circuits de la récompense au niveau cérébral par l’intermédiaire du système endocannabinoïde. Objectifs : Dans ce contexte, nous souhaitions tester l’effet d’un programme d’entraînement physique, centré sur les affects, de 4 semaines sur la consommation de cannabis (en fréquence et en intensité) ainsi que le craving autorapportés chez 4 consommateurs récréatifs de cannabis. Nous souhaitions également étudier l’impact du programme d’entrainement sur les affects positifs et l’envie de manger/craving alimentaire des participants. Méthode : Nous avons réalisé une série de devis expérimentaux à cas unique de type A-B-A’ couplés à des mesures d’évaluations écologiques instantaneés par téléphone. Les critères de jugement principaux ont été mesurés avec une série d’items validés durant 3 notifications quotidiennes. Hypothèses : Nous pensions que la consommation de cannabis et le niveau de craving autorapportés allaient diminuer durant la phase d’entrainement (phase B) en comparaison à la phase A observationnelle. Nous nous attendions également à ce que l’intervention d’exercice physique soit bien acceptée par les participants et qu’elle soit associée à une amélioration des affects positifs ainsi qu’une réduction du craving alimentaire durant la phase B. Résultats : Un total de 504 mesures a été collecté. Pour le craving, deux de nos participants sur quatre ont montré une augmentation significative pendant la phase B. Un seul d’entre eux a montré une diminution significative du craving pendant la phase B. Pour la fréquence de consommation, deux participants sur quatre ont montré une augmentation significative pendant la phase B. Aucun n’a montré une diminution significative de sa fréquence de consommation pendant la phase B. Pour l’intensité de consommation, deux participants sur quatre ont montré une diminution significative pendant la phase B. Aucun n’a montré une augmentation de son intensité de consommation pendant la phase B. Concernant les affects positifs, nos résultats n’ont pas montré d’effets significatifs de notre intervention. Enfin, au niveau du craving alimentaire, seul un participant sur quatre a montré une diminution significative pendant la phase B. Discussion : Nos résultats ont confirmé l’aspect intra et interindividuel de l’AP, c’est-à-dire la grande variabilité des réponses pouvant être obtenues suite à l’AP chez un même, mais aussi chez différents individus. L’absence de patrons de réponses homogènes nous pousse à questionner l’effet bénéfique de ce type d’interventions en AP pour diminuer le craving et la consommation chez des consommateurs récréatifs de cannabis. Conclusion : Il semblerait donc que les interventions en AP centrées sur les affects ne soient pas forcément recommandées pour les consommateurs récréatifs de cannabis si ces derniers souhaitent diminuer leur craving ainsi que leur fréquence de consommation. En revanche, des effets très prometteurs ont été obtenus sur la réduction de l’intensité de consommation. D’autres interventions devraient être menées afin de mieux identifier à la fois les éléments intrinsèques à l’intervention qui mènent à une diminution du craving et de la consommation, mais aussi les caractéristiques des participants chez qui on peut voir des améliorations. / Introduction: Cannabis is one of the most widely used psychotropic substances worldwide and its use can be described on a continuum, ranging from recreational use to cannabis use disorder. As a result, research is increasingly interested in effective interventions, especially for craving management, an extreme urge to consume a substance. Numerous studies have indeed shown that craving is very often associated with consumption of substances, including cannabis. Physical activity (PA) is often mentioned as a potential rehabilitation strategy for substance use. Among the emerging concepts in the field of physical activity is the consideration of affect. An affect could be described as a feeling of pleasure or displeasure which could be used to guide the intensity of physical exercise sessions in order to maximize one's appreciation. Recently, a corpus of evidence has proposed that physical exercise may stimulate reward circuits in the brain via the endocannabinoid system. Objectives: We wanted to test the effect of a 4-week affect-centered training program on cannabis use (in frequency and intensity) as well as self-reported craving in 4 recreational cannabis users. We also wanted to study the impact of the training program on participants' positive affect and food cravings. Method: We carried out a series of single-case experimental studies (A-B-A’ type) coupled with ecological momentary assessment measures via mobile phone. The main judgment criteria were measured with validated items during 3 daily reports. Hypotheses: We thought that self-reported cannabis use and craving would decrease during the training program (B stage) compared to the observational stage (A stage). We also expected that the exercise program would be well accepted by the participants and that it would be associated with an improvement in positive affect as well as a reduction in food craving during B stage. Results: A total of 504 measures were collected. As for craving, two out of four of our participants showed a significant increase during B stage. Only one of them showed a significant decrease in craving during B stage. As for frequency of consumption, two out of four participants showed a significant increase during B stage. None showed a significant decrease in their frequency of consumption during B stage. As for consumption intensity, two out of four participants showed a significant decrease during B stage. None showed a significant increase in consumption intensity during B stage. Regarding positive affect, our results did not show any significant effects of our intervention. Finally, in terms of food craving, only one in four participants showed a significant decrease during B stage. Discussion: Our results confirmed the intra and interindividual aspect of PA, i.e. the great variability of responses that can be obtained following PA in the same person, but also in different individuals. The absence of homogeneous response patterns leads us to question the beneficial effect of this type of PA intervention in reducing craving and consumption in recreational cannabis users. Conclusion: It seems that affect-centered PA interventions are not necessarily recommended for recreational cannabis users if they wish to reduce cannabis craving and frequency of consumption. On the other hand, very promising effects have been obtained on the reduction of consumption intensity. Futures interventions should be carried out in order to better identify both the intrinsic aspects of the intervention that lead to a reduction in craving and consumption, but also characteristics of the participants in whom we can see improvements.

Le craving est considéré comme une composante centrale de l’addiction, potentiellement impliquée dans les processus de rechute, et influencée par de nombreux facteurs. Les études ayant examiné le lien entre craving et rechute montrent cependant des résultats contradictoires. Ces divergences pourraient s’expliquer par les limites méthodologiques rencontrées pour évaluer le craving de façon rétrospective ou pour l’induire expérimentalement en laboratoire. La méthode EMA (Ecological Momentary Assessment) utilise des technologies mobiles afin d’évaluer les sujets dans leur environnement naturel et de récolter des données en temps réel. Cette approche est particulièrement intéressante pour étudier les fluctuations rapides du craving, capturer l’influence des variables environnementales, ainsi que pour examiner le lien prospectif entre plusieurs variables. L’objectif général de cette thèse était d’utiliser la méthode EMA afin d’examiner en vie quotidienne le craving, ses modérateurs, et son lien avec l’usage de substances chez des sujets dépendants débutant une prise en charge pour une addiction à une substance. L’analyse de la littérature révèle que la majorité des études EMA examinant le craving concerne le tabac et l’alcool, et que peu d’études ont examiné ce phénomène pour des substances illégales. La partie expérimentale de cette thèse a permis de 1) démontrer la faisabilité et la validité de la méthode EMA chez des sujets dépendants, quelle que soit la substance de dépendance (tabac, alcool, cannabis ou opiacés), 2) montrer un lien prospectif unidirectionnel entre l’intensité du craving et l’usage de substances pour les 4 groupes de substances, et 3) mettre en évidence une augmentation du craving face à des stimuli conditionnés (cues) rencontrés en vie quotidienne, augmentation d’autant plus importante qu’il s’agissait de cues individuels (personnels à chaque sujet). Cette étude démontre l’intérêt de la méthode EMA dans l’étude des addictions, souligne le rôle du craving dans les processus de rechute, et encourage le développement de protocoles d’extinction de la réactivité aux cues centrés sur des cues individuels propres à chaque sujet. / Craving is a central component of addiction, involved in relapse process and under the influence of many factors. However, studies examining the link between craving and relapse have revealed some contradictory results. These inconsistencies could be due to limits encountered to assess craving in laboratory or clinical settings. Ecological Momentary Assessment (EMA) methods use mobile technologies to assess subjects in their daily life, and collect data in real time. EMA is particularly well suited to assess fluctuations of craving, capture influence of environmental moderators, and examine prospective link between variables. The objective of this thesis was to use EMA to examine craving, its moderators, and its link with substance use in daily life among substance-dependent outpatients evaluated at treatment intake. Review of the literature revealed that majority of EMA studies examining craving concerned tobacco and alcohol, but only few examined illegal substances. The experimental part of this thesis 1) demonstrated that EMA methods are feasible and provide valid data in individuals with dependence for different types of substances (tobacco, alcohol, cannabis, opiates), 2) showed a prospective unidirectional association between craving and subsequent substance use in the 4 groups of substances, and 3) confirmed that conditioned stimuli (cues) encountered in daily life are associated with an increase of craving intensity, and showed that individual personalized cues elicit a more robust effect on craving compared to standard cues. These results highlight the relevance of using EMA methods to study addiction, suggest that craving has a key place in the relapse process, and encourage to develop tailorised extinction protocols centered on individual cues rather than standard non-specific cues.