Day-to-day fluctuations in craving and the value of drugs and food in daily life

Craving is a powerful urge for a specific target (e.g., food, drugs) that prompts decisions directed at satisfying craving. While prior laboratory studies suggest craving biases behavior by amplifying target-specific value, the real-world generalizability of this mechanism remains unknown. We validate and extend these findings in a 28-day naturalistic smartphone-enabled study in patients with opioid use disorder (N=67) and community controls (N=49) who reported on their food (savory, sweet) and drug (opioid) urges and willingness-to-pay values. Despite person-level (mean) covariation, food and drug urges fluctuated largely independently within individuals while maintaining target-specific relationships with value. Using dynamics in drug urge and value and computational modeling, we isolated a distinct, ecologically relevant craving “state” tied to drug cue exposure and drug use in daily life. This research shows craving acts on normative valuation processes in real-world decision making and offers a novel approach to infer clinically vulnerable moments for behavior change.