Background and aims: Among the 11 current diagnostic criteria, craving is a potential central marker for understanding and for treatment of Substance Use Disorders (SUD). Our objective was to explore craving centrality across SUD based on the study of symptom interactions in cross-sectional network analyses of DSM-5 SUD diagnostic criteria. We hypothesized the centrality of "Craving" in SUD across substance types.
Design: Participants from the ADDICTAQUI clinical cohort with regular use (2 times per week threshold for a substance) and at least one DSM-5 SUD.
Setting: Outpatient substance use treatment services in Bordeaux, France.
Participants: The sample of 1359 participants, had a mean age of 39 years old and 67% were males. The prevalence of SUD over the time course of the study was: 93% for alcohol, 98% for opioids, 94% for cocaine, 94% for cannabis and 91% tobacco.
Measurements: Construction of a Symptom Network Model conducted on the DSM-5 SUD criteria evaluated over the past 12 months for Alcohol-, Cocaine-, Tobacco-, Opioid- and Cannabis Use disorder.
Findings: The only symptom that consistently remained in terms of centrality was "Craving" [3.96-6.17] (z-scores), indicating that it exhibits a high degree of connections in the entire symptom network regardless of the substance.
Conclusion: Identifying craving as central in SUD symptoms network confirms the role of craving as a marker of addiction. This constitutes a major avenue in the understanding of the mechanisms of addiction, with implications to ameliorate diagnostic validity and clarify treatment targets.

Highlights:
Symptom network analysis explores the interrelationships between symptoms, considering they influence each other.
Network analysis identified "craving" as the most central symptom of SUD across 5 substances.
Identifying a marker such as craving constitutes a major step in the better understanding of the addiction mechanisms.