Reliability and clinical utility of heroin craving questionnaire factors in treatment-enrolled individuals with opioid use disorder

Psychometric properties of opioid craving assessments are underexamined, limiting their potential utility for treatment studies of opioid use disorder (OUD). To address this gap, the current study aimed to evaluate the predictive utility of the Heroin Craving Questionnaire (HCQ) for future substance use outcomes. Treatment-enrolled participants with OUD (n = 128) completed the Heroin Craving Questionnaire (HCQ) at baseline and were followed up to assess future return to use versus abstinence. Individuals who maintained abstinence at each of three follow-up visits also completed the HCQ again. Exploratory factor analysis (EFA) was performed on baseline HCQ items, and extracted factors were evaluated for: (1) internal consistency reliability (Cronbach's alpha); (2) associations with demographic and clinical variables; (3) follow-up group differences; (4) test-retest reliability (intraclass coefficients: ICCs); and (5) change across visits. EFA results produced a three-factor structure, retaining 30 of 45 HCQ items and accounting for 54.60 % of the variance: (1) Lack of Self-Control (10 items, alpha=.93); (2) Positive Expectancies (11 items, alpha=.91); and (3) Urgency (9 items, alpha=.89). Results indicated that: (1) elevated scores on all three factors were associated with comorbid amphetamine use disorder; (2) higher Lack of Self-Control and Positive Expectancies scores related to fewer days since last heroin use; (3) greater Lack of Self-Control and Urgency scores were associated with higher anxiety severity; and (4) ICCs showed moderate to good test-retest reliability between baseline and follow-up visits. However, factor scores at baseline could not differentiate future relapsers versus abstainers. More research is warranted to replicate these factors in additional OUD samples.