Coverage of Relapse Risk and Occupational Performance in Standardised Craving Assessment Scales for Substance Use Disorders – Implications for Occupational Therapy

TITLE Scoping Review: “Coverage of Relapse Risk and Occupational Performance in Standardised Craving Assessment Scales for Substance Use Disorders – Implications for Occupational Therapy” Primary Research Question: What is the extent, characteristics, and coverage of existing standardised craving assessment scales used in substance use disorders (alcohol and other substances), specifically regarding their measurement of the key dimensions of craving intensity, frequency, triggers, impact on relapse, and impact on occupational performance? Secondary Research Questions: 1. How adequately do current craving scales address the intersection of craving with relapse risk and occupational performance domains (self-care, productivity, leisure, and social participation)? 2. What gaps exist in these scales that limit their utility for guiding Occupational Therapy (OT) interventions in drug addiction recovery? Abstract Background: Drug addiction is a chronic relapsing disorder that severely impairs Occupational Performance. Craving is a core predictor of relapse, yet few craving scales integrate occupational performance domains relevant to Occupational Therapy (OT). Objective: To map standardised craving scales and evaluate their assessment of Intensity, Frequency, Triggers, Impact on relapse, and Occupational Performance. Methods: “A comprehensive database search (PubMed, CINAHL, PsycINFO, Scopus, 1990–2025) confirmed these 11 scales as the most cited and validated tools; no additional scales meeting inclusion criteria were identified that comprehensively assess occupational performance”. Arksey & O’Malley scoping review framework was applied to the provided literature synthesis of 11 key scales. Results: Out Of 11 scales reviewed (6 alcohol-specific, 5 substance-specific), only the Obsessive-Compulsive Drinking Scale (OCDS) directly assesses both relapse impact and occupational performance; however, it is limited to social functioning (2 items) and does not adequately cover self-care and leisure. No scale comprehensively measures all five dimensions while supporting Occupational Therapy intervention planning. Conclusion: A significant gap exists. A new scale integrating Marlatt’s Cognitive-Behavioural Relapse Model and the Canadian Model of Occupational Performance (CMOP) is warranted to enhance Occupational Therapy outcomes in addiction recovery. Background Drug addiction is a multifactorial chronic condition affecting physical, psychological, and occupational health (Farris & Muench, 2016). National data from India (Ministry of Social Justice and Empowerment, 2019) indicate high prevalence: 14.6% current alcohol users (5.2% dependent), 2.8% cannabis users, 2.06% opioid users, and notable inhalant use among youth. Neurobiologically, addiction hijacks the mesolimbic dopamine system (VTA–NAc), leading to synaptic plasticity changes, impaired prefrontal executive control, and HPA-axis-mediated stress vulnerability (Volkow & Morales, 2016). Craving is one of the strongest predictors of relapse (Glover & Bochner, 2015). Substance use disorders restrict personal activities, social participation, and occupational performance, leading to isolation and stigma (O’Day, 2009). Relapse rates remain high (80–90% within the first year), and many programmes lack holistic approaches (Shaffer et al., 2004; Wasmuth et al., 2015). Occupational therapy is ideally positioned to address this through meaningful activity engagement, yet current craving tools rarely link craving directly to OT-relevant outcomes. Methods : Arksey & O’Malley stages with PRISMA-ScR reference. Data were charted according to the five key dimensions identified in the excerpt. Results Eleven standardised craving scales were mapped .All assess intensity to some degree; frequency and triggers are variably covered. Relapse impact is addressed directly by several scales, but occupational performance is rarely included and never comprehensively. Alcohol-Specific Scales (n=6)  ACQ-NOW (47 items) / ACQ-SF (12 items): Direct intensity, frequency, triggers, relapse; None for occupational performance.  OCDS (14 items): Direct intensity, frequency, triggers, relapse, and occupational performance (social functioning only).  DAQ-6 (6 items): Direct intensity, triggers; None for frequency, relapse, or occupational performance.  AUQ (8 items): Direct intensity, frequency, triggers, relapse; None for occupational performance.  PACS (5 items): Direct intensity, frequency, triggers; Indirect relapse; None for occupational performance.  MACE-Q (5 items): Direct intensity, frequency; Indirect relapse; None for triggers or occupational performance. Substance-Specific Scales (n=5)  BSCS (16 items): Direct intensity, frequency, triggers, relapse; None for occupational performance.  MCCS (5 items): Direct intensity, frequency, triggers, relapse; Indirect occupational performance.  OCDUS (13 items): Direct intensity, relapse; Indirect frequency, triggers, occupational performance.  MCQ / MCQ-SF (17/12 items): Direct intensity, triggers, relapse; Indirect frequency, occupational performance.  TCQ (47/12 items): Direct intensity, triggers, relapse; Indirect frequency, occupational performance. Summary Table of Coverage (Key Dimensions) Scale Intensity Frequency Triggers Relapse Impact Occupational Performance Primary Substance ACQ Direct Direct Direct Direct None Alcohol OCDS Direct Direct Direct Direct Direct (limited) Alcohol DAQ-6 Direct None Direct None None Alcohol AUQ Direct Direct Direct Direct None Alcohol PACS Direct Direct Direct Indirect None Alcohol MACE-Q Direct Direct None Indirect None Alcohol BSCS Direct Direct Direct Direct None Multi-substance MCCS Direct Direct Direct Direct Indirect Cocaine OCDUS Direct Indirect Indirect Direct Indirect Heroin MCQ Direct Indirect Direct Direct Indirect Marijuana TCQ Direct Indirect Direct Direct Indirect Tobacco Only the OCDS directly assesses both relapse and occupational performance; however, its two social-functioning items do not cover self-care or leisure – core OT domains under the CMOP. Discussion The scoping review confirms a clear gap: while craving intensity, frequency, and triggers are well-represented, and relapse impact is covered by several tools, occupational performance is either absent or only indirectly and narrowly addressed. This limits the utility of current scales for Occupational Therapy practitioners who require tools that inform client-centred interventions in self-care, productivity, and leisure. Existing scales align variably with Marlatt’s relapse model (cognitive-behavioural triggers and high-risk situations) but lack integration with the CMOP’s emphasis on person–environment–occupation fit. Furthermore, most existing craving scales were developed and validated primarily in Western populations, which limits their cultural relevance and applicability in the Indian context where substance use patterns are highly diverse, prominently featuring alcohol, opioids, cannabis, and notably high inhalant use among children and adolescents. High relapse rates and the inadequacy of purely biomedical programmes underscore the need for multidisciplinary, occupationally focused assessment. The provided data highlight that no single scale currently enables OT-specific intervention planning based on craving–occupational performance relationships . Conclusion and Implications This scoping review maps 11 prominent craving scales and reveals a critical gap in the assessment of craving’s impact on occupational performance. Only one scale (OCDS) partially bridges relapse and occupational domains, but it is insufficient for comprehensive OT practice. Recommendations: 1. Develop and validate a new standardised craving scale that explicitly measures all five dimensions and maps directly onto CMOP domains (self-care, productivity, leisure, social participation). 2. Ground the new scale in Marlatt’s Cognitive-Behavioural Model of Relapse and the CMOP. 3. Conduct psychometric testing in Indian and international populations, incorporating the 2019 national substance-use statistics for cultural relevance. This new tool will enable occupational therapists to quantify craving-related occupational disruption, predict relapse risk more holistically, and design targeted interventions, ultimately improving recovery outcomes and societal reintegration for individuals with substance use disorders. References (selected from provided data)  Farris, S. G., & Muench, F. (2016)  Volkow, N. D., & Morales, M. (2016). Cell, 162(4), 712–725.  Glover, L., & Bochner, S. (2015)  O’Day, J. (2009)  Shaffer et al. (2004); Wasmuth et al. (2015)  Ministry of Social Justice and Empowerment (2019)