Convergence between the Penn Alcohol Craving Scale and diagnostic interview for the assessment of alcohol craving

Exploring heterogeneity in recovery from substance use disorder following mindfulness-based relapse prevention: A latent profile analysis

INTRODUCTION

Substance use disorder (SUD) recovery is heterogeneous. Yet, over the last 50 years, substance use treatment providers and researchers have often defined success as sustained abstinence from substance use. An often overlooked but equally valid pathway to recovery for persons with SUD is non-abstinent recovery. However, most of the literature on non-abstinent recovery exists for individuals with alcohol use disorder (AUD) with few studies of non-abstinent recovery for other types of SUD. Literature exploring the mechanisms that lead to non-abstinent recovery is also lacking. As such, the current study aimed to examine recovery profiles for individuals (N = 454) recruited in two randomized clinical trials comparing mindfulness-based relapse prevention with cognitive-behavioral relapse prevention and/or treatment as usual.

METHODS

Latent profile analysis empirically derived profiles of recovery following outpatient aftercare SUD treatment. Multinomial logistic regression examined associations between treatment assignment and recovery profile, including potential psychological mediators (e.g., mindfulness) and contextual moderators (e.g., annual household income).

RESULTS

Analyses supported four recovery profiles: (1) low-functioning frequent substance use; (2) low-functioning infrequent substance use; (3) high-functioning frequent substance use; (4) high-functioning infrequent substance use. There were no significant interaction effects of race or ethnicity by treatment type, or household income by treatment type, in predicting recovery profiles. Trait mindfulness, craving, and psychological flexibility failed to mediate the association between treatment assignment and recovery profile; however, there were statistically significant differences in trait mindfulness with individuals expected to be classified in the low-functioning infrequent substance use profile showing significantly lower levels of trait mindfulness compared to individuals in the two high-functioning profiles.

CONCLUSIONS

Findings suggest that recovery from SUD is heterogeneous, and profiles of recovery based on dimensions of substance use and functioning can be identified across a variety of SUD, including among people with co-occurring SUD. Additionally, trait mindfulness appears to be a differentiating factor across recovery profiles. Further research is needed to explore how psychological and social factors may moderate and influence both abstinent and non-abstinent forms of recovery.

Developing digital interventions for a post-Covid world: A smartphone-based approach-avoidance training to reduce alcohol craving

Harmful alcohol use is a major public health issue. In-person treatment has been hindered by the restrictions necessary during the Covid-19 pandemic. This study examined the effects of an at-home smartphone-based cognitive bias modification training in heavy drinkers. Experiment 1 tested the effect of a short 20-30-min smartphone-based approach-avoidance training (AAT) on image-induced craving at a 1-day follow-up. Sixty-two participants consuming 14+ units of alcohol/week were allocated to either the training or waitlist group. Experiment 2 used an updated version of the same short AAT intervention with a sample of n = 107 participants who consumed 20+ units of alcohol/week. Training effects at 1-week follow-up were compared to an active control group. Experiment 1 showed a significant reduction in image-induced craving for the training group at 1-day follow-up. Experiment 2 found that AUDIT weekly scores were significantly reduced at 1-week follow-up for the training group, all the while craving for soft drinks remained unchanged. Experiment 1 served as a first proof of concept for the efficacy of the new smartphone-based AAT training, and experiment 2 suggested that training effects on problem alcohol use hold at 1-week follow-up.

Validation of the Chinese Version of Penn Alcohol Craving Scale for Patients With Alcohol Use Disorder

OBJECTIVE

The Penn Alcohol Craving Scale (PACS) is a five-item, single-dimension questionnaire that is used to measure a patient's alcohol craving. We sought to develop the Chinese version of the PACS (PACS-C) and assess its reliability and validity.

METHODS

A total of 160 Taiwanese patients with alcohol use disorder were enrolled in this study. The internal consistency and concurrent validity of the PASC-C with the visual analogue scale (VAS) for craving, the Yale-Brown Obsessive Compulsive Scale for heavy drinking (YBOCS-hd), and the Severity of Alcohol Dependence Questionnaire (SADQ) were assessed. The test-retest reliability of the PASC-C was evaluated 1 day after the baseline measurements. Confirmatory factor analysis (CFA) was performed to examine the psychometric properties of the PACS-C.

RESULTS

The PACS-C exhibited good internal consistency (Cronbach's α=0.95) and test-retest reliability (r=0.97). This scale showed high correlations with the VAS (r=0.81) and YBOCS-hd (r=0.81 and 0.79 for the obsession and compulsion subscales, respectively), and moderate correlation with the SADQ-C (r=0.47). Furthermore, CFA results revealed that the PACS-C had good fit indices under various models.

CONCLUSION

The PACS-C appears to be a reliable and valid tool for assessing alcohol craving in patients with alcohol use disorder in Taiwan.

Psychometric properties and longitudinal measurement invariance of the drug craving scale: Modification of the Polish version of the Penn Alcohol Craving Scale (PACS)

Background

The Penn Alcohol Craving Scale (PACS) is an instrument with good psychometric properties that is widely used to assess alcohol craving. Based on the assumption that the experience of craving is independent of substance type, the Polish version of the PACS was modified to measure drug craving, thus creating the Penn Drug Craving Scale (PDCS). The analyses presented in the paper aim to verify the hypothesis that the PDCS has a unidimensional structure, is highly reliable and features longitudinal measurement invariance.

Methods

The research was conducted in 14 inpatient and 13 outpatient randomly selected facilities that provide psychosocial therapy to people with substance use disorder (SUD) in Poland, during June 2018 –July 2019. The data used for the analyses came from 282 patients diagnosed on the basis of ICD-10 criteria (F11.2-F19.2). The paper presents analyses with the application of: [1] confirmatory factor analysis (CFA) conducted on the basis of a polychoric correlation matrix and the WLSMV estimator; [2] a reliability estimate using Cronbach’s alpha and coefficient omega; [3] verification of longitudinal measurement invariance between the beginning and end of therapy; [4] evaluation of criterion validity; [5] normalisation of the raw scores.

Results

The CFA results confirmed a unidimensional PDCS structure (RMSEA = 0.047, 95% CI: 0.000–0.103; CFI = 0.999; TLI = 0.999) and a high reliability of the scale (ω = 0.93). Moreover, a strict longitudinal measurement invariance of the instrument was confirmed.

Conclusions

Accurate assessment of craving is possible only with valid and reliable instruments. Therefore, the psychometric properties of the PDCS were verified based on the latest statistical approaches. The scale is a valid and highly reliable tool featuring longitudinal measurement invariance and can be usefully used for research and clinical purposes. Thus, the Polish version of the PACS has been modified and successfully applied to the population of people with SUD.

Effect of Transcutaneous Auricular Vagus Nerve Stimulation on Protracted Alcohol Withdrawal Symptoms in Male Alcohol-Dependent Patients

Protracted alcohol withdrawal symptoms (PAWS), characterized by the presence of substance-specific signs and symptoms (including anxiety, irritability, mood instability, insomnia, and cravings), make alcohol abstinence difficult and increase the risk of relapse in recovering alcoholics. The goal of this study was to evaluate the effect of transcutaneous auricular vagus nerve stimulation (taVNS) on PAWS and plasma brain-derived neurotrophic factor (BDNF), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and leptin levels in patients with alcohol dependency. A total of 114 patients with alcohol dependence were randomly divided into two groups: the treatment group and the control group. The patients in the treatment group were treated with taVNS of the bilateral auricular concha using an ear vagus nerve stimulator. The Pennsylvania Alcohol Craving Scale was used to evaluate the extent of craving for alcohol. The Self-Rating Anxiety Scale and Self-Rating Depression Scale (SDS) were used to evaluate the extent of anxiety and depression symptoms, respectively. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. Enzyme-linked immunosorbent assay was used to measure plasma BDNF, IL-6, TNF-α, and leptin levels. The results showed that the SDS and PSQI scores were significantly lower in the treatment group than in the control group. Moreover, compared with the control group, the average BDNF levels in the treatment group were significantly increased. These results suggest that taVNS could improve the depression symptoms and sleep quality in alcohol-dependent patients after withdrawal, which might be related to the upregulation of plasma BDNF levels.