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Kavanagh DJ. Cue exposure for alcohol use disorders: A commentary on Kiyak et al. (2023). Addict Behav 2023; 144:107745. [PMID: 37146484 DOI: 10.1016/j.addbeh.2023.107745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/19/2023] [Accepted: 04/24/2023] [Indexed: 05/07/2023]
Abstract
While cue exposure therapy (CET) gives similar effects to cognitive-behavior therapies (CBTs) for Alcohol Use Disorder, it does not consistently add to effects of CBT alone. If the non-random trial of Nattala, Murthy, Leung, Rentala and Ramakrishna (2018) is omitted from the systematic review and meta-analysis of Kiyak, Simonetti, Norton and Deluca (2023), even average effects against less stringent controls are not substantial. Some trials have used sub-optimal versions of CET, but effects of CET are also constrained by the fact that many alcohol dependent patients do not exhibit strong craving. In vivo coping skills practice in the presence of powerful alcohol cues remains a viable treatment, especially if a key focus is on skills with wide situational application rather than solely on habituation. Multisensory motivational imagery for alcohol control represents one such strategy.
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Affiliation(s)
- David J Kavanagh
- School of Psychology & Counselling, Queensland University of Technology, Australia.
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2
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Cheng B, Coates JM, Gullo MJ, Chan G, Kavanagh DJ, Feeney GFX, Young RMD, Clark PJ, Connor JP. Development of the motivational thought frequency scale for alcohol abstinence (MTF-A). Alcohol Clin Exp Res 2022; 46:2077-2088. [PMID: 36098356 DOI: 10.1111/acer.14938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/16/2022] [Accepted: 09/08/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND AIMS For most treatment-seeking patients with severe Alcohol Use Disorder (AUD), abstinence is the clinically indicated goal. Existing AUD motivation scales are non-specific about treatment consumption goals, which limit their effectiveness. Desires and mental imagery are relevant in the motivation for AUD treatment engagement. The Motivational Thought Frequency Scale for an abstinence goal (MTF-A) was adapted from the MTF for controlled drinking (MTF-CD). This study psychometrically evaluated the MTF-A in an alcohol-dependent sample engaged in treatment with a goal of abstinence. To enhance the clinical utility of the scale, a secondary aim was to evaluate a psychometrically equivalent short version of the MTF-A. METHOD A sample N of 329 treatment-seeking patients with AUD (mean age of 44.44 years, SD = 11.89 years, 72% male) who were undertaking a cognitive behavioral treatment (CBT) program for abstinence completed the Motivational Thought Frequency Scale for Abstinence (MTF-A) and the Severity of Alcohol Dependence Questionnaire (SADQ). The MTF-A measured motivation for abstinence through four factors: intensity, self-efficacy imagery, incentives imagery, and availability. Confirmatory factor analyses (CFAs) were conducted to examine factor structure and model fit. Cronbach's alpha assessed internal consistency. Predictive validity was determined by logistic regression predicting first-session treatment non-attendance and alcohol consumption between baseline assessment and commencement of treatment, controlling for potential confounds. RESULTS A four-factor structure provided the best fit for the MTF-A, compared with one- and three-factor models. A shortened 9-item MTF-A scale (S-MTF-A) provided better fit than the 13-item MTF-A scale. Both MTF-A and S-MTF-A displayed good internal consistency. Although both MTF-A and S-MTF-A successfully predicted first-session treatment non-attendance, neither predicted alcohol consumption between the baseline assessment and commencement of treatment. CONCLUSIONS The model fit of the four-factor, 9-item S-MTF-A was superior to the original 13-item MTF-A. Both scales were predictive of participation of AUD treatment. Desires and mental imagery play an important role in AUD treatment motivation.
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Affiliation(s)
- Brandon Cheng
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia.,National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Jason M Coates
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia.,Alcohol and Drug Assessment Unit, Division of Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Matthew J Gullo
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia.,Alcohol and Drug Assessment Unit, Division of Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Gary Chan
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - David J Kavanagh
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia.,School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Gerald F X Feeney
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia.,Alcohol and Drug Assessment Unit, Division of Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Ross Mc D Young
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia.,Alcohol and Drug Assessment Unit, Division of Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Health and Behavioural Sciences, The University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Paul J Clark
- Alcohol and Drug Assessment Unit, Division of Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Jason P Connor
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia.,Alcohol and Drug Assessment Unit, Division of Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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3
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Relationship between alcohol craving dimensions and features of comorbid mental health in an alcohol dependent sample. Addict Behav 2022; 124:107106. [PMID: 34530206 DOI: 10.1016/j.addbeh.2021.107106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 08/05/2021] [Accepted: 08/29/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Negative affect and alcohol craving are common features of Alcohol Use Disorder (AUD). Both independently contribute to AUD severity and poorer treatment outcomes, but their relationship is poorly understood. Multidimensional alcohol craving measures now allow for examination of key dimensions of craving. This study explored the relationship between depression, anxiety, stress, and the alcohol craving dimensions of intensity, imagery and intrusiveness. METHOD Five-hundred and twenty-five treatment seeking AUD patients (mean age of 39.79 years, SD = 11.57 years, 67% male) completed the Depression Anxiety Stress Scales (DASS), Alcohol Use Disorder Identification Test-Consumption items (AUDIT-C), and Alcohol Craving Experience (ACE-F) questionnaire, which measured the frequency of craving intensity, imagery and intrusiveness. Regression models predicted main effects of predictors and moderation by alcohol consumption. RESULTS Higher levels of stress were independently associated with increased craving intensity, imagery and intrusiveness. Significant positive associations were also found between anxiety and craving imagery. The association between depression and craving was not significant after controlling for other predictors. CONCLUSIONS AUD patients experienced higher cravings when stressed and greater imagery when anxious. These results support the need to consider the relationships between stress and craving when managing alcohol dependence.
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Yoshimura A, Kimura M, Matsushita S, Yoneda JI, Maesato H, Komoto Y, Nakayama H, Sakuma H, Yumoto Y, Takimura T, Tohyama T, Iwahara C, Mizukami T, Yokoyama A, Higuchi S. Alcohol dependence severity determines the course of treatment-seeking patients. Alcohol Clin Exp Res 2021; 45:2335-2346. [PMID: 34585408 DOI: 10.1111/acer.14707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 08/05/2021] [Accepted: 08/28/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND While accumulating evidence suggests a relation between the severity of alcohol dependence and the risk of its recurrence, the impact of dependence severity on the course of the disorder has not been carefully evaluated. The present study examined the impact of several severity indices of alcohol dependence on the drinking course after inpatient treatment. METHODS This prospective study was conducted over a 12-month period following alcohol treatment at a specialized hospital. A total of 712 consecutively admitted alcohol-dependent patients were targeted for enrollment at the time of their hospitalization, with 637 patients registered and followed. The characteristics and severity of the subjects were assessed using multiple methods at admission, with their course after discharge followed continuously using mailed questionnaires that queried them regarding their drinking behavior. RESULTS Greater severity of dependence, assessed using the number of ICD-10 diagnostic criteria met, was associated with a lower rate of abstinence during the study period (p = 0.035). The rate of abstinence also decreased significantly as the baseline blood gamma-glutamyl transferase value and Alcohol Dependence Scale (ADS) score increased (p = 0.031 and p = 0.0002, respectively). In multivariate Cox proportional hazards analyses, the group with the most severe ADS scores had a significantly greater risk of relapse to drinking than the group with the least severe scores (HR = 2.67, p = 0.001). Dependence severity also associated with the drinking pattern; participants in both the controlled drinking group and the abstinence group had lower ADS scores at admission and a later age at first drinking (p = 0.001 and p < 0.001, respectively) than those with poorer drinking outcomes. CONCLUSIONS The present study showed that more severe alcohol dependence predicts a poorer course after alcohol treatment, as reflected by findings on multiple measures. These results suggest that assessing the dependence severity at the outset of treatment could be useful both in predicting treatment outcome and targeting interventions to alcohol-dependent individuals who need additional support in their recovery.
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Affiliation(s)
- Atsushi Yoshimura
- National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan.,Division of Psychiatry, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Mitsuru Kimura
- National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan
| | - Sachio Matsushita
- National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan
| | - Jun-Ichi Yoneda
- National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan
| | - Hitoshi Maesato
- National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan
| | | | - Hideki Nakayama
- National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan.,Hokujinkai Asahiyama Hospital, Sapporo, Japan
| | - Hiroshi Sakuma
- National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan
| | - Yosuke Yumoto
- National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan
| | - Tsuyoshi Takimura
- National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan
| | - Tomomi Tohyama
- National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan
| | - Chie Iwahara
- National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan
| | - Takeshi Mizukami
- National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan
| | - Akira Yokoyama
- National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan
| | - Susumu Higuchi
- National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan
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Cavicchioli M, Vassena G, Movalli M, Maffei C. Is craving a risk factor for substance use among treatment-seeking individuals with alcohol and other drugs use disorders? A meta-analytic review. Drug Alcohol Depend 2020; 212:108002. [PMID: 32413635 DOI: 10.1016/j.drugalcdep.2020.108002] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/07/2020] [Accepted: 04/07/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND It is still unclear whether craving should be considered a key risk factor for substance-use behaviors (SUB) among treatment-seeking individuals with alcohol (AUD) and other drugs use disorders. Therefore, this study aims at clarifying this topic using a meta-analytic approach. METHODS Cohen's d was computed as effect size (ES) measure. Heterogeneity of ESs was computed using the Q statistic and I2 index. The analyses also evaluated the impact assessment length on ESs. Furthermore, proximal effects of craving on SUB were compared to distal ones. The diagnoses of specific substance use disorders (SUDs), together with assessment instruments and research design were considered as additional moderators. RESULTS Thirty-six independent studies were included for a total of 4868 treatment-seeking individuals with SUDs. Patients who used substances showed slightly higher levels of craving than abstinent ones. The heterogeneity of results was large and significant. The length of period of assessment was positively related to ESs. The analyses highlighted no differences between pooled ESs of proximal and distal impacts of craving on SUB. The diagnoses of SUDs were significant moderators. Considering AUD, assessment instruments and research design were additional moderators. CONCLUSIONS Craving is a modest time-dependent proximal and distal risk factor for SUB among individuals with SUDs. Both the frequency of craving episodes and a heightened reactivity to craving cues are largely associated to SUB among individuals with AUD. Future studies should evaluate the mediating and moderating roles of self-regulatory mechanisms on the relationship between craving and SUB.
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Affiliation(s)
- Marco Cavicchioli
- Department of Psychology, University "Vita-Salute San Raffaele", Milan, Italy; Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy.
| | - Giulia Vassena
- Department of Psychology, University "Vita-Salute San Raffaele", Milan, Italy; Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy.
| | - Mariagrazia Movalli
- Department of Psychology, University "Vita-Salute San Raffaele", Milan, Italy; Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy.
| | - Cesare Maffei
- Department of Psychology, University "Vita-Salute San Raffaele", Milan, Italy; Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy.
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Hides L, Quinn C, Stoyanov S, Kavanagh D, Baker A. Psychological interventions for co-occurring depression and substance use disorders. Cochrane Database Syst Rev 2019; 2019:CD009501. [PMID: 31769015 PMCID: PMC6953216 DOI: 10.1002/14651858.cd009501.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Comorbid depression and substance use disorders are common and have poorer outcomes than either disorder alone. While effective psychological treatments for depression or substance use disorders are available, relatively few randomised controlled trials (RCTs) have examined the efficacy of these treatments in people with these comorbid disorders. OBJECTIVES To assess the efficacy of psychological interventions delivered alone or in combination with pharmacotherapy for people diagnosed with comorbid depression and substance use disorders. SEARCH METHODS We searched the following databases up to February 2019: Cochrane Central Register of Controlled Trials, PubMed, Embase, CINAHL, Google Scholar and clinical trials registers. All systematic reviews identified, were handsearched for relevant articles. SELECTION CRITERIA The review includes data from RCTs of psychological treatments for people diagnosed with comorbid depression and substance use disorders, using structured clinical interviews. Studies were included if some of the sample were experiencing another mental health disorder (e.g. anxiety); however, studies which required a third disorder as part of their inclusion criteria were not included. Studies were included if psychological interventions (with or without pharmacotherapy) were compared with no treatment, delayed treatment, treatment as usual or other psychological treatments. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS Seven RCTs of psychological treatments with a total of 608 participants met inclusion criteria. All studies were published in the USA and predominately consisted of Caucasian samples. All studies compared different types of psychological treatments. Two studies compared Integrated Cognitive Behavioural Therapy (ICBT) with Twelve Step Facilitation (TSF), another two studies compared Interpersonal Psychotherapy for Depression (IPT-D) with other treatment (Brief Supportive Therapy (BST) or Psychoeducation). The other three studies compared different types or combinations of psychological treatments. No studies compared psychological interventions with no treatment or treatment as usual control conditions. The studies included a diverse range of participants (e.g. veterans, prisoners, community adults and adolescents). All studies were at high risk of performance bias, other main sources were selection, outcome detection and attrition bias. Due to heterogeneity between studies only two meta-analyses were conducted. The first meta-analysis focused on two studies (296 participants) comparing ICBT to TSF. Very low-quality evidence revealed that while the TSF group had lower depression scores than the ICBT group at post-treatment (mean difference (MD) 4.05, 95% confidence interval (CI) 1.43 to 6.66; 212 participants), there was no difference between groups in depression symptoms (MD 1.53, 95% CI -1.73 to 4.79; 181 participants) at six- to 12-month follow-up. At post-treatment there was no difference between groups in proportion of days abstinent (MD -2.84, 95% CI -8.04 to 2.35; 220 participants), however, the ICBT group had a greater proportion of days abstinent than the TSF group at the six- to 12-month follow-up (MD 10.76, 95% CI 3.10 to 18.42; 189 participants). There were no differences between the groups in treatment attendance (MD -1.27, 95% CI -6.10 to 3.56; 270 participants) or treatment retention (RR 0.95, 95% CI 0.72 to 1.25; 296 participants). The second meta-analysis was conducted with two studies (64 participants) comparing IPT-D with other treatment (Brief Supportive Psychotherapy/Psychoeducation). Very low-quality evidence indicated IPT-D resulted in significantly lower depressive symptoms at post-treatment (MD -0.54, 95% CI -1.04 to -0.04; 64 participants), but this effect was not maintained at three-month follow-up (MD 3.80, 95% CI -3.83 to 11.43) in the one study reporting follow-up outcomes (38 participants; IPT-D versus Psychoeducation). Substance use was examined separately in each study, due to heterogeneity in outcomes. Both studies found very low-quality evidence of no significant differences in substance use outcomes at post-treatment (percentage of days abstinent, IPD versus Brief Supportive Psychotherapy; MD -2.70, 95% CI -28.74 to 23.34; 26 participants) or at three-month follow-up (relative risk of relapse, IPT-D versus Psychoeducation; RR 0.67, 95% CI 0.30 to 1.50; 38 participants). There was also very low-quality evidence for no significant differences between groups in treatment retention (RR 1.00, 95% CI 0.81 to 1.23; 64 participants). No adverse events were reported in any study. AUTHORS' CONCLUSIONS The conclusions of this review are limited due to the low number and very poor quality of included studies. No conclusions can be made about the efficacy of psychological interventions (delivered alone or in combination with pharmacotherapy) for the treatment of comorbid depression and substance use disorders, as they are yet to be compared with no treatment or treatment as usual in this population. In terms of differences between psychotherapies, although some significant effects were found, the effects were too inconsistent and small, and the evidence of too poor quality, to be of relevance to practice.
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Affiliation(s)
- Leanne Hides
- The University of QueenslandSchool of PsychologySt Lucia, BrisbaneQueenslandAustralia4072
| | - Catherine Quinn
- Queensland University of TechnologySchool of Psychology and Counselling, Institute of Health and Biomedical Innovation60 Musk AvenueKelvin GroveBrisbaneQueenslandAustralia4059
| | - Stoyan Stoyanov
- Queensland University of TechnologySchool of Psychology and Counselling, Institute of Health and Biomedical Innovation60 Musk AvenueKelvin GroveBrisbaneQueenslandAustralia4059
| | - David Kavanagh
- Queensland University of TechnologySchool of Psychology and Counselling, Institute of Health and Biomedical Innovation60 Musk AvenueKelvin GroveBrisbaneQueenslandAustralia4059
| | - Amanda Baker
- University of Newcastle, CallaghanCentre for Brain and Mental Health ResearchNewcomen Street, James Fletcher HospitalNewcastleNew South WalesAustralia2300
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Chen L, Chen C, Chen C, Chang H, Huang M, Xu K. Association of Craving and Depressive Symptoms in Ketamine‐Dependent Patients Undergoing Withdrawal Treatment. Am J Addict 2019; 29:43-50. [DOI: 10.1111/ajad.12978] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 09/18/2019] [Accepted: 10/20/2019] [Indexed: 11/27/2022] Open
Affiliation(s)
- Lian‐Yu Chen
- Department of Psychiatry, Taipei City Psychiatric CenterTaipei City Hospital Taipei Taiwan
- Institute of Epidemiology and Preventive MedicineNational Taiwan University Taipei Taiwan
- Kunming Prevention and Control CenterTaipei City Hospital Taipei Taiwan
| | - Chih‐Ken Chen
- Department of Psychiatry & Community Medicine Research CenterChang Gung Memorial Hospital Keelung Taiwan
- Chang Gung University School of Medicine Taoyuan Taiwan
| | - Chun‐Hsin Chen
- Department of Psychiatry, Wan‐Fang HospitalTaipei Medical University Taipei Taiwan
- Department of Psychiatry, School of Medicine, College of MedicineTaipei Medical University Taipei Taiwan
- Psychiatric Research Center, Wang‐Fang HospitalTaipei Medical University Taipei Taiwan
| | - Hu‐Ming Chang
- Department of Psychiatry, Taipei City Psychiatric CenterTaipei City Hospital Taipei Taiwan
| | - Ming‐Chyi Huang
- Department of Psychiatry, Taipei City Psychiatric CenterTaipei City Hospital Taipei Taiwan
- Department of Psychiatry, School of Medicine, College of MedicineTaipei Medical University Taipei Taiwan
- Psychiatric Research Center, Wang‐Fang HospitalTaipei Medical University Taipei Taiwan
- Psychiatric Research CenterTaipei Medical University Hospital Taipei Taiwan
| | - Ke Xu
- Department of PsychiatryYale University School of Medicine New Heaven Connecticut
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8
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Sliedrecht W, de Waart R, Witkiewitz K, Roozen HG. Alcohol use disorder relapse factors: A systematic review. Psychiatry Res 2019; 278:97-115. [PMID: 31174033 DOI: 10.1016/j.psychres.2019.05.038] [Citation(s) in RCA: 154] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 05/23/2019] [Accepted: 05/24/2019] [Indexed: 12/12/2022]
Abstract
A relapsing-remitting course is very common in patients with an Alcohol Use Disorder (AUD). Understanding the determinants associated with alcohol resumption remains a formidable task. This paper examines relapse determinants based on a systematic review of recent alcohol literature (2000-2019). Relevant databases were consulted for articles that contained information about specific relapse determinants and reported statistical significance of each relapse determinant in predicting relapse. Relapse was broadly defined based on the characterization in the included articles. From the initial identified 4613 papers, a total of 321 articles were included. Results encompass multiple relapse determinants, which were ordered according to biopsychosocial and spiritual categories, and presented, using a descriptive methodology. Psychiatric co-morbidity, AUD severity, craving, use of other substances, health and social factors were consistently significantly associated with AUD relapse. Conversely, supportive social network factors, self efficacy, and factors related to purpose and meaning in life, were protective against AUD relapse. Despite heterogeneity in different methods, measures, and sample characteristics, these findings may contribute to a better therapeutic understanding in which specific factors are associated with relapse and those that prevent relapse. Such factors may have a role in a personalized medicine framework to improve patient outcomes.
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Affiliation(s)
- Wilco Sliedrecht
- De Hoop GGZ, Provincialeweg 70, 3329 KP Dordrecht, the Netherlands.
| | - Ranne de Waart
- Mentrum/Arkin, Wisselwerking 46-48, 1112 XR Diemen, the Netherlands.
| | - Katie Witkiewitz
- The University of New Mexico (UNM), MSC 03-2220, Univ of New Mexico, Albuquerque, NM 87131, USA.
| | - Hendrik G Roozen
- The University of New Mexico (UNM), Center on Alcoholism, Substance Abuse, and Addictions (CASAA), MSC 11 6280, 1 Univ of New Mexico, Albuquerque, NM 87106, USA.
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Stohs ME, Schneekloth TD, Geske JR, Biernacka JM, Karpyak VM. Alcohol Craving Predicts Relapse After Residential Addiction Treatment. Alcohol Alcohol 2019; 54:167-172. [DOI: 10.1093/alcalc/agy093] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 12/04/2018] [Accepted: 12/26/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Matthew E Stohs
- Department of Psychiatry and Behavioral Health, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Jennifer R Geske
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Victor M Karpyak
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
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10
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Hollett RC, Stritzke WGK, Edgeworth P, Weinborn M. Changes in the Relative Balance of Approach and Avoidance Inclinations to Use Alcohol Following Cue Exposure Vary in Low and High Risk Drinkers. Front Psychol 2017; 8:645. [PMID: 28533759 PMCID: PMC5420565 DOI: 10.3389/fpsyg.2017.00645] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 04/11/2017] [Indexed: 02/04/2023] Open
Abstract
According to the ambivalence model of craving, alcohol craving involves the dynamic interplay of separate approach and avoidance inclinations. Cue-elicited increases in approach inclinations are posited to be more likely to result in alcohol consumption and risky drinking behaviors only if unimpeded by restraint inclinations. Current study aims were (1) to test if changes in the net balance between approach and avoidance inclinations following alcohol cue exposure differentiate between low and high risk drinkers, and (2) if this balance is associated with alcohol consumption on a subsequent taste test. In two experiments (N = 60; N = 79), low and high risk social drinkers were exposed to alcohol cues, and pre- and post- approach and avoidance inclinations measured. An ad libitum alcohol consumption paradigm and a non-alcohol exposure condition were also included in Study 2. Cue-elicited craving was characterized by a predominant approach inclination only in the high risk drinkers. Conversely, approach inclinations were adaptively balanced by equally strong avoidance inclinations when cue-elicited craving was induced in low risk drinkers. For these low risk drinkers with the balanced craving profile, neither approach or avoidance inclinations predicted subsequent alcohol consumption levels during the taste test. Conversely, for high risk drinkers, where the approach inclination predominated, each inclination synergistically predicted subsequent drinking levels during the taste test. In conclusion, results support the importance of assessing both approach and avoidance inclinations, and their relative balance following alcohol cue exposure. Specifically, this more comprehensive assessment reveals changes in craving profiles that are not apparent from examining changes in approach inclinations alone, and it is this shift in the net balance that distinguishes high from low risk drinkers.
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Affiliation(s)
- Ross C Hollett
- Cognition Research Group, School of Arts and Humanities, Edith Cowan University, JoondalupWA, Australia
| | - Werner G K Stritzke
- School of Psychological Science, University of Western Australia, CrawleyWA, Australia
| | - Phoebe Edgeworth
- School of Psychological Science, University of Western Australia, CrawleyWA, Australia
| | - Michael Weinborn
- School of Psychological Science, University of Western Australia, CrawleyWA, Australia
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11
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Piontek D, Kurktschiev S, Kraus L, Hölscher S, Rist F, Heinz T, Scherbaum N, Bender S, Buchholz A. “This Treatment Can Really Help Me”-A Longitudinal Analysis of Treatment Readiness and Its Predictors in Patients Undergoing Alcohol and Drug Rehabilitation Treatment. Alcohol Clin Exp Res 2017; 41:1174-1181. [DOI: 10.1111/acer.13383] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 03/21/2017] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Ludwig Kraus
- IFT Institut für Therapieforschung; Munich Germany
| | | | - Fred Rist
- Westfälische Wilhelms-Universität Münster; Münster Germany
| | - Thomas Heinz
- Fachkliniken St. Marien - St Vitus GmbH; Neuenkirchen-Vörden Germany
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12
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Motivational factors and negative affectivity as predictors of alcohol craving. Psychiatry Res 2016; 243:53-60. [PMID: 27367491 DOI: 10.1016/j.psychres.2016.02.064] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 12/28/2015] [Accepted: 02/27/2016] [Indexed: 12/20/2022]
Abstract
Craving is thought to play an important role in alcohol use disorders. The recent inclusion of "craving" as a formal diagnostic symptom calls for further investigation of this subjective phenomenon with multiple dimensions. Considering that alcohol-dependent patients compensate negative physical/emotional states with alcohol, the aim of this study is to investigate alcohol craving and its correlation with drinking measures and affective personality dimensions. A sample of 135 alcohol-dependent patients (104 males and 31 females) was collected from a clinical setting. Subjects self-rated their cravings (Penn Alcohol Craving Scale) and the stage of change. Several personality scales were also administered. Craving was related to drinking status, abstinence time, age, and taking steps. After controlling for these conditions, psychological characteristics related to low self-concept, neuroticism, cyclothymic affective temperament, depression, and hostility were found to be predictors of craving in sober alcohol-dependent patients. Our results support craving as a component of the phenomenology of alcohol dependence and highlight the presence of unpleasant feelings as predictors of craving in sober alcohol-dependent patients without co-occurring psychiatric conditions. The predisposition to experience negative emotions may induce a stronger craving response and increase the likelihood of a first drink and a subsequent loss of control.
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Browne KC, Wray TB, Stappenbeck CA, Krenek M, Simpson TL. Alcohol Consumption, Craving, and Craving Control Efforts Assessed Daily in the Context of Readiness to Change Among Individuals with Alcohol Dependence and PTSD. J Subst Abuse Treat 2015; 61:34-41. [PMID: 26597623 DOI: 10.1016/j.jsat.2015.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 08/23/2015] [Accepted: 09/21/2015] [Indexed: 11/30/2022]
Abstract
Research has demonstrated the positive association between alcohol craving and alcohol use and has identified craving as a central component of alcohol use disorders (AUD). Despite potential clinical implications, few studies have examined the relationship between craving and alcohol use in individuals with AUD and common psychiatric comorbidities or explored possible moderators of the craving-alcohol use relationship. The current study used daily monitoring data to: 1) replicate previous findings detecting a positive relationship between craving and alcohol use in individuals with AUD and co-occurring posttraumatic stress disorder (PTSD) and 2) extend these findings by examining the influence of initial change motivation on the craving-use relationship and within-day associations among craving, efforts to control craving, and alcohol consumption. Participants were 84 individuals with alcohol dependence and PTSD enrolled in an intervention study. Generalized estimating equations using pre-treatment baseline daily data revealed significant main effects for craving, craving control, and motivation to change alcohol use. Daily craving was positively related to alcohol use. Greater change motivation and craving control (i.e., efforts to resist craving, avoidance of thoughts and feelings related to craving) were negatively related to alcohol use. A significant interaction was detected between baseline change motivation and daily craving indicating that the association between craving and alcohol use was significantly stronger for those with low baseline change motivation. A significant interaction was also detected between craving control and daily craving, suggesting that participants were more likely to consume alcohol when experiencing high levels of craving if they reported low levels of craving control. Findings bolster the idea that efforts to prevent or ameliorate craving are critical to treatment success for individuals with AUD and PTSD who are seeking to reduce or quit drinking.
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Affiliation(s)
- Kendall C Browne
- Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, 1660S. Columbian Way, Seattle, WA 98108; Department of Psychiatry & Behavioral Sciences, University of Washington, 1959 NE Pacific Street Box 356560, Room BB1644, Seattle, WA 98195
| | - Tyler B Wray
- VA Puget Sound Health Care System, 1660S. Columbian Way, Seattle, WA 98108
| | - Cynthia A Stappenbeck
- Department of Psychiatry & Behavioral Sciences, University of Washington, 1959 NE Pacific Street Box 356560, Room BB1644, Seattle, WA 98195
| | - Marketa Krenek
- Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, 1660S. Columbian Way, Seattle, WA 98108
| | - Tracy L Simpson
- Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, 1660S. Columbian Way, Seattle, WA 98108; Department of Psychiatry & Behavioral Sciences, University of Washington, 1959 NE Pacific Street Box 356560, Room BB1644, Seattle, WA 98195; Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care, 1660S. Columbian Way, Seattle, WA 98108.
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Roos CR, Kirouac M, Pearson MR, Fink BC, Witkiewitz K. Examining temptation to drink from an existential perspective: Associations among temptation, purpose in life, and drinking outcomes. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2015; 29:716-24. [PMID: 25730630 DOI: 10.1037/adb0000063] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Temptation to drink (TTD), defined as the degree to which one feels compelled to drink in the presence of internal or external alcohol-related cues, has been shown to predict alcohol-treatment outcomes among individuals with alcohol-use disorders (AUDs). Research examining TTD from an existential perspective is lacking and little is known about how existential issues such as purpose in life (PIL) relate to TTD, which is surprising given the role of existential issues in many treatments and mutual help approaches for AUDs. In the current study, we examined the longitudinal associations in a sample of 1726 among TTD, PIL, and drinking outcomes using data from Project MATCH (1997, 1998). Parallel process latent growth curve analyses indicated that PIL and TTD were significantly associated across time, such that higher initial levels of PIL and increases in PIL over time were associated with lower initial levels of TTD and decreases in TTD over time. Higher initial levels of TTD, lower initial levels of PIL, increases in TTD, and decreases in PIL were significantly associated with greater intensity and frequency of drinking and greater drinking-related consequences at the 15-month follow-up. Accordingly, TTD and PIL may be important constructs for clinicians to consider throughout the course of treatment. Future studies should examine if and how various kinds of treatments for AUDs are associated with increases in PIL, and whether these increases are related to decreased TTD and reduced drinking.
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Affiliation(s)
- Corey R Roos
- Department of Psychology, University of New Mexico
| | | | - Matthew R Pearson
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico
| | - Brandi C Fink
- Department of Psychiatry and Behavioral Sciences, Clinical and Translational Science Center, University of New Mexico
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Day AM, Celio MA, Lisman SA, Spear LP. Gender, history of alcohol use and number of drinks consumed predict craving among drinkers in a field setting. Addict Behav 2014; 39:354-7. [PMID: 24148138 DOI: 10.1016/j.addbeh.2013.10.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 09/10/2013] [Accepted: 10/01/2013] [Indexed: 11/29/2022]
Abstract
To the extent that craving serves to compel excessive drinking, it would be important to predict the intensity of an individual's craving over the course of a drinking episode. Previous research indicates that regular alcohol use (measured by the AUDIT) and the number of drinks individuals have already consumed that evening independently predict craving to drink (Schoenmakers & Wiers, 2010). The current study aims to replicate those findings by testing whether these same variables predict craving to drink in a sample of 1320 bar patrons in a naturalistic setting. In addition, we extend those findings by testing whether regular alcohol use and self-reported number of drinks consumed interact to predict craving, and whether gender independently predicts craving or interacts with other variables to predict craving. Results indicate that for men, AUDIT score alone predicted craving, whereas for women, AUDIT score and number of drinks consumed interacted to predict craving, with craving highest among women with either high AUDIT scores or relatively high consumption levels. Our findings have implications for targeted intervention and prevention efforts, as women who have a history of harmful alcohol use and consume several drinks in an evening might be at the greatest risk for continued alcohol consumption.
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Affiliation(s)
- Anne M Day
- Center for Alcohol and Addiction Studies, Behavioral and Social Sciences, Box G-S121-4, Providence, RI 02912, United States.
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Baker AL, Kavanagh DJ, Kay-Lambkin FJ, Hunt SA, Lewin TJ, Carr VJ, McElduff P. Randomized controlled trial of MICBT for co-existing alcohol misuse and depression: outcomes to 36-months. J Subst Abuse Treat 2013; 46:281-90. [PMID: 24210534 DOI: 10.1016/j.jsat.2013.10.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 09/19/2013] [Accepted: 10/04/2013] [Indexed: 11/26/2022]
Abstract
Integrated psychological treatment addressing co-existing alcohol misuse and depression has not been compared with single-focused treatment. This trial evaluates changes over 36 months following randomization of 284 outpatients to one of four motivational interviewing and cognitive-behavior therapy (MICBT) based interventions: (1) brief integrated intervention (BI); or BI plus 9 further sessions with (2) an integrated-, (3) alcohol-, or (4) depression-focus. Outcome measures included changes in alcohol consumption, depression (BDI-II: Beck Depression Inventory) and functioning (GAF: Global Assessment of Functioning), with average improvements from baseline of 21.8 drinks per week, 12.6 BDI-II units and 8.2 GAF units. Longer interventions tended to be more effective in reducing depression and improving functioning in the long-term, and in improving alcohol consumption in the short-term. Integrated treatment was at least as good as single-focused MICBT. Alcohol-focused treatment was as effective as depression-focused treatment at reducing depression and more effective in reducing alcohol misuse. The best approach seems to be an initial focus on both conditions followed by additional integrated- or alcohol-focused sessions.
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Affiliation(s)
- Amanda L Baker
- Centre for Translational Neuroscience and Mental Health, The University of Newcastle, Callaghan NSW 2308, Australia.
| | - David J Kavanagh
- Institute of Health & Biomedical Innovation and School of Psychology & Counselling, Queensland University of Technology, Queensland 4001, Australia
| | - Frances J Kay-Lambkin
- National Drug and Alcohol Research Centre, University of New South Wales, NSW 2052, Australia
| | - Sally A Hunt
- Centre for Translational Neuroscience and Mental Health, The University of Newcastle, Callaghan NSW 2308, Australia
| | - Terry J Lewin
- Hunter New England Mental Health, Newcastle NSW 2300, Australia
| | - Vaughan J Carr
- Schizophrenia Research Institute and School of Psychiatry, University of New South Wales, NSW 2052, Australia
| | - Patrick McElduff
- School of Medicine and Public Health, The University of Newcastle, Callaghan NSW 2308, Australia
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