Clinical Factors Associated with Relapse in Male Alcohol Dependents During Six-Month Follow-up

Changes in craving following acute aerobic exercise in adults with alcohol use disorder

AIMS

Exercise is increasingly being studied as treatment for alcohol use disorder (AUD). We examined the effects of an acute bout of exercise on alcohol craving, heterogeneity of response, and factors associated with reductions in craving.

METHODS

Within the context of a randomized controlled trial, we conducted an exploratory, single-arm study. In total, 117 adults with AUD (52.7 years; SD = 12.3; 68.4% female) and indications of alcohol craving (Desire for Alcohol Questionnaire, DAQ-short version total score >8) were included. The intervention was a 12-min sub-maximal fitness test performed on a cycle ergometer. We examined changes in participant's self-rated desire for alcohol immediately before and after exercise. Personal, clinical, and exercise-related factors associated with reductions (≥0.5 SD) in craving were identified using hierarchical logistic regression.

RESULTS

In the total sample craving reduced from pre-to post-exercise (p < 0.001, g = 0.60 [0.40-0.79]). Three groups were observed: those whose craving decreased (70.1%; p < 0.001, g = 1.12 [0.85-1.40]), increased (16.2%; p < 0.001, g = 1.08 [0.51-1.64]), or did not change (13.7%). Forty percent experienced clinically meaningful reductions in craving (≥0.5 SD). In fully adjusted models, two factors were associated with these reductions: higher pre-exercise cravings (OR = 1.15 [1.07-1.23], p < 0.001) and lower cardiorespiratory fitness (OR = 0.88 [0.79-1.00], p = 0.043).

CONCLUSIONS

In most adults with AUD, short bouts of moderately intense aerobic exercise helps reduce cravings for alcohol. Those with higher cravings and lower cardiorespiratory fitness are most likely to benefit.

Predictors of Relapse to Alcohol and Substance Use: Are There Any Differences between 3 and 12 Months after Inpatient Treatment?

Understanding the factors that lead to relapse is important for developing effective treatment strategies. The aim of this study is to examine sociodemographic and clinical factors that predict relapse 3 and 12 months after inpatient treatment in patients with alcohol and substance use disorders. 247 patients were included in the study. A sociodemographic data form and the Addiction Profile Index-Clinical Form (API-C) were filled out during the first days of hospitalization and relapse information was obtained through outpatient interviews. Logistic regression analysis was used to assess predictive factors. Rates of relapse for the 3^rd and 12^th months were 40.5% and 74.6%, respectively. Motivation to quit substance use, risk of depression, being on probation, and being employed predicted relapse within the 3-month period. At the 12^th month, substance use intensity and motivation to quit were the factors associated with relapse. To conclude, motivation to quit is critical to maintaining both early and sustained remission. Moreover, divergent factors may be relevant at different stages of treatment. Defining relapse predictors early in the process and being vigilant to the change in the needs of patients as the treatment continues may help to develop a more effective and focused treatment plan.

Alcohol Craving in Heavy and Occasional Alcohol Drinkers After Cue Exposure in a Virtual Environment: The Role of the Sense of Presence

The development of new technologies, and more specifically the opportunity to immerse participants in virtual controlled environments, provides a new ecological framework for researchers to study complex behaviors. This experiment aimed to compare post-immersion craving in occasional and heavy alcohol drinkers. Twenty-two occasional drinkers and eighteen heavy drinkers were recruited and immersed in a virtual bar, including alcoholic beverages. After the exposure, heavy drinkers reported a significantly higher craving than occasional drinkers. Post-immersion alcohol craving was significantly related to the levels of perceived ecological validity of the virtual environment. Finally, a moderation analysis suggested that the levels of craving more strongly increased with perceived ecological validity in heavy drinkers than in occasional drinkers. Therefore, the perceived ecological validity was an important experimental parameter to study craving in a virtual environment. These results further suggested that virtual reality might be a useful tool for both the scientific study of alcohol addiction and the treatment of alcohol dependence and relapse.

Alcohol Consumption, Craving, and Craving Control Efforts Assessed Daily in the Context of Readiness to Change Among Individuals with Alcohol Dependence and PTSD

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.

The Role of Psychological Distress in Relapse Prevention of Alcohol Addiction. Can High Scores on the SCL-90-R Predict Alcohol Relapse?

OBJECTIVE

The aim of this study was to identify if psychological distress may contribute to treatment outcome in alcohol-addicted patients during a follow-up period of 5 months after detoxification.

METHODS

As part of a prospective, multicenter, randomized study in relapse prevention, patients' levels of psychological distress were assessed using the Symptome Checklist (SCL-90-R). At study inclusion, all patients were detoxified and showed no more withdrawal symptoms. The patients who relapsed during the 5-month follow-up period were compared with those who remained abstinent. Predictors for relapse were investigated in a logistic regression.

RESULTS

First, a significant difference in initial psychological distress between patients who stayed abstinent and patients who relapsed was found: following detoxification, patients who relapsed scored significantly higher on the SCL-90-R at study inclusion. In addition, psychological distress differed over time in both groups. Second, patients without relapse showed a larger decrease in some SCL-90-R scales between the beginning and the end of the observation period than patients who relapsed. Third, the logistic regression analyses showed that high scores on the overall score GSI (Global Severity Index) of the SCL-90-R can be seen as a predictor for future relapse.

CONCLUSION

The SCL-90-R may be a useful instrument to predict relapse. As our study indicates that high levels of psychological distress increases the risk of relapse, specific interventions may be targeted at this risk factor.

Desire thinking as a mediator of the relationship between novelty seeking and craving

Background

The construct of craving has been shown to play a crucial role in the development and maintenance of addictive behaviors. Both novelty seeking and desire thinking have been identified, respectively, as important temperamental and cognitive predictors of craving.

Aims

In the present study we aimed to explore the relative contribution of novelty seeking and desire thinking towards craving, hypothesizing a sequence of multiple mediating relationships starting from novelty seeking and moving onto imaginal prefiguration, verbal perseveration and craving in serial fashion.

Method

A convenience sample of 270 individuals completed measures assessing novelty seeking, desire thinking, and craving relating to a chosen activity.

Results

Findings showed that, controlling for age and gender, desire thinking components predicted craving over and above novelty seeking. The indirect effect from novelty seeking to craving, via desire thinking components, was significant thus supporting a multiple-mediational sequence. Finally, the relationship between imaginal prefiguration and craving was found to be partially mediated by verbal perseveration.

Conclusions

The findings provide support for the conceptualization of desire thinking as an independent construct in predicting craving over and above novelty seeking.

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We examined the relationship between desire thinking, temperament and craving.

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Findings support a multiple mediational sequence from novelty seeking to craving.

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Desire thinking mediates the relationship between novelty seeking and craving.

Pavlovian-conditioned alcohol-seeking behavior in rats is invigorated by the interaction between discrete and contextual alcohol cues: implications for relapse

INTRODUCTION

Drug craving can be independently stimulated by cues that are directly associated with drug intake (discrete drug cues), as well as by environmental contexts in which drug use occurs (contextual drug cues). We tested the hypothesis that the context in which a discrete alcohol-predictive cue is experienced can influence how robustly that cue stimulates alcohol-seeking behavior.

METHODS

Male, Long-Evans rats received Pavlovian discrimination training (PDT) sessions in which one conditioned stimulus (CS+; 16 trials/session) was paired with ethanol (0.2 mL/CS+) and a second stimulus (CS-; 16 trials/session) was not. PDT occurred in a specific context, and entries into a fluid port where ethanol was delivered were measured during each CS. Next, rats were acclimated to an alternate (nonalcohol) context where cues and ethanol were withheld. Responses to the nonextinguished CS+ and CS- were then tested without ethanol in the alcohol-associated PDT context, the nonalcohol context or a third, novel context.

RESULTS

Across PDT the CS+ elicited more port entries than the CS-, indicative of Pavlovian discrimination learning. At test, the CS+ elicited more port entries than the CS- in all three contexts: however, alcohol seeking driven by the CS+ was more robust in the alcohol-associated context. In a separate experiment, extinguishing the context-alcohol association did not influence subsequent CS+ responding but reduced alcohol seeking during non-CS+ intervals during a spontaneous recovery test.

CONCLUSION

These results indicate that alcohol-seeking behavior driven by a discrete Pavlovian alcohol cue is strongly invigorated by an alcohol context, and suggest that contexts may function as excitatory Pavlovian conditioned stimuli that directly trigger alcohol-seeking behavior.

Blocking dopamine d1-like receptors attenuates context-induced renewal of pavlovian-conditioned alcohol-seeking in rats

BACKGROUND

Environmental contexts associated with drug use can trigger craving in humans and the renewal of drug-seeking behaviors in animals. Here, we tested the hypothesis that context-induced renewal of Pavlovian-conditioned alcohol-seeking is mediated by dopamine.

METHODS

Male, Long-Evans rats were trained to discriminate between two, 10-second, auditory conditioned stimuli. One stimulus (CS+) was consistently paired with 15% ethanol (EtOH) (v/v, 0.2 ml per CS+) and the second stimulus (CS-) was not. Each CS occurred 16 times per session, and entries into a fluid port where EtOH was delivered were measured. Pavlovian discrimination training (PDT) occurred in a distinctive context, referred to as Context A. Subsequently, behavior was extinguished by presenting both cues without EtOH in a different context (Context B). At test, rats were injected with a dopamine D1-like receptor antagonist (R)-(+)-7-chloro-8-hydroxy-3-methyl-1-phenyl-2,3,4,5-tetrahydro-1H-3-benzazepine hydrochloride (SCH 23390; 0, 3.33, 10 μg/kg; 1 ml/kg; s.c.) and presented with the CS+ and CS- without EtOH in the prior PDT context (Context A).

RESULTS

Across training, rats developed higher response levels to the alcohol-predictive CS+, compared with the CS-. Port entries during the CS+ decreased across extinction. At test, placement into the alcohol-associated context triggered a selective increase in CS+ responses after saline, which was significantly reduced by SCH 23390 pretreatment. In separate studies, SCH 23390 did not affect lever-pressing for sucrose under reinforced or extinction conditions, but decreased port entries relative to saline in both cases.

CONCLUSIONS

These data indicate that dopamine is required for context-induced renewal of Pavlovian-conditioned alcohol-seeking and may also be necessary for preparatory conditioned approach behaviors.

Craving as a predictor of treatment outcomes in heavy drinkers with comorbid depressed mood

Alcohol and depression comorbidity is high and is associated with poorer outcomes following treatment. The ability to predict likely treatment response would be advantageous for treatment planning. Craving has been widely studied as a potential predictor, but has performed inconsistently. The effect of comorbid depression on craving's predictive performance however, has been largely neglected, despite demonstrated associations between negative affect and craving. The current study examined the performance of craving, measured pre-treatment using the Obsessive subscale of the Obsessive Compulsive Drinking Scale, in predicting 18-week and 12-month post-treatment alcohol use outcomes in a sample of depressed drinkers. Data for the current study were collected during a randomized controlled trial (Baker, Kavanagh, Kay-Lambkin, Hunt, Lewin, Carr, & Connolly, 2010) comparing treatments for comorbid alcohol and depression. A subset of 260 participants from that trial with a Timeline Followback measure of alcohol consumption was analyzed. Pre-treatment craving was a significant predictor of average weekly alcohol consumption at 18 weeks and of frequency of alcohol binges at 18 weeks and 12 months, but pre-treatment depressive mood was not predictive, and effects of Baseline craving were independent of depressive mood. Results suggest a greater ongoing risk from craving than from depressive mood at Baseline.