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Nakovics H, Hoffmann S, Koopmann A, Bach P, Abel M, Sommer WH, Kiefer F, Weinland C, von Zimmermann C, Siegmann EM, Kornhuber J, Mühle C, Schneider U, Toto S, Hillemacher T, Frieling H, Bleich S, Eberlein CK, Lenz B. Psychometric properties of the German Penn Alcohol Craving Scale. Alcohol Alcohol 2023; 58:637-644. [PMID: 37496416 DOI: 10.1093/alcalc/agad045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 06/13/2023] [Accepted: 06/25/2023] [Indexed: 07/28/2023] Open
Abstract
Craving for alcohol is an important diagnostic criterion in alcohol use disorder (AUD) and an established predictor of future relapse. The 5-item Penn Alcohol Craving Scale (PACS) is one of the most widely used questionnaires to quantify craving and has been translated into different languages. It is assumed that the PACS constitutes one factor, although theoretical considerations suggest an additional second factor. We conducted stability and factor analyses (principal component and confirmatory factor analyses) of the German PACS (PACS-G) in samples of patients with AUD from the following three German study sites: Erlangen, N = 188 (mean age: 47.1 years, 43.5% female); Mannheim, N = 440 (45.5 years, 28.6% female); Hannover, N = 107 (48.1 years, 48.6% female). In our samples, the 2-factor solution of the PACS-G version is more stable than the internationally assumed 1-factor solution. The resulting two PACS-G subscores 'difficulty to resist' (items 4 and 5) and 'thoughts about alcohol' (items 1, 2, and 3) have an internal consistency (Cronbach's alpha) of 0.80 ≤ α ≤ 0.90, m = 0.86 and 0.86 ≤ α ≤ 0.91, m = 0.89 with an overlap of R2 = 62%. We found good convergent validity assessed via the Craving Automatized Scale-Alcohol and the Obsessive-Compulsive Drinking Scale, but also correlations with depression and anxiety assessed via the Beck's Depression and Anxiety Inventories. This study is the first to provide evidence for a 2-factor solution ('difficulty to resist' and 'thoughts about alcohol') underlying the PACS-G version.
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Affiliation(s)
- Helmut Nakovics
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, Heidelberg University, J 5, 68159 Mannheim, Germany
| | - Sabine Hoffmann
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, Heidelberg University, J 5, 68159 Mannheim, Germany
- Biostatistics, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, Heidelberg University, J 5, 68159 Mannheim, Germany
| | - Anne Koopmann
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, Heidelberg University, J 5, 68159 Mannheim, Germany
| | - Patrick Bach
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, Heidelberg University, J 5, 68159 Mannheim, Germany
| | - Martin Abel
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, Heidelberg University, J 5, 68159 Mannheim, Germany
| | - Wolfgang H Sommer
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, Heidelberg University, J 5, 68159 Mannheim, Germany
- Institute of Psychopharmacology, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, Heidelberg University, J 5, 68159 Mannheim, Germany
- Bethanian Hospital for Psychiatry, Psychosomatics and Psychotherapy, Gützkower Landstraße 69, 17489 Greifswald, Germany
| | - Falk Kiefer
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, Heidelberg University, J 5, 68159 Mannheim, Germany
| | - Christian Weinland
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054 Erlangen, Germany
| | - Claudia von Zimmermann
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054 Erlangen, Germany
| | - Eva-Maria Siegmann
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054 Erlangen, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054 Erlangen, Germany
| | - Christiane Mühle
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054 Erlangen, Germany
| | - Udo Schneider
- Faculty of Medicine, University Clinic of Psychiatry and Psychotherapy, Virchowstraße 65, 32312 Luebbecke, Ruhr University Bochum Campus OWL, Bochum, Germany
| | - Sermin Toto
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Thomas Hillemacher
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University Nuremberg, Prof.-Ernst-Nathan-Straße 1, 90419 Nürnberg, Germany
| | - Helge Frieling
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Christian K Eberlein
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Bernd Lenz
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, Heidelberg University, J 5, 68159 Mannheim, Germany
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054 Erlangen, Germany
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Vatsalya V, Verster JC, Sagaram M, Royer AJ, Hu H, Parthasarathy R, Schwandt ML, Kong M, Ramchandani VA, Feng W, Agrawal R, Zhang X, McClain CJ. Novel paradigms for the gut-brain axis during alcohol withdrawal, withdrawal-associated depression, and craving in patients with alcohol use disorder. Front Psychiatry 2023; 14:1203362. [PMID: 37840804 PMCID: PMC10570744 DOI: 10.3389/fpsyt.2023.1203362] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/28/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Patients with alcohol use disorder (AUD) exhibit symptoms such as alcohol withdrawal, depression, and cravings. The gut-immune response may play a significant role in manifesting these specific symptoms associated with AUD. This study examined the role of gut dysfunction, proinflammatory cytokines, and hormones in characterizing AUD symptoms. Methods Forty-eight AUD patients [men (n = 34) and women (n = 14)] aged 23-63 years were grouped using the Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA) as clinically significant (CS-CIWA [score > 10] [n = 22]) and a clinically not-significant group (NCS-CIWA [score ≤ 10] [n = 26]). Clinical data (CIWA, 90-day timeline followback [TLFB90], and lifetime drinking history [LTDH]) and blood samples (for testing proinflammatory cytokines, hormones, and markers of intestinal permeability) were analyzed. A subset of 16 AUD patients was assessed upon admission for their craving tendencies related to drug-seeking behavior using the Penn-Alcohol Craving Score (PACS). Results CS-CIWA group patients exhibited unique and significantly higher levels of adiponectin and interleukin (IL)-6 compared to NCS-CIWA. In the CS group, there were significant and high effects of association for the withdrawal score with gut-immune markers (lipopolysaccharide [LPS], adiponectin, IL-6, and IL-8) and for withdrawal-associated depression with gut-immune markers (scored using MADRS with LPS, soluble cells of differentiation type 14 [sCD14], IL-6, and IL-8). Craving (assessed by PACS, the Penn-Alcohol Craving Scale) was significantly characterized by what could be described as gut dysregulation (LBP [lipopolysaccharide binding protein] and leptin) and candidate proinflammatory (IL-1β and TNF-α) markers. Such a pathway model describes the heavy drinking phenotype, HDD90 (heavy drinking days past 90 days), with even higher effects (R2 = 0.955, p = 0.006) in the AUD patients, who had higher ratings for cravings (PACS > 5). Discussion The interaction of gut dysfunction cytokines involved in both inflammation and mediating activity constitutes a novel pathophysiological gut-brain axis for withdrawal symptoms and withdrawal-associated depression and craving symptoms in AUD. AUD patients with reported cravings show a significant characterization of the gut-brain axis response to heavy drinking. Trial registration ClinicalTrials.gov, identifier: NCT# 00106106.
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Affiliation(s)
- Vatsalya Vatsalya
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Louisville, Louisville, KY, United States
- Robley Rex VA Medical Center, Louisville, KY, United States
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States
- Clincial Laboratory for the Intervention Development of AUD and Organ Severity, Louisville, KY, United States
| | - Joris C. Verster
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, Netherlands
- Centre for Human Psychopharmacology, Swinburne University, Melbourne, VIC, Australia
| | - Manasa Sagaram
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Louisville, Louisville, KY, United States
- Clincial Laboratory for the Intervention Development of AUD and Organ Severity, Louisville, KY, United States
| | - Amor J. Royer
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Louisville, Louisville, KY, United States
- Clincial Laboratory for the Intervention Development of AUD and Organ Severity, Louisville, KY, United States
| | - Huirong Hu
- Clincial Laboratory for the Intervention Development of AUD and Organ Severity, Louisville, KY, United States
- Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY, United States
| | - Ranganathan Parthasarathy
- Clincial Laboratory for the Intervention Development of AUD and Organ Severity, Louisville, KY, United States
| | - Melanie L. Schwandt
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States
| | - Maiying Kong
- Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY, United States
- Alcohol Research Center, University of Louisville, Louisville, KY, United States
| | | | - Wenke Feng
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Louisville, Louisville, KY, United States
- Alcohol Research Center, University of Louisville, Louisville, KY, United States
- Department of Pharmacology & Toxicology, University of Louisville, Louisville, KY, United States
- Hepatobiology & Toxicology Center, University of Louisville, Louisville, KY, United States
| | | | - Xiang Zhang
- Alcohol Research Center, University of Louisville, Louisville, KY, United States
- Department of Pharmacology & Toxicology, University of Louisville, Louisville, KY, United States
- Hepatobiology & Toxicology Center, University of Louisville, Louisville, KY, United States
- Department of Chemistry, University of Louisville, Louisville, KY, United States
- Center for Regulatory and Environmental Analytical Metabolomics, University of Louisville, Louisville, KY, United States
| | - Craig J. McClain
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Louisville, Louisville, KY, United States
- Robley Rex VA Medical Center, Louisville, KY, United States
- Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY, United States
- Alcohol Research Center, University of Louisville, Louisville, KY, United States
- Hepatobiology & Toxicology Center, University of Louisville, Louisville, KY, United States
- Center for Regulatory and Environmental Analytical Metabolomics, University of Louisville, Louisville, KY, United States
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Zamboni L, Toldo S, Fusina F, Mattiello M, Mannari V, Campagnari S, Schiavone V, Congiu A, Verlato G, Chiamulera C, Lugoboni F. Study protocol-Evoked craving in high-dose benzodiazepine users. Front Psychiatry 2022; 13:956892. [PMID: 36311534 PMCID: PMC9608779 DOI: 10.3389/fpsyt.2022.956892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
Benzodiazepine (BDZ) abuse, especially concerning high doses of BDZs, is an impairing substance use disorder (SUD) that is often difficult to treat. Craving and cue reactivity (CR) are two important phenomena that have a prominent role in maintaining addiction and triggering relapses in BDZ abuse; nevertheless, they have rarely been addressed in scientific literature. The present study aims to fill these gaps by implementing a highly innovative virtual reality (VR) design to assess the impact of substance-related environmental cues on BDZ craving, as well as their influence on patients' affective states. Therefore, on one hand, this research will contribute to the assessment of VR feasibility in the study of these phenomena, and, on the other, it will help disentangle the role that CR and craving have on mood and attention, which are equally important factors to consider when treating SUDs. We will recruit a healthy control group and a patient group comprising people seeking treatment for BDZ detoxification. The experimental design will consist of the presentation of three VR scenarios, one neutral, one BDZ-related but without BDZ cues, and another with BDZ cues. The craving will be measured through a virtual analog scale (VAS); the Profile of Mood States (POMS) and Alcohol Attention Scale (AAS) questionnaires in a modified version will also be administered. We will additionally control for VR-induced feelings of sickness by administering the Simulator Sickness Questionnaire (SSQ), and the Presence Questionnaire (PQ) will be used to investigate participants' sense of presence in virtual environments. We expect patients to exhibit higher levels of craving, and that the craving will be higher after exposure to a cue-related virtual environment as compared to a neutral scenario.
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Affiliation(s)
- Lorenzo Zamboni
- Unit of Addiction Medicine, Department of Internal Medicine, Integrated University Hospital of Verona, Policlinico “G.B. Rossi”, Verona, Italy
- Department of Neurosciences, University of Verona, Verona, Italy
| | - Silvia Toldo
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Francesca Fusina
- Padova Neuroscience Center, University of Padua, Padua, Italy
- Department of General Psychology, University of Padua, Padua, Italy
| | - Matteo Mattiello
- Unit of Addiction Medicine, Department of Internal Medicine, Integrated University Hospital of Verona, Policlinico “G.B. Rossi”, Verona, Italy
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Vanessa Mannari
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Simone Campagnari
- Unit of Addiction Medicine, Department of Internal Medicine, Integrated University Hospital of Verona, Policlinico “G.B. Rossi”, Verona, Italy
| | - Valentina Schiavone
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Alessio Congiu
- Unit of Addiction Medicine, Department of Internal Medicine, Integrated University Hospital of Verona, Policlinico “G.B. Rossi”, Verona, Italy
| | - Giuseppe Verlato
- Diagnostics and Public Health-Unit of Epidemiology and Medical Statistics, University of Verona, Verona, Italy
| | - Cristiano Chiamulera
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Fabio Lugoboni
- Unit of Addiction Medicine, Department of Internal Medicine, Integrated University Hospital of Verona, Policlinico “G.B. Rossi”, Verona, Italy
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Meredith LR, Green R, Grodin EN, Chorpita M, Miotto K, Ray LA. Ibudilast moderates the effect of mood on alcohol craving during stress exposure. Exp Clin Psychopharmacol 2022; 30:620-631. [PMID: 36102596 PMCID: PMC9484034 DOI: 10.1037/pha0000458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Neuroinflammation is implicated in the development and maintenance of alcohol use disorder (AUD) and neuroimmune therapeutics show promise in treating AUD. Proinflammatory signaling contributes to progressive elevations in the dysfunction of mood and alcohol craving. The current study sought to examine potential biobehavioral mechanisms of neuroimmune modulation in AUD under experimental conditions. In a community sample of individuals with AUD who completed a placebo-controlled crossover trial of ibudilast, we tested the effect of ibudilast on the relationship between mood states and alcohol craving. Multilevel modeling analyses tested the hypothesis that ibudilast would moderate the effect of positive and negative mood states on alcohol craving during stress and cue exposures. Results revealed that after stress-induction, participants' feelings of depression and happiness were more strongly predictive of their craving for alcohol while taking ibudilast as compared with placebo (ps < .03). These results suggest that with neuroimmune modulation, positive and negative mood states may have a stronger influence on one's desire to drink, such that craving may be more mood dependent. No moderating effect of ibudilast on mood states and craving were observed after alcohol cue exposure. Given the potential of anti-inflammatory treatments to reduce depressive symptomatology, this strengthened relationship between mood and craving under ibudilast might reduce the likelihood of stress-related craving and subsequent drinking over time. Moreover, ibudilast may enhance the benefits of happiness, such that maintaining positive mood in the face of acute stress may attenuate craving. Future trials directly testing the clinical implications of these mechanistic findings are warranted. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | - ReJoyce Green
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Erica N. Grodin
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Marie Chorpita
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Karen Miotto
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Lara A. Ray
- Department of Psychology, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
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Khosravani V, Spada MM, Samimi Ardestani SM, Sharifi Bastan F. Desire thinking as an underlying mechanism in alcohol use disorder and nicotine dependence. Clin Psychol Psychother 2022; 29:1886-1896. [PMID: 35649288 DOI: 10.1002/cpp.2757] [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: 04/16/2022] [Revised: 05/20/2022] [Accepted: 05/30/2022] [Indexed: 12/14/2022]
Abstract
Desire thinking is an emerging construct in the addictive behaviours literature. No research, to date, has investigated its contribution to problematic alcohol use and nicotine dependence in patient samples when accounting for established predictors of addictive behaviours. The present study sought to clarify, in patient samples, the relative contribution of desire thinking in the associations between negative affect, impulsivity and thought suppression on the one hand and craving, problematic alcohol use and nicotine dependence on the other. To achieve this goal, two groups of individuals with alcohol use disorder (AUD) (n = 370; age range = 15-67 years) and nicotine dependence (n = 365; age range = 17-75 years) were selected, and measures of negative affect, impulsivity, thought suppression, craving, desire thinking, problematic alcohol use and nicotine dependence were completed by both groups. Results showed that in both groups, negative affect and thought suppression indirectly affected alcohol and nicotine craving, problematic alcohol use and nicotine dependence through the mediating role of desire thinking. The present study shows the independent role of desire thinking in predicting problematic alcohol use and nicotine dependence in patient samples, indicating its potential relevance for treatment.
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Affiliation(s)
- Vahid Khosravani
- Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marcantonio M Spada
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, London, UK
| | - Seyed Mehdi Samimi Ardestani
- Departments of Psychiatry, Behavioral Sciences Research Center, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Sharifi Bastan F, Spada MM, Khosravani V, Samimi Ardestani SM. The independent contribution of desire thinking to problematic social media use. CURRENT PSYCHOLOGY 2022; 42:1-10. [PMID: 35540371 PMCID: PMC9074841 DOI: 10.1007/s12144-022-03158-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 12/12/2022]
Abstract
In the present study, we investigated the role of desire thinking in problematic social media use (PSMU) whilst accounting for negative affect, impulsivity, and thought suppression. A sample of individuals with PSMU (n = 350) who used social media at least 8 h daily was recruited. Participants completed measures of negative affect, impulsivity, thought suppression, craving, desire thinking, and PSMU. Results indicated that negative affect, impulsivity, and thought suppression had significant indirect effects on craving and PSMU through the significant mediating role of desire thinking. The present study shows that desire thinking is an underlying mechanism linking established variables associated with PSMU (negative affect, impulsivity, and thought suppression) to craving and PSMU. Focusing efforts on the interruption of desire thinking may be beneficial to support individuals in disengaging from PSMU.
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Affiliation(s)
| | - Marcantonio M. Spada
- Division of Psychology, School of Applied Sciences, London South Bank University, London, UK
| | - Vahid Khosravani
- Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Mehdi Samimi Ardestani
- Departments of Psychiatry, Behavioral Sciences Research Center, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Hernández-Serrano O, Ghiţă A, Fernández-Ruiz J, Monràs M, Gual A, Gacto M, Porras-García B, Ferrer-García M, Gutiérrez-Maldonado J. Determinants of Cue-Elicited Alcohol Craving and Perceived Realism in Virtual Reality Environments among Patients with Alcohol Use Disorder. J Clin Med 2021; 10:2241. [PMID: 34064120 PMCID: PMC8196721 DOI: 10.3390/jcm10112241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 12/31/2022] Open
Abstract
The identification of variables that can modulate the efficacy of cue exposure using virtual reality (VR) is crucial. This study aimed to explore determinant variables of cue-elicited alcohol craving and perceived realism (PR) of environments and alcoholic beverages during a VR cue-exposure session among alcohol use disorder (AUD) outpatients. A prospective cohort study was conducted amongst 72 outpatients with AUD from a clinical setting. Alcohol craving experienced during VR exposure and PR of virtual environments and alcoholic drinks were evaluated after a VR session of exposure to alcohol-related contexts and cues. Sociodemographic, psychological and consumption characteristics were examined as possible predicting variables. Multiple linear regression analyses showed that the AUD severity and PR of beverages were predictors of cue-elicited alcohol craving. Educational level, PR of beverages and age were predictors of the PR of VR environments. In relation to the PR of VR beverages, cue-elicited alcohol craving and the PR of environments were predictors. A simple mediational model was also performed to analyze the influence of the PR of beverages on the relationship between the AUD severity and alcohol craving experienced during VR exposure: an indirect or mediational effect was found. PR of alcoholic beverages was (1) a key predictor of the PR of VR environments (and vice versa) and the alcohol craving (and vice versa) experienced during VR cue-exposure sessions using ALCO-VR software among AUD patients and (2) a mediator between AUD severity and cue-elicited alcohol craving.
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Affiliation(s)
- Olga Hernández-Serrano
- Department of Psychology, Catholic University of Saint Anthony, Av. de los Jerónimos, 135, Guadalupe de Maciascoque, 30107 Murcia, Spain;
| | - Alexandra Ghiţă
- Department of Psychology, Health and Technology, University of Twente, Drienerlolaan, 5, 7522 NB Enschede, The Netherlands;
| | - Jolanda Fernández-Ruiz
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Passeig de Vall d’Hebron 175, 08035 Barcelona, Spain; (J.F.-R.); (B.P.-G.); (M.F.-G.)
| | - Miquel Monràs
- Addictive Behaviors Unit, Hospital Clinic of Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain; (M.M.); (A.G.)
| | - Antoni Gual
- Addictive Behaviors Unit, Hospital Clinic of Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain; (M.M.); (A.G.)
| | - Mariano Gacto
- Department of Physical Therapy, Faculty of Medicine, Campus Espinardo, University of Murcia, 30100 Murcia, Spain;
| | - Bruno Porras-García
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Passeig de Vall d’Hebron 175, 08035 Barcelona, Spain; (J.F.-R.); (B.P.-G.); (M.F.-G.)
| | - Marta Ferrer-García
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Passeig de Vall d’Hebron 175, 08035 Barcelona, Spain; (J.F.-R.); (B.P.-G.); (M.F.-G.)
| | - José Gutiérrez-Maldonado
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Passeig de Vall d’Hebron 175, 08035 Barcelona, Spain; (J.F.-R.); (B.P.-G.); (M.F.-G.)
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8
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Yoon G, Thompson K, Hakes JK, Westermeyer J, Petrakis IL, Kim SW. Alcohol Craving and Psychiatric Disorders Among Current Drinkers. Am J Addict 2020; 30:34-42. [PMID: 32667738 DOI: 10.1111/ajad.13083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 06/07/2020] [Accepted: 06/16/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Previous research has shown that alcohol craving is associated with psychiatric comorbidities. However, no population studies have examined the odds of psychiatric disorders in cravers and noncravers. The purpose of this study was to investigate current prevalence rates and odds ratios of psychiatric disorders among alcohol drinkers with and without alcohol craving in a population-based sample. We also compared four craving groups (cravers with and without alcohol use disorder [AUD], noncravers with and without AUD) for psychiatric comorbidities. METHODS The study data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). A subset of the NESARC sample (N = 22 000) who reported alcohol use during the past 12 months was included. Prevalence rates of psychiatric disorders were compared among current drinkers with alcohol craving (N = 900) and without alcohol craving (N = 21 500). RESULTS Cravers had higher prevalence rates of current psychiatric disorders than noncravers. Even after adjustment for other psychiatric disorders including AUD, cravers had significantly higher odds of any substance use disorder (adjusted odds ratio [AOR], 9.01), any mood disorder (AOR, 1.78), any anxiety disorder (AOR, 1.86), and any personality disorder (AOR, 1.92) than noncravers. Interestingly, cravers without AUD had even higher rates of any anxiety disorder and any personality disorder than noncravers with AUD. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Alcohol craving is associated with a higher prevalence of various psychiatric disorders. These findings suggest that alcohol craving may be related to transdiagnostic features that are present across various psychiatric disorders. (Am J Addict 2021;30:34-42).
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Affiliation(s)
- Gihyun Yoon
- VA Connecticut Healthcare System, West Haven, Connecticut.,Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut
| | - Katie Thompson
- Minneapolis VA Health Care System, Minneapolis, Minnesota
| | | | - Joseph Westermeyer
- Minneapolis VA Health Care System, Minneapolis, Minnesota.,Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
| | - Ismene L Petrakis
- VA Connecticut Healthcare System, West Haven, Connecticut.,Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut
| | - Suck Won Kim
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
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Kuerbis AN, Shao S, Treloar Padovano H, Jadanova A, Selva Kumar D, Vitale R, Nitzburg G, Vadhan NP, Morgenstern J. Context and craving among individuals with alcohol use disorder attempting to moderate their drinking. Exp Clin Psychopharmacol 2020; 28:677-687. [PMID: 31971419 PMCID: PMC7375899 DOI: 10.1037/pha0000349] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Many individuals with alcohol use disorder (AUD) prefer a goal of moderation, because they do not see their drinking as causing severe enough consequences to merit abstinence. Given that individuals attempting to moderate will continue to put themselves in contexts where drinking occurs, understanding how distinct external alcohol cues prompt craving is important for implementing the optimal treatments for individuals with AUD. Using data from a randomized controlled trial of stepped care brief interventions for AUD, this study explored the relationship between drinking contexts and craving in individuals attempting to moderate their drinking using ecological momentary assessment (EMA). At baseline, participants were asked to prospectively identify drinking contexts that were particularly likely to elicit intense craving and heavy drinking, called highly valued drinking contexts (HVCs). During EMA, participants were asked to report three times a day (morning, afternoon, evening) on their non-mutually exclusive contexts and their level of craving. Using multilevel modeling, all drinking contexts were tested as concurrent predictors of craving across the 84 days of the study. Next, AUD severity was tested as a moderator of HVC on craving. Results demonstrated that being in an HVC corresponded to greater reports of any craving and intensity of craving, over and above the influences of several other contextual factors (e.g., negative affect and already drinking). AUD severity significantly moderated HVC's impact on any craving, such that greater AUD severity potentiated HVC's already high odds of any craving. Implications for treatments for individuals with AUD are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | - Sijing Shao
- Center for Addiction Services and Psychotherapy Research
| | | | - Anna Jadanova
- Center for Addiction Services and Psychotherapy Research
| | | | - Rachel Vitale
- Center for Addiction Services and Psychotherapy Research
| | | | - Nehal P Vadhan
- Center for Addiction Services and Psychotherapy Research
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10
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Xu YY, Ge JF, Chen J, Liang J, Pang LJ, Gao WF, Cao Y, Shan F, Liu Y, Yan CY, Xia QR. Evidence of a Relationship Between Plasma Leptin, Not Nesfatin-1, and Craving in Male Alcohol-Dependent Patients After Abstinence. Front Endocrinol (Lausanne) 2020; 11:159. [PMID: 32265847 PMCID: PMC7105814 DOI: 10.3389/fendo.2020.00159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 03/06/2020] [Indexed: 12/17/2022] Open
Abstract
The goal of this study was to determine whether the plasma leptin, nesfatin-1, cortisol, brain-derived neurotrophic factor (BDNF), and inflammatory cytokines could be used as potential biomarkers for the degree of craving in the alcohol-dependent patients after 1 month of abstinence. A total of 83 patients with alcohol use disorder (AUD) and 61 healthy subjects were assessed. Patients with AUD were selected from Department of Material Dependence, Anhui Mental Health Center, and subjects in the control group were selected from healthy volunteers. The Alcohol Urge questionnaire Scale (AUQ) was used to evaluate the extent of craving for alcohol, and the Michigan Alcoholism Screening Test (MAST), the Fagerstrom Test for Nicotine Dependence (FTND), the Self-Rating Anxiety Scale (SAS), and the Self-Rating Depression Scale (SDS) were also assessed in patients with AUD. Enzyme-Linked Immunosorbent Assay (ELISA) was used for the measurement of plasma leptin, nesfatin-1, cortisol, BDNF, Interleukin-6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor-α (TNF-α) levels. Compare with healthy controls, the average leptin, leptin/BMI, IL-6, CRP, and TNF-α levels in patients with AUD were significantly increased, while the BDNF levels were significantly decreased. Moreover, the partial correlational analysis showed that the AUQ scores of the alcohol-dependent patients were positively correlated with the plasma leptin levels (r = 0.613, P < 0.001), rather than nesfatin-1 (r = 0.066, P = 0.569) after controlling for age as covariate. Furthermore, plasma nesfatin-1 levels were found to be correlated with the SDS scores (r = 0.366, P = 0.001) in the AUD group. In addition, plasma leptin levels were positively associated with the plasma IL-6 (r = 0.257, P = 0.033), CRP (r = 0.305, P = 0.011), and TNF-α (r = 0.311, P = 0.009) levels, and negatively associated with the BDNF levels (r = -0.245, P = 0.042) in patients with AUD. These results suggest that plasma leptin, but not nesfatin-1, might be a potential biomarker for the degree of craving in alcohol-dependent patients after 1 month of abstinence, the mechanism of which might be related to the dysfunction of the inflammatory cytokines and BDNF levels.
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Affiliation(s)
- Ya-Yun Xu
- Department of Pharmacy, Hefei Fourth People's Hospital, Hefei, China
- CAS Key Laboratory of Brain Function and Disease, University of Science and Technology of China, Hefei, China
- Psychopharmacology Research Laboratory, Anhui Mental Health Center, Hefei, China
- Clinical Pharmacy, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
| | - Jin-Fang Ge
- School of Pharmacy, Anhui Medical University, Hefei, China
| | - Jun Chen
- Department of Material Dependence, Hefei Fourth People's Hospital, Hefei, China
| | - Jun Liang
- Department of Pharmacy, Hefei Fourth People's Hospital, Hefei, China
- Psychopharmacology Research Laboratory, Anhui Mental Health Center, Hefei, China
- Clinical Pharmacy, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
| | - Liang-Jun Pang
- Department of Material Dependence, Hefei Fourth People's Hospital, Hefei, China
| | - Wen-Fan Gao
- Department of Pharmacy, Hefei Fourth People's Hospital, Hefei, China
- Psychopharmacology Research Laboratory, Anhui Mental Health Center, Hefei, China
- Clinical Pharmacy, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
| | - Yin Cao
- Department of Pharmacy, Hefei Fourth People's Hospital, Hefei, China
- Psychopharmacology Research Laboratory, Anhui Mental Health Center, Hefei, China
- Clinical Pharmacy, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
| | - Feng Shan
- Department of Pharmacy, Hefei Fourth People's Hospital, Hefei, China
- Psychopharmacology Research Laboratory, Anhui Mental Health Center, Hefei, China
- Clinical Pharmacy, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
| | - Yang Liu
- Department of Pharmacy, Hefei Fourth People's Hospital, Hefei, China
- Psychopharmacology Research Laboratory, Anhui Mental Health Center, Hefei, China
- Clinical Pharmacy, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
| | - Chun-Yu Yan
- Department of Pharmacy, Hefei Fourth People's Hospital, Hefei, China
- Psychopharmacology Research Laboratory, Anhui Mental Health Center, Hefei, China
- Clinical Pharmacy, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
| | - Qing-Rong Xia
- Department of Pharmacy, Hefei Fourth People's Hospital, Hefei, China
- Psychopharmacology Research Laboratory, Anhui Mental Health Center, Hefei, China
- Clinical Pharmacy, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
- *Correspondence: Qing-Rong Xia
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11
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Convergence between the Penn Alcohol Craving Scale and diagnostic interview for the assessment of alcohol craving. Addict Behav Rep 2019; 10:100198. [PMID: 31304230 PMCID: PMC6599943 DOI: 10.1016/j.abrep.2019.100198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 06/09/2019] [Accepted: 06/17/2019] [Indexed: 12/18/2022] Open
Abstract
Introduction The Penn Alcohol Craving Scale (PACS) is one of the most widely used instruments to measure craving for alcohol. Recent research has suggested that scores on the PACS can be used as a “stand in” for the diagnostic criterion of alcohol craving with a proposed cutoff of >20 on the PACS indicating a “positive” alcohol craving symptom. The present study examined the convergence between the PACS and face-to-face diagnostic interview for the assessment of alcohol craving. Method A sample of non-treatment seeking heavy drinkers (N = 338) enrolled in experimental studies of AUD completed the PACS as well as a face-to-face diagnostic interview for AUD, which included the craving item from the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA). Results Using the PACS cut-off score of >20, 12.9% (N = 43) of the sample met criteria for alcohol craving compared to 21% (N = 74) of the sample meeting criteria based on the diagnostic interview. Using the PACS cutoff of >20, sensitivity (i.e., true positive rate) was 41% and specificity (i.e., true negative rate) was 95%. Exploratory analyses suggested that a cut-off score of ≥15 achieved the optimal balance of sensitivity (67%) and specificity (81%) in our sample. Conclusions Advancing the assessment of alcohol craving and the conversion from DSM-IV to DSM-5 diagnostic criteria represents an important research direction. The present study recommends that a PACS score cut off of ≥15 should be used as an indicator of clinically significant alcohol craving in community samples of non-treatment seekers. The relationship between self-report and clinician-administered measures of alcohol craving is poorly understood. Previous studies have used the PACS as a stand-in for diagnostic data, using a score of 20 as a cut off. Using a PACS of >20, 12.9% of the sample would meet for craving; however, this cut off yielded poor sensitivity. Exploratory analysis showed a cut off of >15 produced an acceptable balance of sensitivity and specificity in this sample.
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12
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Besser B, Loerbroks L, Bischof G, Bischof A, Rumpf HJ. Performance of the DSM-5-based criteria for Internet addiction: A factor analytical examination of three samples. J Behav Addict 2019; 8:288-294. [PMID: 31120319 PMCID: PMC7044557 DOI: 10.1556/2006.8.2019.19] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS The diagnosis "Internet Gaming Disorder" (IGD) has been included in the fifth edition of Diagnostic and Statistical Manual of Mental Disorders. However, the nine criteria have not been sufficiently reviewed for their diagnostic value. This study focuses on a broader approach of Internet addiction (IA) including other Internet activities. It is not yet clear what the construct of IA is in terms of dimensionality and homogeneity and how the individual criteria contribute to explained variance. METHODS Three separate exploratory factor analyses and multinomial logistic regression analyses were carried out based on information collected from a general population-based sample (n = 196), a sample of people recruited at job centers (n = 138), and a student sample (n = 188). RESULTS Both of the adult samples show a distinct single-factor solution. The analysis of the student sample suggests a two-factor solution. Only one item (criterion 8: escape from a negative mood) can be assigned to the second factor. Altogether, high endorsement rates of the eighth criterion in all three samples indicate low discriminatory power. DISCUSSION AND CONCLUSIONS Overall, the analysis shows that the construct of IA is represented one dimensionally by the diagnostic criteria of the IGD. However, the student sample indicates evidence of age-specific performance of the criteria. The criterion "Escape from a negative mood" might be insufficient in discriminating between problematic and non-problematic Internet use. The findings deserve further examination, in particular with respect to the performance of the criteria in different age groups as well as in non-preselected samples.
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Affiliation(s)
- Bettina Besser
- Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany,Corresponding author: Bettina Besser; Department of Psychiatry and Psychotherapy, University of Luebeck, Ratzeburger Allee 160, D-23538 Luebeck, Germany; Phone: +49 451 500 98755; Fax: +49 451 500 98754; E-mail:
| | - Lotta Loerbroks
- Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany
| | - Gallus Bischof
- Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany
| | - Anja Bischof
- Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany
| | - Hans-Jürgen Rumpf
- Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany
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