Covariates of craving in actively drinking alcoholics

Analysis of addiction craving onset through natural language processing of the online forum Reddit

AIMS

Alcohol cravings are considered a major factor in relapse among individuals with alcohol use disorder (AUD). This study aims to investigate the frequency and triggers of cravings in the daily lives of people with alcohol-related issues. Large amounts of data are analyzed with Artificial Intelligence (AI) methods to identify possible groupings and patterns.

METHODS

For the analysis, posts from the online forum "stopdrinking" on the Reddit platform were used as the dataset from April 2017 to April 2022. The posts were filtered for craving content and processed using the word2vec method to map them into a multi-dimensional vector space. Statistical analyses were conducted to calculate the nature and frequency of craving contexts and triggers (location, time, social environment, and emotions) using word similarity scores. Additionally, the themes of the craving-related posts were semantically grouped using a Latent Dirichlet Allocation (LDA) topic model. The accuracy of the results was evaluated using two manually created test datasets.

RESULTS

Approximately 16% of the forum posts discuss cravings. The number of craving-related posts decreases exponentially with the number of days since the author's last alcoholic drink. The topic model confirms that the majority of posts involve individual factors and triggers of cravings. The context analysis aligns with previous craving trigger findings related to the social environment, locations and emotions. Strong semantic craving similarities were found for the emotions boredom, stress and the location airport. The results for each method were successfully validated on test datasets.

CONCLUSIONS

This exploratory approach is the first to analyze alcohol cravings in the daily lives of over 24,000 individuals, providing a foundation for further AI-based craving analyses. The analysis confirms commonly known craving triggers and even discovers new important craving contexts.

Craving among patients seeking treatment for substance use disorder

BACKGROUND

Craving has been implicated as a central feature of addiction and a predictor of relapse. However, a complete understanding of how craving varies across patient populations is lacking. This study aimed to better inform the effective and accurate use of craving as a clinical prognostic tool for patients with substance use disorders (SUD).

METHODS

This cross-sectional study utilized information gathered on patients (n = 112) entering specialty treatment for a SUD. Craving in the prior 30 days was assessed with a single item with other intake questionnaires.

RESULTS

Patients who reported substance use in the last 30 days were more likely to report craving compared to patients who did not report substance use in the last 30 days (AOR = 6.86 [95% CI 2.17-21.7], p-value = 0.001). Patients who reported Hispanic/Latinx ethnicity were less likely to report craving compared to patients who did not report Hispanic/Latinx ethnicity (AOR = 0.28 [95% CI 0.08-0.95], p-value = 0.04). There was no association between craving and Adverse Childhood Events (OR = 1.03 [95% CI 0.84-1.25], p-value = 0.81).

CONCLUSION

The association between recent substance use and craving supports previous findings. The observed variation in craving among patients who report Hispanic/Latinx ethnicity is novel and suggests socio-cultural influences and possibly genetic factors influencing reported craving amongst patients. Additional research is needed to further understand the underlying factors leading to this finding, in order for better utilization of craving as a clinical indicator across patient populations.

Leveraging Ecological Momentary Assessment to Examine Bi-directional Associations Between Sleep Quality, Adolescent/Young Adult Alcohol Craving and Use

BACKGROUND

Alcohol use is common among adolescents and young adults (AYA) and linked to poor sleep quality. Poor sleep quality may also increase alcohol use and alcohol craving, yet bi-directional relations between sleep quality and AYA alcohol use are poorly understood.

PURPOSE

This study examined bi-directional associations between sleep quality, alcohol craving, and alcohol use in AYA using ecological momentary assessment (EMA) and explored if biological sex, age, or race moderated these associations.

METHODS

This pre-registered secondary analysis pooled EMA data from the baseline, pre-randomization period (M = 8.18 days, range = 1-17) in two double-blind randomized placebo-controlled clinical trials examining medication effects on alcohol use in AYA (N = 115). Each morning, participants reported sleep quality and alcohol consumption (i.e., number of standard drinks) from the previous day, and craving was rated at several random points each day.

RESULTS

Multilevel modeling showed that poorer average sleep quality was associated with higher levels of alcohol craving for females but not for males, and better overall levels of sleep quality were associated with decreased likelihood of engaging in alcohol use. No other person- or day-level associations between sleep and alcohol use emerged.

CONCLUSIONS

Better sleep quality may be protective against alcohol use in AYA, and female AYA who report poorer sleep quality may experience higher levels of alcohol craving. Research and clinical assessment of AYA sleep quality can contribute to understanding of factors promoting alcohol craving and use.

A meta-analysis of the neural substrates of monetary reward anticipation and outcome in alcohol use disorder

The capacity to anticipate and detect rewarding outcomes is fundamental for the development of adaptive decision-making and goal-oriented behavior. Delineating the neural correlates of different stages of reward processing is imperative for understanding the neurobiological mechanism underlying alcohol use disorder (AUD). To examine the neural correlates of monetary anticipation and outcome in AUD patients, we performed two separate voxel-wise meta-analyses of functional neuroimaging studies, including 12 studies investigating reward anticipation and 7 studies investigating reward outcome using the monetary incentive delay task. During the anticipation stage, AUD patients displayed decreased activation in response to monetary cues in mesocortical-limbic circuits and sensory areas, including the ventral striatum (VS), insula, hippocampus, inferior occipital gyrus, supramarginal gyrus, lingual gyrus and fusiform gyrus. During the outcome stage, AUD patients exhibited reduced activation in the dorsal striatum, VS and insula, and increased activation in the orbital frontal cortex and medial temporal area. Our findings suggest that different activation patterns are associated with nondrug rewards during different reward processing stages, potentially reflecting a changed sensitivity to monetary reward in AUD.

Validity of the DSM-5 craving criterion for alcohol, tobacco, cannabis, cocaine, heroin, and non-prescription use of prescription painkillers (opioids)

BACKGROUND

Although the DSM-5 was adopted in 2013, the validity of the new substance use disorder (SUD) diagnosis and craving criterion has not been investigated systematically across substances.

METHODS

Adults (N = 588) who engaged in binge drinking or illicit drug use and endorsed at least one DSM-5 SUD criterion were included. DSM-5 SUD criteria were assessed for alcohol, tobacco, cannabis, cocaine, heroin, and opioids. Craving was considered positive if "wanted to use so badly that could not think of anything else" (severe craving) or "felt a very strong desire or urge to use" (moderate craving) was endorsed. Baseline information on substance-related variables and psychopathology was collected, and electronic daily assessment queried substance use for the following 90 days. For each substance, logistic regression estimated the association between craving and validators, i.e. variables expected to be related to craving/SUD, and whether association with the validators differed for DSM-5 SUD diagnosed with craving as a criterion v. without.

RESULTS

Across substances, craving was associated with most baseline validators (p values<0.05); neither moderate nor severe craving consistently showed greater associations. Baseline craving predicted subsequent use [odds ratios (OR): 4.2 (alcohol) - 234.3 (heroin); p's ⩽ 0.0001], with stronger associations for moderate than severe craving (p's < 0.05). Baseline DSM-5 SUD showed stronger associations with subsequent use when diagnosed with craving than without (p's < 0.05).

CONCLUSION

The DSM-5 craving criterion as operationalized in this study is valid. Including craving improves the validity of DSM-5 SUD diagnoses, and clinical relevance, since craving may cause impaired control over use and development and maintenance of SUD.

Cravings for alcohol in alcohol use disorders are associated with attention deviation to alcohol: An observational study of Japanese in-patients

Alcohol use disorder (AUD) may be associated with increased attentional bias (AB) toward alcohol-related information. Accordingly, our aim was to explore the relationships between alcohol-related AB, cravings, and risk of relapse among individuals with AUD after treatment. The study group included 24 in-patients with AUD who had completed alcohol withdrawal management. AB was evaluated using an image-based task, with participants asked to select the nonalcoholic image as fast and as accurately as possible and the response time (RT) measured. The intensity of the desire to drink was evaluated using a 100-mm Visual Analog Scale and the risk of relapse using the Alcohol Relapse Risk Scale. Linear regression was used to evaluate the relationship between these variables, with age, gender, duration of hospitalization, and depression score used as covariates. Intensity of cravings was significantly associated with AB RT (R2 =.625) and risk of relapse of drinking behavior (Alcohol Relapse Risk Scale score, R2 =.64). Gender and γ-GTP were significant explanatory variables of identified relationships. The main limitations of our study are a higher proportion of men than women in our study group and the absence of a control group for baseline comparison of AB RTs. This study results suggested that the desire to drink is related to AB among patients with AUD and that the intensity of the desire to drink is related to the risk of a relapse in drinking behavior after AUD treatment.

The Lack of Influence of Homozygous Long Allele of the 5-HTTLPR Gene on the Severity of Alcohol Craving During 6 Weeks of Rehab Hospitalisation in Comparison to Not Homozygous and Homozygous Short Alleles - Preliminary Report

Purpose

The aim of this study was to assess changes in the severity of alcohol craving according to allelic variants of the 5-HTTLPR gene polymorphism during hospitalisation and their association with selected clinical variables in alcohol-dependent patients.

Patients and Methods

The study is exploratory. Participants were investigated at the 2nd and 6th week of alcohol-dependence therapy in the addiction treatment unit. Recruitment was conducted among alcohol-dependent patients from several Polish drug treatment centres. The total sample size was 130 persons (12 females and 118 males). Study subjects' mean age was 43.0 years. Patients were investigated twice by using the Penn Alcohol Craving Scale (PACS) and Beck Depression Inventory (BDI), and once by using Short Alcohol Dependence Data Questionnaire (SADD) and taking a swab for genetic testing. The polymorphism of the gene encoding the serotonin transporter 5-HTTLPR (SLC6A4) was determined from isolated DNA and its homozygous variants of short/short or long/long alleles and heterozygous short/long alleles were analysed.

Results

At 6th week of the follow-up, there was a decrease in the severity of alcohol craving in half of subjects with the short/short allele (p = 0.033) and in one-fifth of subjects with the long/short allele (p = 0.002) of the 5-HTTLPR gene. In subjects with long/long allele of the 5-HTTLPR gene, there was no change in the severity of alcohol craving between 2nd and 6th weeks of the study (p = 0.242).

Conclusion

There was no statistical influence of the homozygous long allele of the 5-HTTLPR gene on severity of alcohol craving during 6 weeks of rehab hospitalisation in comparison to not homozygous and homozygous short alleles. The s-allele was associated with decrease of alcohol craving. It may point on the potential need for differentiated rehabilitation methods depending on the genetic diversity of addicted patients and its role in the severity of alcohol craving.

The 24-hour rhythm in alcohol craving and individual differences in sleep characteristics and alcohol use frequency

BACKGROUND

Evidence implicates sleep/circadian factors in alcohol use, suggesting the existence of a 24-h rhythm in alcohol craving, which may vary by individual differences in sleep factors and alcohol use frequency. This study sought to (1) replicate prior findings of a 24-h rhythm in alcohol craving, and (2) examine whether individual differences in sleep timing, sleep duration, or alcohol use frequency are related to differences in the timing of the peak of the craving rhythm (i.e., the acrophase) or magnitude of fluctuation of the rhythm (i.e., amplitude). Finally, whether such associations varied by sex or racial identity was explored.

METHODS

Two-hundred fifteen adult drinkers (21 to 35 years of age, 72% male, 66% self-identified as White) completed a baseline assessment of alcohol use frequency and then smartphone reports of alcohol craving intensity six times a day across 10 days. Sleep timing was also recorded each morning of the 10-day period. Multilevel cosinor analysis was used to test the presence of a 24-h rhythm and to estimate acrophase and amplitude.

RESULTS

Multilevel cosinor analysis revealed a 24-h rhythm in alcohol craving. Individual differences in sleep timing or sleep duration did not predict rhythm acrophase or amplitude. However, alcohol use frequency moderated this rhythm wherein individuals who used alcohol more frequently in the 30 days prior to beginning the study had higher mean levels of craving and greater rhythm amplitudes (i.e., greater rhythmic fluctuations). Associations did not vary by sex or racial identity.

CONCLUSIONS

Results show that alcohol craving exhibits a systematic rhythm over the course of the 24 h and that the frequency of alcohol use may be relevant to the shape of this rhythm. Consideration of daily rhythms in alcohol craving may further our understanding of the mechanisms that drive alcohol use.

Biomarkers for alcohol abuse/withdrawal and their association with clinical scales and temptation to drink. A prospective pilot study during 4-week residential rehabilitation

A bulk of evidence in the field of translational medicine applied to clinical toxicology and rehabilitation has highlighted the possibility of using biomarkers as a support in the diagnosis of alcohol-related diseases and in monitoring of alcohol withdrawal. In a cohort of 55 subjects admitted to a 4-week residential rehabilitation period for alcohol detoxification, we applied a complementary approach correlating novel and conventional peripheral blood and urine parameters in combination with clinical and functional evaluation, contextually considered with the patient's history. Biomarkers of oxidative, inflammatory, hepatic, and neurochemical effects paralleled by alcohol craving and clinical scale measurements were determined at two specific time points, i.e., admission and discharge. Concerning the post-discharge assessment (i.e., relapse evaluation one month after discharge), a follow-up oral interview during a clinical examination was applied to evaluate alcohol abstinence.Selected biomarkers, i.e., MCP1, F2-IsoPs, and SOD1, were altered in chronic alcoholics at admission, and then showed a clearly changing trend during hospitalization. Our findings demonstrated that these specific non-traditional biomarkers, measured together with more conventional ones (e.g., CDT, EtG, IL8, ALT, AST, GGT), could represent novel key parameters for monitoring alcohol use disorders and withdrawal, being also suggestive of the complexity of the psychoneuroimmune response to alcohol. A general improvement in psychological functioning (i.e., decreases in anxiety, depression, and psychological distress) was also revealed during the 4-week rehabilitation treatment, paralleled by an increase of well-being and positive changes in terms of scores. Moreover, a positive association between SOD1 and drink craving at admission was evidenced. Notably, both SOD1 and well-being displayed a significant relation with lower risk of alcohol relapse one month after discharge, indicating that SOD1 is a good predictor of reduced relapse probability. This 4-week residential rehabilitation protocol represents a sound strategy enabling identification of alcohol use disorders and monitoring of alcohol addiction state and withdrawal. However, it has to be emphasized that results derived from this pilot study need to be extensively validated in large and independent cohorts of subjects.

A pilot randomized clinical trial of Brief Behavioral Treatment for Insomnia to reduce problematic cannabis use among trauma-exposed young adults

BACKGROUND

Insomnia symptoms may be an important etiological factor for substance use disorders; however, whether improving sleep leads to reductions in problematic substance use among at-risk populations remains unclear.

METHOD

As such, the current pilot study used a randomized controlled design to test the effects of Brief Behavioral Treatment for Insomnia (BBTI) against a waitlist control among a sample of trauma-exposed young adults with elevated insomnia symptoms who regularly use cannabis (N = 56).

RESULTS

Intent-to-treat multilevel modeling analyses indicated that BBTI may be more efficacious than waitlist control in reducing self-reported insomnia symptoms, with large effects three months post-treatment (d = 1.34). Further, our initial evidence suggested that BBTI resulted in reductions in cannabis-related problems with medium to large effects at three months post-treatment (d = 0.75). The current pilot analyses indicated BBTI also reduced cravings to use cannabis to reduce negative emotions in response to trauma cues with a large effect size.

CONCLUSION

This pilot study suggests BBTI may be efficacious not only in improving insomnia symptoms among cannabis users but also in reducing cannabis-related problems and cravings over three months. Future research should replicate these results in a larger, fully powered sample with improved follow-up rates designed to test temporal mediation using multimethod assessments of insomnia symptoms and problematic cannabis use. Overall, BBTI may be a promising intervention for trauma-exposed cannabis users to improve sleep and reduce cannabis-related problems.

Contribution of sleep disturbances to the heterogeneity of cognitive and brain alterations in alcohol use disorder

Cognitive and brain alterations are common in alcohol use disorder and vary importantly from one patient to another. Sleep disturbances are also very frequent in these patients and remain largely neglected even though they can persist after drinking cessation. Sleep disturbances may be the consequence of specific brain alterations, resulting in cognitive impairments. But sleep disruption may also exacerbate alcohol-related brain abnormalities and cognitive deficits through common pathophysiological mechanisms. Besides, sleep disturbances seem a vulnerability factor for the development of alcohol use disorder. From a clinical perspective, sleep disturbances are known to affect treatment outcome and to increase the risk of relapse. In this article, we conducted a narrative review to provide a better understanding of the relationships between sleep disturbances, brain and cognition in alcohol use disorder. We suggest that the heterogeneity of brain and cognitive alterations observed in patients with alcohol use disorder could at least partially be explained by associated sleep disturbances. We also believe that sleep disruption could indirectly favor relapse by exacerbating neuropsychological impairments required in psychosocial treatment and for the maintenance of abstinence. Implications for clinical practice as well as perspectives for future research are proposed.

Engagement With a Behavior Change App for Alcohol Reduction: Data Visualization for Longitudinal Observational Study

Background

Behavior change apps can develop iteratively, where the app evolves into a complex, dynamic, or personalized intervention through cycles of research, development, and implementation. Understanding how existing users engage with an app (eg, frequency, amount, depth, and duration of use) can help guide further incremental improvements. We aim to explore how simple visualizations can provide a good understanding of temporal patterns of engagement, as usage data are often longitudinal and rich.

Objective

This study aims to visualize behavioral engagement with Drink Less, a behavior change app to help reduce hazardous and harmful alcohol consumption in the general adult population of the United Kingdom.

Methods

We explored behavioral engagement among 19,233 existing users of Drink Less. Users were included in the sample if they were from the United Kingdom; were 18 years or older; were interested in reducing their alcohol consumption; had a baseline Alcohol Use Disorders Identification Test score of 8 or above, indicative of excessive drinking; and had downloaded the app between May 17, 2017, and January 22, 2019 (615 days). Measures of when sessions begin, length of sessions, time to disengagement, and patterns of use were visualized with heat maps, timeline plots, k-modes clustering analyses, and Kaplan-Meier plots.

Results

The daily 11 AM notification is strongly associated with a change in engagement in the following hour; reduction in behavioral engagement over time, with 50.00% (9617/19,233) of users disengaging (defined as no use for 7 or more consecutive days) 22 days after download; identification of 3 distinct trajectories of use, namely engagers (4651/19,233, 24.18% of users), slow disengagers (3679/19,233, 19.13% of users), and fast disengagers (10,903/19,233, 56.68% of users); and limited depth of engagement with 85.076% (7,095,348/8,340,005) of screen views occurring within the Self-monitoring and Feedback module. In addition, a peak of both frequency and amount of time spent per session was observed in the evenings.

Conclusions

Visualizations play an important role in understanding engagement with behavior change apps. Here, we discuss how simple visualizations helped identify important patterns of engagement with Drink Less. Our visualizations of behavioral engagement suggest that the daily notification substantially impacts engagement. Furthermore, the visualizations suggest that a fixed notification policy can be effective for maintaining engagement for some users but ineffective for others. We conclude that optimizing the notification policy to target both effectiveness and engagement is a worthwhile investment. Our future goal is to both understand the causal effect of the notification on engagement and further optimize the notification policy within Drink Less by tailoring to contextual circumstances of individuals over time. Such tailoring will be informed from the findings of our micro-randomized trial (MRT), and these visualizations were useful in both gaining a better understanding of engagement and designing the MRT.

The relationship between insomnia and the intensity of drinking in treatment-seeking individuals with alcohol dependence

BACKGROUND

Although insomnia is highly prevalent in alcohol use disorders(AUD), its associations with the severity of alcohol use, pre-existing psychiatric comorbidities and psychosocial problems are understudied. The present study evaluates the interplay between these factors using a structural equation model (SEM).

METHODS

We assessed baseline cross-sectional data on patients with AUD (N = 123) recruited to a placebo-controlled medication trial. Severity of alcohol use was measured by the Brief Michigan Alcoholism Screening Test (B-MAST). Insomnia Severity Index was used to assess insomnia symptoms. The Hamilton scales for Depression and Anxiety, Short Index of Problems and Timeline Follow Back evaluated psychiatric symptoms, psychosocial consequences of drinking and level of alcohol consumption respectively. We used logistic regression to evaluate the association between insomnia and severity of alcohol use while controlling for covariates. We constructed a SEM with observed variables to delineate the effect of psychiatric symptoms, psychosocial factors and current alcohol use on the pathway between alcohol use severity and insomnia.

RESULTS

The sample was predominately male(83.9 %), Black(54.6 %) and employed(60.0 %). About 45 % of the participants reported moderate-severe insomnia.The association between insomnia and B-MAST attenuated after adjustment for demographics, psychiatric symptoms and psychosocial problems(OR[95 % CI] = 1.17(0.99-1.47). SEM findings demonstrated that B-MAST and insomnia were linked to psychiatric symptoms (95 % Asymptotic-Confidence Interval (ACI): 0.015-0.159, p < 0.05) but not to psychosocial problems or current alcohol use.

CONCLUSION

Among treatment-seeking patients with AUD, psychiatric burden mediated the relationship between severity of alcohol use and insomnia. Clinicians should screen for underlying psychiatric disorders among treatment-seeking patients with AUD complaining of insomnia.

Craving mediates the effect of impulsivity on lapse-risk during alcohol use disorder treatment

Rash impulsiveness, the propensity for approach behaviour despite potential negative consequences, is associated with stronger alcohol craving in patients with Alcohol Use Disorder (AUD). This relationship is poorly understood and implications for treatment response are unexamined. This study explored the relationship between rash impulsiveness, craving, and treatment response among 304 outpatients enrolled in a 12-week abstinence-based Cognitive-Behavioural Therapy (CBT) program for AUD. Assessments were completed pre-and-post treatment, with craving and alcohol consumption monitored at each treatment session. Higher rash impulsiveness predicted more frequent craving over treatment (b = 0.95, 95% CI = 0.40, 1.50). Higher craving was associated with greater lapse-risk (b = 0.04, 95% CI = 0.03, 0.05), with the association between craving and lapse-risk increasing as treatment progressed (b = 0.01, 95% CI = 0.01, 0.02). Craving positively mediated the relationship between rash impulsiveness and lapse-risk (µ = 0.38, 95% CI = 0.10, 0.70). Contrary to hypotheses, the risk of lapse in response to craving was not moderated by rash-impulsiveness. These results suggest that AUD patients with a predisposition for rash impulsiveness are more vulnerable to alcohol craving, and subsequently, poorer treatment outcomes.

Psychometric properties of the transaddiction craving triggers questionnaire in alcohol use disorder

OBJECTIVES

We aimed to develop the transaddiction craving triggers questionnaire (TCTQ), which assesses the propensity of specific situations and contexts to trigger craving and to test its psychometric properties in alcohol use disorder (AUD).

METHODS

This study included a sample of 111 AUD outpatients. We performed exploratory factor analysis (EFA) and calculated item-dimension correlations. Internal consistency was measured with Cronbach's alpha coefficient. Construct validity was assessed through Spearman correlations with craving, emotional symptoms, impulsivity, mindfulness, and drinking characteristics.

RESULTS

The EFA suggested a 3-factor solution: unpleasant affect, pleasant affect, and cues and related thoughts. Cronbach's coefficient alpha ranged from .80 to .95 for the three factors and the total score. Weak positive correlations were identified between the TCTQ and drinking outcomes, and moderate correlation were found between the TCTQ and craving strength, impulsivity, anxiety, depression, and impact of alcohol on quality of life.

CONCLUSIONS

The 3-factor structure is congruent with the well-established propensity of emotions and cues to trigger craving. Construct validity is supported by close relations between the TCTQ and psychological well-being rather than between the TCTQ and drinking behaviors. Longitudinal validation is warranted to assess sensitivity to change of the TCTQ and to explore its psychometric properties in other addictive disorders.

Evidence for incentive salience sensitization as a pathway to alcohol use disorder

The incentive salience sensitization (ISS) theory of addiction holds that addictive behavior stems from the ability of drugs to progressively sensitize the brain circuitry that mediates attribution of incentive salience (IS) to reward-predictive cues and its behavioral manifestations. In this article, we establish the plausibility of ISS as an etiological pathway to alcohol use disorder (AUD). We provide a comprehensive and critical review of evidence for: (1) the ability of alcohol to sensitize the brain circuitry of IS attribution and expression; and (2) attribution of IS to alcohol-predictive cues and its sensitization in humans and non-human animals. We point out gaps in the literature and how these might be addressed. We also highlight how individuals with different alcohol subjective response phenotypes may differ in susceptibility to ISS as a pathway to AUD. Finally, we discuss important implications of this neuropsychological mechanism in AUD for psychological and pharmacological interventions attempting to attenuate alcohol craving and cue reactivity.

The Relationship between Alcohol Craving and Insomnia Symptoms in Alcohol-Dependent Individuals

AIM

This preliminary investigation evaluated the link between alcohol craving and insomnia in actively drinking patients with alcohol dependence (AD).

METHODS

We conducted a secondary analysis of data from a clinical trial of treatment-seeking patients with AD who drank heavily (N = 61). The Penn Alcohol Craving Scale (PACS) evaluated alcohol craving, and the Short Sleep Index (SSI) assessed insomnia symptoms. We used linear regression models for baseline cross-sectional assessments. Linear mixed effects regression models evaluated craving scores longitudinally across insomnia groups (+/-), and insomnia scores longitudinally across craving groups(high/low). These longitudinal analyses were conducted separately in those treated with placebo (N = 32) and quetiapine (N = 29).

RESULTS

The mean (standard deviation) for PACS total score was 15.9 (8.5) and for SSI was 2.1 (2.3). Alcohol craving was associated with the insomnia symptom of difficulty falling asleep (P = 0.03; effect size = -0.7) and with the SSI total score (P = 0.04, effect size = -0.7). In the longitudinal analysis, insomnia+ subjects had consistently higher PACS total scores, relative to the insomnia- group. The PACS score demonstrated significant group × time interactions in both treatment groups. Insomnia+ individuals demonstrated a relatively steeper rate of decline in the craving with quetiapine treatment (P = 0.03). Insomnia- individuals in the placebo group demonstrated a transient reduction in craving until week 8, followed by an increase in scores(P = 0.004). The SSI score did not demonstrate any interactive effect over time across the craving groups in either treatment arm.

CONCLUSION

Insomnia was associated with higher alcohol craving and quetiapine differentially reduced craving in those with insomnia.

Effects of Social Support and 12-Step Involvement on Recovery among People in Continuing Care for Cocaine Dependence

Background: Social networks that support recovery lead to enhanced treatment outcomes and sobriety regardless if this support stems from family, peer groups or 12-Step programs. Treatment process factors including readiness to change and commitment to abstinence also impact substance use. However, little is understood about the relationship between social support to treatment process factors during and after treatment for substance use disorders. Objectives: To identify the ways in which different social networks foster substance use change in a sample of individuals with cocaine dependence from intensive outpatient programs (IOPs). Methods: Data were drawn from two studies examining adults (N = 489) with cocaine dependence in IOPs for substance use disorders collected between 2004 and 2009. Assessment data were collected at 3- to 6-month intervals from baseline to 24-months and included the University of Rhode Island change assessment questionnaire, timeline followback, thoughts about abstinence, perceived social support - friend, and family versions and analyzed using GEE and mediational analyses. Results: Greater perceived friend social support was associated with greater readiness to change whereas greater perceived familial social support was associated with substance use goal; greater social support from both friends and family were associated with less substance use. Greater AA/NA participation was associated with substance use goal and readiness to change, and less substance use. Substance use goals partially mediated the impact of social support on later substance use. Conclusions/Importance: While peer and familial support are key to sustained recovery, their impact differentially affects treatment process variables. This information could be used to inform social support treatment interventions.

Mediation of time perspectives on inclinations to use alcohol and motivation to change relationship

OBJECTIVES

Trajectories of change accompanying alcohol-specialized care can be affected by numerous variables. Massive urges to drink can substantially hamper personal motivation to change. However, time perspective could also play an indirect role in this association. This research explores whether time perspectives mediates the relationship between inclinations to use or not to use alcohol and patients' motivation to change.

DESIGN

The sample included 150 outpatients in care for their problematic alcohol use. Models of mediation were planned.

RESULTS

At the entry in care, three specific time perspectives, Past Negative, Present Fatalistic, and Future, acted as discrete mediators.

CONCLUSIONS

These findings highlight underlying mechanisms connecting inclinations to use or to avoid the substance and the patient's motivation to change. Time perspective could also be an interesting intervention target in existing alcohol-specialized treatment programs.

Motivation to change and posttreatment temptation to drink: a multicenter study among alcohol-dependent patients

BACKGROUND

An inpatient 28-day rehabilitation program for alcohol dependence is focused on detoxification, enhancing motivation to change, and coping strategies for the management of emotional distress and temptation to drink. The aims of the present study were to investigate 1) changes over time in motivation to change, anxiety, and depression in individuals undergoing residential rehabilitation treatment for alcohol addiction, and 2) which pretreatment factors are associated with posttreatment temptation to drink.

METHODS

We assessed 432 patients diagnosed with alcohol dependence based on the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) consecutively recruited from seven residential rehabilitation centers in Northern Italy. Patients were assessed by means of self-report questionnaires at the beginning of rehabilitation (pretreatment) and before their hospital discharge (posttreatment) regarding motivation to change and self-efficacy (motivation assessment of change - alcoholism version), readiness to change and temptation to drink (visual analog scales), and depression and anxiety (cognitive behavioral assessment - outcome evaluation).

RESULTS

Results showed an overall improvement in motivation to change and a significant reduction over time in depression and anxiety levels for the total sample, particularly patients with low baseline level of temptation to drink. Multivariate linear regression analysis revealed that significant predictors of posttreatment temptation to drink were polysubstance dependence (p<0.001), readiness to change (p=0.01), and self-efficacy (p=0.05).

CONCLUSION

Inpatients' rehabilitation for alcohol dependence is associated with an overall improvement in motivation to change and a significant reduction of psychological distress. Treatments for alcohol-dependent patients should focus on motivation to change, negative moods, and relapse prevention strategies for the management of craving.

Motivational factors and negative affectivity as predictors of alcohol craving

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.

Social network moderators of naltrexone and behavioral treatment effects on heavy drinking in the COMBINE study

BACKGROUND

Oral naltrexone is an efficacious medication for treatment of alcohol dependence, but small effect sizes and variability in outcomes suggest the presence of person-level moderators of naltrexone response. Identification of contextual or psychosocial moderators may assist in guiding clinical recommendations. Given the established importance of social networks in drinking outcomes, as well as the potential effects of naltrexone in reducing cue reactivity which may be especially important among those with more heavy drinkers and more alcohol cues in their networks, we examined pretreatment social network variables as potential moderators of naltrexone treatment effects in the COMBINE study.

METHODS

The sample included all COMBINE study participants in medication conditions with full data on the Important People Inventory (IPI) and covariates at intake (N = 1,197). The intake IPI assessed whether participants had any frequent drinkers in their network and the average frequency of contact with these drinkers. The effects of treatment condition, pretreatment network variables, and their interactions on percent heavy drinking days were tested in hierarchical linear models, controlling for demographics and baseline clinical covariates.

RESULTS

In treatment conditions involving medical management and combined behavioral intervention (CBI), the effects of active naltrexone on heavy drinking were significantly greater for individuals with frequent drinkers in their network (z = -2.66, p < 0.01) and greater frequency of contact with those drinkers (z = -3.19, p < 0.01). These network variables did not moderate the effects of active naltrexone without CBI.

CONCLUSIONS

When delivered in conjunction with behavioral interventions, naltrexone can be more potent for alcohol-dependent adults who have greater contact with frequent drinkers prior to treatment, which may indicate patterns of environmental exposure to alcohol. Contextual, social risk factors are a potential avenue to guide personalized treatment of alcohol dependence.

The Polish Version of the Yale-Brown Obsessive-Compulsive Scale, Modified to Reflect Obsessions and Compulsions Related to Heavy Drinking (YBOCS-hd-PL)

BACKGROUND

The aim of the research work was to present the process of adapting the Polish version of the YBOCS-hd by Modell and colleagues (Alcohol Clin Exp Res 1992;16:266) to Polish conditions and to characterize the psychometric validation of the measure (e.g., validity, internal structure, and reliability). The scale is a self-assessment method consisting of 10 statements designed for measuring the severity of obsessive and compulsive craving-related thoughts and behaviors in alcohol-dependent or alcohol-abusing patients.

METHODS

The study was carried out in a group of 550 patients diagnosed with alcohol dependence syndrome, 510 of whom (396 males and 114 females) were included in the final analysis. The patients were interviewed during the third week of therapy by the Polish version of the Yale-Brown Compulsive Scale Modified to Reflect Obsessions and Compulsions Related to Heavy Drinking (YBOCS-hd-PL), the Penn Alcohol Craving Scale (PACS), Short Alcohol Dependence Data Questionnaire (SADD), and the "compulsive" subscale of SCL-90.

RESULTS

The YBOCS-hd-PL is characterized by good psychometric properties. Factor analysis identified 2 factors corresponding to the structure of the original version. Its internal consistency, assessed on the basis of Cronbach's alpha, is satisfactory: 0.84 for YBOCS-hd-PL (overall), 0.75 for factor 1 (obsessive thoughts), and 0.79 for factor 2 (compulsive behaviors). The discriminant power of the questions ranged from 0.46 to 0.68 (p < 0.001). For the adapted YBOCS-hd-PL, significant correlations were found between its scores and the PACS and the "compulsive" subscale of the SCL-90 scale. The obtained results indicate the Polish version of the YBOCS-hd (YBOCS-hd-PL) proved to be a reliable and valid instrument.

CONCLUSIONS

In view of its very good psychometric properties, the Polish version of the YBOCS-hd can be recommended as an instrument for assessment of alcohol craving and its obsessive and compulsive aspects in individuals with alcohol use disorders.

Transcranial magnetic stimulation: potential treatment for co-occurring alcohol, traumatic brain injury and posttraumatic stress disorders

Alcohol use disorder (AUD), mild traumatic brain injury (mTBI), and posttraumatic stress disorder (PTSD) commonly co-occur (AUD + mTBI + PTSD). These conditions have overlapping symptoms which are, in part, reflective of overlapping neuropathology. These conditions become problematic because their co-occurrence can exacerbate symptoms. Therefore, treatments must be developed that are inclusive to all three conditions. Repetitive transcranial magnetic stimulation (rTMS) is non-invasive and may be an ideal treatment for co-occurring AUD + mTBI + PTSD. There is accumulating evidence on rTMS as a treatment for people with AUD, mTBI, and PTSD each alone. However, there are no published studies to date on rTMS as a treatment for co-occurring AUD + mTBI + PTSD. This review article advances the knowledge base for rTMS as a treatment for AUD + mTBI + PTSD. This review provides background information about these co-occurring conditions as well as rTMS. The existing literature on rTMS as a treatment for people with AUD, TBI, and PTSD each alone is reviewed. Finally, neurobiological findings in support of a theoretical model are discussed to inform TMS as a treatment for co-occurring AUD + mTBI + PTSD. The peer-reviewed literature was identified by targeted literature searches using PubMed and supplemented by cross-referencing the bibliographies of relevant review articles. The existing evidence on rTMS as a treatment for these conditions in isolation, coupled with the overlapping neuropathology and symptomology of these conditions, suggests that rTMS may be well suited for the treatment of these conditions together.

The role of 5-HTTLPR polymorphism in alcohol craving experience

The way in which genetic risk mediates the development of craving in alcohol dependence is still relatively unknown. The authors sought to clarify the extent to which alcohol craving could be predicted by a relevant polymorphism in the promoter region of the gene encoding the 5-HT transporter (5-HTTLPR). A sample of 101 alcohol-dependent patients admitted for alcohol treatment was recruited for the study. At admission, blood samples were taken for DNA extraction and alcohol craving information was collected with a composite measure. The 5-HTT polymorphism was genotyped. Alcohol dependent patients who were homozygous for the long allele (LL) self-reported higher scores of craving when compared to patients that were homozygous for the short allele (SS). However, the results were not statistically significant. Also, no significant associations were observed between the 5-HTTLPR genotype and other drinking variables. No 5-HTTLPR genotype effects were observed on alcohol craving experience in a sample of alcohol-dependent outpatients.

Impaired sleep quality and sleep duration in smokers-results from the German Multicenter Study on Nicotine Dependence

Cigarette smoking is a severe health burden being related to a number of chronic diseases. Frequently, smokers report about sleep problems. Sleep disturbance, in turn, has been demonstrated to be involved in the pathophysiology of several disorders related to smoking and may be relevant for the pathophysiology of nicotine dependence. Therefore, determining the frequency of sleep disturbance in otherwise healthy smokers and its association with degree of nicotine dependence is highly relevant. In a population-based case-control study, 1071 smokers and 1243 non-smokers without lifetime Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I disorder were investigated. Sleep quality (SQ) of participants was determined by the Pittsburgh Sleep Quality Index. As possible confounders, age, sex and level of education and income, as well as depressiveness, anxiety, attention deficit hyperactivity, alcohol drinking behaviour and perceived stress, were included into multiple regression analyses. Significantly more smokers than non-smokers (28.1% versus 19.1%; P < 0.0001) demonstrated a disturbed global SQ. After controlling for the confounders, impaired scores in the component scores of sleep latency, sleep duration and global SQ were found significantly more often in smokers than non-smokers. Consistently, higher degrees of nicotine dependence and intensity of smoking were associated with shorter sleep duration. This study demonstrates for the first time an elevated prevalence of sleep disturbance in smokers compared with non-smokers in a population without lifetime history of psychiatric disorders even after controlling for potentially relevant risk factors. It appears likely that smoking is a behaviourally modifiable risk factor for the occurrence of impaired SQ and short sleep duration.

Craving as an alcohol use disorder symptom in DSM-5: an empirical examination in a treatment-seeking sample

Craving has been added as an alcohol use disorder (AUD) symptom in DSM-5 but relatively few nosological studies have directly examined the empirical basis for doing so. The current study investigated the validity of craving as an AUD symptom in a sample of heavy drinking treatment-seeking individuals. Using a semistructured clinical interview, individuals (N = 104; 62% male) were assessed for symptoms of DSM-IV AUD. The extent to which individuals endorsed pathological levels of craving in comparison with other AUD symptoms was investigated as was the association between craving and several aspects of problematic alcohol involvement. Factor analysis was utilized to examine whether craving and other AUD symptoms comprised a unidimensional syndrome. Results indicated that craving was significantly positively correlated with AUD severity, quantitative indices of drinking, and adverse consequences of alcohol abuse. In terms of frequency of endorsement, craving was present in 47% of the sample and was the 8th most frequent of the 12 symptoms evaluated. When considered with the DSM-IV AUD criteria, craving aggregated with other symptoms to form a unidimensional syndrome. Extending previous findings from epidemiological samples, these data suggest that, in a clinical sample, many relevant aspects of craving aggregate to form a diagnostic criterion that functions similarly to other AUD symptoms and is related to diverse aspects of alcohol-related impairment.

Mindfulness as a strategy for coping with cue-elicited cravings for alcohol: an experimental examination

BACKGROUND

Mindfulness has been identified as a promising strategy for managing cravings for alcohol and other drugs, but little controlled experimental research has directly studied whether this approach is effective. The current study systematically examined the effects of an acute mindfulness manipulation on craving for alcohol during prolonged exposure to alcohol cues.

METHODS

Heavy drinkers (N = 84, 50% male) underwent a prolonged alcohol cue exposure paradigm in a simulated bar environment and received either a mindfulness-based strategy, a distraction (DST)-based strategy (active control), or no strategy (passive control) to cope with alcohol cravings and discomfort associated with craving.

RESULTS

No baseline differences were present between conditions. Manipulation checks revealed that participants in the 2 active conditions reported using the recommended strategies. Across groups, the initial exposure to alcohol cues was associated with significant increases in craving, urge distress, and heart rate. Mixed analyses of variance on these indices following the experimental manipulation revealed significant differences based on condition over the course of the bar laboratory protocol. The DST strategy was significantly more effective at acutely reducing craving and urge distress than the other 2 conditions, which did not significantly differ from each other.

CONCLUSIONS

Contrary to our prediction, these findings suggest that an acute DSTstrategy is beneficial for coping with alcohol cravings. The potential importance of protracted mindfulness training to detect significant effects on in vivo craving, additional implications, and methodological considerations are discussed.

Using conditioned place preference to identify relapse prevention medications

Stimuli, including contexts, which predict the availability or onset of a drug effect, can acquire conditioned incentive motivational properties. These conditioned properties endure after withdrawal, and can promote drug-seeking which may result in relapse. Conditioned place preference (CPP) assesses the associations between drugs and the context in which they are experienced. Here, we review the potential utility of CPP procedures in rodents and humans to evaluate medications that target conditioned drug-seeking responses. We discuss the translational potential of the CPP procedure from rodents to humans, and review findings with FDA-approved treatments that support the use of CPP to develop relapse-reduction medications. We also discuss challenges and methodological questions in applying the CPP procedure to this purpose. We argue that an efficient and valid CPP procedure in humans may reduce the burden of full clinical trials with drug-abusing patients that are currently required for testing promising treatments.

A daily process examination of the bidirectional relationship between craving and alcohol consumption as measured via interactive voice response

BACKGROUND

Craving is a central component to alcohol use disorders, although there are contradictory findings in the literature regarding the importance of craving in alcohol use. The study goal was to examine the bidirectional relationship between craving and alcohol consumption in heavy drinkers.

METHODS

Participants received brief alcohol interventions from their primary care physicians and then were asked to make daily reports of craving and alcohol consumption to an interactive voice response (IVR) telephone system for 180 days. The study sample included 246 participants (166 men) with mean age of 46. Ninety-seven percent were Caucasian and 66% met criteria for alcohol dependence. Analysis used generalized estimating equations (GEE) to evaluate whether craving intensity predicted next day alcohol consumption and whether alcohol consumption predicted next day craving intensity. Significant interactions with gender led to stratified analyses.

RESULTS

GEE analyses revealed a significant bidirectional relationship between craving and drinking, where craving intensity predicted next day total drinks consumed (p = 0.001), and total drinks predicted next day craving intensity (p = 0.02). Exploratory analysis found that gender significantly moderated the craving-drinking relationship (p = 0.002) with men increasing next day alcohol use more (b = 0.19) than women (b = 0.08).

CONCLUSIONS

Findings suggest a bidirectional relationship between craving and drinking may contribute to the development or maintenance of heavy drinking, particularly for men. Based on our findings, we recommend that during brief interventions, physicians address both drinking and craving and provide advice for coping with craving.

Predictive value of obsessive-compulsive drinking scale (OCDS) for outcome in alcohol-dependent inpatients: results of a 24-month follow-up study

BACKGROUND

The present study examined whether craving as measured by the obsessive-compulsive drinking scale (OCDS) predict long-term outcome in alcohol-dependent inpatients.

METHODS

This was a 24-month prospective, observational study in 198 alcohol-dependent inpatients treated under standardized conditions. The primary outcome criterion was abstinence, defined as no subjective report or objective indication of alcohol consumption since discharge from treatment. The patients self-rated their craving for alcohol at the 6- and 12-month follow-ups by using the German version of the OCDS, which measures obsessive and compulsive aspects of craving. Univariate and logistic regression analyses with covariates were performed.

RESULTS

Of the 104 patients interviewed at the 24-month follow-up, 60% (n = 62) were abstinent. We found significant associations between total OCDS scores at 6 months and outcome at 12 months and between total OCDS scores at 12 months and outcome at 24 months: the higher the OCDS total score at one follow-up evaluation, the less likely patients were to be abstinent at the subsequent one. The same association was found for each of the two OCDS subscales, control and consequences and drinking obsessions.

CONCLUSIONS

These results support earlier findings that OCDS scores can predict outcome in alcohol-dependent patients. This information can be used for the timely development of protective resources. Hence, decisions over the use of resources can be made on the basis of objectified parameters to develop a personalized treatment concept. Consequently, economic considerations can induce a reduction of high medical costs.