Article

An in vivo Study of the Relationship between Craving and Reaction Time during Alcohol Detoxification Using the Ecological Momentary Assessment

INSERM (Institut National pour la Santé et la Recherche Medicale), Paris, France.
Alcoholism Clinical and Experimental Research (Impact Factor: 3.31). 01/2006; 29(12):2135-43. DOI: 10.1097/01.alc.0000191760.42980.50
Source: PubMed

ABSTRACT To study cognitive interference associated with craving for alcohol, the Ecological Momentary Assessment (EMA) method was used to measure the relationship between craving and reaction time. A secondary aim was the study of the predictive factors for craving during alcohol detoxification. The EMA enables both repeated measures of craving in a natural setting and the recording of reaction time without the patient being aware of this.
Craving for alcohol, reaction time, sadness and anxiety were recorded 8 to 12 times a day, over three weeks of detoxification in 14 alcoholics (n=1767 measures), on an electronic diary issuing random prompts. Mixed models were used for statistical analysis (alpha=5%, 1-beta=88%).
Reaction time was significantly increased in univariate analysis when a craving episode occurred but this difference did not persist after multivariate analysis. Craving episodes were more frequent and intense than previously reported. Predictive factors of craving during detoxification were: age, gender, sadness, anxiety and the number of previous detoxifications. Antidepressants, anti-craving medications but not benzodiazepines were negatively associated to craving.

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    • "Numerous clinical and preclinical studies have demonstrated that there is a positive relationship between the number of previous alcohol withdrawals and withdrawal-induced seizures (Becker and Hale 1993; McCown and Breese 1990; Rogawski 2005). Furthermore, alcohol withdrawing subjects who have experienced multiple alcohol withdrawal episodes have more severe cravings during the withdrawal phase, are more likely to have a heavy drinking episode during the first few days after quitting, and display a slower decline in Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar, includes among others nausea, tremor, anxiety and agitation) scores compared to subjects who experience their first or second alcohol withdrawal episode (Lukasiewicz et al. 2005; Malcolm et al. 2000). Preclinical studies suggest that repeated alcohol withdrawals may potentiate anxietylike behavior associated with alcohol withdrawal. "
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    • "Craving has been linked to several aspects of alcoholism and associated psychopathology (Yoon et al. 2006). The analysis of the relationship between craving and the clinical characteristics of dependent patients point out that severity of illness (Yoon et al. 2006), number of previous multiple detoxifications (Malcolm et al. 2000, Hillemacher et al. 2006), age (Turkcapar et al. 2005), gender (Vukovic 2006), anxiety (Lukasiewicz et al. 2005), and depression (Yoon et al. 2006) are the most significant predictors of craving. Ludwig et al. (1974) found that alcohol withdrawal symptoms amplified craving possibly as a homeostatic mechanism to lessen physical symptoms. "
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