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: 3.21). 01/2006; 29(12):2135-43. DOI: 10.1097/01.alc.0000191760.42980.50
Source: PubMed


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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    • "We expected this effect to generalize to the natural environment, such that adolescents would experience a greater likelihood and severity of craving when in the presence of alcohol cues in their daily lives compared to situations where alcohol cues are not present. We examined both the likelihood and severity of craving in the field because we anticipated infrequent reports of craving based on previous studies utilizing EMA methods to assess craving for alcohol among adults (Litt et al. 2000; Lukasiewicz et al. 2005). Similar to the lab portion of the study, we expected this effect would be more pronounced among adolescents with more severe alcohol-related problems . "
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    ABSTRACT: Initial lab studies suggest that adolescent drinkers crave alcohol when presented with alcohol cues. Whether this effect generalizes to the natural environment, however, remains unknown, and studies have not examined whether craving predicts drinking among youths. This study builds on existing research by pairing controlled lab-based cue reactivity assessments (CRAs) with data collected in the natural environment using ecological momentary assessment (EMA) methods. We examined whether alcohol cues evoke craving among adolescent drinkers in the lab and natural environment, and tested the clinical relevance of craving during adolescence by examining the prospective association between craving and alcohol use. Non-treatment-seeking adolescent drinkers (N = 42; ages 15 to 20 years) completed a lab-based CRA followed by a 1-week EMA monitoring period. During the EMA period, youth were prompted randomly throughout the day to record momentary data on craving and contextual factors (e.g., alcohol cues, peers present). Alcohol cues elicited craving in the lab, and this effect generalized to the natural environment, especially among adolescents with more alcohol problems. In addition, craving predicted subsequent drinking levels in the natural environment. This study demonstrates the utility of pairing lab paradigms with EMA methods to better characterize adolescents' reactivity to alcohol cues. Results implicate craving as a clinically meaningful motivator for drinking among adolescents and highlight a potentially important target of pharmacological or behavioral intervention.
    Psychopharmacology 12/2013; 231(8). DOI:10.1007/s00213-013-3372-6 · 3.88 Impact Factor
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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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    ABSTRACT: Discontinuation of chronic and excessive alcohol consumption leads to a dysphoric state in humans. It is not known if there are changes in brain reward function after the discontinuation of an alcohol liquid in rats. The aim of these studies was to investigate the effect of withdrawal from an alcohol liquid diet on brain reward function and acute and protracted anxiety-like behavior. The intracranial self-stimulation procedure was used to assess brain reward function, and the elevated plus maze test was used to assess anxiety-like behavior. Discontinuation of chronic, 12 weeks, exposure to a 6.2% v/v alcohol liquid diet lead to a minor deficit in brain reward function and did not increase anxiety-like behavior. Discontinuation of chronic, 12 weeks, exposure to a 10% v/v alcohol liquid diet lead to a pronounced deficit in brain reward function and increased anxiety-like behavior. Two weeks after discontinuation of the 10% v/v alcohol liquid diet, the rats with a history of alcohol dependence did not display increased anxiety-like behavior. Restraint stress increased anxiety-like behavior in the rats with a history of alcohol dependence, but not in the control rats. Brain reward thresholds were assessed during the chronic 10% v/v alcohol exposure period. During this period, there were no differences between the brain rewards thresholds of the alcohol and control rats. These findings indicate that withdrawal from a 10% v/v alcohol liquid diet leads to a pronounced deficit in brain reward function and acute and protracted anxiety-like behavior in rats.
    Psychopharmacology 04/2009; 203(3):629-40. DOI:10.1007/s00213-008-1409-z · 3.88 Impact Factor
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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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    ABSTRACT: Fifty years ago, craving was defined as an "urgent and overpowering desire, or irresistible impulse", but subsequently, craving definitions have been modified by many authors and no unique definition of this phenomena, or a consensus in regards to its manifestation and significance exists. This review discusses the contemporary views of alcohol craving. Issues such as definition and different types, dynamics of craving, its mediators and moderators and clinical correlations are explored. We focused on the literature search (MEDLINE, PSYCHLIT, and EMBASE) and new findings in the addiction field, especially paying attention on the study of craving. There is growing evidence to suggest that craving is associated with different aspects of addiction (i.e. withdrawal, relapse) and clinical characteristics such as depression and anxiety. These different phenomena contribute individual differences in intensity, frequency and types of craving. At present, there are several different models to better describe the complexity of craving. Craving is not an exact, precisely measurable value but it is rather an uncertain, descriptive phenomenon. Further research (biological, sociological and psychological) should be orientated primarily toward exploration of the relationship between environmental factors and personality variables and craving and its maintenance, with special attention to gender differences.
    Psychiatria Danubina 01/2009; 20(4):500-7. · 1.30 Impact Factor
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