An in vivo Study of the Relationship between Craving and Reaction Time during Alcohol Detoxification Using the Ecological Momentary Assessment
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. "
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 01/2009; 203(3):629-40. DOI:10.1007/s00213-008-1409-z · 3.99 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. "
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. · 0.65 Impact Factor
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ABSTRACT: Numerous symptoms in psychiatry are subjective (e.g., sadness, anxiety, craving or fatigue), fluctuate and are environment dependent. Accurate measurement of these phenomena requires repeated measures, and ideally needs to be performed in the patient's natural environment rather than in an artificial laboratory environment or a protected hospital environment. The usual paper and pencil questionnaires do not meet these two conditions for reasons of logistics. A recently developed method, ecological momentary assessment (EMA), made it possible to implement these field assessments via ingenious use of various devices (most frequently an electronic diary) coupling an auditory signal with computerized data capture. The subject carries the device with him/her at all times, and data is recorded in vivo in real time. The programming of repeated measures in the form of a Likert scale or pull-down menu is easily achieved. A recall alarm system can help increase compliance. Compared with classical self-report, EMA improves the validity of the assessment of certain symptoms, which are the main evaluation criteria in clinical trials concerning certain pathologies (e.g., craving and treatment of addiction), where measurement was previously liable to bias. This article sets out to present this method, its advantages and disadvantages, and the interest it presents in psychiatry, in particular via three original applications developed by the authors including: measurement of reaction time without the knowledge of the subject in order to test certain cognitive models; use of a graphic solution for the data recorded for functional analysis of disorders; and the use of data collection via mobile phone and text messages, which also enables therapeutic interventions in real time by text messages, personalized on the basis of the situational data collected (e.g., in the case of craving, the associated mood, solitary or group consumption or concomitant occupations).Expert Review of Neurotherapeutics 09/2007; 7(8):939-50. DOI:10.1586/1473718.104.22.1689 · 2.83 Impact Factor