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Experimental and Clinical Psychopharmacology Context and Craving Among Individuals with Alcohol Use Disorder Attempting to Moderate Their Drinking Alexis N

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Experimental and Clinical Psychopharmacology Context and Craving Among Individuals with Alcohol Use Disorder Attempting to Moderate Their Drinking Alexis N Experimental and Clinical Psychopharmacology Context and Craving Among Individuals With Alcohol Use Disorder Attempting to Moderate Their Drinking Alexis N. Kuerbis, Sijing Shao, Hayley Treloar Padovano, Anna Jadanova, Danusha Selva Kumar, Rachel Vitale, George Nitzburg, Nehal P. Vadhan, and Jon Morgenstern Online First Publication, January 23, 2020. http://dx.doi.org/10.1037/pha0000349 CITATION Kuerbis, A. N., Shao, S., Treloar Padovano, H., Jadanova, A., Selva Kumar, D., Vitale, R., Nitzburg, G., Vadhan, N. P., & Morgenstern, J. (2020, January 23). Context and Craving Among Individuals With Alcohol Use Disorder Attempting to Moderate Their Drinking. Experimental and Clinical Psychopharmacology. Advance online publication. http://dx.doi.org/10.1037/pha0000349 Experimental and Clinical Psychopharmacology © 2020 American Psychological Association 2020, Vol. 1, No. 999, 000 ISSN: 1064-1297 http://dx.doi.org/10.1037/pha0000349 Context and Craving Among Individuals With Alcohol Use Disorder Attempting to Moderate Their Drinking Alexis N. Kuerbis Sijing Shao City University of New York Center for Addiction Services and Psychotherapy Research, Northwell Health, Great Neck, New York Hayley Treloar Padovano Anna Jadanova, Danusha Selva Kumar, Center for Alcohol and Addiction Studies, Providence, Rachel Vitale, George Nitzburg, Nehal P. Vadhan, Rhode Island and Jon Morgenstern Center for Addiction Services and Psychotherapy Research, Northwell Health, Great Neck, New York 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 interven- tions 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. Public Health Significance Alcohol use disorder (AUD) is a highly prevalent disorder, experienced around the globe. Craving, one of the hallmarks of AUD, is highly associated with continued use and/or relapse to use. This study provides important information about context eliciting craving that is useful to both those suffering with and treating AUD, so as to provide greater opportunities for reduction of harm and successful recovery. Keywords: alcohol craving, alcohol use disorder, drinking context, drinking cues This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. analysis and research questions. In addition, Jon Morgenstern was PI on the X Alexis N. Kuerbis, Silberman School of Social Work, Hunter Col- parent study grant. Alexis N. Kuerbis was primary for write-up of the lege, City University of New York; Sijing Shao, Center for Addiction manuscript, and Hayley Treloar Padovano consulted on analytic methods Services and Psychotherapy Research, Northwell Health, Great Neck, New and reviewed and edited manuscript. Sijing Shao was the data manager and York; X Hayley Treloar Padovano, Department of Psychiatry and Human implemented the analytic plan and wrote up the results of the analysis. Behavior, Center for Alcohol and Addiction Studies, Providence, Rhode Nehal P. Vadhan was project director of the parent study and contributed Island; Anna Jadanova, Danusha Selva Kumar, Rachel Vitale, X George to the write-up of the study and edited the manuscript. Anna Jadanova, Nitzburg, Nehal P. Vadhan, and Jon Morgenstern, Center for Addiction Danusha Selva Kumar, Rachel Vitale, and George Nitzburg were all Services and Psychotherapy Research, Northwell Health. involved in parent study, actively involved in coding the craving contexts, This study was supported with funding from the National Institute on and contributed to the conceptualization of the study and write-up. Alcohol Abuse and Alcoholism (Grant R01 AA022714; PI: Jon Morgen- Correspondence concerning this article should be addressed to Alexis N. stern). None of the material presented in this article had been presented Kuerbis, Silberman School of Social Work, Hunter College, City Univer- anywhere prior to its submission. Jon Morgenstern, Alexis N. Kuerbis, and sity of New York, 2180 Third Avenue, New York, NY 10035. E-mail: Hayley Treloar Padovano were primary contributors for the design of this [email protected] 1 2 KUERBIS ET AL. Alcohol use disorder (AUD) is a costly, heterogeneous disorder Fatseas, Swendsen, & Auriacombe, 2015). Some studies also that is widespread across the globe (Rehm et al., 2009). Individuals demonstrated that craving is a stronger predictor of drinking than with AUD present with a continuum of symptoms, with some even prior drinking (e.g., Flannery, Poole, Gallop, & Volpicelli, demonstrating greater severity than others. Among those individ- 2003). Importantly for individuals with AUD attempting to mod- uals with AUD, a subset are characterized by having mild to erate their drinking, alcohol use and craving are demonstrated to moderate levels of AUD severity, low rates of co-occurring dis- have a reciprocal relationship (Browne, Wray, Stappenbeck, orders, and higher psychosocial functioning than those with severe Krenek, & Simpson, 2016; Fazzino et al., 2013; Flannery et al., AUD (Hester, 1995; Morgenstern et al., 2007, 2012, 2017; Rosen- 2003), each increasing the other prospectively. berg, 1993). These individuals, historically referred to as problem drinkers, may endorse symptoms of AUD but do not report a The Association Between Alcohol Cues and Craving history of withdrawal or extreme personal or social consequences from drinking in their lives. Given their tendency for higher Alcohol cues predict alcohol craving (Carter & Tiffany, 1999), functioning and a symptom profile that is relatively less severe, yet there is surprisingly little research on which types of cues or this subset often does not identify consequences from drinking as contexts drive alcohol craving on a daily basis (Serre et al., 2015), being severe enough to require abstinence, thus preferring a goal of particularly in the context of a goal of moderation or among a moderation, and rarely seek specialized treatment. These individ- general population of individuals with AUD. In vivo alcohol cues uals are estimated to make up about half of all individuals with extend beyond direct exposure to alcohol itself; studies have AUD (Moss, Chen, & Yi, 2007). Engaging with individuals with consistently shown that contexts associated with alcohol use be- AUD around a goal of moderation can lead to harm reduction, come cues for use themselves (Childs & de Wit, 2016). Although health improvement, and prevention of worsening AUD. a number of studies have examined alcohol craving using ecolog- ical momentary assessment (EMA), few have examined type of The Unique Situation of Craving in the Context of context directly or in detail among adults, beyond experiencing negative affect (e.g., Hallgren et al., 2018; Kaysen et al., 2014; Moderation as a Drinking Goal Law et al., 2016; Lukasiewicz, Benyamina, Reynaud, & Falissard, For individuals with AUD, achieving moderate drinking (i.e., 2005; Piasecki et al., 2011; Richardson et al., 2008; Todd et al., drinking within the healthy/low-risk guidelines set out by the 2005). The few studies that focused on context beyond negative National Institute for Alcohol Abuse and Alcoholism (NIAAA); affect provide information about the additional real-world alcohol National Institute on Alcohol Abuse and Alcoholism, 2013) may cues driving craving (Dulin & Gonzalez, 2017; Lane, Carpenter, pose unique challenges compared with abstinence. Given that Sher, & Trull, 2016; Trela et al., 2018; Witteman et al., 2015), each individuals attempting to moderate drinking regularly expose focusing on a subpopulation of individuals with AUD. Witteman et themselves to alcohol and other external alcohol-related cues, such al. (2015) found, not surprisingly, that exposure to advertisements as drinking contexts (i.e., bars), they are likely to trigger highly for alcohol in the real world environments of alcohol dependent automated neurocognitive processes involving craving that
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