Craving mediates the effect of impulsivity on lapse-risk during alcohol use disorder treatment. 2020

Jason M Coates, and Matthew J Gullo, and Gerald F X Feeney, and Ross McD Young, and Genevieve A Dingle, and Paul J Clark, and Jason P Connor
Alcohol and Drug Assessment Unit, Division of Medicine, Princess Alexandra Hospital, Brisbane, Australia; Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, Australia; School of Psychology, The University of Queensland, Brisbane, Australia.

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.

UI MeSH Term Description Entries
D007175 Impulsive Behavior An act performed without delay, reflection, voluntary direction or obvious control in response to a stimulus. Impulsivity,Behavior, Impulsive,Behaviors, Impulsive,Impulsive Behaviors,Impulsivities
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D012008 Recurrence The return of a sign, symptom, or disease after a remission. Recrudescence,Relapse,Recrudescences,Recurrences,Relapses
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000081983 Mediation Analysis A type of statistical analysis used to understand, clarify, and explain the relationship and pathway between a presumed cause (an independent variable) and effect (dependent variable) with respect to causal links (mediating variables) and/or to analyze the effect of an intervention (mediating factor/variable) on an outcome. Causal Mediation Analysis,Intermediary Factors,Intermediary Variables,Intervening Factors,Intervening Variables,Mediating Factors,Mediating Variables,Causal Mediation Analyses,Intermediary Factor,Intermediary Variable,Intervening Factor,Intervening Variable,Mediating Factor,Mediating Variable,Mediation Analyses,Mediation Analyses, Causal,Mediation Analysis, Causal,Variables, Intermediary
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly
D000437 Alcoholism A primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial. Each of these symptoms may be continuous or periodic. (Morse & Flavin for the Joint Commission of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine to Study the Definition and Criteria for the Diagnosis of Alcoholism: in JAMA 1992;268:1012-4) Alcohol Abuse,Alcoholic Intoxication, Chronic,Ethanol Abuse,Alcohol Addiction,Alcohol Dependence,Alcohol Use Disorder,Abuse, Alcohol,Abuse, Ethanol,Addiction, Alcohol,Alcohol Use Disorders,Chronic Alcoholic Intoxication,Dependence, Alcohol,Intoxication, Chronic Alcoholic,Use Disorders, Alcohol

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