Context and craving among individuals with alcohol use disorder attempting to moderate their drinking.

Abstract

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 interventions 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 SignificanceAlcohol 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.

Alcohol craving in the natural environment: Moderating roles of cue exposure, drinking, and alcohol sensitivity.

“…The present study aimed to (a) examine synergistic effects of cue exposure and alcohol exposure (i.e., postdrinking status) on craving in the natural environment and (b) test the extent to which these effects are moderated by individual differences in sensitivity to alcohol’s effects (Fleming et al, 2021; Trela et al, 2018). Consistent with findings from prior laboratory (e.g., de Wit & Chutuape, 1993; Kirk & de Wit, 2000; Litt & Cooney, 1999; Manchery et al, 2017; Monti et al, 1993; Ramirez et al, 2015a, 2015b) and field-based studies (Fatseas et al, 2015; Kuerbis et al, 2020; Miranda et al, 2014; Ramirez & Miranda, 2014; Schoenmakers & Wiers, 2010; Trela et al, 2018; Treloar Padovano & Miranda, 2021), craving in the natural environment was increased after cue exposure and during drinking episodes.…”

The effect of alcohol on mood among males drinking with a platonic friend

“…For instance, research is indicated that contrasts romantic and platonic relationships, same and mixed‐gender interactions, and more generally, relationships differing in degree of familiarity. Moreover, it will be important to explore how subjective effects of alcohol and other drinking‐related experiences (e.g., alcohol cravings) differ according to solitary vs. social contexts among both social drinkers and those struggling with alcohol use disorder (Creswell, 2021; Kuerbis et al, 2020). Such studies hold promise for developing more comprehensive models of alcohol use disorder etiology and psychotherapeutic treatments that embrace the social nature of alcohol.…”

Contextual influences on subjective alcohol response.

“…Our results largely support prior EMA studies that highlight the importance of contextual effects on drinking behavior (Freisthler, Lipperman-Kreda, Bersamin, & Gruenewald, 2014; Ray et al, 2010). For example, drinking in groups and/or in contexts with drinking cues has been shown to increase craving for alcohol and alcohol consumption (Kuerbis et al, 2020; O’Donnell et al, 2019; Trela et al, 2018). Overall, our results suggest that stimulating responses to alcohol may depend on the context, particularly the social context, in which one drinks.…”