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

Abstract

Background: 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 unexamined. This study explored the relationship between rash impulsiveness, craving, and treatment response in a sample of AUD outpatients.Design: Longitudinal study conducted over a 12-week intervention period.Setting: University public hospital outpatient alcohol and drug clinic. Participants: Patients attending an abstinence-based Cognitive-Behavioural Therapy program for AUD (N = 304).Procedure: Assessments were completed pre-and-post treatment. Craving and alcohol consumption were assessed at each treatment session.Results: 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). The association between craving and lapse-risk increased as treatment progressed (b = 0.01, 95% CI = 0.01, 0.02). Craving positively mediated the relationship between impulsivity and lapse-risk (µ = 0.38, 95% CI = 0.10, 0.70). Conclusions:Craving mediates the effect of impulsivity in the prediction of lapse during abstinence-oriented treatment for AUD. Frequent assessment and management of craving during treatment is recommended to reduce alcohol lapse.

The Role of Impulsivity and Reward Deficiency in “Liking” and “Wanting” of Potentially Problematic Behaviors and Substance Uses

“…Considering that “wanting” and craving are closely related ( 103 ), this is in line with the findings of Meule and Blechert ( 104 ), who reported no direct effect of impulsivity on the body mass index, but higher impulsivity predicted more frequent and intense food cravings, which in turn predicted lower perceived self-regulatory success in eating, and that in turn predicted a higher body mass index. Also, in another study, higher rash impulsiveness (the tendency for approach despite potential negative consequences) did not directly predict the risk of relapse but was found to increase vulnerability to the craving, which in turn, increased the risk of relapse ( 105 ). However, the lack of direct association between impulsivity and problem behaviors is in contrast with a large literature [for a review see ( 106 )], thus, more focused studies would be necessary to better understand the role of impulsivity-related constructs on incentive sensitization.…”

A double-blind sham-controlled phase 1 clinical trial of tDCS of the dorsolateral prefrontal cortex in cocaine inpatients: craving, sleepiness, and contemplation to change

“…Our results also showed a significant decrease in impulsivity with time in inpatient treatment, with both groups better able to value monetary reinforcement even if delayed in time (Odum, 2011; Mejía-Cruz et al , 2016). The association between impulsivity and craving deserves further exploration especially in light of a recent study in patients with alcohol use disorder showing that increased impulsivity was associated with higher craving, which, in turn, increased the likelihood of alcohol use in treatment, suggesting that craving mediates the relationship between impulsivity and the likelihood to relapse (Coates et al , 2020).…”

Psychosocial Factors Predict the Level of Substance Craving of People with Drug Addiction: A Machine Learning Approach

“…First, impulsivity and alexithymia have been proved that could promote substance craving [20,67]. A study of patients with alcohol use disorder (AUD) found that AUD patients with a predisposition for rash impulsiveness are more vulnerable to alcohol craving, and subsequently, poorer treatment outcomes [68]. As for the mechanism of impulsivity on craving, relevant studies have shown that impulsivity could moderate the effect of social anxiety on alcohol craving, specifically, under the premise of increased impulsivity, socially anxious individuals receiving alcohol cues have a stronger craving for alcohol [69].…”