Inpatient Desire to Drink as a Predictor of Relapse to Alcohol Use Following Treatment

Abstract

Cravings for alcohol are identified as a trigger for relapse, though laboratory studies of cravings produce mixed results in predicting relapse. The objective of this analysis is to assess the usefulness of craving as a predictor of relapse by assessing 218 adult, alcohol-dependent patients admitted to two separate residential addiction treatment programs. Days craving reported in the week prior to discharge predicted alcohol use at three-month follow-up. Admission spirituality, alcohol-refusal self-efficacy, and depression levels differentiated cravers from non-cravers. Patients who crave alcohol in residential treatment may be at higher relapse risk and identified by intake assessments of self-efficacy, depression, and spirituality.

Do Spirituality and Religiosity Help in the Management of Cravings in Substance Abuse Treatment?

“…Future research would benefit from the longitudinal examination of the relationship between spirituality, self-efficacy and cravings, the exploration of a broader range of client specific and interpersonal variables, and the inclusion of a control group from a secular treatment facility. Further, Gordon et al (2006) found that increased craving in the week prior to discharge predicted relapse more effectively than treatment duration or levels of alcohol severity measured at admission.In contrast, factors such as self-efficacy, spirituality, and religiosity may improve substance abuse outcomes. Self-efficacy can be defined as an individual's belief that he or she can effectively cope with difficult situations (Bandura, 1986).…”

“…Spiritual well being has been positively correlated with abstinence self efficacy at both intake and discharge to a 3-week outpatient treatment facility (Piderman, Schneekloth, Pankratz, Maloney and Altchuler, 2007). A study involving telephone interviews of 130 participants 3 months after completing an inpatient alcohol treatment program included measures of cravings, spirituality and self-efficacy being collected at intake, during treatment and at end of treatment (Gordon et al, 2006). As noted, craving prior to discharge was related to drinking relapse at 3 month follow-up.…”

“…As noted, craving prior to discharge was related to drinking relapse at 3 month follow-up. At follow-up, "two distinct clusters of participants" were identified, those who reported no craving to drink (59%) and those still actively craving (41%).Discriminant function analysis indicated that the active cravers were more likely to have entered treatment with lower levels of spirituality and self-efficacy for refusing alcohol and higher levels Spirituality and cravings 7 of depression (Gordon et al, 2006). The authors noted that limitations of their study were the use of a single item craving measure and a relatively homogeneous sample of white, middle-aged individuals who were primarily alcohol-dependent.…”

“…Self-reported experiences of craving for a substance whilst undergoing treatment have been linked to depression, low self-efficacy, psychological distress and relapse (Bottlender & Soyka, 2004;Daughters, Lejuez, Kahler, Strong & Brown., 2005;Gordon et al, 2006). A craving is defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as a 'persistent desire to use a substance ' (American Psychiatric Association, 2000, p. 201).…”

“…Craving measures at entry to treatment have been found to predict relapse (e.g., Gordon et al, 2006;Bottlender & Soyka, 2004). Not only are those with higher levels of craving more likely to drop-out and relapse before completing their treatment program, but high craving at treatment completion predicted relapse at a 12 month follow-up (Bottlender & Soyka, 2004).…”