Predicting relapse in patients with severe alcohol use disorder: The role of alcohol insight and implicit alcohol associations

Dandaba, Meira; Serra, Wilfried; Harika‐Germaneau, Ghina; Silvain, Christine; Langbour, Nicolas; Solinas, Marcello; Noël, Xavier; Jaafari, Nemat; Chatard, Armand

doi:10.1016/j.addbeh.2020.106433

Cited by 15 publications

(21 citation statements)

References 61 publications

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“…Our results are consistent with a previous study, which showed that lower clinical insight level was related to lower craving for alcohol self-reported retrospectively on the Obsessive-Compulsive Drinking Scale (OCDS) (23). Interestingly, some studies in addiction suggest that low clinical insight relates to earlier relapse (24,37) or worse outcomes (e.g., drinking behavior) (38) after addiction treatment. Based on our results, we make the hypothesis that low clinical insight may negatively impact the ability to self-report craving retrospectively (the most common way craving is assessed in standard clinical practice) that in turn may interfere with participant's ability to seek treatment, and control craving when in treatment, and in turn be associated with a greater risk of relapse.…”

Section: Discussionsupporting

confidence: 92%

“…In another study, no association was found between "perceived need to change one's own drug use, " also evaluated with task choice preference, and cocaine craving, but the sample was very small (n = 18) (22). In contrast, two studies reported lower or equal level of craving for alcohol among individuals with lower clinical insight evaluated on the self-reported Hanil Alcohol Insight Scale (23,24). To our knowledge, no study has yet examined the association between PTN and craving.…”

Section: Introductionmentioning

confidence: 95%

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Link Between Perception of Treatment Need and Craving Reports in Addiction

et al. 2022

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BackgroundPerception of treatment need (PTN), a component of clinical insight, is associated to negative addiction treatment outcomes when low. Our hypothesis was that lower PTN was associated with less craving when reported retrospectively, the most common measure of craving in clinical settings.ObjectiveTo explore the association between PTN and craving among a dataset of subjects with severe substance use disorders.MethodsParticipants were recruited from outpatient addiction clinic admissions or harm reduction program services. Good and low PTN were based on consistency between severe addiction (at least six DSM-5 criteria) and self-report need for addiction treatment from the Addiction Severity Index. Craving was retrospectively characterized over the past 30 days. Multiple regression analyses were conducted.ResultsParticipants with low PTN (n = 97) retrospectively reported less frequent and intense episodes of craving, compared with participants with good PTN (n = 566) after controlling for sociodemographic factors, addiction type, and severity (p < 0.0001).ConclusionLow perception of treatment need among subjects with severe addictions is associated to less retrospective report of craving, which may contribute to reduced efficiency of treatment. Further studies are needed to explore the mechanisms of the association.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 95%

Link Between Perception of Treatment Need and Craving Reports in Addiction

et al. 2022

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“…Indeed, 3 independent studies by 3 different research groups using a similar methodology (Field et al, 2017;Martin Braunstein et al, 2016;Spruyt et al, 2013) found that avoidance orientation of alcohol was higher among patients with AUD during rehabilitation, compared to healthy controls. This negative bias is also consistent with prior research showing that patients treated for AUD often show a negative implicit attitude toward alcohol (Dandaba et al, 2020;De Houwer et al, 2004;Wiers et al, 2002) on various versions of the implicit association task. Although this approach bias might initially appear counterintuitive, it could be attributable to several factors, each of which can potentially lead to negative alcohol expectations.…”

Section: Impact/relevance Of the Findingssupporting

confidence: 90%

Distinct Whole‐Body Movements in Response to Alcohol and Sexual Content in Alcohol Use Disorder

Noël

Dubuson

Rougier

et al. 2021

Alcoholism Clin & Exp Res

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Background Spontaneous motor responses of approach and avoidance toward stimuli are important in characterizing psychopathological conditions, including alcohol use disorder (AUD). However, divergent results have been reported, possibly due to confounded parameters (e.g., using a symbolic vs. a sensorimotor task, implementation of approach–avoidance as a measure vs. a manipulation). Methods We studied whole‐body/posturometric changes by using a sensorimotor measure relying on embodied cognition principles to assess forward (approach) and backward (avoidance) spontaneous leaning movements. Over a 12‐second period, 51 male patients with AUD and 29 male control participants were instructed to stand still in response to both alcohol and sexual visual content. Patients with AUD were then divided into “abstainers” and “relapsers,” depending on their continuous abstinence at 2 weeks postdischarge (obtained via a telephone follow‐up interview). The effects of the group, the stimulus type, the experimental period, and their interactions on the posturometric changes were tested using mixed Analyses of variance (ANOVAs), with a significance threshold set at 0.05. Results Contrary to our expectations, patients and controls did not show significant difference in their forward/backward micromovements while passively viewing alcohol or sexual content (p > 0.1). However, in line with our hypothesis, patients who relapsed several weeks following discharge from the rehabilitation program were significantly more reactive and more likely to lean back during the first seconds of viewing alcohol cues (p = 0.002). Further, “relapsers” were more likely to lean forward during exposure to sexual content than participants who remained abstinent (p < 0.001). Conclusions Among individuals with AUD, there are distinct pattern of spontaneous movements that differentiate “abstainers” and “relapsers,” findings that can be understood in light of existing data and theories on action tendencies.

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“…Although translation of the animal concepts and methodologies described above is limited, human studies have addressed related constructs, such as cue reactivity [90,124] ( Table 1). The presentation of alcohol-associated cues, e.g., the sight or smell of an alcoholic beverage, has been shown to bias approach tendencies [199][200][201] and attention [202][203][204], with increased attentional bias predicting relapse risk [205,206], and induce conscious craving [204,[207][208][209][210][211][212] in individuals diagnosed with AUD. Passive viewing tasks, in which participants are shown alcohol cues (images of alcoholic beverages), affectively neutral images and abstract images, have been widely used to research cue reactivity in AUD patients.…”

Section: Findings In Alcohol Use Disorder and At-risk Populationsmentioning

confidence: 99%

Instrumental and Pavlovian Mechanisms in Alcohol Use Disorder

et al. 2020

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Purpose of Review Current theories of alcohol use disorders (AUD) highlight the importance of Pavlovian and instrumental learning processes mainly based on preclinical animal studies. Here, we summarize available evidence for alterations of those processes in human participants with AUD with a focus on habitual versus goal-directed instrumental learning, Pavlovian conditioning, and Pavlovian-to-instrumental transfer (PIT) paradigms. Recent Findings The balance between habitual and goal-directed control in AUD participants has been studied using outcome devaluation or sequential decision-making procedures, which have found some evidence of reduced goal-directed/model-based control, but little evidence for stronger habitual responding. The employed Pavlovian learning and PIT paradigms have shown considerable differences regarding experimental procedures, e.g., alcohol-related or conventional reinforcers or stimuli. Summary While studies of basic learning processes in human participants with AUD support a role of Pavlovian and instrumental learning mechanisms in the development and maintenance of drug addiction, current studies are characterized by large variability regarding methodology, sample characteristics, and results, and translation from animal paradigms to human research remains challenging. Longitudinal approaches with reliable and ecologically valid paradigms of Pavlovian and instrumental processes, including alcohol-related cues and outcomes, are warranted and should be combined with state-of-the-art imaging techniques, computational approaches, and ecological momentary assessment methods.

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Predicting relapse in patients with severe alcohol use disorder: The role of alcohol insight and implicit alcohol associations

Cited by 15 publications

References 61 publications

Link Between Perception of Treatment Need and Craving Reports in Addiction

Link Between Perception of Treatment Need and Craving Reports in Addiction

Distinct Whole‐Body Movements in Response to Alcohol and Sexual Content in Alcohol Use Disorder

Instrumental and Pavlovian Mechanisms in Alcohol Use Disorder

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