Reward and relief dimensions of temptation to drink: construct validity and role in predicting differential benefit from acamprosate and naltrexone

Abstract

Researchers have sought to distinguish between individuals whose alcohol use disorder (AUD) is maintained by drinking to relieve negative affect (“relief drinkers”) and those whose AUD is maintained by the rewarding effects of alcohol (“reward drinkers”). As an opioid receptor antagonist, naltrexone may be particularly effective for reward drinkers. Acamprosate, which has been shown to down-regulate the glutamatergic system, may be particularly effective for relief drinkers. This study sought to replicate and extend prior work (PREDICT study; Glöckner-Rist et al. 2013) by examining dimensions of reward and relief temptation to drink and subtypes of individuals with distinct patterns of reward/relief temptation. We utilized data from two randomized clinical trials for AUD (Project MATCH, n=1726 and COMBINE study, n=1383). We also tested whether classes of reward/relief temptation would predict differential response to naltrexone and acamprosate in COMBINE. Results replicated prior work by identifying reward and relief temptation factors, which had excellent reliability and construct validity. Using factor mixture modeling, we identified 5 distinct classes of reward/relief temptation that replicated across studies. In COMBINE, we found a significant class-by-acamprosate interaction effect. Among those most likely classified in the high relief/moderate reward temptation class, individuals had better drinking outcomes if assigned to acamprosate versus placebo. We did not find a significant class-by-naltrexone interaction effect. Our study questions the orthogonal classification of drinkers into only two types (reward or relief drinkers) and adds to the body of research on moderators of acamprosate, which may inform clinical decision making in the treatment of AUD.

Differences between treatment-seeking and non-treatment-seeking participants in medication studies for alcoholism: do they matter?

“…These results provide initial evidence that demographical and clinical differences between treatment-seekers and non-treatment seekers with AUD are significantly related to treatment outcomes. And while in-depth analyses of moderators of response to each intervention in the COMBINE Study (i.e., Acamprosate, Naltrexone, and CBI) are beyond the scope of the present study, recent studies have proposed a host of putative moderators, including craving for alcohol [21], reward and relief drinking dimensions [22], social network [23], and body mass index (BMI) [24]. In the context of this study, we sought to examine the clinical significance (i.e., prediction of clinical outcome) of the variables found to differ between treatment-seekers and non-treatment seekers, as opposed to investigate their potential moderating role.…”

A contextual model of self-regulation change mechanisms among individuals with addictive disorders

“…We have found preliminary support for this notion in our secondary analysis of Project MATCH. We demonstrated that the frequency of using coping skills at post-treatment significantly mediated the treatment effects of CBT for alcohol use disorder among outpatient clients with high dependence severity, but not those with low dependence severity (Roos, Maisto, & Witkiewitz, in press). …”

“…However, they did not report whether coping skills mediated the effects of TES on longer-term outcomes. Finally, Roos, Maisto, and Witkiewitz (in press) conducted secondary analyses of the Project MATCH data to examine whether baseline alcohol dependence severity moderated the indirect effect of CBT on alcohol use outcomes via coping skills. Results indicated that end-of-treatment coping skills mediated the positive treatment effects of CBT on one-year drinking outcomes among outpatient clients with high dependence severity, but not those with low dependence severity.…”

“…For example, latent class analysis can be used to empirically identify latent classes of individuals based on similar patterns of responses across several variables. The latent class variable can then be used to test how class membership may moderate the effect of treatment condition on MOBC variables or outcomes (see Cooper & Lanza, 2014 and Roos, Mann, & Witkiewitz, in press, as examples). The incorporation of multiple contextual factors with higher-order interaction analyses or latent class analysis will often require relatively large sample sizes.…”

The Addictions Neuroclinical Assessment Negative Emotionality Domain Among Treatment‐Seekers with Alcohol Use Disorder: Construct Validity and Measurement Invariance

“…Those with greater substance use and negative affect severity are more likely to benefit from mindfulness-based relapse prevention (Roos et al, 2017a). Furthermore, reasons for alcohol use (e.g., reward vs. relief motives, drinking to cope) differentially predict response to naltrexone and acamprosate (Mann et al, 2018;Roos et al, 2017b;Witkiewitz et al, 2019b) and cognitive-behavioral therapy (Anker et al, 2016).…”