Kindling of withdrawal: A study of craving and anxiety after multiple detoxifications in alcoholic inpatients

Background: The increased severity of withdrawal during successive detoxifications from alcohol is well documented for seizures, but the importance of the number of withdrawal events for other withdrawal symptoms such as anxiety and for alcohol craving is not known. Studies in animals are consistent with increases in reinforcing properties of alcohol with a greater number of withdrawal experiences. Thus, we predicted that patients who had undergone multiple detoxifications would show greater desire for alcohol and might experience more anxiety compared with patients with fewer detoxifications or compared with social drinkers. Methods: Forty-two alcoholic inpatients were divided on the basis of medically supervised detoxifications into HI-med (more than two previous detoxifications, n=6) and LO-med (two or fewer previous detoxifications, n=36) and compared with a group of social drinkers matched for age, sex, and verbal IQ (n=43). An additional analysis was performed by dividing the participants into HI-total (n=22) and LO-total (n=20) previous detoxification groups (three or more and less than three previous detoxifications, respectively) by using all previous detoxifications, which included unsupervised attempts. Anxiety was measured by Spielberger's State-Trait Anxiety Inventory; mood was evaluated by using the Profile of Mood States; craving was evaluated with a short version of the Desire for Alcohol Questionnaire; and an emotional Stroop test was used that employed positive, negative, and alcohol-related words. Results: When the analysis was based on the medically supervised detoxifications only, alcoholic participants (HI- and LO-med) had higher ratings in trait anxiety and in feelings of anger, anxiety, depression, and confusion, but also friendliness; had higher craving ratings; and made more errors in the alcohol Stroop compared with social drinkers. In addition, the number of errors in the emotional Stroop for negative words was higher in the group with the higher number of detoxifications. When we analyzed the total number of detoxifications, this effect for the emotional Stroop errors was no longer seen. Instead, ratings of anger in the Profile of Mood States were greater in the HI-total compared with the LO-total detoxification group. These effects remained when the correlates alcohol consumption and degree of dependency were introduced as covariates, which showed that the effects found are probably attributable to the number of withdrawals. Conclusions: These data suggest that for inpatients with short history of alcoholism, the consequences of multiple withdrawals may not relate to anxiety or craving.