Reactivity to alcohol-related stimuli in the laboratory and in the field: predictors of craving in treated alcoholics

Aims. (1) To search for predictors of alcohol craving in treated alcoholics; (2) to evaluate the relationship between craving and drinking immediately after treatment. Design. Alcoholic patients in treatment underwent cue-reactivity trials in the laboratory and then recorded craving in the field using hand-held computers. Laboratory craving was correlated with craving in the field, and moods and situations recorded in the field were correlated with contemporaneous craving ratings using a multi-level correlational design. Setting. A VA Medical Center substance abuse treatment program provided the treatment and laboratory settings. The patients' home environment was the field setting. Participants. Male alcohol-dependent veterans (N = 26) treated in a VA inpatient or intensive outpatient program. Intervention. Participants underwent two cue-reactivity laboratory sessions prior to discharge to measure craving. Following discharge, participants recorded drinking and cravings eight times per day for 21 consecutive days. Measurements. Craving ratings in the laboratory and multiple recordings per day of surroundings, craving and mood state in the field. Findings. Desire to drink in the laboratory accounted for 8-10% of the variance in later drinking and urges to drink recorded in the field-a modest correlation. Frequency of positive urges in the field was significantly correlated with drinking frequency. Those who reported urges in the field had greater alcohol dependence and higher trait anger and anxiety scores than non-reporters. Conclusions. Craving is related to drinking immediately following treatment, and is most likely in those who have more severe dependence and greater mood disturbance. These individuals may benefit most from interventions for coping with cravings after treatment.