Obsessive and Compulsive Characteristics of Craving for Alcohol in Alcohol Abuse and Dependence

Abstract

The purpose of this study was to quantify the extent to which subjective ratings of craving for alcohol in the alcohol-abusing or dependent person (herein, alcoholic) correlate with measurable and specific characteristics of obsessions and compulsions. The Yale-Brown Obsessive Compulsive Scale modified to reflect obsessionality and compulsivity specifically related to heavy drinking (Y-BOCS-hd) was used for this purpose. Highly significant correlations were found in the alcoholic population (n = 62) between subjectively rated craving for alcoholic beverages and several of the Y-BOCS-hd questions regarding alcohol-related thoughts and drinking behavior. Additionally, mean craving scores were considerably greater in the alcoholic population than in the matched control population (n = 62). The data suggest that craving shares specific features in common with the obsessions of obsessive-compulsive disorder and that the existence of craving is dependent on the presence of obsessive thoughts about drinking. Positive correlations between craving and measures of compulsive drinking behavior also were found; compulsive drinking behavior, however, may reflect the consequences of craving rather than a fundamental characteristic of craving itself. The data show that despite difficulties in defining the term craving, it is clearly a phenomenon that is experienced or endorsed by most alcoholic subjects and is not by most persons who do not abuse alcohol.

Endogenous Opioid Activity Is Associated with Obsessive-Compulsive Symptomology in Individuals with a Family History of Alcoholism

“…Based on the clinical similarities between the obsessive thoughts and compulsive behaviors of alcoholdependent subjects and those of patients with obsessive-compulsive symptomology, and evidence that serotonin reuptake inhibitors used in the treatment of OCD are also effective in inhibiting volitional drinking (Naranjo et al 1987) alcohol dependence has been compared to OCD (Modell et al 1992a(Modell et al , 1992b. Although the experience of compulsive "alcohol seeking" and "craving" reported by alcoholics long after withdrawal can not be equated with obsessive-compulsive symptomology, there may be some behavioral similarities.…”

“…Studies with OCD subjects have shown naloxone decreases obsessional doubt and compulsive behaviors at low doses (Insel and Pickar 1983;Keuler et al 1996) and decreases at higher doses (Sandyk 1987) in a small subgroup of subjects. Furthermore, opioid agents have been reported to affect stereotypic behavior observed in animals and humans, suggesting possible contributions by these neurotransmitter systems in obsessive-compulsive symptomology (Rapoport 1990, Rapoport et al 1992Stein et al 1994;Gietzen 1990;Dodman et al 1988).Based on the clinical similarities between the obsessive thoughts and compulsive behaviors of alcoholdependent subjects and those of patients with obsessive-compulsive symptomology, and evidence that serotonin reuptake inhibitors used in the treatment of OCD are also effective in inhibiting volitional drinking (Naranjo et al 1987) alcohol dependence has been compared to OCD (Modell et al 1992a(Modell et al , 1992b. Although the experience of compulsive "alcohol seeking" and "craving" reported by alcoholics long after withdrawal can not be equated with obsessive-compulsive symptomology, there may be some behavioral similarities.…”

“…Observations of behaviors associated with alcohol and drug withdrawal in animal studies along with clinical reports of patients in drug treatment suggest behavioral similarities between "drug seeking" behaviors and stereotypic behaviors reversed by opioid antagonists (Carrion 1995; Noel and Gratton 1995). Indeed, theories of alcohol dependence have suggested behavioral similarities (Anton 1996; Kranzler and Anton 1994) based on the clinical observation that alcohol "craving" involves "obsessive thoughts about alcohol use", followed by "compulsive drinking" (Modell et al 1992a(Modell et al , 1992b. The relationship between obsessive-compulsive symptomology and "craving" has been strengthened by a study of alcoholics in treatment reporting decreased subjective symptom ratings on The Obsessive Compulsive Drinking Scale (OCDS) during alcohol reduction and increased ratings during relapse drinking (Anton et al 1995).…”

The Sooner You Drink It All, the More Time You Will Have Thereafter

“…The latter does suffer from his/her condition in the very literal sense of this word (ibid.). However, the early studies on phenomenology and behaviour symptomatic of the craving for alcohol, performed at the end of the 1980s and beginning of the 1990s, immediately showed that the similarities between the two conditions were deeper than believed (Modell et al 1992a;Anton 2000). So deep were these similarities that the so-called obsessive-compulsive scale, the basic instrument used by psychiatrists to assess the severity of the obsessive-compulsive syndrome, as well as to plan its treatment and predict its outcome, could easily be adopted to assess the severity of alcohol-related problems and predict the outcome of their treatment (Modell et al 1992b).…”

Le craving comme symptôme central de la toxicomanie : de ses fondements neurobiologiques à sa pertinence clinique

“…Tout d'abord, l'intensité du symptôme nécessaire pour que ce critère du DSM soit rempli pourrait être mieux définie. Dans les cas de dépendance à l'alcool, par exemple, certaines données laissent entrevoir des similitudes entre le craving et un processus d'intensité obsessionnel (Modell, Glaser, Cyr et Mountz, 1992). L'ajout d'une telle spécification aiderait à mieux illustrer le degré d'intensité du craving nécessaire pour que le critère soit rempli.…”