Trajectories of drinking urges and the initiation of abstinence during cognitive–behavioral alcohol treatment

Abstract

Background and aims Drinking urges during treatment for alcohol use disorders (AUDs) are common, can cause distress, and predict relapse. Clients may have little awareness of how their drinking urges might be expected to change during AUD treatment in general and in response to initiating abstinence. The aim of the present study was to test whether drinking urges change on a daily level during treatment and after initiating abstinence. Design Secondary data analysis was performed using daily drinking urge ratings from two randomized clinical trials. Setting and Participants Women (N=98) and men (N=79) with AUDs in separate clinical trials of outpatient AUD-focused cognitive-behavioral therapy. Measurements Daily dichotomous indicators of any drinking urges or acute escalations in urges (i.e., at least two more urges compared with the previous day) were examined using generalized linear mixed growth-curve modeling. Findings Participants who initiated abstinence reported reductions in urges immediately thereafter (log odds ratios: women B=−0.701, p<.001; men B=−0.628, p=0.018), followed by additional, gradual reductions over time (women B=−0.118, p<.001; men B=−0.141, p<.001). Participants who entered treatment abstaining from alcohol also reported significant reductions in urges over time (women B=−0.147, p<.001; men B=−0.142, p<.001). Participants who drank throughout treatment had smaller (women B=−0.042, p =.012) or no reductions in urges (men B=0.015, p=.545). There was no evidence that urges systematically increased in response to initiating abstinence. Conclusions Drinking urges during outpatient behavioral treatment for alcohol use disorders may be maintained in part by alcohol consumption. Initiating abstinence is associated with reductions in drinking urges immediately and then more gradually over time.

Effects of Initiating Abstinence from Alcohol on Daily Craving and Negative Affect: Results from a Pharmacotherapy Clinical Trial

“…The present study aims to replicate this previous study that found reductions in daily craving associated with initiating abstinence (Hallgren et al, 2016) under improved methodological conditions, including the use of interactive voice response (IVR) technology to ensure same-day data collection (versus hand-written daily diaries asking patients to report on urges when they occur) and the use of multiple items that assessed different facets of daily craving including frequency and intensity (versus a single item assessing the presence or absence of any daily cravings). The present study also extends this previous work by evaluating changes in daily negative affect (versus only craving) and by studying these changes in the context of a pharmacotherapy trial with no behavioral intervention (versus cognitive-behavioral treatments that include substantial education and psychotherapy around craving and negative affect).…”

“…Among 92 participants in the parent study, a total of N =78 had enough daily IVR drinking data to assess an abstinence status over 14 or more consecutive days. Following identical procedures to Hallgren et al (2016), these 78 participants were classified into three groups based on whether and when they first initiated 14 consecutive days of abstinence from alcohol during treatment. Abstinence initiators ( n =17) drank on at least one of the first 14 days of treatment then eventually obtained at least 14 consecutive days of abstinence during the treatment period.…”

“…Continued drinkers ( n =41) drank during the first 14 days of treatment and never obtained 14 consecutive days of abstinence. Although the AUD treatment literature has had numerous definitions of drinking “remission” (Maisto et al, 2016), the 14-day window for classifying abstinence initiation in the present study was informed by previous research suggesting a low likelihood of 14 or more consecutive days of abstinence between drinking episodes before and during alcohol treatment (Epstein et al, 2004; Hallgren et al, 2016). In the present sample, only four participants (4.4% of original sample) had any abstinence periods lasting 14 or more days between drinking episodes within the baseline period, suggesting that achieving abstinence for 14 consecutive days would likely reflect a deliberate transition in drinking behavior rather than being part of a pre-existing drinking pattern.…”

“…A previous study (Hallgren et al, 2016) evaluated the extent to which daily alcohol craving changed in relationship to initiating abstinence. In that study, outpatients in individual- and couple-based cognitive-behavioral treatments recorded their daily alcohol consumption and whether they experienced any cravings each day via hand-written daily diary cards.…”

Treatment Interventions for Women With Alcohol Use Disorder

“…Previously, Hallgren and colleagues had found that daily-rated alcohol craving (a different mediator) decreased in relation to initiation of abstinence in men and women in outpatient CBT for AUD. 91 …”