A day-by-day prospective analysis of stress, craving and risk of next day alcohol intake during alcohol use disorder treatment.
paper
Cited
Public
- Authors
- Wemm, Stephanie E; Larkin, Chloe; Hermes, Gretchen; Tennen, Howard; Sinha, Rajita
- Year
- 2019
- Journal
- Drug and alcohol dependence
- PMID
- 31574406
- DOI
- 10.1016/j.drugalcdep.2019.107569
- PMCID
- PMC6916671
BACKGROUND: Stress has been known to increase craving in individuals with Alcohol Use Disorders (AUD) and predict future alcohol relapse risk, but whether stress on a particular day affects craving on that day to impact prospective alcohol intake in the real world, particularly during early treatment and recovery, has not been studied thus far. METHOD: The first study included 85 AUD individuals who reported their daily stress, craving, and alcohol intake in the first two weeks of early treatment. A second validation study included 28 AUD patients monitored daily during eight weeks of outpatient 12-Step based behavioral counseling treatment for AUD. Data were collected from telephone-based daily diaries for 903 days in Study 1 and 1488 in Study 2. Multilevel latent models tested if daily and person-averaged craving mediated the link between stressful events and next day drinking during treatment. RESULTS: In both Study 1 and 2, exposure to a stressful event on a particular day predicted increased craving on that day (p's≤.002); and such increases in craving predicted the likelihood of drinking the next day (p's≤.014) and the drinking amount (p's< = 008). Individuals who experienced more stressful events reported higher craving (p's≤.012), and higher cravers reported greater next day drinking (p's<.001). CONCLUSIONS: The results across two studies with separate samples are the first to establish that craving directly mediates the association between stress and next day alcohol intake in individuals with AUD. Findings suggest a need for novel treatment approaches to address stress-induced craving to improve alcohol use outcomes.
Conceptual diagram for testing hypothesized effects using Multilevel Structural Equation Models. Specifically, we examined the mediating effect of craving between stress events and next day drinking in the day-to-day fluctuations (within-person) and the averaged differences across individuals (between-person) in both studies.
The between and within-person results for the multilevel structural equation models in both studies assessing the mediating effect of craving on the relationship between stress and drinking outcomes. Depicted are the standardized coefficients for each path. R2 refers to the explained variance proportion in an underlying continuous latent response variable. *indicates significant results.
The within- and between-person effects of stress on craving. Each point is plotted using the person-centered (within-person) and grand-mean centered (between-person) craving variables. Error bars ± SE. Within-Person effects are for days when stress occurrence consistently increased craving for that day (within-person; p’s<.001). Between-person effects indicate individuals that were higher in stress relative to their peers reported higher craving on average (between-person; p’s≤.010).
Effects of craving on alcohol intake at the within- and between-person levels in both studies when between-person level variables are at their average and on a stress day. The gray areas indicate the increased probability of a drinking day as craving increases in Study 1 (within-person: p’s<.001, between-person: p’s<.001) and in Study 2 (within-person: p’s<.001, between-person: p’s≤.001). In Study 1, each point is plotted at 1-point intervals of the craving measure; in Study 2, each point is plotted at 10-point intervals.
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