Regulation of craving by cognitive strategies in cigarette smokers

Cigarette craving is an important contributor to cigarette smoking, and clinical approaches that focus on regulation of craving are effective in reducing rates of relapse. However, a laboratory model that targets the use of cognitive strategies to regulate craving is lacking. To develop such a model, twenty heavy cigarette smokers (>12/day), twenty-two tobacco “chippers” (<6/day), and twenty non-smoking controls completed this outpatient study, during which they were presented with photographs of cigarettes and foods that have been previously shown to induce craving. During each trial, participants were instructed to think of the stimulus in one of two ways: by focusing either on the short-term consequences associated with consuming the item (e.g., it will taste good) or on the long-term consequences associated with regular consumption (e.g., I may get lung cancer). Participants reported significantly reduced food cravings when focusing on the long-term consequences associated with eating. For cigarette-smoking participants, cigarette craving was significantly reduced when focusing on the long-term consequences associated with smoking. This latter finding confirms clinical data and extends it by highlighting the importance of cognition in the modulation of craving. Future studies using this laboratory model could test the efficacy of different cognitive strategies and develop targeted interventions for smoking cessation based on the regulation of craving.     

It's the thought that counts: Craving metacognitions and their role in abstinence from methamphetamine use

Craving is frequently reported as a trigger for relapse by those trying to remain abstinent from psychoactive substances. Metacognitive beliefs about managing craving may play an important role in determining further cognition and behavior. They are, therefore, important to measure in treatment and may serve as target cognitions to be modified in support of behavioral change. As part of the assessment battery of a randomized controlled trial among 214 methamphetamine users, we included the Craving Beliefs Questionnaire (CBQ), a measure designed to assess an individual's perception of the potential negative impact of craving, at baseline. Changes in abstinence rates were significantly related to CBQ score, suggesting that craving beliefs are associated with changes in methamphetamine use. Further validation of the CBQ is warranted. Future clinical research among methamphetamine users could focus on directly manipulating craving beliefs through cognitive therapy to affect abstinence.     

Ethical implications of research on craving

Cravings, intense desires to experience the effects of a drug, are widely regarded as significant impediments to overcoming addiction, although their role in relapse may be overstated. Scientists and clinicians wish to better understand the neurobiological and cognitive basis of craving so that they may develop psychotherapeutic, pharmacological and other medical methods to reduce craving and thereby drug use. The conduct of such research raises significant ethical issues. When recruiting individuals and conducting this research, scientists need to ensure that substance dependent participants have the capacity to provide free and uncoerced consent. This is especially the case in studies in which dependent participants are given their drug of addiction or provided with other inducements to participate (e.g. financial incentives) that may undermine their ability to fully consider the risks of participation.     

An acute psychosocial stressor does not potentiate alcohol cue reactivity in non-treatment-seeking alcoholics

Background: Relapse risk factors, such as psychological stress and alcohol cues, are often encountered together. Understanding how they interact has the potential to improve alcoholism treatments. This study was conducted to examine whether an acute psychosocial stressor enhanced alcohol cue reactivity in non‐treatment‐seeking alcoholics. Methods: Seventy‐nine alcohol‐dependent individuals (39 women) randomly received either the Trier Social Stress Test or a no‐stress control condition. Stress reactivity was measured with serum adrenocorticotropic hormone and cortisol, mean arterial blood pressure, and subjective distress. Immediately following the stress manipulation, participants held and sniffed a neutral cue then their preferred alcoholic beverage. Cue reactivity was measured by 2 subjective measures of craving following each cue. Additionally, general craving was assessed with the Alcohol Urge Questionnaire at the beginning and end of the laboratory procedure. Results: The stress manipulation showed internal validity on all measures of stress reactivity. There was not a main effect of stress nor a stress × cue interaction on either cue reactivity measure. As expected, there was a main effect of cue (alcohol > neutral cue) on both measures of cue reactivity. General craving increased during the challenge, but not differently by stress group. Magnitude of stress reactivity was not associated with magnitude of cue reactivity, and all results were independent of gender. Conclusion: In this well‐controlled clinical laboratory study of non‐treatment‐seeking alcoholics, an acute psychological stressor did not make an alcohol cue a more potent urge‐inducing stimulus, and stress had no effect on general alcohol craving.     

Prolactin serum levels during alcohol withdrawal are associated with the severity of alcohol dependence and withdrawal symptoms

Background: Prolactin serum levels have been described to be elevated during alcohol withdrawal in alcohol‐dependent patients and normalize during abstinence. Alterations in prolactin levels may reflect disturbances of dopaminergic neurotransmission which is of crucial importance for alcohol‐seeking behavior. Methods: In this longitudinal observational study, we investigated prolactin serum levels in 99 male patients during the first 14 days of alcohol withdrawal and early abstinence and in 43 healthy controls. To assess the severity of alcohol dependence, the extent of withdrawal symptoms, craving, depressive symptoms, and anxiety, we employed a structured interview including psychologic measurements. Results: Prolactin serum levels were elevated during the whole study period in alcohol‐dependent patients compared to the healthy control group. Prolactin levels at admission (first day of alcohol withdrawal) were associated with the severity of alcohol withdrawal (CIWA‐Ar) and of alcohol dependence (SESA) but not with the other assessed psychologic parameters. Conclusions: The presented findings confirm that prolactin is significantly elevated in alcohol‐dependent patients during alcohol withdrawal and early abstinence, not showing a rapid decline after cessation of drinking. The association with the severity of withdrawal and dependence may reflect at least partially the individual alterations in the dopaminergic and glutamatergic pathways.     

The temporal dynamics of ambivalence: changes in positive and negative affect in relation to consumption of an "emotionally charged" food

Ambivalence is thought to impact consumption of food, alcohol and drugs, possibly via influences on craving, with cravers often being simultaneously drawn toward and repelled from ingestion. So far, little is known about the temporal dynamics of ambivalence, especially as it varies in relationship to consumption. Participants (n = 482, 56.8% female) completed the Positive and Negative Affect Schedule prior to, immediately and 30 min after the opportunity to eat a bar of chocolate. Affective ambivalence was calculated based on the relative strengths of and discrepancy between ratings of positive and negative affect. Ambivalence peaked prior to a decision about consumption and subsequently decreased, whether or not the decision was in favor of or against consuming. Decreasing ambivalence was driven by a drop in positive affect over time; positivity decreased more rapidly in those who consumed chocolate. Findings represent a first step in characterizing the dynamics of ambivalence in interactions with a target stimulus.     

临床特征对酒精依赖复发的影响:前瞻性队列研究

目的 探讨人口学因素和心理渴求对酒精依赖患者复发的影响。方法 采用前瞻性研究方法,选择2017年8月至2018年8月在3家精神专科医院招募符合《美国精神疾病诊断与统计手册》第4版(Diagnositic and Statistical Manual Disorder-Fourth Version, DSM-Ⅳ)酒精依赖诊断标准的住院治疗的男性患者158例,进行基线测查,并在基线后3个月进行随访,调查复饮情况。基线测查包括人口学资料、饮酒特征、临床机构酒精依赖戒断评估表(clinical institute withdrawal assessment-advanced revised, CIWA-Ar)、环境线索诱导及戒断期心理渴求视觉模拟标尺评分(visual analog scale,VAS)、密歇根酒精依赖筛查量表(Michigan alcoholism screening test, MAST)、焦虑自评量表(self-rating anxiety scale, SAS)、抑郁自评量表(self-rating depression scale, SDS)及饮酒促迫性量表(alcohol urge questionnaire, AUQ)。根据随访结果,将“复发”定义为在基线和随访之间任何时刻饮用含有乙醇的饮料,“复发时间”定义为首次饮酒距离基线的天数。是否复发和复发时间是主要结局指标,采用Cox比例风险回归模型分析影响酒精依赖复发的因素。结果酒精依赖患者3个月复发率为63.7%, 多因素Cox比例风险回归模型分析发现年龄(OR=0.975,P=0.030)及CIWA-Ar评分(OR=1.126,P=0.010)是影响酒精依赖复发的因素,两种环境下心理渴求与复饮差异无统计学意义(P > 0.05)。结论 年龄与住院期间酒精依赖戒断症状严重程度是酒精依赖复发的影响因素,其中年龄大是保护因素,戒断症状的严重程度重是危险因素,而线索诱导及戒断期心理渴求对酒精依赖患者复发的影响作用较小。     

Insulin but not insulin growth factor-1 correlates with craving in currently drinking alcohol-dependent patients

Background:  Preclinical data suggest that brain insulin and insulin growth factor-1 (IGF-1) may contribute to the development of addiction. The aim of this clinical study was to evaluate the relationships between insulin and IGF-1 plasma concentrations and alcohol craving.
Methods:  The correlations between insulin and craving in actively drinking alcoholics were evaluated in the experiment 1 retrospectively and in the experiment 2 in a case-control study. Experiment 3 evaluated the correlations between insulin and craving in 12-weeks abstinent alcoholics in a longitudinal study. C-peptide and IGF-1 were also investigated in experiments 2–3. Alcohol craving was evaluated by the Obsessive–Compulsive Drinking Scale (OCDS).
Results:  Significant positive correlations between insulin concentrations and craving scores were found in actively drinkers ( p  < 0.05). Specifically, in the first experiment insulin significantly correlated with the compulsive scores. In the second experiment and in an analysis of experiments 1–2 together, insulin plasma concentration correlated with total OCDS craving ( p  < 0.05) and compulsive craving ( p  < 0.05) and showed a trend of correlation with the obsessive craving. At 12 weeks no correlation was found between insulin and craving scores. In all the experiments the correlations between C-peptide and craving were close to the ones between insulin and craving while IGF-1 never correlated with craving.
Conclusions:  This study suggests that insulin could be involved in the neurobiology of alcohol craving and addiction. This characteristic seems specific of insulin since similar data were found on C-peptide but not on IGF-1. Future confirming studies on larger samples are needed, also to investigate possible therapeutic implications.