Alcohol craving in patients diagnosed with a severe mental illness and alcohol use disorder: Bidirectional relationships between approach and avoidance inclinations and drinking

Robert C. Schlauch, Ash Levitt, Clara M. Bradizza, Paul R. Stasiewicz, Joseph F. Lucke, Stephen A. Maisto, Yue Zhuo, Gerard J. Connors

Research output: Contribution to journalArticle

17 Scopus citations

Abstract

Objective: The current study was undertaken to better understand the craving-drinking relationship among individuals dually diagnosed with a severe mental illness (SMI) and an alcohol use disorder (AUD). Using an ambivalence conceptualization of craving (Breiner, Stritzke, & Lang, 1999), we investigated the bidirectional relationships between desires and behavioral intentions to use (approach inclinations) and not use (avoidance inclinations) alcohol and drinking outcomes in patients diagnosed with an SMI-AUD. Method: Patients (N = 278) seeking outpatient dual diagnosis treatment from a community mental health center were followed longitudinally over the course of 6 months. Assessments at baseline, 2-month, 4-month, and 6-month intervals included approach and avoidance inclinations, alcohol urges, readiness to change, and drinking outcomes. Results: Time-lagged multilevel growth curve modeling found that avoidance inclinations moderated the effect of approach inclinations on subsequent drinking outcomes differentially over time. Specifically, avoidance inclinations attenuated the effect of approach on subsequent heavier drinking levels, and high avoidance/low approach demonstrated significant decreases on levels of drinking over time. Results also indicated that number of drinks consumed and heavy drinking days predicted subsequent approach inclinations differentially over time, such that lower levels of drinking predicted decreases in approach inclinations. Decreases in drinking also predicted higher subsequent avoidance inclinations, which were maintained over time. Conclusions: These findings highlight the complexity of subjective craving responses and the importance of measuring both approach and avoidance inclinations. Among those diagnosed with SMI-AUDs, treatment strategies that increase avoidance inclinations may increase abstinence rates in this difficult-to-treat population.

Original languageEnglish (US)
Pages (from-to)1087-1099
Number of pages13
JournalJournal of Consulting and Clinical Psychology
Volume81
Issue number6
DOIs
StatePublished - Dec 2013

Keywords

  • alcohol craving
  • alcohol dependence
  • approach
  • avoidance
  • severe mental illness

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health

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