Craving and Indicators of Depression and Anxiety Levels in Different Time Points of Intensive Alcohol Dependence Treatment

Abstract

Addiction/dependence is a chronically relapsing disorder that is characterized by a compulsion to take drugs and loss of control in limiting intake; brain stress systems can contribute to the compulsivity of drug-taking and therefore participate in the development and persistence of dependence (Koob, 2008). The concept of craving for alcohol can be recognized as a central component of the alcohol dependence syndrome together with the loss of control over and relapse to alcohol use (Anton, 1999). Gradual adaptation of brain function (neuroadaptation) to the presence of alcohol seems to be a central feature in the development of alcohol dependence (Koob & Le Moal, 2008). The neuroadaptation is not a conscious process and many alcohol dependent persons are likely to deny any craving for alcohol. Craving seems to emerge fully only when a person is prevented from access to alcohol or consciously attempts to quit alcohol use (Tiffany, 1990). Certain similarities exist between obsessive-compulsive disorder (OCD) and some aspects of craving (Anton et al., 1996) in form of recurrent and irresistible thoughts about alcohol during early recovery and during later recovery when experiencing stimulus clues or stressful states. Several scales have been developed to assess certain specific aspects of the craving phenomenon as a multidimensional and temporary phenomenon; the Obsessive Compulsive Drinking Scale (OCDS) (Anton et al., 1996) is suitable for determining the amount of craving experienced over a longer time interval (e.g. one week) and not only as a momentary urge to drink. Concurrent depression and anxiety symptoms are among the most common problems in alcohol dependent patients: heavy drinkers with co-occurring depressive and anxiety symptoms evidence heavier alcohol use and increased risk of relapse (Hasin et al., 2007). In detoxified alcoholics, in early abstinence, overall dopaminergic neurotransmission in the ventral striatum of alcohol dependent patient is reduced. Brain studies with positron emission tomography revealed a reduction of availability and sensitivity of central dopamine D2-receptors in alcohol dependent patients, which may reflect a compensatory down-regulation after chronic alcohol intake and was associated with the subsequent relapse risk (Heinz et al., 2009). Dysfunction of dopaminergic, glutamatergic, and opioidergic neurotransmission in the brain reward system can be associated with alcohol craving. In early abstinence state of higher levels of glutamate and noradrenergic activity