Penn Alcohol Craving Scale Research Articles

Association of bone turnover markers and craving reduction in patients with alcohol use disorder during withdrawal: Exploring the role of bone-brain axis.

Alcohol use disorder (AUD) is associated with imbalanced bone turnover and psychological symptoms, but the relationship between bone and brain remains unclear. The study analyzed serum levels of a bone formation marker, procollagen type 1 N-terminal propeptide (P1NP), and bone resorption marker, C-terminal telopeptide of type I collagen (CTX-1), in AUD patients before and after 2 weeks of alcohol withdrawal and investigated their correlation with psychological symptoms. Ninety patients with AUD and 117 healthy controls were recruited. P1NP and CTX-1 levels were measured using Enzyme-Linked Immunosorbent Assay. The Penn Alcohol Craving Scale (PACS), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) were assessed in the AUD group at baseline, week 1, and week 2 of withdrawal. Baseline CTX-1 levels, along with the CTX-1/P1NP and P1NP/CTX-1 ratio, were higher in the AUD group than controls. Over the 2-week withdrawal, PACS, BDI, and BAI scores demonstrated significant reductions. P1NP (p < 0.001) and P1NP/CTX-1 ratio increased (p < 0.001), while CTX-1/P1NP ratio decreased (p < 0.001), indicating a propensity toward bone formation. Univariate analysis revealed that reductions in PACS, BDI, and BAI scores during withdrawal correlated with increased P1NP levels and decreased CTX-1/P1NP ratios. However, multivariate analysis indicated that only PACS score reductions correlated with these changes. Bone metabolism shifted toward increased bone formation and decreased bone resorption during 2-week alcohol withdrawal. The correlation between improvements in bone turnover markers and reduction in craving scores during withdrawal supports the concept of the bone-brain axis.

A mindfulness-based intervention for Substance Use Disorder in a Brazilian vulnerable population: a feasibility mixed method study

IntroductionSubstance Use Disorder (SUD) is a chronic condition that impacts various facets of an individual’s life, and society as a whole. The Mindfulness-Based Relapse Prevention (MBRP) protocol is an innovative intervention that can help to prevent relapse, particularly when used as a post-treatment approach. However, although there is significant evidence of its effectiveness in studies from high-income countries (HICs), there is a dearth of studies examining its feasibility and efficacy in low- and middle-income countries (LMICs). Thus, this study investigates the feasibility of MBRP as an adjunct to outpatient treatment for SUD in a socially vulnerable Brazilian population.MethodsThe study employed a mixed-methods design in eight Psychosocial Care Centers for Alcohol and Drugs (CAPS-ad) in the city of São Paulo, and involved 140 participants, 24 healthcare professionals and 7 CAPS-ad managers. In total, 17 MBRP intervention groups were conducted. The study assessed qualitative indicators of acceptability, demand, implementation, adaptation, integration, and limited efficacy testing through group interviews, in-depth interviews and field diary records. It also included limited efficacy testing of the protocol using a quantitative pre-post pilot study to investigate consumption behavior, using the Timeline Followback (TLFB) assessment method; depression, using the Center for Epidemiologic Studies Depression (CES-D) scale; anxiety, using the state trait anxiety index (STAXI-2); craving, using the Penn Alcohol Craving Scale (PACS); readiness to change, using the Readiness-to-Change Ruler (RCR); and severity of dependence, using the Severity of Dependence Scale (SDS). The qualitative data were triangulated with the quantitative data to comprehensively evaluate the feasibility of the intervention.ResultsThe sample comprised socially vulnerable participants with a high dropout rate, primarily due to social factors. Despite facing challenges in respect of regular engagement and initial cultural misperceptions of meditation, the intervention showed positive acceptance and mental health benefits, including impacts on consumption behavior.DiscussionThe study emphasizes the importance of adapting the format of the protocol to better suit vulnerable populations, and to ensure its effective integration into the public healthcare system. Future research should explore protocol modifications, assess its effectiveness in different contexts, and conduct cost-benefit analyses for broader implementation.

Insomnia treatment effects on negative emotionality among veterans in treatment for alcohol use disorder.

Insomnia symptoms are pervasive and persistent in alcohol use disorder (AUD), though little is known about the mechanisms that underlie this association. We previously found that cognitive behavioral therapy for insomnia (CBT-I) reduced alcohol-related problems among veterans by improving insomnia severity (NCT03806491). In this planned secondary analysis of the same clinical trial data, we tested negative emotionality as one potential mechanism to explain this effect. Specifically, we tested the change in negative emotionality as a mediator of the association between change in insomnia symptoms and alcohol-related outcomes (craving, heavy drinking frequency, and alcohol-related problems). Participants were 67 veterans in treatment for AUD who also met the criteria for insomnia disorder (91% male, 84% White, average age = 46.3 years). Participants were randomized to five sessions of CBT-I or a single-session sleep hygiene control. Assessments occurred at baseline, immediately posttreatment (~6 weeks after baseline), and at 6-week follow-up. Measures included the Insomnia Severity Index, Penn Alcohol Craving Scale, Timeline Followback, and Short Inventory of Problems. We created a latent negative emotionality indicator based on five validated and reliable measures of negative emotionality. Contrary to hypotheses, CBT-I did not improve negative emotionality relative to sleep hygiene control. However, across both treatment conditions, decreases in insomnia symptoms from baseline to posttreatment were associated with concurrent decreases in negative emotionality, which in turn predicted reductions in alcohol craving and heavy drinking. Negative emotionality may help explain links between insomnia symptoms and alcohol-related outcomes.

Interoceptive sensibility and alcohol craving in Polish prisoners: the role of alexithymia and emotional dysregulation.

Alcohol craving, characterized by a strong desire or compulsion to consume alcohol, is a prominent symptom of substance dependence syndrome. Research indicates that alcohol craving is a significant factor leading to the termination of abstinence. The mechanisms underlying the activation of alcohol craving remain not fully understood. The urge to reach for alcohol may be stimulated by emotions, memories, thoughts, or bodily sensations, as well as external factors. It has been postulated that individuals with high levels of interoceptive sensibility tend to exhibit a high degree of alexithymia and emotion dysregulation in the context of alcohol craving. Deficits in identifying and verbalizing emotions, along with an operational thinking style, facilitate alcohol consumption by impeding accurate insight into one's mental state, thereby hindering the comprehension of bodily states, emotions, and the regulation of self. This study involved 160 inmates incarcerated in a prison in Poland, awaiting participation in therapy for individuals with substance dependence following psychiatric diagnosis. Four questionnaires were used in the study: multidimensional Assessment of Interoceptive Sensibility (MAIA) for interoceptive sensibility, Toronto Alexithymia Scale (TAS-20) for alexithymia, Difficulties in Emotion Regulation Scale (DERS) for emotional dysregulation, and the Penn Alcohol Craving Scale (PACS) for alcohol craving assessment. The results of the study are as follows: the study findings indicated that alexithymia and emotional dysregulation significantly mediates the relationship between interoceptive sensibility and alcohol craving. The indirect effect for both factors was found to be significant, similar to the indirect effect observed for alexithymia as an mediator. However, in the case of emotional dysregulation, no significant indirect effect was observed. Our study provides insights into the potential contribution of interoceptive sensibility to the heightened risk of alcohol dependence. Specifically, impaired interoceptive sensibility may be associated with the development of alexithymia and emotional dysregulation, potentially rendering individuals more susceptible to alcohol craving. Interoceptive sensibility could serve as a prerequisite for the cultivation of positive emotional processing skills.

Mental health conditions of Colombian adolescent population: An approach to risk.

To determine the mental health conditions of adolescents in the city of Manizales, Colombia, and explore risk regarding gender-based differences. Quantitative, nonexperimental, descriptive research with associative scope. A total of 316 adolescents were assessed using five scales to evaluate mental health conditions: the Perceived Stress Scale, Patient Health Questionnaire-9, Generalized Anxiety Disorder Scale, Penn Alcohol Craving Scale and The Substance Dependence Severity Scale. Univariate and bivariate analysis was performed, Chi square and Odds Ratio were tested. The findings indicated that being female is a risk factor for high levels of perceived stress, depressive episodes and anxiety. Additionally, adolescents who are not attending school are at higher risk for dependence and abuse of psychoactive substances. Conversely, being female acts as a protective factor against dependence on psychoactive substances. The findings suggest a higher tendency among the participants towards experiencing depressive episodes. Regarding perceived stress, 71.5% of the participants fell into the low category, while 70.6% experienced a current episode of generalized anxiety.

Safety of acamprosate for alcohol use disorder after liver transplant: A pilot randomized controlled trial.

Acamprosate is a therapy for alcohol use disorder, but data on feasibility and safety in recipients of liver transplants are lacking. This was a single-center unblinded prospective pilot randomized controlled trial of adults (≥18y) with liver transplant for alcohol-associated liver disease enrolled between 2021 and 2023, who were randomized 2:1 to the intervention of acamprosate (666mg dose 3 times daily) or standard of care (SOC) over 14 weeks. Outcomes included safety (prevalence of adverse events [AEs]), feasibility (weekly survey response rate >60%), adherence (self-reported acamprosate use >60%), and efficacy (reduction in Penn Alcohol Craving Scale), and relapse-blood phosphatidylethanol (≥20ng/mL/reported alcohol use) evaluated by standardized weekly surveys. The efficacy analysis was done in both the intention-to-treat (excluding withdrawals before medication administration) and per-protocol population (excluding withdrawals/<4 weeks participation). Of 78 participants who were approached, 30 enrolled (19 acamprosate and 11 SOC) with similar baseline characteristics. Eight participants withdrew (6 acamprosate before medication administration and 2 SOC). AEs were similar between acamprosate and SOC groups (92.3% vs. 90.0%, p > 0.99), including grade 3 AEs (53.9% vs. 60.0%, p > 0.99) with no reported grade 4/5 AEs. Survey response rates were similar in acamprosate versus SOC groups (61.0% vs. 76.0%, p = 0.19), and 69.0% were acamprosate adherents. Baseline Penn Alcohol Craving Scale values were low with no difference by the group in median absolute change in Penn Alcohol Craving Scale for intention-to-treat (0, IQR: -4 to 0 vs. 0, IQR: 0-0, p = 0.32), and per-protocol analyses (-1, IQR: -6 to 0 vs. 0, IQR: -0 to 0, p = 0.36). There was no reported or biochemical evidence of alcohol relapse. In this pilot study, preliminary data suggest that acamprosate may be safe and feasible. These data can inform larger studies and clinician efforts to address alcohol use disorder in post-liver transplant care (ClinicalTrials.gov, Number: NCT06471686).

Naltrexone augmented with prazosin for alcohol use disorder: results from a randomized controlled proof-of-concept trial.

We conducted a proof-of-concept randomized controlled trial of the mu-opioid receptor antagonist, naltrexone, augmented with the alpha-1 adrenergic receptor antagonist, prazosin, for alcohol use disorder in veterans. We sought a signal that the naltrexone plus prazosin combination regimen would be superior to naltrexone alone. Thirty-one actively drinking veterans with alcohol use disorder were randomized 1:1:1:1 to naltrexone plus prazosin (NAL-PRAZ [n = 8]), naltrexone plus placebo (NAL-PLAC [n = 7]), prazosin plus placebo (PRAZ-PLAC [n = 7]), or placebo plus placebo (PLAC-PLAC [n = 9]) for 6weeks. Prazosin was titrated over 2weeks to a target dose of 4mg QAM, 4mg QPM, and 8mg QHS. Naltrexone was administered at 50mg QD. Primary outcomes were the Penn Alcohol Craving Scale (PACS), % drinking days (PDD), and % heavy drinking days (PHDD). In the NAL-PRAZ condition, % reductions from baseline for all three primary outcome measures exceeded 50% and were at least twice as large as % reductions in the NAL-PLAC condition (PACS: 57% vs. 26%; PDD: 51% vs. 22%; PHDD: 69% vs. 15%) and in the other two comparator conditions. Standardized effect sizes between NAL-PRAZ and NAL-PLAC for each primary outcome measure were >0.8. All but one participant assigned to the two prazosin containing conditions achieved the target prazosin dose of 16mg/day and maintained that dose for the duration of the trial. These results suggest that prazosin augmentation of naltrexone enhances naltrexone benefit for alcohol use disorder. These results strengthen rationale for an adequately powered definitive randomized controlled trial.

A comparative study of old versus novel psychoactive substances on craving, perceived stigma and suicidal risk among rural-dwelling patients with substance abuse.

INTRODUCTION: Substance use disorder is a leading public health concern that currently, nations regulatory agencies are grappled with. The noticeable difference in the chemical structures between old and novel psychoactive substances can result in significant clinical complications among patients with substance abuse. The study aims to compare substance craving, perceived stigma and suicidal risk among patients addicted to old and novel psychoactive substances (NPS). A descriptive comparative design was adopted on a sample of 105 patients with substance use who completed The Penn Alcohol Craving Scale (PACS), The Perceived Stigma of Addiction Scale (PSAS) and Suicide Probability Scale (SPS). Most participants were male, with 89.5% in the old addictive substance group and 93.8% in the new addictive substance group. A statistically significant difference in the NPS groups' perceptions of stigma (23.4 ± 5.3) compared to the old addictive substance group (20.6 ± 4.2), (t = 3.037, p = .003). Participants in the new substance group report more suicidal ideation, negative self-evaluation and hostility than those in the old substance group. Policies and practices should be tailored to the type of drug used and potential risk factors to avoid suicide among patients with substance abuse.

Role of Acamprosate and Baclofen as Anti-craving Agents in Alcohol Use Disorder: A 12-Week Prospective Study.

Background Alcohol use disorder (AUD) is one of the most common substance use disorders globally.It is a chronic mental illness characterized by frequent relapses.Hence, preventing relapse is one of the most important aspects of the management of patients with AUD. Aims This study aimed to compare the role of acamprosate and baclofen as anti-craving agents in patients diagnosed with AUD. Settings and design This was a 12-week interventional follow-upstudy conducted in the Department of Psychiatry of S N Medical College, a tertiary care teaching hospital in Agra,Uttar Pradesh, India. Methods and materials Patients with AUDwere enrolled in the study. Following medical management of alcohol withdrawal symptoms, patients were alternately assigned to receive either acamprosate or baclofen and were then followed up for 12 weeks. Measures to compare the effectiveness of the two medications were craving as measured using the Penn Alcohol Craving Scale (PACS), days to first alcohol consumption, days to relapse, number ofdrinks consumed at one occasion, number of patients who completed the study, and number of patients who remained abstinent throughout the duration of the study. Descriptive statistics were used to present the data while unpaired t-test and Fisher's exact test were used to compare the two groups. Results A total of 63 patients were enrolled in the study. Following medical management of alcohol withdrawal symptoms for one week, 50 (79.37%)patients were retained in the study. Hence, these 50 patients were assigned to treatment with either acamprosate or baclofen alternately in a 1:1 ratio. Only 32 (64%) of the patients who were started on these medications completed the study and were available for analysis at the end of 12 weeks. Acamprosate-treated patients were found to have less severe cravings (p < 0.01) for alcohol at the end of the study and also had consumed less number of drinks on a single occasion (p < 0.05). For other variables being considered in the study, namely, days to first alcohol consumption, days to relapse to previous drinking pattern, number of patients who dropped from the study versus those who completed the study, and those who were abstinent versus those who relapsed, nostatistically significant difference was noted. Conclusion Acamprosate-treated patients had significantly lesser cravings for alcohol and consumed a lesser number ofdrinks on one occasion compared to baclofen-treated patients in this 12-week study.

Cortisol Levels Chorelated with Exposure to Alcohol Related Visual Stimuli in Patients with Alcohol Use Disorder

IntroductionThe mechanism of craving is not yet fully understood. It implies numerous factors contributing to the decisions an individual has to ponder when faced with a stimulus that has resemblance with the previous experiences related to it. Neural pathways implying the reward mechanism play a significant role in the interpretation of visual, auditory, olfactive stimuli, polarizing the perception towards positive or negative experiences with that substance of abuse.Objectives In this study we focus on the cravings related to alcohol use, in a sample of patients admitted in hospital due to alcohol use disorder pathologies, providing the fact that Romania has the 2nd highest prevalence of heavy episodic drinking at least once a month (35% of adults, in a statistic published by Eurostat in 2019).Methods We included 30 patients with alcohol use disorder. The PACS (Penn Alcohol Craving Scale) was used to assess the severity of craving in the week prior to the hospital admission.Before visualising any alcohol related cues using VRET, patients will have a half hour of group therapy to lower levels of anxiety. Cortisol and blood sugar will be measured after this half hour to set a baseline . Afterwards, using VRET, subjects will be asked to watch a number of visual stimuli that will include cues to alcohol consumption and different types of beverages. Half hour after visualising cues of alcohol, the craving will be assessed by measuring blood sugar and salivary cortisol levels once again. Completing these measurement, patients will be asked to complete the PACS scale one more time to corelate the patients craving with the biological findings. Blood sugar levels will be measured with a blood glucose meter with test strips. Cortisol levels will be measured using salivary levels of cortisol. We choose measuring the salivary levels of cortisol, due to the fact that using this method, the biological active, free cortisol. Measurements of the serum cortisol indicate the total quantity, but not the biologically effective cortisol.ResultsVisual stimuli of alcohol, with the help of VRET modifies the autonomous glucocorticoid secretion, and provide objective information complimentary to the each individual’s craving assessmentConclusionsThere are a great number of strong ties between alcoholic craving in patients and endogenous shifts in cortisol secretion. We aimed towards a better understanding on craving in patients hospitalised for AUD. Other directions for future research are to find out if it possible to consider craving a form of stress or if we could limit craving, by limiting stress.Disclosure of InterestNone Declared

Validation of the Chinese Version of Penn Alcohol Craving Scale for Patients With Alcohol Use Disorder.

The Penn Alcohol Craving Scale (PACS) is a five-item, single-dimension questionnaire that is used to measure a patient's alcohol craving. We sought to develop the Chinese version of the PACS (PACS-C) and assess its reliability and validity. A total of 160 Taiwanese patients with alcohol use disorder were enrolled in this study. The internal consistency and concurrent validity of the PASC-C with the visual analogue scale (VAS) for craving, the Yale-Brown Obsessive Compulsive Scale for heavy drinking (YBOCS-hd), and the Severity of Alcohol Dependence Questionnaire (SADQ) were assessed. The test-retest reliability of the PASC-C was evaluated 1 day after the baseline measurements. Confirmatory factor analysis (CFA) was performed to examine the psychometric properties of the PACS-C. The PACS-C exhibited good internal consistency (Cronbach's α=0.95) and test-retest reliability (r=0.97). This scale showed high correlations with the VAS (r=0.81) and YBOCS-hd (r=0.81 and 0.79 for the obsession and compulsion subscales, respectively), and moderate correlation with the SADQ-C (r=0.47). Furthermore, CFA results revealed that the PACS-C had good fit indices under various models. The PACS-C appears to be a reliable and valid tool for assessing alcohol craving in patients with alcohol use disorder in Taiwan.

Grouping motivational interviewing is only effective for younger patients with alcohol dependence in the rehabilitation stage.

Alcohol dependence (AD) is a risk factor for death and disability. Relapse prevention for AD has been exclusively dominated by psychotherapy intervention for many years. Our study aimed to investigate the efficacy of group motivational interviewing (MI) on the psychological craving for alcohol and depressive symptoms in AD patients in the rehabilitation phase, as well as the impact of age. The participants included 108 individuals with AD in the rehabilitation phase. All participants were assigned to the MI intervention group or the control group and were treated for 6weeks. The severity of psychological craving for alcohol was assessed by the Penn Alcohol Craving Scale (PACS), and psychological status was evaluated by the Hamilton Depression Rating Scale (HAMD). We found that group MI significantly reduced the psychological craving for alcohol in patients with AD in the rehabilitation phase (p < 0.05). In addition, when patients were divided into two groups according to their ages, we found that group MI interventions tended to be effective only in younger patients with AD, but not in older patients. Our findings provide further evidence that the efficacy of group MI interventions was influenced by the age of patients with AD in the rehabilitation stage.

Russian Version of the Reasons for Heavy Drinking Questionnaire: the study of psychometric properties and validation

The heterogeneity of the clinical presentation of alcohol use disorder significantly affects the effectiveness of a standardized approach to the treatment of the disease and requires the use of targeted interventions based on an understanding of the underlying mechanisms and processes. Experimental studies of using drinking motive phenotypes for developing personalized treatment approaches had promising results and have demonstrated the theoretical and practical relevance of their further investigation and assessment.The purpose of this paper is to explore the psychometric properties of the Russian version of the Reasons for Heavy Drinking Questionnaire. For this study 163 patients (108 men (71%), mean age 43.00 years [38.00;43.00] (Mdn [Q1; Q3]), mean disease duration 10 years [4.00;17.00] (Mdn[Q1; Q3]) undergoing inpatient treatment for alcohol use disorder were recruited. The following instruments were used: clinical interview, Reward, Relief, Habit Drinking Scale, Penn Alcohol Craving Scale, Hospital Anxiety and Depression Scale, Snaith-Hamilton Pleasure Scale, and Carver and White’s BIS/BAS scale.The results did not confirm the factor structure proposed by the authors of the questionnaire. However, two factors - "Positive Reinforcement" and "Normalization and Habit" - were identified. Multiple significant correlations were also identified between drinking motivation phenotypes and clinical and psychological characteristics (previous treatment experience and periods of alcohol remission, emotional impairment, behavioral activation and inhibition in response to reward and punishment, and another scale for assessment of reward, relief, and habit drinking motives).

Relationship between craving to drugs, emotional manipulation and interoceptive awareness for social acceptance: the addictive perspective

BackgroundDrug addiction (DA) is a global psychiatric worldwide problem. Patients with substance use disorder are more likely to use the numerous defenses at their disposal to control their surroundings emotionally. This could virtually cause a tidal wave of social rejection of them in the community. The study aims to investigate drug craving, emotional manipulation, and interoceptive awareness for social acceptance among patients with substance use disorder.MethodsThis study followed a descriptive correlational design on a sample of 110 patients with substance use disorder who were recruited to complete the Penn Alcohol Craving Scale, the Emotion Manipulation Questionnaire, and the Perceived Acceptance Scale.ResultsMost respondents recorded high levels of PACS and emotional manipulation ability. A highly positive and significant correlation was found between scores on emotional manipulation ability and PACS.ConclusionCraving for drugs was a significant predictor of emotional manipulation ability. Incorporation of effective nursing interventions to enable patients with substance use disorder to engage in self-reflection related to how their cravings for drugs may lead them to prioritize their needs over others.

The efficacy of virtual reality exposure therapy for the treatment of alcohol use disorder among adult males: a randomized controlled trial comparing with acceptance and commitment therapy and treatment as usual.

This multicenter, three-armed, parallel, single-blind randomized controlled trial (RCT) primarily aims to compare the efficacy of virtual reality exposure therapy (VRET) with that of acceptance and commitment therapy (ACT) and treatment as usual (TAU) to depreciate the degree of alcohol craving among alcohol use disorder patients who have undergone in-patient detoxification across four timelines (t0 = baseline prior to intervention, t1 = 4 weeks after baseline, t2 = 12 weeks after baseline, and t3 = 24 weeks after baseline). The secondary aims of this RCT are to compare the efficacy of VRET with that of ACT and TAU to alleviate the severity of alcohol use disorder, dissipate comorbid depressive and anxiety symptoms, and normalize event-related potential (ERP) in electroencephalogram (EEG) monitoring across the four timelines. Initially, after 2 weeks of in-patient detoxification, 120 patients with alcohol use disorder will be randomized into three groups (VRET, ACT, and TAU control groups) via stratified permuted block randomization in a 1:1:1 ratio. Baseline assessment (t0) commences, whereby all the participants will be administered with sociodemographic, clinical, and alcohol use characteristics questionnaire, such as Alcohol Use Disorder Identification Test (AUDIT), Penn Alcohol Craving Scale (PACS), Hamilton Anxiety Rating Scale (HAM-A), and Hamilton Depression Rating Scale (HAM-D), while event-related potential (ERP) detection in electroencephalogram (EEG) will also be carried out. Then, 4 weeks of VRET, ACT, and non-therapeutic supportive activities will be conducted in the three respective groups. For the subsequent three assessment timelines (t1, t2, and t3), the alcohol use characteristic questionnaire, such as AUDIT, PACS, HAM-D, HAM-A, and ERP monitoring, will be re-administered to all participants. As data on the effects of non-pharmacological interventions, such as VRET and ACT, on the treatment of alcohol craving and preventing relapse in alcohol use disorder are lacking, this RCT fills the research gap by providing these important data to treating clinicians. If proven efficacious, the efficacy of VRET and ACT for the treatment of other substance use disorders should also be investigated in future. NCT05841823 (ClinicalTrials.gov).

Psychometric properties of the German Penn Alcohol Craving Scale.

Craving for alcohol is an important diagnostic criterion in alcohol use disorder (AUD) and an established predictor of future relapse. The 5-item Penn Alcohol Craving Scale (PACS) is one of the most widely used questionnaires to quantify craving and has been translated into different languages. It is assumed that the PACS constitutes one factor, although theoretical considerations suggest an additional second factor. We conducted stability and factor analyses (principal component and confirmatory factor analyses) of the German PACS (PACS-G) in samples of patients with AUD from the following three German study sites: Erlangen, N = 188 (mean age: 47.1years, 43.5% female); Mannheim, N = 440 (45.5years, 28.6% female); Hannover, N = 107 (48.1years, 48.6% female). In our samples, the 2-factor solution of the PACS-G version is more stable than the internationally assumed 1-factor solution. The resulting two PACS-G subscores 'difficulty to resist' (items 4 and 5) and 'thoughts about alcohol' (items 1, 2, and 3) have an internal consistency (Cronbach's alpha) of 0.80 ≤ α ≤ 0.90, m = 0.86 and 0.86 ≤ α ≤ 0.91, m = 0.89 with an overlap of R2 = 62%. We found good convergent validity assessed via the Craving Automatized Scale-Alcohol and the Obsessive-Compulsive Drinking Scale, but also correlations with depression and anxiety assessed via the Beck's Depression and Anxiety Inventories. This study is the first to provide evidence for a 2-factor solution ('difficulty to resist' and 'thoughts about alcohol') underlying the PACS-G version.

Evaluation of microRNA expression levels during the craving period of patients diagnosed with severe alcohol use disorder

ABSTRACT Background The aim of this study is to compare the serum MicroRNA (miRNA) expression levels on the first day of hospitalization and at the end of the first month of treatment in patients with alcohol use disorder and severe craving symptoms. Through the obtained data, biological agents targeting microRNA for alcohol craving may be developed. Methods The volunteer group consists of four patients diagnosed with severe alcohol use disorder. Sociodemographic and Clinical Information Form, DSM-5 Structured Clinical Interview-Clinical Version (SCID-5-CV), Penn Alcohol Craving Scale (PACS) were used as clinical assessment tools. Peripheral blood samples were obtained at the time of application and on the 30th day. miRNA isolation was performed. The expression levels of 2578 different mature human miRNAs were measured. Results The miRNAs showing statistically significant differences in peripheral blood samples taken on the 1st and 30th days from alcohol users are as follows: miR-19a-3p, miR-6849-5p, miR-6726-5p, miR-6848-5p, miR-186-5p, miR-6889-5p, miR-933, miR-370-3p, miR-5739, miR-103a-2-5p, miR-6860, miR-1254, miR-1260a, miR-3921, miR-127-3p, miR-8064, miR-6870-5p, miR-4688 Conclusions A significant difference was found between the 1st and 30th days in 18 of 2578 miRNAs scanned. It is aimed to investigate these 18 miRNAs in larger sample groups during the alcohol craving period.

Effect of PDYN and OPRK1 polymorphisms on the risk of alcohol use disorder and the intensity of depressive symptoms.

The dynorphin (DYN)/Kappa Opioid Receptor (KOR) system has been suggested to be involved in both negative affective states and the action of alcohol. The present study was undertaken to explore whether the DYN/KOR system genes, PDYN and OPRK1, influence on individual differences in the intensity of depressive symptoms at admission as well as the risk of alcohol use disorder (AUD) risk in a sample of 101 individuals with AUD and 100 controls. PDYN (rs2281285, rs2225749 and rs910080) and OPRK1 (rs6473797, rs963549 and rs997917) polymorphisms were analyzed by PCR-RFLP. The intensity of depressive and anxiety symptoms and craving were measured by the Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), and Penn Alcohol Craving Scale, respectively. A significant association between the risk of AUD and OPRK1 rs6473797 (P < 0.05) at the gene level. OPRK1 rs6473797 CC genotype was found to lead to a 3.11 times greater alcohol dependence risk. In addition, the BDI-II score of the OPRK1 rs963549 CC genotype was found to be significantly lower (20.9 ± 11.2, min: 1.0, max: 48.0) than that of the CT + TT genotypes (27.04 ± 12.7, min: 0.0, max: 49.0) (t: -2.332, P = 0.022). None of the PDYN polymorphisms were associated with BDI-II score. Variations in the KOR are associated with the risk of AUD and the intensity of depressive symptoms at admission at the gene level in Turkish males. On the other hand, PDYN gene seemed not to be associated with AUD, depression, anxiety, and craving.

Ghrelin and impulsivity relationship in alcohol-dependent patients and healthy individuals.

Abundant research indicates that ghrelin hormone levels are associated with alcohol use and addiction. One of the mediators of this association may be impulsivity, which is one of the common traits observed in alcohol addiction and some eating disorders. This study evaluated participants with alcohol dependency and healthy volunteers to determine whether trait impulsivity and ghrelin levels are associated. This study analyzed trait impulsivity scores and fasting serum ghrelin levels of 44 males with alcohol dependency and 48 healthy male participants. The Barratt Impulsiveness Scale and the UPPS Impulsive Behaviour Scale (UPPS) were used to measure trait impulsivity levels. Penn Alcohol Craving Scale and Yale Brown Obsessive Compulsive Drinking Scale for heavy drinking were used to assess craving at the baseline and after the detoxification period. Alcohol-dependent patients' fasting ghrelin levels were significantly higher than that of healthy participants. Ghrelin plasma levels were positively correlated with UPPS total impulsivity scores and sensation-seeking among healthy individuals. In alcohol-dependent participants, there was a positive correlation between UPPS urgency scores obtained at the baseline and fasting ghrelin levels before and after the detoxification period. Ghrelin-impulsivity relationship could be observed in certain dimensions of impulsivity in both alcohol-dependent and healthy individuals and even independent of the effect of alcohol. Although the associated impulsivity dimensions differ in different groups, the results are parallel to other studies in terms of demonstrating the relationship between ghrelin and impulsivity.

Development of a mobile mindfulness smartphone app for post-traumatic stress disorder and alcohol use problems for veterans: Beta test results and study protocol for a pilot randomized controlled trial

BackgroundPost-traumatic stress disorder (PTSD) and alcohol use disorder (AUD) are highly prevalent, and co-occurring among post-9/11 veterans. Mobile health (mHealth) applications, specifically those focused on mindfulness-based techniques, may be an effective avenue to intervene with veterans who cannot or will not seek care at traditional in-person settings. Thus, to address areas of improvement in mHealth for veterans, we developed Mind Guide and prepared it for testing in a pilot randomized controlled trial (RCT) with veterans. MethodsWe have completed phase 1 (treatment development) and Phase 2 (beta test) of our mobile mHealth app, Mind Guide. In this paper we describe the methods for Phase 1 as well as results for our beta test (n = 16; inclusion criteria included screen for PTSD, AUD, a post-9/11 veteran, and not currently receiving treatment) for Mind Guide as well as outline procedures for our pilot RCT of Mind Guide (Phase 3). The PTSD Checklist, self-reported alcohol use, the Perceived Stress Scale, Penn Alcohol Craving Scale, and the Emotion Regulation Questionnaire were used. ResultsResults of our beta test of Mind Guide show promising past 30 day effects on PTSD (d = −1.12), frequency of alcohol use (d = −0.54), and alcohol problems (d = −0.44), and related mechanisms of craving (d = −0.53), perceived stress (d = −0.88), and emotion regulation (d = −1.22). ConclusionOur initial beta-test of Mind Guide shows promise for reducing PTSD and alcohol related problems among veterans. Recruitment is ongoing for our pilot RCT in which 200 veterans will be recruited and followed up for 3 months.ClinicalTrials.gov Identifier: NCT04769986.