title: Recurrent detoxifications are associated with craving in patients classified as type 1 according to Lesch's typology.
abstract: OBJECTIVE
  Recurrent detoxifications have been suggested to be associated with elevated alcohol craving. The aim of this investigation was to study the influence of preceding detoxifications on craving in patients with alcoholism classified according to Lesch's typology.
  
  
  METHODS
  We examined 192 patients (154 men, 38 women) after admission for detoxification treatment. Craving was assessed using the Obsessive Compulsive Drinking Scale, and patients were classified into one of the four subgroups of Lesch's typology. The number of preceding detoxifications was assessed with a structured interview.
  
  
  RESULTS
  Lesch's typology type 4 patients showed significantly higher craving scores than type 1-3 patients (Mann-Whitney U-Test; P < 0.05). With respect to the influence of recurrent detoxifications, we found a significant correlation between the number of preceding detoxifications and the extent of craving for the whole population (Spearman's rho r = 0.241, P = 0.001, N = 192), particularly for patients of Lesch's type 1 (Spearman's rho r = 0.534, P = 0.001, N = 37). No significant association was found for patients of the other subgroups (Lesch's type 2-4).
  
  
  CONCLUSIONS
  The influence of recurrent detoxifications on craving is especially important in patients with Lesch's type 1. Our results underline the importance of the kindling effect particularly in this group of patients, possibly mediated by an increase of glutamatergic neurotransmission. Furthermore, our results emphasize the need to classify patients with alcohol-dependency in addiction research.
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Erlangen-Nuremberg, Schwabachanlage 6, D-91054 Erlangen, Germany. thomas.hillemacher@psych.imed.uni-erlangen.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Hillemacher
authors.forename: Kristina
authors.initials: K
authors.lastname: Bayerlein
authors.forename: Julia
authors.initials: J
authors.lastname: Wilhelm
authors.forename: Dominikus
authors.initials: D
authors.lastname: Bönsch
authors.forename: Daniela
authors.initials: D
authors.lastname: Poleo
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Sperling
authors.forename: Johannes
authors.initials: J
authors.lastname: Kornhuber
authors.forename: Stefan
authors.initials: S
authors.lastname: Bleich
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000453:epidemiology* / Q000534:rehabilitation*; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000145:classification* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008658:Inactivation, Metabolic; D008297:Male; D010507:Periodicity; D011446:Prospective Studies; D012008:Recurrence