title: Daily ratings measures of alcohol craving during an inpatient stay define subtypes of alcohol addiction that predict subsequent risk for resumption of drinking.
abstract: BACKGROUND
  Both depressive symptoms and alcohol craving have been postulated as important predictors of relapse in patients with addictive disorders. The purpose of this study was to examine the course of affective symptoms and cravings for alcohol use during the initial 25 days of residential treatment for middle aged and older adults addicted to alcohol and the relationship between these symptoms and recovery outcomes.
  
  
  METHODS
  95 alcohol-dependent subjects were enrolled in this observational study. Participants completed a daily diary of alcohol craving, positive affect, and negative affect during residential treatment. Participants were interviewed 1 and 6 months after discharge to assess clinical symptoms of relapse and functioning.
  
  
  RESULTS
  Latent class analysis identified three groups of individuals for each of the three daily measures. For alcohol craving, 17 subjects reported elevated cravings during the entire treatment stay, 37 subjects reported initially elevated but then a slight improvement in craving, and 41 subjects reported relatively low craving from the time of admission to the end of residential treatment. Alcohol craving class was associated with negative affect but not positive affect. Alcohol craving class but not affective class was predictive of time to relapse to any drinking in the 6 months after residential treatment (p<0.05).
  
  
  CONCLUSIONS
  Results suggest that non-cue induced alcohol craving may define a subtype of alcohol dependence that is less responsive to treatment and may explain heterogeneity in treatment outcomes. These results also may suggest a role for differential treatment programming to address high states of craving for alcohol.
authors.affiliation: University of Pennsylvania, School of Medicine, Department of Psychiatry, Treatment Research Center, Philadelphia, PA 19104, USA. oslin@upenn.edu
authors.forename: David W
authors.initials: DW
authors.lastname: Oslin
authors.forename: Mark
authors.initials: M
authors.lastname: Cary
authors.forename: Valarie
authors.initials: V
authors.lastname: Slaymaker
authors.forename: Carol
authors.initials: C
authors.lastname: Colleran
authors.forename: Frederic C
authors.initials: FC
authors.lastname: Blow
mesh_terms: D000339:Affect; D000368:Aged; D000437:Alcoholism / Q000175:diagnosis* / Q000517:prevention & control / Q000523:psychology* / Q000628:therapy; D016739:Behavior, Addictive; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012114:Residential Treatment / Q000706:statistics & numerical data; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome