title: Reward and relief craving tendencies in patients with alcohol use disorders: results from the PREDICT study.
abstract: BACKGROUND
  Previous research suggests that patients' tendencies toward either reward or relief craving are distinct continuous factorial dimensions of craving for alcohol. According to these tendencies patients with alcohol use disorders (AUD) might also be allocated into distinct subgroups. In personalized treatment, patients of such different subgroups might respond differently to various psychotherapeutic and pharmacological interventions aimed at relapse prevention.
  
  
  OBJECTIVE
  To establish that the items of the subscale Temptation to Drink of the Alcohol Abstinence Self-Efficacy Scale (AASE) capture two continuous dimensions of reward and relief craving, and that they allow the identification of respective discrete class factors and subgroups of patients with AUD.
  
  
  METHODS
  Nonlinear confirmatory factor analysis (CFA) and latent class factor analysis (LCFA) were performed with data from 426 detoxified patients with AUD. The validity of continuous relief and reward dimensions, discrete class factors, and subtypes with different craving tendencies was established by including past drinking in positive and negative settings, gender, trait anxiety and perceived stress as covariates in the finally accepted CFA and LCFA measurement models.
  
  
  RESULTS
  The AASE temptation items formed two continuous relief and reward craving factors. They also associated themselves to two binary class factors, which defined four craving subgroups. Two of them (21% and 29% of patients) were characterized by high levels of either reward or relief craving tendencies. A third subgroup (31%) rated both tendencies in an equal high measure, while a fourth (18%) reported almost no craving tendencies at all. Past drinking in negative and positive settings was significantly associated with relief or reward craving tendencies. Male patients reported reward drinking more frequently than female patients. Trait anxiety was positively related only to the relief craving tendency. Unexpectedly, patients' level of perceived stress was associated with both craving tendencies.
  
  
  CONCLUSIONS
  The AASE temptation items are suited to identify relief and reward craving dimensions and to assign patients to according subtypes. Thus, they can be used to screen for corresponding patient subgroups, possibly allowing allocation to interventions that are specifically tailored to patient's particular craving tendencies. Hence: A relatively simple psychometric measure could help in improving treatment outcomes through a personalized approach to intervention.
authors.affiliation: GESIS - Leibniz Institute for the Social Sciences, Department of Survey Design and Methodology, Mannheim, Germany.
authors.forename: Angelika
authors.initials: A
authors.lastname: Glöckner-Rist
authors.affiliation: Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany. Electronic address: Tagrid.Lemenager@zi-mannheim.de.
authors.forename: Tagrid
authors.initials: T
authors.lastname: Lémenager
authors.affiliation: Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: Karl
authors.initials: K
authors.lastname: Mann
mesh_terms: D000428:Alcohol Drinking / Q000523:psychology; D000437:Alcoholism / Q000145:classification / Q000175:diagnosis / Q000523:psychology*; D001007:Anxiety / Q000523:psychology; D016739:Behavior, Addictive / Q000145:classification / Q000175:diagnosis / Q000523:psychology*; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D011594:Psychometrics; D012201:Reward; D055502:Secondary Prevention; D020377:Self Efficacy; D057566:Self Report / Q000592:standards; D012720:Severity of Illness Index; D012737:Sex Factors; D013315:Stress, Psychological / Q000523:psychology; D013695:Temperance / Q000523:psychology