title: Alcohol craving as a predictor of relapse.
abstract: OBJECTIVE
  Alcoholism treatment interventions, both psychosocial and pharmacologic, aim to reduce cravings to drink. Yet, the role of craving in treatment outcomes remains unclear. This study evaluated craving intensity measured with the Penn Alcohol Craving Scale (PACS) at admission and discharge from residential treatment as a predictive factor of relapse after treatment.
  
  
  METHODS
  The study cohort included 314 alcohol-dependent subjects. Associations between relapse after discharge, PACS score, and clinical variables were investigated using time-to-event analyses. The primary analysis, based on the intent-to-treat principle, presumed relapse in those declining follow-up or not responding to contact attempts. Secondary analysis utilized data from 226 subjects successfully contacted after discharge with a median follow-up time of 365 days.
  
  
  RESULTS
  The intent-to-treat analysis demonstrated that relapse was associated with higher level of craving at admission (p= .002) and discharge (p < .001). The analysis of data from patients successfully contacted after discharge led to similar results. A multivariable analysis indicated that relapse rates increased as PACS scores increased, and a higher discharge PACS score was significantly associated with relapse (p= .006) even after adjusting for covariates.
  
  
  CONCLUSIONS
  This study demonstrates that higher PACS scores at the time of admission and discharge are associated with relapse following residential addiction treatment. These data support the role of craving in relapse and the utility of craving measurement as a clinical guide in assessing relapse risk.
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. schneekloth.terry@mayo.edu
authors.forename: Terry D
authors.initials: TD
authors.lastname: Schneekloth
authors.forename: Joanna M
authors.initials: JM
authors.lastname: Biernacka
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Hall-Flavin
authors.forename: Victor M
authors.initials: VM
authors.lastname: Karpyak
authors.forename: Mark A
authors.initials: MA
authors.lastname: Frye
authors.forename: Larissa L
authors.initials: LL
authors.lastname: Loukianova
authors.forename: Susanna R
authors.initials: SR
authors.lastname: Stevens
authors.forename: Maureen S
authors.initials: MS
authors.lastname: Drews
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Geske
authors.forename: David A
authors.initials: DA
authors.lastname: Mrazek
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000517:prevention & control / Q000523:psychology* / Q000534:rehabilitation; D002492:Central Nervous System Depressants / Q000009:adverse effects*; D015331:Cohort Studies; D000431:Ethanol / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012114:Residential Treatment; D013375:Substance Withdrawal Syndrome / Q000209:etiology / Q000523:psychology*; D016896:Treatment Outcome
chemical_list: D002492:Central Nervous System Depressants; D000431:Ethanol