title: Alcohol craving in patients diagnosed with a severe mental illness and alcohol use disorder: bidirectional relationships between approach and avoidance inclinations and drinking.
abstract: OBJECTIVE
  The current study was undertaken to better understand the craving-drinking relationship among individuals dually diagnosed with a severe mental illness (SMI) and an alcohol use disorder (AUD). Using an ambivalence conceptualization of craving (Breiner, Stritzke, & Lang, 1999), we investigated the bidirectional relationships between desires and behavioral intentions to use (approach inclinations) and not use (avoidance inclinations) alcohol and drinking outcomes in patients diagnosed with an SMI-AUD.
  
  
  METHODS
  Patients (N = 278) seeking outpatient dual diagnosis treatment from a community mental health center were followed longitudinally over the course of 6 months. Assessments at baseline, 2-month, 4-month, and 6-month intervals included approach and avoidance inclinations, alcohol urges, readiness to change, and drinking outcomes.
  
  
  RESULTS
  Time-lagged multilevel growth curve modeling found that avoidance inclinations moderated the effect of approach inclinations on subsequent drinking outcomes differentially over time. Specifically, avoidance inclinations attenuated the effect of approach on subsequent heavier drinking levels, and high avoidance/low approach demonstrated significant decreases on levels of drinking over time. Results also indicated that number of drinks consumed and heavy drinking days predicted subsequent approach inclinations differentially over time, such that lower levels of drinking predicted decreases in approach inclinations. Decreases in drinking also predicted higher subsequent avoidance inclinations, which were maintained over time.
  
  
  CONCLUSIONS
  These findings highlight the complexity of subjective craving responses and the importance of measuring both approach and avoidance inclinations. Among those diagnosed with SMI-AUDs, treatment strategies that increase avoidance inclinations may increase abstinence rates in this difficult-to-treat population.
authors.affiliation: Research Institute on Addictions, University at Buffalo, SUNY.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Schlauch
authors.forename: Ash
authors.initials: A
authors.lastname: Levitt
authors.forename: Clara M
authors.initials: CM
authors.lastname: Bradizza
authors.forename: Paul R
authors.initials: PR
authors.lastname: Stasiewicz
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Lucke
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Maisto
authors.forename: Yue
authors.initials: Y
authors.lastname: Zhuo
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: Connors
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology* / Q000517:prevention & control / Q000523:psychology*; D000437:Alcoholism / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology* / Q000534:rehabilitation; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology* / Q000534:rehabilitation; D003073:Cognitive Dissonance; D003131:Combined Modality Therapy; D003155:Community Mental Health Centers; D066249:Craving; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York; D011379:Prognosis; D011618:Psychotic Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology* / Q000534:rehabilitation; D012008:Recurrence; D013695:Temperance / Q000523:psychology*
references.citation: J Psychiatr Res. 1975 Nov;12(3):189-98
references.pmid: 1202204
references.citation: Psychiatr Serv. 1999 Jan;50(1):75-80
references.pmid: 9890583
references.citation: Psychol Addict Behav. 2013 Dec;27(4):1159-66
references.pmid: 23276313
references.citation: Addict Behav. 2003 Jan-Feb;28(1):157-69
references.pmid: 12507534
references.citation: J Clin Psychiatry. 1994 Mar;55(3):109-13
references.pmid: 8071247
references.citation: J Stud Alcohol. 2004 Nov;65(6):774-81
references.pmid: 15700516
references.citation: Addiction. 2000 Aug;95 Suppl 2:S155-63
references.pmid: 11002910
references.citation: Psychol Rev. 1990 Apr;97(2):147-68
references.pmid: 2186423
references.citation: JAMA. 1990 Nov 21;264(19):2511-8
references.pmid: 2232018
references.citation: J Subst Abuse Treat. 2010 Sep;39(2):132-40
references.pmid: 20598834
references.citation: Alcohol Res Health. 1999;23(3):197-206
references.pmid: 10890815
references.citation: J Stud Alcohol Drugs. 2013 Jan;74(1):152-7
references.pmid: 23200161
references.citation: Addict Behav. 2013 Apr;38(4):1970-9
references.pmid: 23380493
references.citation: Harv Rev Psychiatry. 2009;17(1):24-34
references.pmid: 19205964
references.citation: J Psychopathol Behav Assess. 2013 Mar 1;35(1):45-56
references.pmid: 23543075
references.citation: Am J Addict. 2006 May-Jun;15(3):242-5
references.pmid: 16923671
references.citation: Addiction. 2000 Aug;95(8 Suppl 2):145-153
references.pmid: 11002909
references.citation: Addiction. 2004 Apr;99(4):482-97
references.pmid: 15049748
references.citation: Addiction. 2000 Aug;95 Suppl 2:S177-87
references.pmid: 11002913
references.citation: Addiction. 2000 Aug;95 Suppl 2:S73-81
references.pmid: 11002904
references.citation: Addiction. 2000 Aug;95 Suppl 2:S91-117
references.pmid: 11002906
references.citation: Addiction. 2002 Nov;97(11):1465-72
references.pmid: 12410786
references.citation: Addiction. 2000 Aug;95 Suppl 2:S189-210
references.pmid: 11002914
references.citation: Addiction. 2000 Aug;95 Suppl 2:S45-54
references.pmid: 11002901
references.citation: J Nerv Ment Dis. 1994 Dec;182(12):704-8
references.pmid: 7989915
references.citation: J Stud Alcohol. 2003 Jan;64(1):120-6
references.pmid: 12608492
references.citation: Alcohol Clin Exp Res. 2012 Feb;36(2):361-8
references.pmid: 21895719
references.citation: Psychopharmacology (Berl). 2004 Mar;172(3):291-7
references.pmid: 14634716
references.citation: J Stud Alcohol. 2005 May;66(3):369-78
references.pmid: 16047526
references.citation: Psychol Addict Behav. 2007 Jun;21(2):244-8
references.pmid: 17563145
references.citation: Addict Behav. 2012 Jul;37(7):824-30
references.pmid: 22459327
references.citation: J Clin Epidemiol. 2008 Apr;61(4):344-9
references.pmid: 18313558
references.citation: J Consult Clin Psychol. 2009 Dec;77(6):1147-58
references.pmid: 19968390
references.citation: Clin Psychol Rev. 2009 Aug;29(6):519-34
references.pmid: 19577831
references.citation: Psychiatr Serv. 2005 Oct;56(10):1297-302
references.pmid: 16215199
references.citation: Psychol Addict Behav. 2004 Dec;18(4):402-6
references.pmid: 15631616
references.citation: J Stud Alcohol. 2001 Jan;62(1):79-88
references.pmid: 11271968
references.citation: Addict Behav. 2013 Feb;38(2):1572-1584
references.pmid: 23142210
references.citation: Addiction. 2000 Aug;95 Suppl 2:S247-55
references.pmid: 11002919
references.citation: Psychol Addict Behav. 2004 Jun;18(2):148-59
references.pmid: 15238057
references.citation: Alcohol Clin Exp Res. 2008 Mar;32(3):489-97
references.pmid: 18215213
references.citation: Alcohol Clin Exp Res. 1995 Jun;19(3):600-6
references.pmid: 7573780
references.citation: Addiction. 2006 Jan;101(1):60-8
references.pmid: 16393192
references.citation: J Stud Alcohol. 2005 May;66(3):332-43
references.pmid: 16047522
references.citation: Addict Behav. 2007 Aug;32(8):1699-704
references.pmid: 17182194
references.citation: Schizophr Res. 1996 May;20(1-2):145-151
references.pmid: 8794502
references.citation: Am J Addict. 2007 Jul-Aug;16(4):253-9
references.pmid: 17661192
references.citation: J Nerv Ment Dis. 1991 Mar;179(3):136-8
references.pmid: 1997660