title: Trajectories of drinking urges and the initiation of abstinence during cognitive-behavioral alcohol treatment.
abstract: OBJECTIVE
  Drinking urges during treatment for alcohol use disorders (AUDs) are common, can cause distress and predict relapse. Clients may have little awareness of how their drinking urges might be expected to change during AUD treatment in general and in response to initiating abstinence. The aim of the present study was to test whether drinking urges change on a daily level during treatment and after initiating abstinence.
  
  
  METHODS
  Secondary data analysis was performed using daily drinking urge ratings from two randomized clinical trials.
  
  
  METHODS
  Women (n = 98) and men (n = 79) with AUDs in separate clinical trials of out-patient AUD-focused cognitive-behavioral therapy.
  
  
  METHODS
  Daily dichotomous indicators of any drinking urges or acute escalations in urges (i.e. at least two more urges compared with the previous day) were examined using generalized linear mixed growth-curve modeling.
  
  
  RESULTS
  Participants who initiated abstinence reported reductions in urges immediately thereafter (log odds ratios: women B = -0.701, P < 0.001; men B = -0.628, P = 0.018), followed by additional, gradual reductions over time (women B = -0.118, P < 0.001; men B = -0.141, P < 0.001). Participants who entered treatment abstaining from alcohol also reported significant reductions in urges over time (women B = -0.147, P < 0.001; men B = -0.142, P < 0.001). Participants who drank throughout treatment had smaller (women B = -0.042, P = 0.012) or no reductions in urges (men B = 0.015, P = 0.545). There was no evidence that urges increased systematically in response to initiating abstinence.
  
  
  CONCLUSIONS
  Drinking urges during out-patient behavioral treatment for alcohol use disorders may be maintained in part by alcohol consumption. Initiating abstinence is associated with reductions in drinking urges immediately and then more gradually over time.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Hallgren
authors.affiliation: Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM, USA.
authors.forename: Barbara S
authors.initials: BS
authors.lastname: McCrady
authors.affiliation: Department of Psychiatry, University of Massachusetts School of Medicine, Worcester, MA, USA.
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Epstein
mesh_terms: D064829:Alcohol Abstinence / Q000523:psychology*; D000428:Alcohol Drinking / Q000517:prevention & control* / Q000523:psychology; D000553:Ambulatory Care; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D054526:Men's Health; D008875:Middle Aged; D009042:Motivation; D016032:Randomized Controlled Trials as Topic; D016387:Women's Health
keywords: Abstinence initiation; alcohol; alcohol use disorder treatment; cognitive-behavioral therapy; craving; drinking urges; process of change; quit date