title: Craving Mediates Stress in Predicting Lapse During Alcohol Dependence Treatment.
abstract: Stress, craving, and depressed mood have all been implicated in alcohol use treatment lapses. Few studies have examined all 3 factors. Progress has been limited because of difficulties with craving assessment. The Alcohol Craving Experience Questionnaire (ACE) is a new measure of alcohol craving. It is both psychometrically sound and conceptually rigorous. This prospective study examines a stress-treatment response model that incorporates mediation by craving and moderation by depressed mood and pharmacotherapy.
  
  
  
  Five hundred and thirty-nine consecutively treated alcohol-dependent patients voluntarily participated in an abstinence-based 12-week cognitive-behavioral therapy (CBT) program at a hospital alcohol and drug outpatient clinic. Measures of stress, craving, depressed mood, and alcohol dependence severity were administered prior to treatment. Treatment lapse and treatment dropout were assessed over the 12-week program duration.
  
  
  
  Patients reporting greater stress experienced stronger and more frequent cravings. Stronger alcohol craving predicted lapse, after controlling for dependence severity, stress, depression, and pharmacotherapy. Alcohol craving mediated stress to predict lapse. Depressed mood and anticraving medication were not significant moderators.
  
  
  
  Among treatment seeking, alcohol-dependent patients, craving mediated the relationship between stress and lapse. The effect was not moderated by depressed mood or anticraving medication.
authors.affiliation: School of Medicine , The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Law
authors.affiliation: Alcohol and Drug Assessment Unit , Princess Alexandra Hospital, Brisbane, Queensland, Australia.|Centre for Youth Substance Abuse Research , Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Gullo
authors.affiliation: School of Medicine , The University of Queensland, Brisbane, Queensland, Australia.|Hospital Alcohol and Drug Service , Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Daglish
authors.affiliation: Institute of Health and Biomedical Innovation , Queensland University of Technology, Brisbane, Queensland, Australia.
authors.forename: David J
authors.initials: DJ
authors.lastname: Kavanagh
authors.affiliation: Alcohol and Drug Assessment Unit , Princess Alexandra Hospital, Brisbane, Queensland, Australia.|Centre for Youth Substance Abuse Research , Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Gerald F X
authors.initials: GF
authors.lastname: Feeney
authors.affiliation: Alcohol and Drug Assessment Unit , Princess Alexandra Hospital, Brisbane, Queensland, Australia.|Institute of Health and Biomedical Innovation , Queensland University of Technology, Brisbane, Queensland, Australia.|Faculty of Health , Queensland University of Technology, Brisbane, Queensland, Australia.
authors.forename: Ross M
authors.initials: RM
authors.lastname: Young
authors.affiliation: School of Medicine , The University of Queensland, Brisbane, Queensland, Australia.|Alcohol and Drug Assessment Unit , Princess Alexandra Hospital, Brisbane, Queensland, Australia.|Centre for Youth Substance Abuse Research , Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Jason P
authors.initials: JP
authors.lastname: Connor
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000150:complications / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D066249:Craving; D003863:Depression / Q000523:psychology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010352:Patient Dropouts / Q000706:statistics & numerical data*; D011446:Prospective Studies; D013315:Stress, Psychological / Q000150:complications / Q000523:psychology / Q000628:therapy; D055815:Young Adult
keywords: Alcohol Dependence; Craving; Mood; Stress; Treatment