Alcohol craving as a predictor of relapse.
Alcohol craving as a predictor of relapse.
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DOI：
10.1111/j.1521-0391.2012.00297.x
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发表时间：
2012-11-01
期刊：
影响因子：
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通讯作者：
Mrazek, David A
中科院分区：
文献类型：
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作者：
Schneekloth, Terry D;Biernacka, Joanna M;Mrazek, David A
背景和目的：酒精中毒的治疗干预，包括心理社会干预和药理学干预，旨在减少饮酒欲望。然而，渴望在治疗结果中的作用仍然不清楚。本研究用宾夕法尼亚酒精渴求量表(PACS)在住院治疗前后测量的渴求强度作为治疗后复发的预测因素。方法：研究队列包括314名酒精依赖者。出院后复发、PACS评分和临床变量之间的关联通过事件发生时间分析进行了研究。根据意向治疗原则，初步分析认为那些拒绝随访或对接触尝试没有反应的人会复发。二次分析使用了226名出院后成功联系的受试者的数据，中位随访时间为365天。结果：意向治疗分析表明，复发与入院时(p=.002)和出院时(p<；.001)较高的渴望程度相关。对出院后成功联系的患者的数据分析得出了类似的结果。多变量分析表明，复发率随着PACS评分的增加而增加，即使在调整协变量后，较高的出院PACS评分仍与复发率显著相关(p=.006)。结论和科学意义：本研究表明，入院和出院时PACS评分较高与住宅成瘾治疗后的复发相关。这些数据支持渴望在复发中的作用，以及渴望测量作为评估复发风险的临床指南的实用性。
BACKGROUND AND OBJECTIVES: 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 AND SCIENTIFIC SIGNIFICANCE: 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.