Hillemacher Thomas, Bayerlein Kristina, Wilhelm Julia, Bönsch Dominikus, Poleo Daniela, Sperling Wolfgang, Kornhuber Johannes, Bleich Stefan
Department of Psychiatry and Psychotherapy, University of Erlangen-Nuremberg, Schwabachanlage 6, D-91054 Erlangen, Germany.
Alcohol Alcohol. 2006 Jan-Feb;41(1):66-9. doi: 10.1093/alcalc/agh227. Epub 2005 Oct 17.
Recurrent detoxifications have been suggested to be associated with elevated alcohol craving. The aim of this investigation was to study the influence of preceding detoxifications on craving in patients with alcoholism classified according to Lesch's typology.
We examined 192 patients (154 men, 38 women) after admission for detoxification treatment. Craving was assessed using the Obsessive Compulsive Drinking Scale, and patients were classified into one of the four subgroups of Lesch's typology. The number of preceding detoxifications was assessed with a structured interview.
Lesch's typology type 4 patients showed significantly higher craving scores than type 1-3 patients (Mann-Whitney U-Test; P < 0.05). With respect to the influence of recurrent detoxifications, we found a significant correlation between the number of preceding detoxifications and the extent of craving for the whole population (Spearman's rho r = 0.241, P = 0.001, N = 192), particularly for patients of Lesch's type 1 (Spearman's rho r = 0.534, P = 0.001, N = 37). No significant association was found for patients of the other subgroups (Lesch's type 2-4).
The influence of recurrent detoxifications on craving is especially important in patients with Lesch's type 1. Our results underline the importance of the kindling effect particularly in this group of patients, possibly mediated by an increase of glutamatergic neurotransmission. Furthermore, our results emphasize the need to classify patients with alcohol-dependency in addiction research.
反复戒酒被认为与酒精渴望增加有关。本研究的目的是探讨既往戒酒对根据莱施分类法分类的酒精中毒患者渴望的影响。
我们对192例入院接受戒酒治疗的患者（154例男性，38例女性）进行了检查。使用强迫性饮酒量表评估渴望程度，并将患者分为莱施分类法的四个亚组之一。通过结构化访谈评估既往戒酒的次数。
莱施分类法4型患者的渴望得分显著高于1-3型患者（曼-惠特尼U检验；P<0.05）。关于反复戒酒的影响，我们发现既往戒酒次数与整个人群的渴望程度之间存在显著相关性（斯皮尔曼等级相关系数r=0.241，P=0.001，N=192），特别是对于莱施1型患者（斯皮尔曼等级相关系数r=0.534，P=0.001，N=37）。在其他亚组（莱施2-4型）患者中未发现显著关联。
反复戒酒对渴望的影响在莱施1型患者中尤为重要。我们的结果强调了点燃效应的重要性，特别是在这组患者中，可能是由谷氨酸能神经传递增加介导的。此外，我们的结果强调了在成瘾研究中对酒精依赖患者进行分类的必要性。
