Schlauch Robert C, Levitt Ash, Bradizza Clara M, Stasiewicz Paul R, Lucke Joseph F, Maisto Stephen A, Zhuo Yue, Connors Gerard J
Research Institute on Addictions, University at Buffalo, SUNY.
J Consult Clin Psychol. 2013 Dec;81(6):1087-99. doi: 10.1037/a0033914. Epub 2013 Jul 29.
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.
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.
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.
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.
开展本研究以更好地理解同时患有严重精神疾病（SMI）和酒精使用障碍（AUD）的个体中渴望与饮酒之间的关系。我们采用了对渴望的矛盾概念化（Breiner、Stritzke和Lang，1999），研究了被诊断为SMI - AUD的患者中使用酒精（趋近倾向）和不使用酒精（回避倾向）的欲望与行为意图之间的双向关系以及饮酒结果。
对从社区心理健康中心寻求门诊双重诊断治疗的278名患者进行了为期6个月的纵向跟踪。在基线、2个月、4个月和6个月时进行的评估包括趋近和回避倾向、饮酒冲动、改变的意愿以及饮酒结果。
时滞多级增长曲线模型发现，回避倾向在不同时间对趋近倾向对后续饮酒结果的影响具有调节作用。具体而言，回避倾向减弱了趋近对后续更高饮酒水平的影响，高回避/低趋近随着时间推移饮酒水平显著下降。结果还表明，随着时间推移，饮酒量和重度饮酒天数对后续趋近倾向的预测存在差异，即较低的饮酒水平预测趋近倾向下降。饮酒量的减少也预测了随后更高的回避倾向，且这种倾向会随着时间持续存在。
这些发现凸显了主观渴望反应的复杂性以及测量趋近和回避倾向的重要性。在被诊断为SMI - AUD的人群中，增加回避倾向的治疗策略可能会提高这一难以治疗人群的戒酒率。
