Dandaba Meira, Serra Wilfried, Harika-Germaneau Ghina, Silvain Christine, Langbour Nicolas, Solinas Marcello, Noël Xavier, Jaafari Nemat, Chatard Armand
Service Hospitalo-Universitaire de Psychiatrie et de Psychologie Médicale, Centre Hospitalier Henri Laborit, Poitiers, France; Centre de Recherches sur la Cognition et l'Apprentissage, Université de Poitiers, CNRS 7295, Poitiers, France.
Service Hospitalo-Universitaire de Psychiatrie et de Psychologie Médicale, Centre Hospitalier Henri Laborit, Poitiers, France.
Addict Behav. 2020 Aug;107:106433. doi: 10.1016/j.addbeh.2020.106433. Epub 2020 Apr 7.
Low insight is reported as a risk factor for relapse among patients treated for alcohol use disorders. However, to date, little is known on why patients with low insight are at higher risk for relapse. In this study, we tested the hypothesis that an implicit preference for alcohol over abstinence predicts relapse in patients with low, but not high, alcohol insight. Participants consisted of 77 patients who had received treatment for severe alcohol use disorder in a hospital in France. During hospitalization, they completed a self-report measure of insight and an implicit association test to assess implicit preference for alcohol over abstinence. The primary outcome was relapse assessed one month after discharge. Control variables were gender, age, cognitive deficit, anxiety, depression, craving, and impulsivity. Data were analysed using logistic regression analysis. After adjusting for demographic and clinical variables, relapse was predicted by the interaction between insight and implicit preference for alcohol but not by their main effects alone. Implicit preference for alcohol predicted relapse among patients with relatively low insight, but not among those with relatively high insight. These findings suggest that patients with low insight and strong implicit preference for alcohol are at a higher risk of relapse. Clinicians may therefore focus on and tailor specific interventions to prevent relapse in this vulnerable and at-risk population.
低自知力被报告为酒精使用障碍患者复发的一个风险因素。然而，迄今为止，对于低自知力患者复发风险更高的原因知之甚少。在本研究中，我们检验了这样一个假设：相较于戒酒，对酒精的内隐偏好预示着低酒精自知力（而非高酒精自知力）患者的复发。研究参与者包括77名在法国一家医院接受过严重酒精使用障碍治疗的患者。在住院期间，他们完成了一项自知力的自我报告测量以及一项内隐联想测验，以评估对酒精相较于戒酒的内隐偏好。主要结局是出院后一个月评估的复发情况。控制变量包括性别、年龄、认知缺陷、焦虑、抑郁、渴望和冲动性。数据采用逻辑回归分析进行分析。在对人口统计学和临床变量进行调整后，复发是由自知力与对酒精的内隐偏好之间的相互作用预测的，而不仅仅由它们各自的主效应预测。对酒精的内隐偏好预示着自知力相对较低的患者会复发，但自知力相对较高的患者则不会。这些发现表明，自知力低且对酒精有强烈内隐偏好的患者复发风险更高。因此，临床医生可能需要关注并针对这一脆弱且有风险的人群量身定制具体干预措施以预防复发。
