Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany.
Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, Heidelberg University, Germany.
Alcohol Clin Exp Res. 2021 Mar;45(3):577-586. doi: 10.1111/acer.14550. Epub 2021 Feb 20.
Alcohol can be instrumentalized to achieve goals that without the drug would either not be achievable or would be so only with considerably more workload. While an understanding of the neurobiological mechanisms of alcohol instrumentalization is emerging, little information is available concerning instrumentalization goals in controlled consumers and how these goals change during the development of an alcohol use disorder (AUD).
We surveyed instrumentalization goals in 103 male and 78 female inpatients with AUD (before / after onset of the disorder) and compared them with the goals of 124 male and 96 female age-matched non-addicted controls. We also investigated whether instrumentalization goals predict 24-month alcohol-related hospital readmissions in the patients using a false discovery rate (FDR) approach.
Separately for both sexes, the most frequently (>25%) self-reported alcohol instrumentalization goals in patients were "stress coping," "craving for alcohol," and "reduction of anxiety and / or depressive mood" and in controls "facilitation of social interaction." Relative to controls, and in a sex-dependent manner, patients with AUD reported the goals "facilitation of social interaction" and "search for a partner" significantly less frequently and "reduction of anxiety and / or depressive mood," "stress coping," "improvement of sexual activity," "improvement of concentration," "euphoria," and "craving for alcohol" more frequently. During the transition to addiction, many of the instrumentalization goals changed significantly, some in a sex-dependent manner. In female AUD patients, a goal of "euphoria" nominally predicted a lower risk of alcohol-related readmission, although not significantly when FDR corrected.
We identified cross-sectional and intra-individual differences in instrumentalization goals that support the assumption that the onset of an AUD coincides with a shift in instrumentalization goals from prosocial instrumentalization toward the self-management of aversive mental states.
酒精可以被利用来实现目标，如果没有药物，这些目标要么无法实现，要么只有通过更多的工作量才能实现。虽然人们对酒精利用的神经生物学机制有了一定的了解，但关于受控消费者的利用目标以及这些目标在酒精使用障碍（AUD）发展过程中如何变化的信息却很少。
我们调查了 103 名男性和 78 名女性 AUD 住院患者（在疾病发作前后）的利用目标，并将其与 124 名男性和 96 名年龄匹配的非成瘾对照者的目标进行了比较。我们还使用虚假发现率（FDR）方法，研究了利用目标是否能预测患者 24 个月的酒精相关住院再入院。
分别对男性和女性而言，患者自我报告的最常见（>25%）酒精利用目标是“应对压力”、“渴望酒精”和“减轻焦虑和/或抑郁情绪”，而在对照组中则是“促进社交互动”。与对照组相比，AUD 患者报告的“促进社交互动”和“寻找伴侣”的目标明显较少，而“减轻焦虑和/或抑郁情绪”、“应对压力”、“改善性功能”、“改善注意力”、“欣快”和“渴望酒精”的目标则明显较多。在向成瘾过渡期间，许多利用目标发生了显著变化，有些是性别依赖的。在女性 AUD 患者中，“欣快”这一目标名义上预测了较低的酒精相关再入院风险，尽管在 FDR 校正后并不显著。
我们发现了利用目标的横断面和个体内差异，这些差异支持了这样的假设，即 AUD 的发作与利用目标从亲社会利用向应对不良心理状态的自我管理转变相一致。
