Di Nicola Marco, Pepe Maria, Montanari Silvia, Bonomo Lorenzo, Casile Francesca, Panaccione Isabella, Franza Raffaella, Chieffo Daniela, Martinotti Giovanni, Addolorato Giovanni, Janiri Luigi, Sani Gabriele
Department of Neuroscience, Section of Psychiatry, Università Cattolica Del Sacro Cuore, Rome, Italy; Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
J Psychiatr Res. 2023 Sep;165:290-297. doi: 10.1016/j.jpsychires.2023.07.041. Epub 2023 Aug 2.
Different craving typologies (i.e., reward, relief, obsessive) have been identified in alcohol use disorder (AUD) but have been less investigated in specific populations like AUD patients with polysubstance use (PSU). The role of dysfunctional personality traits and reward pathways has been reported in both AUD and PSU. We hypothesized that patients with AUD-PSU might show a prevalent reward craving, alongside specific sociodemographic, clinical, and personality features, and aimed at investigating differences in 423 severe AUD outpatients with and without PSU.
One hundred fifteen patients (27.1% of the sample, 67% males, 42 ± 11.6 years old) displayed PSU. Sociodemographic, clinical features and psychopathological/personality dimensions were assessed through: Craving Typologies Questionnaire (CTQ); Obsessive-Compulsive Drinking Scale (OCDS); UPPS-P Impulsive Behavior Scale (S-UPPS-P); Difficulties in Emotion Regulation Scale (DERS). A binomial logistic regression explored factors associated with PSU.
We found higher CTQ 'reward' scores (p < 0.001) in AUD-PSU patients, and a significant association between reward craving and PSU through logistic regression (OR:1.13; p = 0.005). Earlier AUD onset (p < 0.001), greater rates of binge drinking (p = 0.029), more legal problems (p = 0.015), but no significantly higher S-UPPS-S and DERS scores, were detected in AUD-PSU patients.
Reward craving was associated with increased risk for PSU in severe AUD patients. Given AUD-PSU participants greater severity and detrimental treatment responses imputed to PSU, identifying prevalent craving types among risk factors for PSU in AUD may help to implement therapeutic strategies. Addressing neurobiological and behavioral mechanisms through combined psychotherapies, pharmacological and neuromodulation treatments could support tailored interventions with better long-term outcome.
在酒精使用障碍（AUD）中已识别出不同的渴望类型（即奖励性、缓解性、强迫性），但在酒精使用障碍合并多种物质使用（PSU）的特定人群中研究较少。功能失调的人格特质和奖励通路在酒精使用障碍和酒精使用障碍合并多种物质使用中均有报道。我们假设酒精使用障碍合并多种物质使用的患者可能表现出普遍的奖励性渴望，以及特定的社会人口学、临床和人格特征，并旨在调查423例有或无多种物质使用的重度酒精使用障碍门诊患者之间的差异。
115例患者（占样本的27.1%，男性67%，42±11.6岁）存在多种物质使用。通过以下方式评估社会人口学、临床特征以及心理病理/人格维度：渴望类型问卷（CTQ）；强迫性饮酒量表（OCDS）；UPPS-P冲动行为量表（S-UPPS-P）；情绪调节困难量表（DERS）。二项逻辑回归分析探索与多种物质使用相关的因素。
我们发现酒精使用障碍合并多种物质使用的患者CTQ“奖励”得分更高（p<0.001），并且通过逻辑回归分析发现奖励性渴望与多种物质使用之间存在显著关联（比值比：1.13；p=0.005）。酒精使用障碍合并多种物质使用的患者酒精使用障碍发病更早（p<0.001），暴饮率更高（p=0.029），法律问题更多（p=0.015），但S-UPPS-S和DERS得分无显著更高。
奖励性渴望与重度酒精使用障碍患者多种物质使用风险增加相关。鉴于酒精使用障碍合并多种物质使用的参与者病情更严重，且多种物质使用会导致有害的治疗反应，识别酒精使用障碍中多种物质使用风险因素中普遍存在的渴望类型可能有助于实施治疗策略。通过联合心理治疗、药物治疗和神经调节治疗来解决神经生物学和行为机制问题，可以支持制定更具针对性的干预措施，以获得更好的长期效果。
