Schøler Peter Næsborg, Søgaard Nielsen Anette, Witkiewitz Katie, Bogenschutz Michael, Bilberg Randi, Mellentin Angelina Isabella, Andersen Kjeld
Unit for Clinical Alcohol Research, Research Unit of Psychiatry, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
Department of Psychiatry Odense, Mental Health Services Region of Southern Denmark, Odense, Denmark.
Alcohol Clin Exp Res (Hoboken). 2025 Aug;49(8):1803-1817. doi: 10.1111/acer.70097. Epub 2025 Jun 18.
Craving alcohol for reward (positive reinforcement) and relief (negative reinforcement) has been proposed as useful phenotypes for precision medicine approaches to alcohol use disorder (AUD) treatment. This study examined reward and relief craving in nonpharmacological treatments, Motivational Enhancement Therapy (MET) versus MET + Community Reinforcement Approach (CRA), among older adults.
Secondary analyses of data from The Elderly Study (N = 693; mean age 64.0 years; male 59.7%), a single-blinded, multisite, randomized controlled trial of two nonpharmacological treatments in an elderly population (60+ years) diagnosed with DSM-5 AUD. Latent profile analysis (LPA) was used to identify craving profiles based on The Alcohol Abstinence Self-Efficacy Scale (AASE) temptation subscale scores. The classification performance of clinical cutoff scores on the AASE scale was tested against the LPA solution. Associations between cutoff-based craving groups and treatment success (binary variable representing change in alcohol consumption and quality of life across profiles pre-/posttreatment) were analyzed using logistic regression, stratified on MET versus MET + CRA. Differences in alcohol consumption and quality of life scores pre-/posttreatment were analyzed using the Wilcoxon signed-rank test.
Four reward-relief craving profiles were identified but were more distinguished by variation in relief craving (low relief, medium-low relief, medium-high relief, and high relief). Compared to the low relief craving group, the medium-high relief craving group had lower odds for treatment success when receiving MET: adjusted Odds Ratio (aOR) 0.42 (95% CI 0.21-0.84), and the high relief craving group had lower odds for treatment success when receiving MET + CRA: aOR 0.38 (95% CI 0.15-0.94). Alcohol consumption was reduced, and psychological quality of life was improved at follow-up across all relief craving groups.
This study identified reward and relief drinking craving among older adults with AUD. Results indicate that considering relief craving when offering nonpharmacological treatment to older adults suffering from AUD may be clinically relevant.
为了获得奖赏（正性强化）和缓解（负性强化）而渴望饮酒已被提议作为酒精使用障碍（AUD）精准医学治疗方法的有用表型。本研究在老年人中考察了非药物治疗——动机增强疗法（MET）与MET+社区强化法（CRA）——中的奖赏性渴望和缓解性渴望。
对老年研究（N=693；平均年龄64.0岁；男性占59.7%）的数据进行二次分析，该研究是一项针对60岁及以上被诊断为DSM-5 AUD的老年人群的两种非药物治疗的单盲、多中心、随机对照试验。采用潜在类别分析（LPA），根据戒酒自我效能量表（AASE）诱惑分量表得分来确定渴望类别。将AASE量表临床临界值的分类性能与LPA结果进行对比检验。使用逻辑回归分析基于临界值的渴望组与治疗成功（代表治疗前后各类别酒精消费量和生活质量变化的二元变量）之间的关联，并按MET与MET+CRA进行分层。使用Wilcoxon符号秩检验分析治疗前后酒精消费量和生活质量得分的差异。
识别出四种奖赏-缓解性渴望类别，但更多是通过缓解性渴望的差异（低缓解、中低缓解、中高缓解和高缓解）来区分。与低缓解性渴望组相比，接受MET时，中高缓解性渴望组治疗成功的几率较低：调整后的优势比（aOR）为0.42（95%置信区间0.21-0.84）；接受MET+CRA时，高缓解性渴望组治疗成功的几率较低：aOR为0.38（95%置信区间0.15-0.94）。在所有缓解性渴望组中，随访时酒精消费量均有所减少，心理生活质量得到改善。
本研究识别出患有AUD的老年人中的奖赏性和缓解性饮酒渴望。结果表明，在为患有AUD的老年人提供非药物治疗时考虑缓解性渴望可能具有临床意义。
