Do Alcohol Cravings Increase Over Time in Abstinent Drinkers?

New research from a team of Chinese scientists indicates that alcohol craving levels in alcohol-dependent drinkers who establish abstinence rise significantly over a period of a couple of months. People who feel strong urges or cravings for alcohol between drinking sessions are commonly at risk for developing a diagnosable case of alcohol use disorder (alcoholism and/or alcohol abuse). In a person receiving treatment for alcohol-related problems, the presence of cravings substantially increases the odds for a relapse back into active drinking. In a study published in April 2015 in the journal Addiction Biology, researchers from four Chinese institutions sought to establish the timeframe during which abstinent alcohol-dependent drinkers feel increasing urges to resume alcohol use.

Abstinence and Alcohol Treatment

Most alcohol treatment programs in the U.S. have a goal of abstinence, or complete cessation of alcohol intake. Underlying this goal is a belief that the consumption of even small amounts of alcohol can trigger the onset of uncontrolled, dysfunctional intake in a person addicted to drinking or in a non-addicted drinker who abuses alcohol. Medications used to help establish or maintain abstinence include naltrexone (which promotes a reduction in drinking levels), disulfiram (which greatly amplifies the unpleasant effects of alcohol use), acamprosate (which helps reduce alcohol cravings in abstinent drinkers) and topiramate (which helps correct chemical imbalances in the brain that promote dysfunctional alcohol consumption). Psychotherapeutic options for abstinence-oriented alcohol treatment include motivational enhancement therapy—which helps people with alcohol problems overcome resistance to participation in an appropriate program—and cognitive behavioral therapy, which helps people with drinking problems understand and change the emotional reactions that make drinking more likely in specific situations. Alcoholism (alcohol dependence) is now well-recognized among doctors, researchers, public health officials and addiction specialists as a chronic condition that has the same long-lasting, periodic impact on affected individuals as such non-addiction-related conditions as heart disease and diabetes. In practical terms, this means that relapse is a frequent occurrence in people with drinking problems who attempt to halt their alcohol consumption. For this reason, the administrators of treatment centers typically integrate methods of successfully recovering from a relapse into the core of their programs.

Alcohol Cravings

Recurring alcohol cravings are one of 11 symptoms that doctors use to diagnose the presence of alcohol use disorder. (A minimum of two symptoms is needed for such a diagnosis.) Generally speaking, the urge to drink increases substantially when an affected person experiences internal or external cues that he or she has come to associate with the act of alcohol consumption. Internal cues that support alcohol cravings include mental states or lines of thought that have provoked or accompanied drinking in the past. External cues that support alcohol cravings can include settings or locations previously linked to drinking, the presence of friends or acquaintances who drink and the presence of alcohol-consuming strangers.

Do Cravings Rise Over Time?

In the study published in Addiction Biology, researchers from China’s Ministry of Health, Peking University, Inner Mongolia Medical University and Chinese Academy of Medical Sciences used data gathered from 339 men to assess the time-related intensity of alcohol cravings in a person with drinking problems who establishes abstinence. All of the study participants had received a diagnosis for alcohol dependence. Three hundred twenty of the participants underwent tests designed to detect craving levels one week after establishing abstinence, two weeks after establishing abstinence, one month after establishing abstinence and two months after establishing abstinence. The remaining 19 participants went through repeated testing of their alcohol craving levels at each of the four indicated times rather than just a single instance of testing. The researchers found that certain underlying indicators of recovery from alcohol dependence (including baseline blood pressure levels and heart rate) do not differ very much after one week of abstinence, two weeks of abstinence, one month of abstinence or two months of abstinence. However, they also found that the objectively measured level of alcohol craving reached its peak roughly two months after the study participants established abstinence. The study’s authors undertook their project, in part, because they wanted to know if craving levels rise over time in abstinent drinkers in a manner similar to the cravings associated with nicotine/tobacco use and methamphetamine use. They concluded that alcohol cravings do indeed follow a generally similar pattern of increase over time.

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