Alcohol Abuse: Craving Scores, Early-Age Drinking Predict Relapse Risk

Nancy A. Melville

December 14, 2017

SAN DIEGO, California ― Scores on an alcohol craving assessment scale, combined with early-age drinking, were found to be reliable predictors of long-term relapse risk following discharge from a residential alcohol addiction treatment program.

"This is the first study to show that persistent posttreatment alcohol craving is associated with ongoing increased relapse of any drinking after substance use treatment," stated first author Matthew E. Stohs, MD, of the Medical College of Wisconsin and Milwaukee VA Medical Center.

The findings were presented here at the American Academy of Addiction Psychiatry (AAAP) 28th Annual Meeting.

Clinical Implications

In a previous study, researchers with the Mayo Clinic in Rochester, Minnesota, found that a higher score on the Penn Alcohol Craving Scale (PACS) upon admission to a treatment program and on discharge was associated with a significantly increased risk for relapse.

For the new study, conducted while Dr Stohs was at the Mayo Clinic in Rochester, the researchers sought to further determine whether scores on the PACS, when the PACS was administered up to a year following treatment, as well as other factors also relate to alcohol relapse risk.

The retrospective analysis included 218 patients with primary alcohol use disorders who were discharged from a 30-day residential addiction treatment program from November 2012 through April 2014.

Of 141 patients for whom follow-up data were available at 3, 6, 9, or 12 months, results showed an increased risk for relapse of as much as 6% in the year following treatment for each point increase on the PACS score at dismissal (hazard ratio [HR], 1.06; P = .01).

Interestingly, the age of the patient at the time alcohol use began was also predictive. Each year of lower age at initiation of alcohol use increased the risk for relapse (HR = .81; P = .0003).

Additional findings in an intent-to-treat analysis further showed that each 1-point increase in PACS score 3 months after discharge was associated with an increased risk for relapse of up to 12% in the upcoming 9 months (HR = 1.12; P = .0003).

PACS score and age at the first regular use of alcohol remained significant independent predictors of relapse after adjustment in a multivariate analysis.

The PACS scale consists of five questions; responses are ranked from 0 (never or none at all) to 6 (all the time or extremely difficult):

  • How often have you thought about drinking or about how good a drink would make you feel during this period?

  • At its most severe point, how strong was your craving during this period?

  • How much time have you spent thinking about drinking or about how good a drink would make you feel during this period?

  • How difficult would it have been to resist taking a drink during this period of time if you had known a bottle were in your house?

  • Keeping in mind your responses to the previous questions, please rate your overall average alcohol craving for the stated period of time?

The findings suggest that craving scores may play a key role in identifying those at greatest risk and who are therefore in need of closer monitoring, said Dr Stohs.

"We may use high craving scores as a cue to intervene more aggressively at the end of alcohol use disorder treatment and in the first several months after treatment," he said.

He added, "Recognizing that patients who start drinking regularly at an earlier age are at a higher risk of relapse after treatment may guide treatment planners to promote higher-intensity interventions, including longer treatment duration, more frequent visits, or more aggressive antidipsotropic pharmacotherapy."

Valuable Information

Elie Aoun, MD, a fellow in forensic psychiatry at Columbia University School of Medicine, New York City, and a member of the AAAP's board of directors, who moderated the session, said the findings are important and show the potential efficacy of a well-recognized assessment tool that is easily administered.

"These are complex medical diseases and conditions, and we're always looking for factors that can help us determine how well patients are doing and predict treatment response, because early intervention is always better than after a relapse has already happened," said Dr Aoun.

Other assessments, such as blood markers, which require a blood draw, or MRI can be inconvenient, not to mention costly, he told Medscape Medical News.

"So, if someone can develop a simplified scale to help at least stratify people based on the risk of relapse, then it could be tremendously helpful, because that is where you would want to put your resources.

"What this paper shows is that the PACS score, at any given time, can predict relapse for up to a year, and this could be very valuable information," he added.

Understanding the changes that patients experience over time is essential in their management, Dr Aoun underscored.

"The value of surveys is not so much in administering them once but over time to get a sense of the patient's trajectory, to give us longitudinal information," he said.

He noted that longer-term research will help better elucidate the full benefits of the craving scale.

"The sample in this study is pretty large, but obviously, we would need larger studies looking at subpopulations with a lot of longitudinal follow-up to determine for sure if this could be used clinically. But I think what this paper contributes is very valuable in terms of guidance," he said.

Dr Stohs and Dr Aoun report no relevant financial relationships.

American Academy of Addiction Psychiatry (AAAP) 28th Annual Meeting. Abstract B2, presented December 9, 2017.

For more Medscape Psychiatry news, join us on Facebook and Twitter.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.