Relief craving severity moderates nonpharmacological treatment outcomes in treatment-seeking older adults with alcohol use disorder.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.