Exploring factors related to craving and relapse in alcohol-dependent outpatients

Despite years of research and improvements in treatment and prevention, relapse in alcohol dependence remains a problem. Even though many patients become abstinent or controlled drinkers after treatment, relapse rates remain high. Therefore, the goal of this thesis was to explore determinants of relapse, focusing on those determinants that are present in the moments leading up to a relapse, so-called proximal determinants.
Using the dynamic model of relapse (Witkiewitz and Marlatt, 2004), proximal determinants of relapse were examined in this thesis. Especially the role of craving, negative affect, alcohol-related stimuli and implicit processes were subject of investigation. Additionally, since craving is often seen as important to relapse even though a firm empirical foundation is lacking, extra attention was given to craving and its determinants.

Overall, negative affect, including stress, was an important predictor of both relapse and craving. More specifically, negative affect is an important determinant of relapse but is accompanied by other determinants when a patient relapses. However, predicting relapse based on a prior measurement of attentional bias or avoidance tendencies during treatment does not seem warranted even though these biases seem to be present in abstinent alcohol-dependent outpatients. When looking at determinants of craving, stress and anxiety are predictive of craving, and drinking to cope with negative affect seems to serve as a vulnerability for experiencing craving. Additionally, craving is accompanied by higher levels of stress and negative affect in those patients who had relapsed. However, patients infrequently experience craving and the intensity of episodes varies both between and within patients. Finally, the mere experience of craving was not a determinant for relapse.