Background: Negative affective states and alcohol-related stimuli increase risk of relapse in alcohol dependence. In research and in clinical practice, craving is often used as another important indicator of relapse, but this lacks a firm empirical foundation.
Objectives: The goal of the present study is to explore and compare determinants for relapse and craving, using Marlatt's (1996) taxonomy of high risk situations as a template.
Methods: We conducted semi-structured interviews with 20 alcohol-dependent patients about their most recent relapse and craving episodes. Interview transcripts were carefully reviewed for their thematic content, and codes capturing the thematic content were formulated.
Results: In total, we formulated 42 relapse-related codes and 33 craving-related codes. Descriptions of craving episodes revealed that these episodes vary in frequency and intensity. The presence of alcohol-related stimuli (n = 11) and experiencing a negative emotional state (n = 11) were often occurring determinants of craving episodes. Both negative emotional states (n = 17) and testing personal control (n = 11) were viewed as important determinants of relapses. Craving was seldom mentioned as a determinant for relapse. Additionally, participants reported multiple determinants preceding a relapse, whereas craving episodes were preceded by only one determinant.
Conclusions: Patient reports do not support the claim that craving by itself is an important proximal determinant for relapse. In addition, multiple determinants were present before a relapse. Therefore, future research should focus on a complexity of different determinants.

Additional Metadata
Keywords Alcohol, craving, determinants, interviews, relapse
Persistent URL dx.doi.org/10.1080/10826084.2017.1399420, hdl.handle.net/1765/104653
Journal Substance Use and Misuse
Citation
Snelleman, M, Schoenmakers, T.M, & van de Mheen, H. (2018). Relapse and Craving in Alcohol-Dependent Individuals. Substance Use and Misuse, 1–9. doi:10.1080/10826084.2017.1399420