Andrew J Waters1, Tim M Schoenmakers2, Michelle Snelleman3, Edwin H Szeto4, Ingmar H A Franken5, Vincent M Hendriks6, Dike van de Mheen7. 1. Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA. Electronic address: andrew.waters@usuhs.edu. 2. Department of Clinical Psychology, University of Amsterdam, PO Box 15933, 1001 NK, Amsterdam, the Netherlands; IVO Addiction Research Institute, Postbus 30833, 2500 GV, Den Haag, the Netherlands. 3. IVO Addiction Research Institute, Postbus 30833, 2500 GV, Den Haag, the Netherlands; Erasmus Medical Center, Postbus 2040, 3000 CA, Rotterdam, the Netherlands. 4. Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA. 5. Institute for Psychology, Erasmus University Rotterdam, Postbus 1738, 3000 DR, Rotterdam, the Netherlands. 6. Curium, Leiden University Medical Center, Department of Child and Adolescent Psychiatry, PO Box 15, 2300 AA, Leiden, the Netherlands; Parnassia Addiction Research Centre (PARC) Brijder Addiction Treatment, Zoutkeetsingel 40, 2512 HN, The Hague, the Netherlands. 7. IVO Addiction Research Institute, Postbus 30833, 2500 GV, Den Haag, the Netherlands; Tranzo, School of Social and Behavioural Sciences, Tilburg University, PO Box 90153, 5000 LE, Tilburg, the Netherlands.
Abstract
OBJECTIVES: Using Ecological Momentary Assessment we aimed to describe the time course of temptation episodes in alcohol-dependent outpatients in a real-life setting. We also examined whether affective and motivational variables were cross-sectionally and prospectively associated with temptation episodes. Additionally, we tested whether outpatients who drank against treatment goals (i.e., "lapsers") differed in craving, affect, and motivation from abstainers. METHODS: Participants were 43 alcohol-dependent outpatients (13 female). Using personal digital assistants (PDAs), patients were signaled to complete three random assessments per day for 4 weeks. They were also instructed to complete a temptation assessment whenever they experienced the temptation to drink alcohol. RESULTS: The number of temptation assessments declined over time and did not differ between lapsers and abstainers. Overall, craving was generally higher in lapsers (n = 14) than abstainers (n = 27). In lapsers, but not abstainers, abstinence motivation was lower at temptation assessments vs. random assessments. Across all patients, negative affect was prospectively associated with entry of temptation assessments later the same day. There were no significant effects for positive affect. CONCLUSIONS: In alcohol-dependent outpatients attempting to remain abstinent, negative affect is cross-sectionally associated with entry of temptation assessments. There is more evidence that negative affect precipitates temptations than vice versa. Professionals should be watchful of outpatients who report generally high levels of craving, and who report more negative affect and lower abstinence motivation, when tempted.
OBJECTIVES: Using Ecological Momentary Assessment we aimed to describe the time course of temptation episodes in alcohol-dependent outpatients in a real-life setting. We also examined whether affective and motivational variables were cross-sectionally and prospectively associated with temptation episodes. Additionally, we tested whether outpatients who drank against treatment goals (i.e., "lapsers") differed in craving, affect, and motivation from abstainers. METHODS:Participants were 43 alcohol-dependent outpatients (13 female). Using personal digital assistants (PDAs), patients were signaled to complete three random assessments per day for 4 weeks. They were also instructed to complete a temptation assessment whenever they experienced the temptation to drink alcohol. RESULTS: The number of temptation assessments declined over time and did not differ between lapsers and abstainers. Overall, craving was generally higher in lapsers (n = 14) than abstainers (n = 27). In lapsers, but not abstainers, abstinence motivation was lower at temptation assessments vs. random assessments. Across all patients, negative affect was prospectively associated with entry of temptation assessments later the same day. There were no significant effects for positive affect. CONCLUSIONS: In alcohol-dependent outpatients attempting to remain abstinent, negative affect is cross-sectionally associated with entry of temptation assessments. There is more evidence that negative affect precipitates temptations than vice versa. Professionals should be watchful of outpatients who report generally high levels of craving, and who report more negative affect and lower abstinence motivation, when tempted.
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