Portuguese validation of the Alcohol Craving Questionnaire-Short Form-Revised.

Alcohol craving has been described as a strong subjective desire to drink, being considered highly valuable in the clinical practice, as it is recognized as a strong predictor of alcohol relapse in alcohol-dependent individuals. However, to date, there is not a multifactorial questionnaire available for assessing short-term acute craving experience in Portugal. The aim of the present study was to validate a swift and efficient tool for the assessment of acute alcohol craving in a sample of Portuguese citizens. For that purpose, the Alcohol Craving Questionnaire-Short Form-Revised (ACQ-SF-R) was translated into European Portuguese and administered to a sample of 591 college participants with ages between 18 and 30 years. Results suggested that a three-factor model (i.e., Emotionality, Purposefulness, and Compulsivity) proved to be most suitable for the Portuguese sample. Overall, the ACQ-SF-R exhibited good psychometric properties, having a good internal consistency both for the general craving index (Cronbach's α = 0.85) and each subscale (Cronbach's α = 0.66-0.83), as well as an appropriate convergent validity with the Penn Alcohol Craving Scale (r = 0.65, p<0.001), suggesting a good construct validity. In addition, the ACQ-SF-R also showed a good concurrent validity with the Alcohol Use Disorders Identification Test (r = 0.57, p<0.001), indicating that risky alcohol use patterns are associated with increased craving scores in the ACQ-SF-R. Collectively, these findings suggest that the Portuguese version of the ACQ-SF-R can accurately measure alcohol craving at a multifactorial level, being a valid and reliable tool to use in Portuguese samples in research settings.

Introduction

Alcohol craving has been classically described as a strong subjective desire to drink, being considered a hallmark of alcohol dependence [1, 2]. As such, it has been suggested that craving for alcohol is involved in the development and maintenance of severe alcohol use disorder (AUD), facilitating the emergence of alcohol-related obsessive thoughts and compulsive approach behaviors, despite repeated efforts to stop the consumption [3]. Therefore, craving conceptualization is considered highly valuable in clinical practice, as it is recognized as a strong predictor of alcohol relapse in alcohol-dependent individuals [4]. In addition, reduction of alcohol craving can lead to several benefits throughout rehabilitation, ultimately preventing relapses and boosting natural treatment outcomes [5], becoming one of the main targets for intervention in alcohol addiction [6, 7]. Indeed, the International Classification of Diseases (ICD-10 and ICD-11) [8, 9], as well as the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) [10] considered craving as a major criterion in the diagnosis of alcohol dependence and AUD, respectively.

The urge to drink or the intense and recurrent thoughts about alcohol, typically linked to alcohol craving, have often been associated with physiological and environmental cues [11]. Accordingly, specific environmental contexts (e.g., seeing/smelling alcohol) and physiological signals (i.e., bodily perceptions such as those linked to withdrawal symptoms) are known inducers of craving [3, 12–14]. Craving levels may also be time persistent, remaining low for long periods and still having high peak occurrences after weeks or months [11]. In this sense, it has been proposed that craving measures may be included within two main categories with respect to their timeframe: the state measures, which focus on the “here-and-now” craving status; and the global measures, which reflect the craving experience over the course of days, weeks or longer periods [1]. Additionally, recent investigation has described craving in terms of a triadic model, considering the craving experience as the interplay between three subcomponents: cognitive craving, associated with reduced efficiency in high-level cognitive abilities (e.g., inhibitory control); automatic craving, which represents the cue reactivity and the attentional bias to addiction-related cues; and physiological craving, expressed by body signals caused by a homeostatic imbalance such as stress or sleep deprivation [15].

The complexity of the craving phenomenon has led to the development of different questionnaires in order to capture the temporal nature of this experience as well as the potential sub-components or dimensions of craving. Specifically, two of the most commonly used questionnaires for assessing craving, namely the Alcohol Urge Questionnaire (AUQ) [16] and the Alcohol Craving Questionnaire (ACQ) [17], are measures of short-term acute craving experience. On the other hand, the Penn Alcohol Craving Scale (PACS) [18] and the Desires for Alcohol Questionnaire (DAQ) [19] retroactively assess past level of craving in the midterm. Concerning the dimensionality of these questionnaires, AUQ and PACS are characterized by having a unidimensional -single factor- structure, whereas ACQ and DAQ comprise multiple sub-scales or factors, thus being considered multidimensional.

Accordingly, as craving is often described as being composed of multiple subcomponents [1, 15], it is likely to be beneficial to use multifactorial scales for measuring craving, since these can have different predictive utility and offer contrasting treatment targets [20]. However, this type of scale usually has a great number of items, which has a negative effect on respondents’ willingness to accurately complete them [21, 22]. Aiming to overcome these limitations, several short forms of multifactorial alcohol craving questionnaires have been developed and validated, including the six-item version of the DAQ (DAQ-6) [23] and the short form of the ACQ (ACQ-SF-R) [24]. Whereas DAQ-6 has six items divided into only two factors (i.e., “expectancy of negative reinforcement” and “strong desires and intentions to drink or use drugs”), the ACQ-SF-R is more comprehensive and comprises 12 items divided into four factors (i.e., Compulsivity, Expectancy, Purposefulness and Emotionality). This latter questionnaire has already been adapted and validated to the Brazilian and Spanish populations [25, 26], and it is considered a valuable and reliable measure widely used both in research and clinical settings to assess acute alcohol craving [27-29].

In Portugal, as far as we know, the PACS is the only alcohol craving measure that has been translated and validated to European Portuguese speakers [30]. However, this questionnaire simply allows assessing the craving levels retrospectively (during the past week) and as a single factor disregarding the individual’s current craving and the potential multidimensional nature of this phenomenon [15, 31]. With the intention of providing a swift and more efficient tool for the assessment of acute alcohol craving to researchers working with a sample of European Portuguese speakers, the objective of the present study was to develop and validate the Portuguese version of the ACQ-SF-R.

Methods

Participants

The initial sample included a total of 842 students from the University of Minho (Portugal). Data were collected between October 2018 and October 2019 by administering the questionnaires in a classroom setting. From the initial sample, 162 participants were excluded for not completing all questions of both questionnaires (ACQ-SF-R and PACS) and 89 for not meeting the age criteria (ages between 18–30 years old), which besides being Portuguese was the only inclusion criteria. There were no exclusion criteria. Thus, the final sample included 591 participants (67.3% female; see Table 1), of which eight did not complete the Alcohol Use Disorders Identification Test (AUDIT). Additionally, the sample was divided in two groups based on alcohol use pattern, i.e., non/low-risk drinkers (AUDIT < 8) and risky drinkers (AUDIT ≥ 8).

Table 1

Age and alcohol consumption by gender and alcohol use pattern.

	Age M(SD)	AUDIT M(SD)	PACS M(SD)	ACQ-SF-R M(SD)
Gender
Men (N = 193)	20.65 (2.16)	4.68 (4.35)	2.40 (3.45)	2.18 (1.00)
Women (N = 398)	20.23 (1.64)	5.11 (5.47)	1.73 (3.35)	1.80 (0.86)
Alcohol Use Pattern
Risky Drinkers (N = 129)	20.29 (1.60)	12.88 (5.47)	5.08 (5.04)	2.73(1.10)
Non/low Risk Drinkers (N = 454)	20.43 (1.89)	2.59 (2.20)	1.07 (2.06)	1.70(0.73)
Total Sample (N = 591)	20.37 (1.84)	4.97 (5.13)	1.95 (3.40)	1.93(0.93)

Note: M, mean; SD, standard deviation; AUDIT, Alcohol Use Disorders Identification Test; PACS, Penn Alcohol Craving Scale; ACQ-SF-R, Alcohol Craving Questionnaire–Short Form–Revised.

Measures

The Alcohol Craving Questionnaire–Short Form–Revised (ACQ-SF-R) [24]

This questionnaire is a self-report measure consisting of 12 items derived from the 47-item Alcohol Craving Questionnaire (ACQ-Now) [17] and was designed to provide a brief screening method to be used in research and clinical practice to assess current craving for alcohol. Items are rated in a 7-point Likert-scale, from “totally disagree” (1) to “totally agree” (7), with the items 3, 8, and 11 being inversely scored, and a general craving index may be derived by summing all items and dividing by 12.

According to Singleton [24], the factor analysis of the ACQ-SF-R supported the same four factors as the ACQ-Now, with a good internal consistency (Cronbach’s α ranged between 0.77 and 0.86). These factors measure different dimensions of craving for alcohol: Compulsivity, related to the loss of control over drinking; Expectancy, concerned with the positive benefits of drinking; Purposefulness, associated with the intention and plan to drink; and Emotionality, linked to the relief from withdrawal/negative affect [32].

Penn Alcohol Craving Scale (PACS) [18]

The PACS is a self-report measure with five questions, each one with seven answer options (from 0 to 6). The first three questions range from different levels of intensity, frequency and duration of alcohol-related thoughts. The fourth question concerns the alcohol consumption restraint capacity and the last one focuses on the levels of craving in the past week. This scale has been translated and valitated for European Portuguese speakers, and presents good psychometric properties [30].

Alcohol Use Disorders Identification Test (AUDIT) [33]

The AUDIT is a self-report measure with ten questions, used to identify current harmful and hazardous drinking. This test has been validated to assess alcohol-related problems and/or AUD [34] and has become the world’s most widely used alcohol screening instrument, including in Portugal [35]. AUDIT scores < 8 reveal low risk of alcohol use; scores between 8 and 15 represent a risky consumption; scores from 16 to 19 are considered a harmful intake pattern; and scores ≥ 20 indicate very high risk for alcohol dependence and warrant further diagnostic evaluation for alcohol dependence [33, 36, 37]. In the present study, we used the European Portuguese translated version of the AUDIT [37].

Procedure

The study consisted of three phases: (1) scale translation; (2) questionnaire administration; and (3) analysis of validity and reliability.

In the first phase, ACQ-SF-R was independently translated from the English version into European Portuguese by four Portuguese native researchers with a high level of proficiency in English and, subsequently, compared and discussed in a small group of expert researchers in the topic. This version was then back translated into English by an independent researcher with English as first language and compared with the original English questionnaire. After verifying the equality of contents between the original and the final translation as well as the proper understanding of all items, the final version was created (see S1 Appendix).

In the second phase, the two alcohol craving measurements (ACQ-SF-R and PACS) were administered, along with the AUDIT, to college students at University of Minho in a classroom context, with the professor and students’ verbal consent. The Ethics Subcommittee for Social and Human Sciences (SECSH) of the University of Minho gave written approval for this study, associated with the approval number CE.CSH 078/2018.

During the third phase, statistical analyses of validation and reliability of the Portuguese version of ACQ-SF-R were performed. The guidelines of the General Data Protection Regulation (UE 2016/679) and the Declaration of Helsinki [38] were followed to guarantee the confidential treatment of the data and to ensure compliance with international standards of ethical research involving human beings.

Data analysis

Firstly, an Exploratory Factorial Analysis (EFA) with a Varimax rotation was conducted to identify the factorial structure of the scale. The method of extraction used was unweighted least squares (ULS), and factors with eigenvalue below one were excluded. Kaiser Meyer Olkin (KMO) and Bartlett’s Test were performed as a preliminary step to determine the properties of the inter-item correlation matrix and to measure the strength of the relationship between factors. The items were checked for double loading to a factor (i.e., having a loading > 0.60 to more than one factor). Subsequently, a Confirmatory Factor Analysis was completed by the Maximum Likelihood method to test the Portuguese three-factor model and the original four-factor model. To this extent, we considered the following fit indexes: Relative Chi-Square (x2 /df); Normed Fit Index (NFI); Comparative Fit Index (CFI); Goodness-of-Fit Index (GFI); and Root Mean Square Error of Approximation (RMSEA). In accordance, commonly accepted fit indices and acceptable limits for model fit are presented in Table 2 [39, 40]. Akaike information criterion (AIC) was also considered for the comparisons between different models, where smaller values represent the best model.

Table 2

Goodness of fit indices and acceptable limits.

Indices	Acceptable limits
χ2/df	≤ 5 acceptable fit, ≤ 2 perfect fit
RMSEA	0.10–0.08 weak fit, ≤ 0.08 good fit, ≤ 0.06 perfect fit
GFI	0.85–0.89 acceptable fit, ≥ 0.90 good fit, ≥ 0.95 perfect fit
CFI	≥ 0.90 acceptable fit, ≥ 0.95 good fit, ≥ 0.97 perfect fit
NFI	≥ 0.90 acceptable fit, ≥ 0.95 good fit

Note: χ2, chi-Square; df, degrees of freedom; RMSEA, Root mean square error of approximation; GFI, Goodness-of-fit statistic; CFI, Comparative fit index; NFI, Normed-fit index.

The internal consistency of the full scale and each factor was calculated using the Cronbach’s α coefficient and the mean inter-item correlation was calculated to confirm if each individual item provides a consistent and appropriate measurement of the construct. Furthermore, Pearson’s correlations were conducted to assess convergent validity using PACS data as reference, and concurrent validity using AUDIT scores. Additionally, in order to compare ACQ-SF-R scores for participants in the two levels alcohol risk (see Table 1), a repeated measures ANOVA was conducted with one between-subjects factor with two levels (alcohol use pattern: risk and non/low risk) and one within-subjects factor with three levels (ACQ-SF-R: Emotionality, Purposefulness and Compulsivity) to evaluate potential differences in the craving levels between these two groups.

Finally, configurational invariance across gender was also explored. Specifically, EFA, KMO and Bartlett’s Test, as well as the Cronbach’s α coefficient and mean inter-item correlation, were conducted separately within each gender.

Results

Exploratory Factor Analysis (EFA)

Results of the Kaiser-Meyer-Olkin measure of sampling adequacy and Bartlett’s test of sphericity were appropriate for factor analysis (KMO = 0.87; χ2 = 2429.56; p < 0.001). Three different factors, which together accounted for 60.64% of the total variance were extracted (see Table 3). Factor 1, Emotionality, explained 38.58% of the variance and it was comprised of items 6, 7, 9, 10 and 12. Factor 2, Purposefulness, explained 12.03% of the variance and it included the items 3, 8 and 11. Factor 3, Compulsivity, explained 10.03% of the variance and encompassed items 1, 2, 4 and 5. None of the items were double loaded on any factor.

Table 3

Total explained variance from the exploratory factor analysis.

Factor	Initial Eigenvalues			Extraction Sums of Squared Loading			Rotation Sums of Squared Loadings
	Total	Variance %	Cumulative %	Total	Variance %	Cumulative %	Total	Variance %	Cumulative %
1	4.628	38.567	38.567	4.628	38.567	38.567	3.037	25.312	25.312
2	1.453	12.107	50.674	1.453	12.107	50.674	2.381	19.842	45.153
3	1.201	10.011	60.685	1.201	10.011	60.685	1.864	15.532	60.685
4	0.762	6.350	67.035
5	0.710	5.913	72.948
6	0.624	5.198	78.146
7	0.585	4.879	83.025
8	0.538	4.487	87.512
9	0.456	3.803	91.315
10	0.413	3.444	94.759
11	0.360	3.001	97.760
12	0.269	2.240	100.000

Confirmatory factor analysis

In conformity with the Maximum Likelihood method, the three-factor model and the original four-factor model were tested. The three-factor model reached the following fit indices: x2/df = 4.98, NFI = 0.90, CFI = 0.92, GFI = .94, RMSEA = 0.08, while the four-factor model reached the following fit indices: x2/df = 6.50, NFI = 0.87, CFI = 0.89, GFI = 0.91, RMSEA = 0.10. Each model scored 307.72 and 372.14 for AIC, respectively. The upper mentioned indices and AIC indicated a better model fit for the three-factor model (see Fig 1 and, Tables 2 and 4).

Fig 1

Confirmatory factor analysis for the ACQ-SR-N-PT F1 -Emotionality- includes items 6, 7, 9, 10, and 12; F2 -Purposefulness- includes items 3, 8, and 11; F3 –Compulsivity includes items 1, 2, 4, and 5 (N = 591).

Table 4

Model fit indices.

Model	χ2	df	χ2/df	NFI	CFI	GFI	RMSEA	AIC
Three-factor	253.72	51	4.98	0.90	0.92	0.94	0.08	307.72
Four-factor	312.14	48	6.50	0.87	0.89	0.91	0.10	372.14

Note: χ2 –Chi-Square; df–degrees of freedom; NFI–Normed Fit Index; CFI–Comparative Fit Index; GFI–Goodness-of-Fit Index; RMSEA–Root Mean Square Error of Approximation; AIC–Akaike Information Criterion.

Reliability

Both the total scale (α = 0.85) and the three factors (F1, α = 0.83; F2, α = 0.66; F3, α = 0.70) showed good internal consistency values [41]. Calculation of the mean inter-item correlation also showed good internal consistency for the full scale (0.32) and the three factors (F1 = 0.32; F2 = 0.40; F3 = 0.37) [42]. Finally, the reliability of the scale did not improve by removing any of the items.

Validity

A significant correlation was found when PACS was compared with the full-scale score of the ACQ-SF-R (r = 0.65, p < 0.001), indicating good convergent validity. Furthermore, a significant correlation was also observed between ACQ-SF-R and AUDIT (r = 0.57, p < 0.001), indicative of appropriate concurrent validity. Additionally, comparisons between risky drinkers and non/low risk drinkers showed significant differences regarding their craving scores (F (1, 581) = 155.86, p < 0.001). Specifically, risky drinkers reported higher scores of alcohol craving for all three subscales in comparison with non/low risk drinkers (F (2, 1655 = 16.91, p < 0.001) (Table 5).

Table 5

Craving scores across alcohol use pattern groups.

	Non/Low Risk Drinkers M(SD)	Risky Drinkers M(SD)
	N = 454	N = 129
F1—Emotionality	1.60 (0.91)	2.56 (1.40)
F2—Purposefulness	2.35 (1.45)	3.83 (1.57)
F3—Compulsivity	1.34 (0.58)	2.11 (1.21)
ACQ-SF-R–Full Scale	1.70 (0.73)	2.72 (1.10)

Note: ACQ-SF-R, Alcohol Craving Questionnaire–Short Form–Revised; M, mean; SD, standard deviation.

Factorial invariance and reliability across gender

When conducting EFAs separately within each gender, results of both female (KMO = .84; χ2 = 1638.29, p < 0.001) and male groups (KMO = 0.84; χ2 = 799.69, p < 0.001) were appropriate. EFA showed that males and females had identical factor loadings in all the subscales as the main exploratory analysis, except for item 1 which had a higher factor loading on F2 (Purposefulness) than F3 (Compulsivity) for females. Additionally, the three factors explained similar amounts of variance, namely F1, F2 and F3 explained 38.49%, 12.49% and 9.50% of the variance for males, and 37.42%, 12.93% and 9.92% for females.

Furthermore, good internal consistency values in the total scale and the three subscales were expressed for both males (Total scale: α = 0.84; F1: α = 0.81; F2: α = 0.60; F3: α = 0.72) and females (Total scale: α = 0.83; F1: α = 0.81; F2: α = 0.69; F3: α = 0.64). Likewise, mean inter-item correlations also showed good internal consistency in the full scale and the three factors, in both male (Total scale: α = 0.31; F1: α = 0.49; F2: α = 0.33; F3: α = 0.42) and female (Total scale: α = 0.30; F1: α = 0.50; F2: α = 0.42; F3: α = 0.32) groups.

Discussion

The ACQ-SF-R is a widely used screening instrument to assess craving in both clinical and non-clinical populations. However, there are no studies to date assessing the psychometric properties of this questionnaire in Portugal. Thus, the main objective of the present study was to adapt and validate a version of the ACQ-SF-R for European Portuguese speakers. The findings of the present study suggest that the ACQ-SF-R possesses good psychometric properties and is a valid and reliable measure to assess acute alcohol craving in three complementary dimensions: Emotionality, Purposefulness, and Compulsivity. Additionally, the instrument showed good convergent and concurrent validity and showed cohesiveness within each gender, with good internal consistency of the scale for both males and females.

Regarding instrument reliability, results revealed good internal consistency values (α = 0.85), with similar values to the original version of the ACQ-SF-R (α range between 0.77 and 0.86; Singleton, 1997) as well as the Spanish (α = 0.87; Gálvez et al., 2016) and the Brazilian (α = 0.91; Girelli et al., 2019) validations. Similarly, the Portuguese version of the ACQ-SF-R showed good convergent validity with the PACS, with a higher relationship strength than the Spanish ACQ-SF-R validation [25]. Thus, the present study seems to complement the psychometric results found for the Portuguese version of the PACS, which to date is the only questionnaire assessing alcohol craving validated in European Portuguese. Furthermore, and contrary to the PACS, ACQ-SF-R also allows the assessment of different dimensions of alcohol craving, which can be useful to differentiate how this phenomenon is expressed in different populations (e.g., light drinkers, binge drinkers, alcohol dependent individuals).

Additionally, Pearson’s correlations showed satisfactory concurrent validity between the ACQ-SF-R and the AUDIT (r = 0.57), reflecting an interaction between alcohol craving and alcohol consumption. In a related vein, levels of alcohol craving were significantly higher in risky drinkers when compared to non/low risk drinkers. Indeed, alcohol craving has often been associated with higher detrimental patterns of alcohol use [3, 43, 44]. Consequently, ACQ-SF-R may be a useful tool for clinical practice, being able to help to detect risky drinking, and future research could determine whether this questionnaire will be useful in predicting risk for relapse and other treatment outcomes.

According to Singleton [24], the English version of ACQ-SF-R is a four-factor measure, however, in our study, the confirmatory factor analysis showed better fit indices for the three-factor model when compared to the original model. Nonetheless, with the number of factors reduced to three, the Portuguese version of the ACQ-SF-R still presented a good construct validity [45] with a total explained variance of 60.6%. Concerning the overall structure of the scale, in the Portuguese version the Expectancy factor was removed, and its items merged into the Emotionality and Compulsivity factors. Furthermore, item 6, which previously loaded on the Compulsivity factor, was included in the Emotionality factor. Thus, the Emotionality dimension included five items (i.e., 6, 7, 9, 10, 12) that paired abstinence from alcohol with feelings of irritability, tension, and restlessness together with the anticipation of some benefits of drinking (e.g., on mood); the Compulsivity factor was composed of four items (i.e., 1, 2, 4, 5) reflecting the urges and desires to drink along with the ability to refrain from consuming alcohol; and, finally, the Purposefulness factor remained identical to the original scale, characterized by three items (i.e., 3, 8, 11) reflecting the intention and plan to drink alcohol.

Consistent with the present study, both the Spanish and Brazilian validations [25, 26] suggested better fit with a smaller number of factors than the original version of the ACQ-SF-R, i.e., three factors for the Spanish validation and two factors for the Brazilian one. With regard to the latter, there are a number of differences between the Brazilian version and the current validation that are worth mentioning. Participants of the Brazilian study were patients recently admitted into a detoxification facility, therefore they had high motivation to change [46] and, consequently, scored low on the scale of purposefulness in regard to drinking. In addition, prior to the craving assessment, these patients were exposed to two pictures of alcoholic beverages, which could lead to incremental changes in craving levels [14] and might have increased both the positive alcohol expectancies and the compulsive tendencies to approach alcohol [47, 48]. Thus, it could be suggested that this previous exposure to alcohol cues may have led to this co-occurrence, causing items associated with expectancies, compulsivity, and emotionality to have higher correlation, which may entail a bigger loading to the same factor [49]. Therefore, these methodological differences might have led to the structural differentiation between the Brazilian and the Portuguese validations.

Finally, the present study has some limitations that deserve consideration. While a strength of the study was that the sample size was higher than previous validation studies of the scale [25, 26], the nature of the sample (young college students) may limit the generalization of the results to the adult population or population without higher education. In the same vein, although part of the sample had a risky consumption pattern, participants cannot be considered a clinical population. As such, results from this validation should not be generalized to clinical populations (e.g., patients with AUD). Moreover, only students from a single public university completed the questionnaire, hence external validity concerning the sociodemographic characteristics of the population might be limited. In addition, the fact that this study presents a significantly higher number of females than males (67.3% vs 32.7%), might be affecting our results. Lastly, all variables analyzed were self-reported, which makes it difficult to determine possible underestimation/overestimation of the levels of alcohol consumption. Thus, additional studies trying to equate the number of each gender and include a general adult population should be conducted in order to validate the present results.

In conclusion, the Portuguese version of the ACQ-SF-R showed good psychometric properties, i.e., revealing good internal consistency and satisfactory convergent validity with the PACS and concurrent validity with the AUDIT. Furthermore, despite having a shorter length, it allows assessment of different dimensions of alcohol craving (i.e., Emotionality, Purposefulness and Compulsivity). Collectively, these findings suggest that this version of the ACQ-SF-R can accurately measure acute alcohol craving at a multifactorial level, being a valid and reliable tool to use in Portuguese samples in research settings.

Administration sheet of the Portuguese version of the Alcohol Craving Questionnaire-Short Form-Revised.

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File concerning all data analysed in this article.

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9 Mar 2021

PONE-D-21-05321

Portuguese Validation of the Alcohol Craving Questionnaire – Short Form – Revised

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The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: No

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Writing corrections:

Does PLOS-One use the American or European system of decimals (page 5 shows “67,3%” where the comma should be a decimal). Page 5: “8” should be “eight” under standard professional rules for use of numerals. “To this extend” should be “To this extent” (page 8). On page 12, change “for a by gender factor analysis” to “for a factor analysis by gender”, and change “similar variances” to “similar amounts of variance”. Bottom of p 13: “this scale also allows to evaluate” should be “this scale also allows one to evaluate”. Middle of p. 14: change “which previously was comprised in the Compulsivity dimension,” to “which previously loaded on the Compulsivity factor”. Change “Compulsivity factor was composed by” to “Compulsivity factor was composed of”. Change “ability to restrain from” to “ability to refrain from”. Page 15 (top): a version does not have participants – a study does, so change “version” to “study” in the 4th line, then change “who have” to “so they had” (it was not a sentence in the way it was written, and past tense must be used). Remove “As such” (not appropriate in this sentence). Change “changes on craving levels” to “changes in craving levels”. Bottom of p 15: Incorrect use of the term “fulfilled”: change “fulfilled” to “completed” or “filled out”. Top of page 16: change “Concluding” to “In conclusion” for correct grammar. The phrase “having a short extension” has no meaning”; reword that. What was meant by “extension”?

Other comments that need addressing:

Introduction and Discussion: Was the Brazilian version of the ACQ-SF-R also in Portuguese, given that Portuguese is the national language of Brazil and that their manuscript is in Portuguese? Would it therefore make it untrue that this manuscript’s version is the first one in Portuguese? Is it instead true that this is the first one in European Portuguese? The manuscript needs to be accurate about this. Maybe sometimes the word “Portuguese” is being used to refer to the country studied rather than the language, but this is highly confusing, if so, since Portuguese is the language of both Portugal and Brazil.

Discussion: Bottom of p. 13: It is inaccurate to say this translation of the measure was given to a clinical population since the participants were college students not recruited from a clinical setting. The fact that many are risky drinkers does not qualify this as clinical. Remove any statements about this translation of the measure being validated in a clinical population. The following sentence is confusing: “This present study seems to complement the only Portuguese-validated questionnaire so far assessing craving in clinical and non-clinical population”. Does this mean the present study complements the Brazilian study’s Portuguese validated questionnaire results? Is the word “complement” a mistranslation of some other intended meaning? A study cannot complement itself as the sentence seems to be saying.

Method: State in the Measures section which of these measures have previously been translated and validated in Portuguese.

Say if the “consent” was written informed consent or oral informed consent. (page 8)

Say what method was used to identify number of factors in the exploratory step (it looks like the Eigenvalue method was used rather than Minimum Partial or Parallel Analysis), or say that the analysis was constrained to three or to four factors. That should be done before the steps that follow the first sentence.

Before doing the steps on page 9, it is usual to check to see if any items are double loaded (e.g., load > .60 on a second factor) and remove them from the final factors.

Combine the two validity sections under one header, called “Validity, with no sub-headers, and make it one continuous paragraph. (A one sentence paragraph is too short to stand alone).

Abstract: Add the word “college” before “participants” or “in college” after “participants”.

Reviewer #2: This manuscript reports the results of a study validating the Alcohol Craving Questionnaire – Short Form - Revised (ACQ-SF-R) in a sample of European Portuguese speakers.

The study was well-designed in its methods, with some limitations, and included Portuguese-speaking college students. The AUDIT was used to classify individuals as “risky drinkers” or non/low risk drinkers.” The ACQ-SF-R indicated that “risky drinkers” had increased craving scores on the ACQ-SF-R. Overall, the ACQ-SF-R was found to have good validity and reliability in the study population.

The manuscript was easy to follow and the data were statistically accurately analyzed. The results support the need to continue to study this instrument in a more representative sample. Some format f the language construction has a very European style; I would recommend to have an English native speaker to review the manuscript prior resubmission.

Below are some specific comments to improve the manuscript:

Abstract

1) Please change “administrated” to “administered.”

Introduction

1) Please change “However, this type of scales is usually” to “However, this type of scale is usually” or “However, these types of scales are usually.”

Methods

1) Please change the comma on page 5 to a decimal: “67,3%” to “67.3%.”

2) I would suggest stating a bit earlier in the Methods that the AUDIT was used to classify individuals as either “risky drinkers” or “non/low risk drinkers” since Table 1 appears pages before that explanation.

3) In the Data Analysis subsection, please change “To this extend” to “To this extent.”

Results

1) Please italicize all statistical symbols.

2) Please add a zero in front of decimals: .87 becomes 0.87, etc.

3) Change sentences beginning with “Significant correlation” to “A significant correlation.”

Discussion

1) On page 13, please change “contrarily” to “contrary.”

2) On page 15 where study limitations are discussed, age and income are mentioned, but the disproportionate number of women (n = 398) to men (n = 193) in the study is not discussed. Please include this limitation in the Discussion section on page 15.

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6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

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17 Mar 2021

We thank the reviewers for their useful suggestions. In the next pages, we try to address each of their considerations.

Reviewer 1

First of all, we thank the reviewer for their valuable comments and suggestions as we believe they have helped substantially to improve the manuscript.

Issue 1. Writing corrections

1. In the abstract, “college” was added before “participants” for a better understanding and more specific characterization of the sample.

2. On page 5 where it showed “67,3%” has been changed to “67.3%”, in accordance with the correct system of decimals. All other decimals have been checked.

3. Also, on page 5, “8” has been changed to “eight”, to meet the standard professional rules for use of numerals. Additionally, the manuscript was checked for similar cases.

4. On page 8, “to this extend” has been changed to “to this extent”.

5. On page 12, “for a by gender factor analysis” has been changed to “for a factor analysis by gender” and “similar variances” has been changed to “similar amounts of variance”.

6. On page 13, “this scale also allows to evaluate” has been changed to “this scale also allows one to evaluate”.

7. On page 14, “which previously was comprised in the Compulsivity dimension,” has been changed to “which previously loaded on the Compulsivity factor”; “Compulsivity factor was composed by” has been changed to “Compulsivity factor was composed of”; “ability to restrain from” has been changed to “ability to refrain from”.

8. On page 15, “version” has been changed to “study” and “who have” has been changed to “so they had”; “As such” was removed from the sentence; “changes on craving levels” has been changed to “changes in craving levels”; “fulfilled” has been changed to “completed”.

9. On page 16, “Concluding” has been changed to “In conclusion”.

10. The phrase “having a short extension” was reworked and changed to “having a shorter length”.

Additionally, the manuscript was revised by an independent person with high proficiency in English and further changes were made regarding grammar.

Issue 2. Clarification concerning the use of European or Brazilian Portuguese when referring to the sample and validation language

The authors would like to thank the Reviewer 1 for highlighting these issues since it could, in fact, lead the reader towards misconceptions regarding the nature of the study and its objectives. In this sense, the manuscript was fully reviewed, and expressions “Portuguese citizens” and “European Portuguese speakers” were introduced to provide more clarity.

Despite it remains true that the Brazilian validation of ACQ-SF-R was developed in Portuguese, there are differences between Brazilian Portuguese and European Portuguese. Additionally, the need for a validation in European Portuguese was also tied in with the sociocultural differences between Brazilian and Portuguese citizens. In this sense, this is, indeed, the first validation of the scale for the population of Portugal, while also being the first in European Portuguese.

Issue 3. Inaccurate statements suggesting the scale validation in a clinical sample

We thank the reviewer for bringing our attention to these inaccurate statements. All mentions of the use of a clinical sample, or possible validation of the scale in a clinical population have been removed from the manuscript. Additionally, in the end of the discussion (pp. 16, lines 325 and 335) we suggested that future investigation should include a clinical sample aiming to strengthen the scale’s generalization properties, while also enabling its use in these populations.

“Although part of the sample had a risky consumption pattern, participants cannot be considered a clinical population. As such, results from this validation should not be generalized to clinical populations (e.g., patients with AUD)”.

“Further research including a greater sociodemographic representation as well as the inclusion of a clinical (i.e., alcohol-dependent) group is recommended in order to enhance the external strength and generalization properties of the questionnaire (e.g., for using in clinical setting).”.

Issue 4. Confusing sentence regarding ACQ-SF-R being a complement to PACS

As it was highlighted by reviewer, the sentence “The present study seems to complement the only Portuguese-validated questionnaire so far assessing craving in clinical and non-clinical population” was indeed confusing. In this sense, the full sentence was amended to “Thus, the present study seems to complement the PACS, which to date is the only questionnaire validated in European Portuguese assessing alcohol craving” providing a better understanding of its true meaning. In this sense, what the sentence should imply is that ACQ-SF-R comes to fill possible gaps that PACS had (e.g., only having a single factor), and together they can mutually enhance each other.

Nevertheless, if the use of the word “complement” remains confusing or misused we will gladly change it for another that fits better in the meaning of the sentence.

Issue 5. Missing information in the Method

In agreement with reviewer’s suggestions, PACS has now been clearly described as being a measure previously validated to the Portuguese population. To our knowledge, there is no validation of the AUDIT questionnaire to the Portuguese population, notwithstanding we followed the translation and the values suggested by Serviço de Intervenção nos Comportamentos Aditivos e nas Dependências (2013), which is one of the most regarded institutions in the field of substance abuse in Portugal. Additionally, information specifying the use of verbal informed consent was added.

As described by reviewer 1, the method used to identify the number of factors in the exploratory step was, indeed, Eigenvalue (i.e., a factor was considered when its Eigenvalue was higher than 1), and this information has now been described in the manuscript. Likewise, we followed the reviewer’s advice and performed a Parallel Analysis. Results from this analysis were identical to those obtained with Eigenvalue (see Table 1), in a sense that the same number factors met the selection criteria (i.e., having an Eigenvalue in the Exploratory Factor Analysis superior to the random generated one). We decided not to include the Parallel Analysis in the final version of the manuscript due to a possible redundance with the Eigenvalue approach. However, we highly value the reviewer’s suggestion and would gladly make further changes on this matter if the reviewer deemed necessary.

Minor Issues.

As suggested by the reviewer, items were checked for double loading and it was accordingly described in the new version of the manuscript (pp. 8, line 172): “The items were checked for double loading to a factor (i.e., having a loading > 0.60 to more than one factor)”. Also, as suggested by the reviewer, the two validity sections were combined under a single header called “Validity”.

Reviewer 2

We thank the reviewer for the overall positive evaluation of the manuscript and for their meaningful comments, that we have carefully tried to address below. Additionally, and as suggested, the whole manuscript was revised by an independent person with a high degree of proficiency in English.

Issue 1. Writing corrections

1. In the Abstract, “administrated” has been changed to “administered”.

2. In the Introduction, “However, this type of scales is usually” has been changed to “However, this type of scale is usually”.

3. On page 5 where it showed “67,3%” has been changed to “67.3%”, in accordance with the correct system of decimals. All other decimals have been checked. A zero has been added in front of all decimals.

4. In Data Analysis, “To this extend” has been changed to “To this extent”.

5. In the Results, sentences beginning with “Significant correlation” have been changed to “A significant correlation”.

6. In the Discussion, “contrarily” has been changed to “contrary”.

Issue 2. Missing description of “risky drinkers” and “non/low risk drinkers” prior to Table 1

As suggested, it has been stated earlier in the Methods section (pp. 6, line 111) the classification of individuals regarding their pattern of alcohol use. Thus, the meaning of “risky drinkers” and “non/low risk drinkers” has been explicitly described prior to Table 1 appearance.

In this sense the following was added to the manuscript “Additionally, the sample was divided in two groups based on alcohol use pattern, i.e., non/low drinkers (AUDIT < 8) and risky drinkers (AUDIT ≥ 8).”

Issue 3. Limitation regarding disproportionate number of women to men was not discussed

As pointed out by Reviewer 2, this limitation is, indeed, important and should be thoroughly discussed. As such, we added information stating that “In addition, the fact that this study presents a significantly higher number of females than males (67.3% vs 32.7%), might be affecting our results. Thus, additional studies trying to match the gender distribution should be conducted in order to validate the present results.”

References

Serviço de Intervenção nos Comportamentos Aditivos e nas Dependências. AUDIT - Alcohol Use Disorders Identification Test. Serviço de Intervenção Nos Comportamentos Aditivos e Nas Depências. 2013. Available from: http://www.sicad.pt/PT/Intervencao/RedeReferenciacao/SitePages/detalhe.aspx?itemId=2&lista=SICAD_INSTRUMENTOS&bkUrl=/BK/Intervencao/RedeReferenciacao/

Submitted filename: Response to Reviewers.docx

Click here for additional data file.

13 Apr 2021

PONE-D-21-05321R1

Portuguese Validation of the Alcohol Craving Questionnaire – Short Form – Revised

PLOS ONE

Dear Dr. Crego,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: (No Response)

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: No

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Writing corrections:

A great many improvements have been made since the first version. There still are many more ways English usage needs to be improved, often due to revisions that were made. Some are hard for people not raised with English as the first language in their country (such as which preposition sounds right to native speakers based on customary use) and some involve the advanced rules used in professional writing in English (I use the Publication Manual of the American Psychological Association for guidance in writing for professional journals). In other places there was lack of clarity about what was meant.

Specific changes needed are listed.

Page 4: “composed by” should be “composed of”. Change “its likely to be beneficial in measuring craving in multifactorial scales, which can have” to “it is likely to be beneficial to use multifactorial scales for measuring craving, since these can have”. Change “is usually extensive and with a great number of items” to “usually has a great number of items”. Change “negative effect on respondents’ motivational and cognitive processes” to “negative effect on respondents’ willingness to accurately complete them”. Change “short-forms of multifactorial alcohol” to “short forms of multifactorial alcohol”. (The rule is to hyphenate the two words only when they together act as an adjective modifying another noun, according to my publication manual.)

Page 6 top: Change “non/low drinkers” to “non/low-risk drinkers”.

Table 1: It is necessary to have any abbreviations in a table explained in the table without people referring to the text, so you need a note defining M, SD. AUDIT, PACS, ACQ-SF-R.

Page 6: Measures: “is a self-reported measure” should be “is a self-report measure” (this is just the way it is phrased) for every measure you describe. Change “12–item” to “12 items” since “item” acts as a noun rather than as part of a modifying phrase (such as “47-item”) in this sentence. Change “Items are ranked on a” to “Items are rated on a”. (These have different meanings). Change “same four factors than ACQ-Now” to “same four factors as the ACQ-Now”. To meet the rules of parallel grammar, the following phrase must be changed from “the intent and planning to drink” either to “intending and planning to drink” or “the intention and plan to drink”.

Page 7: Top: Change “restrain capacity” to “restraint capacity” (restrain is a verb). Change “valitated to European Portuguese speakers” either to “validated in European Portuguese” or “validated for European Portuguese speakers”. At the end of the AUD section add: “This measure was translated into European Portuguese” or some similar statement.

Page 8, lower half: change “inter-items correlation” to “inter-item correlation” (since “inter-item” is being used as an adjective to modify a noun).

Page 9: Please fix this sentence by changing “Additionally, using the two groups based on alcohol use pattern (see Table 1), it was conducted a repeated measures ANOVA” to “Additionally, in order to compare ACQ-SF-R scores for participants in the two levels alcohol risk (see Table 1), a repeated measures ANOVA was conducted”. The last sentence on page 9 is unclear as to what was done; should “were assessed” be changed to “were compared between genders” or “were conducted separately within each gender”?

EFA Results: Since the Method section already said an EFA with Varimax was conducted, do not repeat that fact here. The Method did not say the EFA used ULS so you should add that to the Data Analysis Method. Change “comprised by items” to “comprised of items”. Change “double loaded to any factor” to “double loaded on any factor”.

Table 5 should be deleted. It is customary to take the authors’ word for the statement referenced and not waste space presenting those details.

Validity Results: Change “non/low drinkers” to “non/low risk drinkers” in two places. When significant differences are reported, the means and sds for each significant difference need to be presented. This could be done in a small table since you will present eight of each of these (total and each subscale).

Page 12, factorial invariance: What is meant by “groups by gender”? What groups? Should this say “When conducting EFAs separately within each gender”? What does “factor analysis by gender” mean? I have not heard of entering gender as a variable in a factor analysis. Was the EFA conducted this way? I think you meant to say item 1 had a higher factor loading “on” F2 than F3.

Page 13, top: “Likewise, mean inter-item correlation” should use the plural.

Discussion, 1st paragraph: “the ACQ-SF-R possesses good psychometric properties and reveals to be a valid and reliable measure” is not matching noun with verb correctly in that phrase. Instead it could say “the ACQ-SF-R possesses good psychometric properties and is a valid and reliable measure” (both verbs linking back to the measure as the subject of that clause). If “reveals” was supposed to refer to the sentence subject “findings”, then the wrong case was used, causing confusion about the referent. Change “showed cohesiveness between genders” to “showed cohesiveness within each gender”.

Bottom of page 13, third from last sentence “validation” should be plural, since referring to two other measures. Change “Thus, the present study seems to complement the PACS” to “Thus, the present study seems to complement the psychometric results found for the Portuguese version of the PACS”; then change “which to date is the only questionnaire validated in European Portuguese assessing alcohol craving” by moving “assessing alcohol craving” to after the word “questionnaire”, for clarity.

Page 14: Change “satisfactory concurrent validity with between ACQ-SF-R and AUDIT” to “satisfactory concurrent validity between the ACQ-SF-R and the AUDIT”. Change “non/low drinkers” to “non/low risk drinkers”. The following sentence is too strongly worded, given the lack of extant evidence supporting it: “Consequently, ACQ-SF-R seems to be a useful tool for clinical practice, helping to detect risky drinking, and predict relapses and treatment outcomes.” Change “seems to be” to “may be”, and eliminate mention of predicting relapse and treatment outcomes. You could say that future research could determine whether it will be useful in predicting risk for relapse and other treatment outcomes. These two terms are redundant: “four-factor dimensional measure” – remove either factor or dimensional.

Page 15: “reflecting the intent and planning to drink alcohol” is mixing verb with noun where parallel grammar is needed. Change either to “intending and planning to drink” or “the intention and plan to drink”. Change “and, consequently, low purposefulness to drink” to “and, consequently, scored low on the scale of purposefulness in regard to drinking”. (No one says “purposefulness to drink” in English so that is very hard to understand.) Change “Despite the sample size is higher” to “Despite the sample size being higher” or “Despite the fact that the sample size was higher”. Better yet, change “Despite the sample size is higher” to “While a strength of the study was that the sample size was higher”. Change “than previous validations of the scale” to “than previous validation studies of the scale”.

Page 16: Change “match the gender distribution” to “equate the number of each gender and include a general adult population”. The remove the phrase about greater sociodemographic representation to focus on the need for a clinical group in that next sentence. Change “it allows to assess” to “it allows assessment of”.

Reviewer #2: The authors have extensively responded to all my questions and accepted my suggestions. The manuscript has improved from the original submission.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

25 Apr 2021

We thank the reviewer for their useful suggestions. In the next pages, we try to address each of their considerations.

Reviewer 1

First of all, we thank the reviewer for their valuable comments and suggestions, specifically the care they gave into writing and grammar corrections and suggestions, as we believe they have helped substantially to improve the manuscript.

Issue 1. Writing corrections

1. On page 4, “composed by” was changed to “composed of”; “its likely to be beneficial in measuring craving in multifactorial scales, which can have” was changed to “it is likely to be beneficial to use multifactorial scales for measuring craving, since these can have”; “is usually extensive and with a great number of items” was changed to “usually has a great number of items”; “negative effect on respondents’ motivational and cognitive processes” was changed to “negative effect on respondents’ willingness to accurately complete them”; and “short-forms of multifactorial alcohol” was changed to “short forms of multifactorial alcohol”.

2. On page 6, “non/low drinkers” was changed to “non/low-risk drinkers”. This changed was also conducted in every instance the consumption group was named.

3. Further on page 6, “is a self-reported measure” was changed to “is a self-report measure”, and this correction was applied to every instance of the same error; “12–item” was changed to “12 items”: “Items are ranked on a” was changed to “Items are rated on a”; “same four factors than ACQ-Now” was changed to “same four factors as the ACQ-Now”; and “the intent and planning to drink” was changed to “the intention and plan to drink”.

4. On page 7, “restrain capacity” was changed to “restraint capacity”; and “validated to European Portuguese speakers” was changed to “validated for European Portuguese speakers”.

5. On page 8, “inter-items correlation” was changed to “inter-item correlation”.

6. On page 9, “Additionally, using the two groups based on alcohol use pattern (see Table 1), it was conducted a repeated measures ANOVA” was changed to “Additionally, in order to compare ACQ-SF-R scores for participants in the two levels alcohol risk (see Table 1), a repeated measures ANOVA was conducted”; and “were assessed” was clarified and changed to “were conducted separately within each gender”.

7. On page 10, “comprised by items” was changed to “comprised of items”; and “double loaded to any factor” was changed to “double loaded on any factor”.

8. On page 12, “When assessing groups by gender” was changed to “When conducting EFAs separately within each gender”; and “for F2 (Purposefulness) instead of F3” was changed to “on F2 (Purposefulness) than F3”.

9. On page 13, “Likewise, mean inter-item correlation” was written using its plural “Likewise, mean inter-item correlations”; “the ACQ-SF-R possesses good psychometric properties and reveals to be a valid and reliable measure” was changed to “the ACQ-SF-R possesses good psychometric properties and is a valid and reliable measure”; “showed cohesiveness between genders” was changed to “showed cohesiveness within each gender”; “validation” when referring to the previously validated versions of the scale was changed to “validations” since its plural form should be the one used; “Thus, the present study seems to complement the PACS” was changed to “Thus, the present study seems to complement the psychometric results found for the Portuguese version of the PACS”; and “which to date is the only questionnaire validated in European Portuguese assessing alcohol craving” was changed to “which to date is the only questionnaire assessing alcohol craving validated in European Portuguese”.

10. On page 14, “satisfactory concurrent validity between ACQ-SF-R and AUDIT” was changed to “satisfactory concurrent validity between the ACQ-SF-R and the AUDIT”; given its redundancy “dimensional” was removed from “four-factor dimensional measure”.

11. On page 15, “reflecting the intent and planning to drink alcohol” was changed to “reflecting the intention and plan to drink”; “and, consequently, low purposefulness to drink” was changed to “and, consequently, scored low on the scale of purposefulness in regard to drinking”; “Despite the sample size is higher” was changed to “While a strength of the study was that the sample size was higher”; and “than previous validations of the scale” was changed to “than previous validation studies of the scale”.

12. On page 16, “match the gender distribution” was changed to “equate the number of each gender and include a general adult population”, and the following sentence regarding greater sociodemographic representation was removed; “it allows to assess” was changed to “it allows assessment of”.

Issue 2. Table 1 was missing the necessary note defining the abbreviations used

We thank the reviewer for bringing out attention to this issue. The following note was added below Table 1 “Note: M, mean; SD, standard deviation; AUDIT, Alcohol Use Disorders Identification Test; PACS, Penn Alcohol Craving Scale; ACQ-SF-R, Alcohol Craving Questionnaire – Short Form – Revised.”; the remaining tables were checked for abbreviations that were not correctly described.

Issue 3. The AUDIT was not correctly described has being translated to European Portuguese

In agreement with the reviewer’s suggestion, we added the following sentence to our Measures on page 7 “In the present study, we used the European Portuguese translated version of the AUDIT”, hence, clarifying the scales translation into European Portuguese.

Issue 4. Information regarding EFA characteristics was mentioned in the Method and repeated in the Results

Following the reviewer’s suggestion, duplicated information describing the EFA was removed from the Results. Additionally, the sentence that mentioned the use of ULS in our EFA was moved so that it gets better highlighted during the reading of the manuscript.

Issue 5. Table 5 removal

As highlighted by the reviewer, it is customary to take the authors’ word for possible changes in the reliability of the scale when removing any items. As such, Table 5 was considered by us redundant and consequently removed from the manuscript.

Issue 6. No information (means and standard deviation) regarding the significant differences in craving between the two consumption groups were reported

We would like to thank the reviewer for alerting us of this issue. Considering their suggestion, we added Table 5 to the manuscript following the Validity section of the manuscript.

Issue 7. Too strong wording was used when describing possible uses for the ACQ-SF-R

We sincerely thank the reviewer for highlighting this issue, and taking into account their suggestions. Thus, in the page 15, the phrase “Consequently, ACQ-SF-R seems to be a useful tool for clinical practice, helping to detect risky drinking, and predict relapses and treatment outcomes” was changed to “Consequently, ACQ-SF-R may be a useful tool for clinical practice, being able to help to detect risky drinking”

Submitted filename: Response to Reviewers.docx

Click here for additional data file.

3 May 2021

Portuguese Validation of the Alcohol Craving Questionnaire – Short Form – Revised

PONE-D-21-05321R2

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14 May 2021

PONE-D-21-05321R2

Portuguese Validation of the Alcohol Craving Questionnaire – Short Form – Revised

Dear Dr. Crego:

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