The impact of craving on relapse during and after outpatient alcohol treatment

In an alternative to AA, a self-empowering approach can be used to help individuals cope with cravings upon completion of a drug or alcohol treatment program. With individualized treatment plans, the score from the Obsessive Compulsive Drinking Scale can be used to rate individuals, where those with higher OBCD scores may find increased relapse prevention approaches more useful. From a self-empowering perspective, coping with cravings is an integral aspect of relapse prevention.

Many individuals relapse after alcohol treatment, often because of cravings for alcohol. The Obsessive Compulsive Drinking Scale (OCDS) is a self-rating measure that has been used to predict future alcohol consumption after alcohol treatment. Bottlender and Soyka of Ludwig Maximilians University in Munich, Germany, used the OCDS to investigate the relationship between craving and relapse in alcohol dependent individuals during and after an outpatient alcohol treatment program (2004).

Participants in the study were interviewed at intake, during, at the end, and 12 months after the alcohol treatment program. The OCDS was administered at the beginning of treatment and again at the end for those who completed the program. Of 103 alcohol dependent individuals, 74 completed the treatment program, and 97 percent of those who completed treatment were interviewed 12 months later.

Results show that 32 individuals relapsed during the alcohol treatment phase, and these individuals had higher craving as measured by total OCDS scores. They also had significantly higher scores on subscales for “obsessions” and “drinking control and consequences” compared those who remained abstinent throughout treatment. Of the 74 individuals who completed the program, 16 percent had a major relapse in the 12 months following the completion of treatment. Results show that relapse was predicted by the total OCDS score as well as the subscale for “obsessions.”

The researchers concluded that total OCDS score as a measure of craving predicts relapse after alcohol treatment. They suggest that individuals with high levels of craving should receive more intense treatment as well as aftercare.

“Results of our study indicate that measurement of craving with the OCDS can be a useful tool to predict subsequent drinking during outpatient treatment, and may be useful in monitoring patients during treatment to identify individuals at risk for relapse,” report the authors. “Relapse during the treatment phase occurred in 32 patients and more than half of them dropped out due to relapse. We have found that patients with increased cravings measured by the OCDS dropped out significantly more often during the treatment phase. As a consequence, patients with increased craving should be treated more intensively by using additional relapse prevention approaches which may help the patient to recognize cues that lead to drinking. Patients should develop strategies to cope with high-risk situations such as negative emotional states and interpersonal conflicts. Higher OCDS total scores at the end of the treatment predict relapse in the following 12 months. Maybe those patients with elevated craving scores who are at a higher risk for relapsing would benefit from intensified aftercare and of additional anti-craving medication such as acamprosate.”

Bottlender M, Soyka M. Impact of craving on alcohol relapse during, and 12 months following, outpatient treatment. Alcohol and Alcoholism. 2004; 39(4): 357-361.

http://alcalc.oxfordjournals.org/cgi/content/full/39/4/357