Craving Mediates Stress in Predicting Lapse During Alcohol Dependence Treatment

Background Stress, craving, and depressed mood have all been implicated in alcohol use treatment lapses. Few studies have examined all 3 factors. Progress has been limited because of difficulties with craving assessment. The Alcohol Craving Experience Questionnaire (ACE) is a new measure of alcohol craving. It is both psychometrically sound and conceptually rigorous. This prospective study examines a stress–treatment response model that incorporates mediation by craving and moderation by depressed mood and pharmacotherapy. Methods Five hundred and thirty‐nine consecutively treated alcohol‐dependent patients voluntarily participated in an abstinence‐based 12‐week cognitive‐behavioral therapy (CBT) program at a hospital alcohol and drug outpatient clinic. Measures of stress, craving, depressed mood, and alcohol dependence severity were administered prior to treatment. Treatment lapse and treatment dropout were assessed over the 12‐week program duration. Results Patients reporting greater stress experienced stronger and more frequent cravings. Stronger alcohol craving predicted lapse, after controlling for dependence severity, stress, depression, and pharmacotherapy. Alcohol craving mediated stress to predict lapse. Depressed mood and anticraving medication were not significant moderators. Conclusions Among treatment seeking, alcohol‐dependent patients, craving mediated the relationship between stress and lapse. The effect was not moderated by depressed mood or anticraving medication. Stress, craving and depressed mood are implicated in alcohol‐use treatment lapses. This prospective study examined a stress–treatment response model that incorporated mediation by craving and moderation by depressed mood and pharmacotherapy using the newly developed Alcohol Craving Experience Questionnaire (ACE). In a sample of 539 alcohol‐dependent patients, craving mediated stress to predict lapse. This effect was not moderated by depressed mood or anticraving medication. Treatment focusing on craving reduction could prevent lapse in selected patients.