Craving as an Indicator of Psychopharmacotherapy Efficiency

INTRODUCTIONCraving is defined as a strong need for drinking or as intensive thinking about alcohol, which occurs at the attempt to stop taking alcohol or to control drinking and is often accompanied with the feeling of compulsion to take alcohol. MKB10 includes craving as one of the important diagnostic criteria for diagnosing the addiction to alcohol.For the first time, some fifty years ago, Jellinek recognized craving as the central component of alcoholism, and over the last ten or so years, the interest for that concept grew.1 It should be understood as a multifactorial phenomenon and there are many models complementing each other.Conditional craving model: Any sign connected with drinking of alcohol, after it has been repeated together with drinking, becomes conditional stimulus, i.e., it has the same psychological effect as the drinking of alcohol itself. If drinking does not happen craving develops or it acts by means of strengthening the sensation of alcoholic comfort.2Cognitive craving model: Alcohol and alcohol-related signs include various cognitive processes, such as expectations connected with sensation of comfort produced by alcohol and a person's belief in the own capability to solve the problem and abstinence.3,4Neuroadaptive craving model: Neuroadaptation, i.e. permanent brain function adaptation to the presence of alcohol is the central component in developing the alcohol dependency.5,6 It manifests itself as tolerance, abstinence syndrome or rewarding memory. The rewarding memory stands for an unconscious process which appears depending on the chemical changes in the brain cells. It intensifies the attention paid to external factors connected with consumption of alcohol or with very drinking of alcohol. In the circumstances of neuroadaptation, changes occur in the neurotransmitting systems as well. Therefore, GABA and glutamate play the leading role in abstinence syndrome, while the credit for developing the rewarding memory goes to dopamine, GABA, glutamate and endogenous opiates, and finally serotonin plays its part in the development of stress, depressiveanxious conditions and impulsiveness.As far as the measuring of craving is concerned, it should be mentioned that there are numerous questionnaires, i.e. tests fulfilled by patients themselves, by which the intensity of craving is estimated. All tests are short and filled by patients and their flaw lies in the patient's subjectivity. However, there are several tests usually used for measuring of the alcohol craving: Alcohol Urge Questionnaire (AUQ), Obsessive Compulsive Drinking Scale (OCDS) and Alcohol Craving Questionnaire.7-9 Duration of test completion is between one and ten minutes.Among the clinical implications of craving, it should be mentioned that in the cases of alcohol dependency, a co-morbid disorder often develops in the form of depression, anxiety, panic disorders and obsessive-compulsive disorder, consequently leading to the increase of craving. Treatment of these disorders reduces the craving as well.Treatment includes psychotherapy according to the behavioural-cognitive principles with a purpose to enable the recognition of risky situations, to prevent relapse and increase self-esteem. Psychopharmacotherapy includes drugs which directly reduce craving (naltrexon, acamprosat), as well as anti-depressants and anxiolytics. Social therapy interventions include treatment within a therapeutical community and clubs of treated alcoholics.THE GOAL OF THE RESEARCHThe goal of this research was to establish whether the craving was reduced in patients, who, after the hospital treatment, including a complex psychosociomedical treatment, continued their treatment as out-patients along with further psychotherapeutical and sociotherapeutical treatment (by way of clubs of treated alcoholics) and who continued taking pharmacotherapy (naltrexon and disulfiram).SUBJECTS AND METHODSThe research included 30 male patients who were treated during 2005 at the Department for alcoholism of the Psychiatric Clinic of the Sestre milosrdnice University Hospital and continued their treatment later as out-patients. …