Mechanisms explaining links between early-episode alcohol craving and subsequent drinking during naturally occurring drinking episodes.

rationaleAlcohol craving is an antecedent and consequence of drinking. However, there is little research regarding cyclic relations between alcohol-induced craving and drinking behavior occurring during naturalistic drinking episodes.

objectivesThis study tested a theoretical model wherein early-episode craving predicts continued drinking and heightened reinforcing subjective effects, which then are associated with increases in craving and subsequent drinking thereafter.

methodsYoung adults (N = 131) completed 21 days of ecological momentary assessment, including event-contingent reports completed after first drink, followed by assessments 60-minutes and 120-minutes later. Participants self-reported consumption quantity, alcohol craving, and subjective stimulation/relaxation.

resultsCraving during the drink initiation assessment predicted increased consumption over the next 60-minutes, which predicted increased stimulation and decreased relaxation at the 60-minute assessment. Increased stimulation (and decreased relaxation) were then associated with increased craving at the 60-minute assessment, which in turn predicted increased consumption between 60-minute and 120-minute assessments. Thus, early-episode craving predicted increased consumption 60-minutes later, which was then associated with subsequent craving and consumption another 60-minutes later indirectly via increased stimulation and decreased relaxation during the 60-minute assessment. Residual relations between craving and consumption remained. Sensitivity analyses demonstrated that cyclic indirect effects beginning with early-episode craving were only present during binge drinking episodes, and models were unchanged when accounting for early-episode subjective effects. Further, cyclic indirect effects operated through craving but not subjective effects when specified as contemporaneously correlated mediators.

conclusionsRelations between craving and naturalistic drinking appear to be cyclic processes in young adults, with subjective reinforcement potentially serving a mechanistic role in relations.