Abstract

Previous studies have shown an association between the number of withdrawal attempts and increased severity of withdrawal symptoms in patients with an alcohol use disorder (AUD). An underlying allostatic neuroadaptive response may negatively affect the withdrawal pathology after alcohol discontinuation. The objective of the present research is to examine the intensification of psychiatric distress, craving, and post-detoxification drinking outcomes, which may result from these neurobehavioral alternations. Fifty-two AUD inpatients were divided into two groups: <2 previous detoxifications and ≥2 previous detoxifications. Patients completed the Dutch version of the Severity of Withdrawal Scale (SWS), Depression Anxiety Stress Scales (DASS-21), VAS Craving, and Desires for Alcohol Questionnaire (DAQ). Linear mixed effects models were applied, controlling for the number of drinks consumed in the past 30 days and alcohol drinking history (years). Patients who had undergone ≥2 detoxifications reported statistically significantly higher scores on SWS withdrawal and DASS psychiatric symptoms. Also, craving patterns were different between groups, as shown by a statistically significant interaction effect for VAS craving for the time of day factor (morning vs. evening). No statistically significant group differences were found for DAQ scores and post-detoxification drinking outcomes. Due to relatively low 1-month follow-up rates our power was limited to detect such a difference. The present study contributes to the existing body of evidence that multiple detoxifications are associated with aggravated withdrawal/psychiatric pathology, and distinct diurnal patterns of VAS craving. Several clinical implications are discussed and alternative strategies are provided to manage repeated cycles of detoxifications.

摘要

先前的研究表明，酒精使用障碍 (AUD) 患者戒断尝试的次数与戒断症状的严重程度之间存在关联。潜在的异体神经适应反应可能会对戒酒后的戒断病理产生负面影响。本研究的目的是检查精神痛苦、渴望和戒毒后饮酒结果的加剧，这可能是由这些神经行为改变引起的。52 名 AUD 住院患者分为两组：<2 次既往戒毒史和≥2 次既往戒毒史。患者完成了荷兰版戒断严重程度量表 (SWS)、抑郁焦虑压力量表 (DASS-21)、VAS 渴望和酒精愿望问卷 (DAQ)。应用了线性混合效应模型，控制过去 30 天内饮用的饮料数量和饮酒历史（年）。接受 ≥ 2 次戒毒的患者在 SWS 戒断和 DASS 精神症状方面的得分具有统计学意义。此外，各组之间的渴望模式不同，如对一天中的时间因素（早上与晚上）的 VAS 渴望的统计显着交互效应所示。在 DAQ 评分和解毒后饮酒结果方面没有发现统计学上显着的组间差异。由于 1 个月的随访率相对较低，我们的能力有限，无法检测到这种差异。本研究有助于现有的证据，即多重解毒与严重的戒断/精神病学和 VAS 渴望的不同昼夜模式有关。