Measuring Alcohol Craving: Development of the Alcohol Craving Experience

Abstract The role of craving in alcohol dependence is well-documented and several measures have been developed to explore and quantify this phenomenon. The literature shows that these measures suffer from considerable theoretical and methodological limitations. The aims of this project were to develop a robust measure of craving based on the Elaborated Intrusion Theory of Desire (EI) [Study 1] and to examine the construct, concurrent, discriminant and predictive validity of the instrument [Study 2]. In Study 1, a 29 item questionnaire, The Alcohol Craving Experience questionnaire (ACE) was developed based on the key features of craving as described by EI: the sensory aspects of craving (imagining taste, smell and somatic sensations of drinking), and the intrusiveness of thoughts and urges about drinking. The ACE consisted of two parts. In the first part, participants used an 11-point, visual analogue scale to report on the intensity of their craving experiences at a time of maximal intensity (focal period) in the previous week. In the second part, participants indicated the frequency of their craving experiences during the same week. One hundred and fifty individuals receiving treatment for Alcohol Use Disorders completed the ACE. Exploratory factor analysis demonstrated a clear three-factor structure representing Imagery, Strength and Intrusion for both the focal period and for frequency. In Study 2, an independent sample of 299 individuals receiving treatment for Alcohol Use Disorders completed the ACE. Using confirmatory factor analysis two items from the first part of the questionnaire and five items from the second part were removed. The final revised version of the questionnaire consisted of 22 items, and the three-factor structure provided a good fit for both parts of the questionnaire. Concurrent validity with the ‘gold standard’ measure of craving, the Obsessive Compulsive Drinking Scale (OCDS), and with measures of alcohol consumption, alcohol dependence severity, depression, anxiety and stress (DASS), and alcohol expectancies (DEP) was demonstrated. The ACE was able to discriminate between individuals in the clinical sample and those in an independent non-treatment seeking sample (N = 204) of university students. In the student sample, the ACE also discriminated between those who screened positive for alcohol dependence on the Alcohol Use Disorders Identification Test and those who did not. Post-treatment data were obtained for a sub-sample of the clinical group. The ACE was associated with increased days abstinence at three month follow-up. Overall, the ACE performed well as a robust measure of craving. Further research could explore the application of this instrument with other alcohol using populations, for example, non-treatment seeking drinkers and heavy episodic alcohol consumers. Modifications of the ACE could be tested with other addictive substances