Does treatment status matter? An examination of daily approach and avoidance inclinations predicting drinking in individuals diagnosed with alcohol use disorder

Traditional craving models do not assess competing desires and account for craving as a function of attempts to change problematic drinking behaviors, thereby limiting the utility of the information obtained. The Ambivalence Model of Craving defines craving as the coactivation of both desires to consume (approach) and to avoid consuming alcohol (avoidance). The current study examined the daily associations between approach/avoidance, and drinking in those diagnosed with alcohol use disorder (AUD), including how treatment status moderated such relationships.

Individuals diagnosed with AUD (n = 98) provided daily reports on drinking and approach/avoidance inclinations for 90-days. At the end of the first 30 days, participants were offered treatment. Multilevel negative binomial hurdle modeling was conducted to examine within-person effects of approach, avoidance, treatment status, and their interaction on drinking likelihood and quantity.

A significant Approach×Avoidance×Treatment-Status interaction was found for drinking likelihood. On days not enrolled in treatment, higher approach was associated with increased drinking likelihood. On days enrolled in treatment, as avoidance increased, the effect of approach on drinking likelihood was attenuated, with such effects more robust at average and low levels of approach. Approach was also associated with a small increase in number of drinks consumed on drinking days; these findings did not vary by avoidance nor treatment status. Conclusion These findings reiterate the importance of adopting a multidimensional framework of craving that considers co-occurring approach and avoidance and suggests that craving processes may operate differently among individuals who are endorsing some degree of motivation for change.