Comparison of three models of alcohol craving in young adults: a cross-validation
Article first published online: 25 MAR 2004
Volume 99, Issue 4, pages 482–497, April 2004
How to Cite
McEvoy, P. M., Stritzke, W. G. K., French, D. J., Lang, A. R. and Ketterman, R. (2004), Comparison of three models of alcohol craving in young adults: a cross-validation. Addiction, 99: 482–497. doi: 10.1111/j.1360-0443.2004.00714.x
- Issue published online: 25 MAR 2004
- Article first published online: 25 MAR 2004
- Submitted 9 July 2003; initial review completed 16 November 2003; final version accepted 23 December 2003
- drinking problems;
- readiness for change
Aims The aim of study 1 was to develop a three-factor Approach and Avoidance of Alcohol Questionnaire (AAAQ), designed to assess mild and intense inclinations to drink, as well as inclinations to avoid drinking. The aims of study 2 were to cross-validate the AAAQ with an independent sample and to test the goodness-of-fit of three models of craving for alcohol: (a) the traditional unidimensional model; (b) a two-dimensional, approach–avoidance ambivalence model; and (c) an expanded two-dimensional neuroanatomical model that retains avoidance, while positing a threshold that partitions approach into two distinct levels and relates all three factors involved in craving to brain pathways associated with inhibitory processes, reward and obsessive–compulsive behaviour, respectively.
Design, setting and participants The survey was administered to 589 Australian university students (69% women) in study 1 and to 523 American university students (64% women) in study 2.
Measurements Inclinations to drink and to not drink (AAAQ), drinking behaviour (quantity and frequency), drinking problems (Young Adult Alcohol Problems Screening Test; YAAPST) and readiness for change (Stages of Change Readiness and Treatment Eagerness Scale; SOCRATES).
Findings The expanded two-dimensional neuroanatomical model provided the best fit to the data. The AAAQ explained a substantial proportion of the variance in drinking frequency (41–53%), drinking quantity (49–60%) and drinking problems (43%). AAAQ profiles differed as a function of drinking-related risk, and the three AAAQ scales differentially predicted readiness for change.
Conclusions Approach and avoidance inclinations toward alcohol are separable constructs, and their activation may not be invariably reciprocal. Craving can be defined as the relative activation of substance-related response inclinations along these two primary dimensions. There may be a threshold of intensity that separates mild from intense approach inclinations.