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May 6, 2008 (Washington, DC) - Depressive symptoms in women, but not men,
correlated with alcohol craving in an early retrospective study of over 300
patients who were self-referred for an alcohol addiction treatment program
at the Mayo Clinic.

The study was presented in a poster at the American Psychiatric Association
161st Annual Meeting.

On admission to the treatment program, compared with the men, women also had
higher depressive-symptom and alcohol-craving scores. This was true for
subjects with a clinical diagnosis of alcohol dependence alone as well as
those with a dual diagnosis, which was defined as alcohol dependence plus
depression, bipolar disorder, or anxiety disorder.

"It appears that the women are drinking to relieve anxiety and to relieve
depression, whereas the men might be drinking just to feel good, for a
positive feeling," lead study author Nelli Boykoff, from the University of
California, San Francisco, California, told Medscape Psychiatry.

"What we were really struck by was that when women came into the 28-day
program, their depressive symptoms and cravings for alcohol were
significantly higher than those of the men, and that correlation [between
depression and alcohol craving] was robust," said study coauthor Mark A.
Frye, MD, from the Mayo Clinic in Rochester, Minnesota.

"To our knowledge, this is one of the first studies to show that indeed
women and men differ in their clinical correlates of alcoholism, and there
may be some very relevant ways to target treatment based on some of these
correlational data," he added.

Depressed Women Drinkers

The investigators performed a retrospective analysis of clinical data from
364 patients (135 women and 229 men) who participated in the Intensive
Addiction Program, a 28-day residential treatment program, in the Mayo
Clinic. Depressive symptoms were measured by the Beck Depression Inventory
(BDI), and alcohol cravings were measured by the Pennsylvania Alcohol
Craving Scale (PACS).

On average, the patients were aged 47.9 years and had started drinking when
they were 19.7 years old. Women were drinking almost as heavily as the men -
on average, as many as 10.8 drinks/day vs the men's 13.8 drinks/day. About
half of the patients (53%) were daily drinkers, and 75% met the National
Institute on Alcohol Abuse and Alcoholism (NIAAA) definition of hazardous
user (more than 5 drinks/day for a man or more than 4 drinks/day for a
woman). There were 92 subjects with alcohol-only addiction and 139 subjects
with alcoholism along with depression, bipolar disorder, or anxiety
disorder.

On admission to the treatment program, compared with the men, the women had
significantly higher depression (P = < .001) and alcohol craving (P = .001)
scores.

Women, but not men, had a marked correlation between their depression and
craving scores. This correlation was found in women who had only alcohol
dependence (r = .78; P < 0.0001) and as well as in those who had both
alcohol dependence and an additional Axis 1 nondrug diagnosis (r = .36; P =
0.01).

Possible Explanation: Relief Craving vs Reward Craving

Craving for alcohol is a central component of alcohol dependence and has
been shown to be linked with relapse, which makes successful control of
craving a key element of alcoholism treatment strategies, the group writes.

They note that craving can be divided into subtypes with different possible
mechanisms - relief craving (involving glutamate), reward craving (involving
dopamine, opiate), and obsessive craving (involving serotonin). Some
preliminary work has suggested that naltrexone and acamprosate may be more
effective for reward craving and relief craving, respectively, they observe.


"Depression seems so strongly correlated with alcohol craving in women that
we definitely need to take a look at it [and at relief craving] in further
studies and see whether it will affect outcome and treatment," Ms. Boykoff
concluded.

Dr. Frye is a consultant for Janssen-Cilag, AstraZeneca Pharmaceuticals,
Abbott Laboratories, Bristol-Myers Squibb, GlaxoSmithKline, and Otsuka
Pharmaceuticals. Ms. Boycoff did not provide any financial disclosure.

American Psychiatric Association 161st Annual Meeting: New Research Young
Investigators' Poster Session 1. Poster NR1-013. May 3-8, 2008.

 

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