알콜의존 환자에서 음주욕구를 유발하는 조건화자극에 대한 연구

Study of the Conditioned Stimuli Provoking Alcohol Craving in the Patients with Alcohol Dependence

Conditioned stimuli provoking alcohlol craving in the alcoholics were surveyed in 110 hospitalized male patients with the diagnosis of alcohol dependence according to DSM-IV who had had 3 weeks or more of successful periods of alcohol abstinence after the onset of alcohol dependence. A preliminary study of preparing a list of 50 alcohol related cues (ARCs) was performed by collecting ARCs from 50 alcoholic patients, choosing the more frequent stimuli and rearranging those into 25 internal and 25 external ARCs. And then, each of the 110 subjects was asked to choose all the ARCs which provoked alcohol craving in the past to survey the frequency of the ARCs and their relevance with regards to a number of variables such as certain demographic data, alcohol history and anxiety and depression. The results were as follows ； 1) The ARCs were divided into internal and external ARCs ； the internal ARCs were categorized into positive affects, negative affects and somatic conditions and the external ARCs into pleasant situations, unpleasant situations, alcohlol-related situations and other situations. 2) Total mean number of ARCs per person was 14.1 ±8.6，that of internal ARCs being 7.5 ±4. 8 and that of external ARCs being 6.5 ±4.4. All the subjects chose at least one of the internal ARCs and 99.1% chose one or more external ARCs. ARCs of negative affects and unpleasant situations were chosen by 97.3% and 88.2% of the subjects respectively, whereas those of positive affects and pleasant situations were chosen by 42.7% and 71.8% respectively, showing unexpectedly high frequency. ARCs pertaining to somatic conditions were chosen by 68.2% of the subjects, those of alcohol-related situations were chosen by 68.2% and those of other situations by 49.1%. 3) Frequently chosen items of internal ARCs were ‘when I was angry，(71%)，‘when I was lonely (47%), when I was distressed’ (45%), ‘when I was hungry’ (45%) and ‘when I had trouble sleeping (45%). Those of external ARCs were when I had an argument or conflict with a relative，(53%), ‘when I was at a social meeting such as party or funeral ceremony (52%), when the things were not going to work out (49%), ‘when I met a friend whom I liked，(49%) and when I had an argument with a friend or people at work’ (42%). 4) Positive correlations were seen between age and ARCs of somatic conditions and between age at the first psychiatric hospitalization and ARCs of somatic conditions. However, negative correlation was found between educational level and ARCs of somatic conditions. Number of psychiatric hospitalization was positively correlated with ARCs of negative affects. But there were no significant correlations in age at the first drink, age of onset of alcohol related problems, duration of alcohol related problem drinking, maximal length of abstinence, usual duration of abstinence after hospital treatment and score of trait anxiety and BDI. No significant difference was noted in the mean number of ARC subtypes between different groups divided by other demographic or clinical variables such as status of job, social class, family history of alcohol dependence, status of marriage, religion and drinking patterns.