Joint effects of real-world cue exposure and affective states on momentary alcohol craving in adults with alcohol use disorder

Abstract

Background Alcohol use disorder (AUD) is characterized by high return to drinking rates, often driven by craving. However, little is known about whether momentary mood (or affect) influences alcohol cue–elicited craving in real-world settings. This study examined whether positive and negative affect moderated associations between alcohol-related cues and momentary craving among adults with AUD participating in an alcohol intervention study. Methods Thirty-three adults with AUD completed ecological momentary assessments (EMAs) up to four times daily for 28 days. Assessments measured craving, direct (in vivo) exposure to alcohol, being around usual drinking partners, being in usual drinking places, and high-arousal positive affect (PA) and negative affect (NA). Multilevel mixed-effects models adjusted for demographics, intervention phase (1 = post, 0 = pre), AUD severity, and temporal and contextual covariates. Results EMA adherence was high (Median per-participant = 86.6%). Within-person elevations in in vivo alcohol exposure and being around usual drinking partners were independently associated with greater momentary craving, whereas being in usual drinking places was not. In vivo alcohol exposure was more strongly associated with craving during higher-than-usual PA (β = 0.08, p = .032), whereas being in usual drinking places was more strongly associated with craving during higher-than-usual NA (β = 0.06, p = .036), adjusting for intervention phase (which was associated with lower craving). Conclusions Findings indicate the potential of personalized just-in-time adaptive interventions tailored to high-risk, momentary cue–affect contexts in AUD, beyond low-frequency clinician-delivered feedback that may reduce average craving but not fully address real-time risk.