Development and initial validation of a cue encounters and a cue salience questionnaire in an alcohol dependent population

Abstract

Research on alcohol dependence has yielded considerable evidence that cues associated with drinking play a role in the maintenance of alcohol-seeking behaviour, even after long periods of abstinence. Classical conditioning models of addiction support the view that addiction develops and persists because different alcohol-related cues become salient to the individual and elicit conditioned responses even if the person has stopped drinking. The objective of the current research was to develop two 'naturalistic' cue exposure self-report questionnaires that measure how salient different cues are to an individual (Cue Salience Questionnaire - CSQ) and the frequency with which these cues are encountered (Cue Encounters Questionnaire - CEQ). The validity of the CSQ and CEQ was assessed amongst a UK and Maltese sample of alcoholics. In both samples, scores on the CSQ and CEQ correlated positively with a person's abstinence levels and Alcohol Urge Questionnaire (AUQ), and Beck Depression Inventory (BDI) scores. Severity of Alcohol Dependence Questionnaire (SADQ) scores only correlated with CSQ and CEQ scores in the UK sample, which was a more severely dependent sample than the Malta one. Exploratory principal component analysis indicated that although incorporating multiple domains, both cue salience and cue encounters are best described by a single factor. From a classical conditioning perspective, this finding would seem to imply that after years of pervasive drinking, an individual's associations with alcohol-related cues become generalized to a wider range of situations, thereby increasing the salience and the likelihood of more frequent encounters with conditioned cues, even after the person has stopped drinking. Based on these analyses, 25-item versions of both the CSQ and CEQ were developed and proposed for further investigation as shorter and more clinically practical versions. The study also examined prospectively whether CSQ and CEQ baseline scores and other influential variables would predict the probability of drinking during a 12-month follow-up period. The results of a multinomial logistic regression analysis provided an initial indication that individuals who did not drink during the 12-month follow-up period had lower baseline CSQ and CEQ scores and lower BDI and AUQ scores. The strongest predictor for drinking outcome was baseline abstinence levels. In effect, those with longer periods of abstinence at baseline, scored lower on the BDI, AUQ, CSQ and CEQ. The question of whether these scores really do decline with increased abstinence or whether different abstinent levels and stages of recovery amongst the sample confounded the results, was not determined in the current study and warrants further investigation. Future research implications and replicability of findings are discussed.

Keywords: alcohol dependence, cue exposure, naturalistic, cue salience, cue encounters, drink, follow-up.