“Craving”: exploring the components of the desires for alcohol questionnaire (DAQ) and the relation to the severity of alcohol problems

Objective: the aims of this study were: 1) to explore the components of craving, as measured by the Desires for Alcohol Questionnaire (DAQ); and 2) to examine how craving may relate to the severity of alcohol problems. Method: 106 patients seeking treatment for an alcohol use disorder (AUD) completed the DAQ and Alcohol Use Disorder Identification Test (AUDIT). The overall sample was predominantly male (63%) with a mean age of 44 years. 61% of the participants were abstinent from alcohol at the time of the study. Principal components analysis was conducted on the DAQ for the overall, abstinent and currently drinking samples. Correlations were computed between the DAQ and AUDIT scores, and differences in craving between the abstinent and currently drinking samples were investigated. Results: components of craving, as measured by the DAQ, included the desire to drink, the ability to control drinking, positive reinforcement and negative reinforcement. Drinkers displayed stronger cravings (Mdn=47.00, IQR=32.0 – 65.0) than those currently abstinent (Mdn=33.00, IQR=26.0 – 43.0; U=850.0, z=3.127, p&lt;.01, r=0.30). Intensity of craving increases with severity of an AUD in current drinkers (r=.739, p&lt;.001). Conclusions: due to the small sample size, the results of the study should be regarded as preliminary. The components of craving, as measured by the DAQ, support those previously identified in the literature. The study supports the notion that craving is positively associated with the severity of an alcohol use disorder<br/

It's never too late to publish an abandoned trial

It is estimated that half of all trials have never been published which can lead to patients being denied the most effective treatment and being exposed to unnecessary side effects. Furthermore the trial participants have been misinformed since the trial results have not contributed to the care of future patients. However the non-publication of trials is often not due to a deliberate decision to cover up results. Commonly in academia it is due to more understandable reasons such as researchers having busy clinical posts, moving onto other more demanding projects, changing research areas or starting a family. This is called the “file drawer” problem. The examples in this editorial demonstrate that it is possible to go back, even decades later, and make the results available to inform future evidence based medicine. We call on others to look into their “file drawer” for unpublished trials

Suicide and antidepressants

The causes of suicide are complex, and our understanding of the processes and pathways leading to suicide is complicated by the limitations of the available data. Suicide is strongly associated with mental illness, especially in patients with significant depressive features, and those with a history of suicidal behaviour. Prevention of suicide both in the general population and in severely mentally ill patients is a feature of health policy initiatives in many countries. However, whilst there is significant evidence for the efficacy of treatment for depressive disorders, a meta-analysis of treatment for the secondary prevention of suicidal behaviour found that few treatments were effective or feasible in practice. Randomised controlled trials, analyses of pooled data, pharmacoepidemiological studies, case series and psychological autopsy studies provide different strands of evidence when examining the question of whether antidepressant drugs might provoke or prevent attempted and completed suicide. Ecological studies consistently show an association between increased antidepressant prescribing and reduction of suicide. Recent pharmacoepidemiological reports found no evidence for an increase in suicide associated with different classes of antidepressant classes, although weak evidence for an increase in suicidal behaviour in young adults prescribed some antidepressants. The challenge for the clinician continues to be the effective management of patients with depressive symptoms and suicidal behaviour, weighing the relative risks and benefits from the evidence available

Core principles for mental health

This editorial highlights three key principles for clinicians working with people with mental illness. These include clear communication, clinical practice in accordance with legislation (Mental Capacity Act and Mental Health Act) and reducing stigma and discrimination.<br/