Ambivalence model of craving:A latent profile analysis of cue-elicited alcohol craving in an inpatient clinical sample

Objective: Craving has been defined as intense desires or urges to consume alcohol and is considered predictive of future drinking and relapse. Despite this assumption, research on the craving– drinking relationship has been mixed, calling into question how researchers define and measure craving. The primary aim of the current study was to examine a promising, but understudied, model of craving (Ambivalence Model of Craving [AMC]) that calls for the concurrent assessment of both approach (desires to use) and avoidance (desires to not use) inclinations. Method: Participants (N = 175) were recruited from an acute detoxification facility. Alcohol craving was evaluated with a cue-reactivity paradigm in which participants viewed substance cue slides and separately rated their desire to consume and not consume the substance after each image. Latent profile analysis examined distinct motivational profiles for alcohol predicted by the AMC: ambivalence (high approach, high avoidance), indifference (low approach, low avoidance), approach (high approach, low avoidance), and avoidance (low approach, high avoidance). Results: Latent classes corresponded to the AMC, but a fifth class differentiated moderate versus high ambivalence. Classes were associated with auxiliary variables in predicted directions; high ambivalence and approach classes were associated with greater drinking and negative consequences, whereas voluntary admittance to treatment was more likely with ambivalence and avoidance classes. Conclusions: The AMC provides a promising framework for evaluating cue-elicited craving and alcohol use in clinical samples and may be a useful model of craving for clinicians during treatment.