Measuring alcohol craving: development of the Alcohol Craving Experience questionnaire

Aims To develop a measure of craving based on the Elaborated Intrusion (EI) theory of desire and to examine the construct, concurrent and discriminant validity of the instrument. Design Cross-sectional. Setting and participants-Patients from a hospital alcohol and drug out-patient service (n = 230), participants in a randomized controlled trial (n = 219) and students in a university-based study of alcohol craving (n = 202) were recruited. Measurements The Alcohol Craving Experience questionnaire (ACE) was developed to measure sensory aspects of craving (imagining taste, smell or sensations of drinking and intrusive cognitions associated with craving) when craving was maximal during the previous week (ACE-S: strength), and to assess frequency of desire-related thoughts in the past week (ACE-F: frequency). All participants completed the ACE and the Alcohol Use Disorders Identification Test (AUDIT). The Obsessive Compulsive Drinking Scale (OCDS) and the Depression Anxiety and Stress Scale (DASS) were completed by hospital patients and randomized control trial participants. Findings Exploratory factor analysis on the ACE-S and ACE-F resulted in a three-factor structure representing imagery, intensity and intrusion. An attempt to confirm this factor structure required a reduction in items (two from ACE-S, five from ACE-F) before a good fit to the three-factor model was obtained. Concurrent validity with the OCDS, with severity of alcohol dependence and with depression, anxiety and stress, was demonstrated. The ACE discriminated between clinical and non-clinical populations and between those at higher risk of alcohol dependence and those at lower risk. Conclusions A new scale, the Alcohol Craving Experience questionnaire, based on the Elaborated Intrusion theory of desire appears to capture key constructs of the theory and correlate with indices of alcohol dependence.