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Peer-reviewedCC BY-NCAddiction neuroscience

Investigating Tonic and Phasic Craving in Currently Drinking and Abstinent Individuals with Alcohol Use Disorder: A Preliminary Case-Control Study

  • Carlotta Vizioli1
  • Jennifer J. Barb2
  • Ryan E. Tyler3
  • Lorenzo Leggio3,4,5,6
  • Mehdi Farokhnia3,7
7 affiliations
  1. 1Interoceptive Disorders Unit, Office of the Clinical Director, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA.
  2. 2Translational Biobehavioral and Health Promotion Branch, Clinical Center, NIH, Bethesda, MD, USA.
  3. 3Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, NIH, Baltimore, MD, USA.
  4. 4Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA
  5. 5Division of Addiction Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
  6. 6Department of Neuroscience, Georgetown University Medical Center, Washington DC, USA.
  7. 7Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Abstract

Craving is a complex construct that is not fully understood. Craving for alcohol is an important motivator of alcohol use, a known risk factor for return-to-drinking, and one of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) diagnostic criteria for alcohol use disorder (AUD). Craving can be assessed retrospectively over a defined period (tonic) or in response to alcohol cues in real-time, e.g., through alcohol cue exposure (CE) paradigms (phasic). We conducted exploratory analyses of a clinical study including three matched groups: currently drinking (CD, N=9) and abstinent (AB, N=10) people with AUD and healthy controls (HC, N=12). Tonic craving was assessed using the Penn Alcohol Craving Scale (PACS) and the Obsessive-Compulsive Drinking Scale (OCDS). Phasic craving was assessed using the Alcohol Urge Questionnaire (AUQ) alongside the Alcohol Attention Scale (AAS) during two alcohol CE sessions (CE1, CE2). The CD group showed higher AUQ and AAS than AB and HC groups (main effect of group, CE1: P =.048; CE2: P =.047). Group differences were also observed for tonic craving: the CD group reported higher PACS scores than HC ( P =.001), while AB and CD groups showed higher OCDS scores than HC (HC vs . CD P <.0001, HC vs. AB P =.015). PACS scores correlated positively with OCDS (r=0.565, P =.001) and AUQ (r=0.595, P =.0004) scores in the full sample; within-group analyses showed a positive correlation between PACS and AUQ only in the AB group. Given the small sample size, these exploratory results should be considered preliminary and require confirmation in larger studies.

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Cite

BibTeXRIS
BibTeX
@article{vizioli2026investigating,
  title = {{Investigating Tonic and Phasic Craving in Currently Drinking and Abstinent Individuals with Alcohol Use Disorder: A Preliminary Case-Control Study}},
  author = {Carlotta Vizioli and Jennifer J. Barb and Ryan E. Tyler and Lorenzo Leggio and Mehdi Farokhnia},
  journal = {Addiction neuroscience},
  year = {2026},
  month = aug,
  doi = {10.1016/j.addicn.2026.100279},
  url = {https://doi.org/10.1016/j.addicn.2026.100279},
  note = {CC BY-NC},
}
RIS
TY  - JOUR
TI  - Investigating Tonic and Phasic Craving in Currently Drinking and Abstinent Individuals with Alcohol Use Disorder: A Preliminary Case-Control Study
AU  - Carlotta Vizioli
AU  - Jennifer J. Barb
AU  - Ryan E. Tyler
AU  - Lorenzo Leggio
AU  - Mehdi Farokhnia
PY  - 2026
DA  - 2026/08/14
JO  - Addiction neuroscience
DO  - 10.1016/j.addicn.2026.100279
UR  - https://doi.org/10.1016/j.addicn.2026.100279
AB  - Craving is a complex construct that is not fully understood. Craving for alcohol is an important motivator of alcohol use, a known risk factor for return-to-drinking, and one of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) diagnostic criteria for alcohol use disorder (AUD). Craving can be assessed retrospectively over a defined period (tonic) or in response to alcohol cues in real-time, e.g., through alcohol cue exposure (CE) paradigms (phasic). We conducted exploratory analyses of a clinical study including three matched groups: currently drinking (CD, N=9) and abstinent (AB, N=10) people with AUD and healthy controls (HC, N=12). Tonic craving was assessed using the Penn Alcohol Craving Scale (PACS) and the Obsessive-Compulsive Drinking Scale (OCDS). Phasic craving was assessed using the Alcohol Urge Questionnaire (AUQ) alongside the Alcohol Attention Scale (AAS) during two alcohol CE sessions (CE1, CE2). The CD group showed higher AUQ and AAS than AB and HC groups (main effect of group, CE1: P =.048; CE2: P =.047). Group differences were also observed for tonic craving: the CD group reported higher PACS scores than HC ( P =.001), while AB and CD groups showed higher OCDS scores than HC (HC vs . CD P <.0001, HC vs. AB P =.015). PACS scores correlated positively with OCDS (r=0.565, P =.001) and AUQ (r=0.595, P =.0004) scores in the full sample; within-group analyses showed a positive correlation between PACS and AUQ only in the AB group. Given the small sample size, these exploratory results should be considered preliminary and require confirmation in larger studies.
SN  - 2772-3925
ER  -