Page 21 - JCBP-3-2

Journal of Clinical and
Basic Psychosomatics Alcohol use disorder relapse: Tools and factors

knowledge will be used to develop targeted medical and 4.2.4. Michigan alcohol screening test (MAST)
nursing interventions, reduce relapse rates, and prevent The MAST is a self-report questionnaire developed by
the recurrence of AUDs. 19 Selzer for screening AUDs. This instrument covers
26
4.2. Relapse assessment instruments various aspects, such as health status, family problems,
and interpersonal relationships affected by alcohol
4.2.1. Penn alcohol craving scale (PACS) consumption. It also assesses physical and psychological
PACS, developed by Flannery et al., is a single-factor, dependence, as well as the effects of drinking on
20
multidimensional scale consisting of five items across three psychological, physical, occupational, and social
dimensions. Questions 1 – 3 assess the frequency, intensity, functioning. The test consists of 25 items, with the first item
and duration of alcohol consumption, question 4 evaluates serving as an introductory question and the remaining 24
the ability to resist drinking, and question 5 measures the items being common questions for patients with alcohol
average craving level after 1 week of abstinence. The scale use problems. Each item has only two response options:
uses a 7-point Likert rating system, with scores ranging “yes” or “no.” A higher total MAST score indicates more
from 0 to 6, corresponding to the following levels of behaviors related to AUDs.
craving: 0 (no symptoms), 1 (very mild symptoms), 2 (mild 4.2.5. Visual analog scale
symptoms), 3 (noticeable symptoms), 4 (controllable severe
symptoms), 5 (difficult-to-control severe symptoms), and The Visual Analog Scale is a single-factor, one-dimensional
6 (intolerable severe symptoms). A higher score indicates scale that uses a straight line, corresponding to a score of
a greater level of alcohol craving. Wang et al. confirmed 0 – 10, to indicate the level of alcohol craving. The scale
21
the reliability and validity of the PACS, demonstrating that ranges from “completely unwilling to drink” to “difficult to
its content is sound, its structure is consistent, and it meets control the urge to drink.” The patient draws a line segment
the standards for psychological assessment. This scale can from left to right to indicate their craving level, with the
be used for the clinical assessment of alcohol cravings in score based on the length of the segment. To minimize bias
AUD patients in China. from visible numerical markers, no specific numbers are
marked on the scale.
4.2.2. Alcohol urge questionnaire (AUQ)
Among the assessment instruments mentioned above,
The AUQ developed by Michael et al., is designed to the PACS demonstrates the best reliability and validity.
22
assess the level of alcohol craving in patients. It consists There are no apparent flaws, and it features fewer questions,
of eight items across three dimensions: craving for a single lower difficulty, and shorter response time, making it easier
glass of alcohol, craving when alcohol is available, and for patients to use and providing good feedback. As a
difficulty resisting the urge to drink. The scoring system result, it is currently the most frequently used and widely
ranges from 1 to 7, with scores from l (completely disagree) employed assessment tool in psychiatry.
to 7 (completely agree). A higher total score indicates the
more eager to drink alcohol. 5. Factors influencing relapse in AUDs

MacKillop confirmed the practicality of the AUQ The mechanism behind relapse in AUD patients remains
23
through experimental studies; however, he noted that the unclear. A survey conducted by Beijing Anding Hospital
scale could not fully explain the significant differences Capital Medical University shows that relapse is closely
between AUQ scores and actual alcohol consumption. related to factors such as gender, age, employment,
residence, education level, drinking habits, family situation,
4.2.3. Obsessive-compulsive drinking scale (OCDS) economic status, prior mental illnesses, and medication
27
The OCDS, compiled by Anton et al., contains eight use. In other words, sociodemographic, individual, and
24
items. The scale uses a line segment method for self- societal factors may all have an impact on the relapse rate
assessment, with responses from 1 (completely disagree) among patients.
to 7 (completely agree). Items 2 and 7 are reverse-scored, 5.1. Sociodemographic factors
which is common practice for assessing alcohol cravings.
Wang et al. conducted the translation, reliability, and 5.1.1. Gender factors
25
validity assessment of the OCDS, confirming that it has At present, research on relapse in AUD patients, both
high internal consistency and good retest reliability. These domestically and internationally, has predominantly
findings support the OCDS as a reliable tool for assessing focused on males, with limited studies examining the
the severity of AUDs and an effective instrument for impact of gender on relapse rates. A study by Aguiar
screening AUD patients. et al. found that being male is associated with a poorer
28

Volume 3 Issue 2 (2025) 15 doi: 10.36922/jcbp.6559