Prazosin-Related Reductions in Daily Craving Mediate Treatment-Related Daily Alcohol Use Outcomes in Alcohol Use Disorder.

BACKGROUND

Prazosin has been shown to reduce drinking, particularly in individuals with alcohol withdrawal symptoms, possibly due to reducing craving as shown in experimental studies. However, it is unclear whether prazosin decreases daily changes in alcohol craving and whether such changes drive prazosin-related changes in alcohol intake in the treatment of alcohol use disorder (AUD).

METHODS

Using an intensive daily-level longitudinal design embedded within a 12-week, double-blind, placebo-controlled, randomized clinical trial of prazosin (16 mg/day) versus placebo (PBO) for the treatment of AUD, we examined treatment effects using daily phone surveys of alcohol craving and intake. Participants were treatment-seeking individuals (52 on prazosin, 45 on placebo, 97% of the treated sample) who met current criteria for AUD and who provided a total of 4289 daily surveys over the 12-week treatment period.

RESULTS

Prazosin but not PBO significantly reduced daily craving (estimate [Est] = -0.902, 95% credibility interval [CI] [-1.296 to 0.475]), and this craving reduction predicted lower next-day drinking for participants taking prazosin (Est = -1.317, 95% CI [-2.196 to -0.599]) but not PBO (Est = -0.491, 95% CI [-1.147 to 0.087]), which represented a 66.7% versus 26.7% craving-mediated reduction in alcohol intake.

CONCLUSIONS

Utilizing an intensive daily longitudinal design and random slope modeling, the current study examined daily craving change as a dynamic process associated with changes in daily alcohol intake during treatment. The findings support prazosin's anticraving mechanism of action underlying prazosin-related reductions in alcohol intake.