Modeling Relapse Situations in the Human Laboratory

Abstract

It is well known that alcoholism is a chronic relapsing illness. While stress significantly impacts alcoholism risk, there is also evidence that increasing levels of alcohol use affect peripheral and central stress and reward pathways thereby setting up a reciprocal relationship among the effects of alcohol consumption of the development, course of and recovery from alcoholism. This chapter reviews our efforts in assessing the integrity of stress pathways in alcoholism by examining whether altered responses of the stress pathways play a role in relapse risk. Using validated human laboratory procedures to model two of the most common situations that contribute to relapse risk, we review how such models in the laboratory can predict subsequent alcohol relapse. Empirical findings from human laboratory and brain imaging studies are reviewed to show that specific stress-related dysregulation accompanies the alcohol craving state in alcohol-dependent individuals, and such dysregulation along with increases in alcohol seeking are predictive of increased alcohol relapse risk. Finally, the significant implications of these findings for the development of novel treatment interventions that target stress processes and alcohol craving to improve alcoholism relapse outcomes are discussed.

Genetically Selected Alcohol Preferring Rats to Model Human Alcoholism

“…Overall these data suggest that genetically selected preferring lines and heterogeneous nonselected rats both show relapse-like behaviors after exposure to stressful stimuli but in the preferring lines the sensitivity appears to be higher. This reflects the results of several clinical studies showing that a large population of alcoholics have lower ability to engage into stress-coping strategies and that resumption of alcohol abuse is often a mechanism to ameliorate the negative affective state in which they precipitate following exposure to anxiogenic stimuli or stress, especially during protracted withdrawal (Bartlett and Heilig 2011; Sinha 2011). …”

Childhood Trauma and Neural Responses to Personalized Stress, Favorite-Food and Neutral-Relaxing Cues in Adolescents

“…Two scripts each were developed for stress, favorite-food, and neutral/relaxing conditions using the Scene Development Questionnaire (Sinha, 2013) and audiotaped in a female voice for presentation in the scanner. Examples of stress, favorite-food, and neutral/relaxing scripts are provided elsewhere (Yip et al, 2014).…”

“…The guided-imagery fMRI procedure, in which personal experiences are recalled and developed into scripts to be recorded and played back in the scanner, is validated and has been used in both adults and adolescents (Hommer et al, 2013;Jastreboff et al, 2013;Sinha, 2013). To our knowledge, this is the first study to investigate the relationship between childhood trauma and the neural correlates of personally salient appetitive, aversive, and neutral/relaxing cues.…”

Experimental psychopathology paradigms for alcohol use disorders: Applications for translational research

“…In the addiction literature, the guided imagery task developed by Sinha and colleagues has become increasingly popular (Fox, Bergquist, Hong, & Sinha, 2007; Sinha, 2009, 2011; Sinha et al, 2008; Sinha, Catapano, & O’Malley, 1999; Sinha et al, 2000). In this paradigm, participants are asked to provide details about a current unresolved stressful situation to a trained research assistant.…”

“…Typically, this paradigm also includes a neutral script and alcohol-related scripts can be developed to serve as a cue condition. Generally both stress and alcohol imagery increase measures of craving, negative affect, and physiological reactivity (Sinha, 2011). The most rigorously controlled of these paradigms involve additional training in mental imagery to ensure the fidelity of the guided imagery task (Sinha, 2011).…”