Stress‐Induced and Alcohol Cue‐Induced Craving in Recently Abstinent Alcohol‐Dependent Individuals

Abstract

Background: Research has shown that exposure to stress/negative affect and to alcohol cues can each increase alcohol craving and relapse susceptibility in alcohol-dependent individuals. However, whether the emotional and physiological states associated with stress-induced and alcohol cueinduced craving are comparable has not been well studied. Therefore, this study examined the craving, emotional, and physiological responses to stress and to alcohol cues in treatment-engaged, 4-week abstinent, alcohol-dependent individuals using analogous stress and alcohol cue imagery methods.Method: Twenty treatment-seeking, alcohol-dependent participants (18 males/2 females) were exposed to a brief 5-minute guided imagery procedure that involved imagining a recent personal stressful situation, a personal alcohol cue-related situation, and a neutral-relaxing situation, 1 imagery per session presented in random order. Alcohol craving, anxiety and emotion rating scales, cardiovascular measures, and salivary cortisol were compared across the 3 conditions.Results: Exposure to stress and to alcohol cues each produced significant increases in alcohol craving, anxiety, and negative emotions and decreases in positive emotions. Stress-induced alcohol craving was significantly correlated with increases in sadness, anger, and anxiety ratings, but alcohol cueinduced craving was associated with decreases in positive affect (joy and neutral relaxed state) and increases in anxiety and fear ratings. Furthermore, stress increased systolic and diastolic blood pressure responses, but significant increases in salivary cortisol were only observed in the alcohol cue condition.Conclusions: Although both stress and alcohol cues produce increases in anxiety associated with alcohol craving, each produced a dissociable psychobiological state involving subjective emotional, cardiovascular, and cortisol responses. These data could have significant implications for understanding the specific psychobiology associated with stress or alcohol cue exposure and their potential effects on alcohol relapse susceptibility.

Stress and Alcohol Cues Exert Conjoint Effects on Go and Stop Signal Responding in Male Problem Drinkers

“…Coding trials to capture these temporal variations could reveal additional effects of salient stimuli. Whether similar effects are seen with other stressors, such as guided imagery (Fox et al, 2007), is another important question, given that uncontrollable noise may not fully characterize the stressful conditions that precipitate relapse outside the laboratory.…”

Behavioral characteristics and neurobiological substrates shared by Pavlovian sign-tracking and drug abuse

“…Nevertheless, there are many reports of spontaneous relapse of drug-taking, even though drug cue reactivity had previously been significantly reduced or eliminated by drug cue extinction procedures (Wikler, 1973;Monti et al, 2001;Junghanns et al, 2005;Loeber et al., 2006), and Hammersley (1992) has attributed relapse to drug-taking following cue extinction therapy to spontaneous recovery. A role for spontaneous recovery of sign-tracking in relapse to drugtaking is suggested by reports that alcohol drinking glassware provides cues eliciting alcoholrelated physiological responses (Carter and Tiffany, 1999) and subjective cravings for alcohol (Cooney et al, 1983;Fox, 2007), and the persistence of these cue-elicited responses contribute to relapse (Marlatt, 1990;Rohsenow et al, 1994;Sinha and Li, 2007).…”

Altered levels of sex and stress steroid hormones assessed daily over a 28-day cycle in early abstinent cocaine-dependent females

“…Moreover, these changes have been documented during protracted cocaine abstinence (Mantsch et al 2003;Zhou et al 2003) alongside a range of symptoms comprising dysphoria, anxiety, and increased sensitivity to stress and craving (Kampman et al 2001;Mulvaney et al 1999). Recent laboratory studies have also shown increased sensitivity to stress-induced craving, HPA axis function, and negative emotion in recently abstinent cocaine (Fox et al 2007a;Sinha et al 2003) and alcohol (Fox et al 2007b;Sinha et al 2005) dependent individuals. Notably, these factors have been shown to be sex-specific (Fox et al 2006a;Kirschbaum et al 1999) and integral to relapse (Adinoff et al 2005;Sinha et al 2006).…”