Craving in response to stress induction in a human laboratory paradigm predicts treatment outcome in alcohol-dependent individuals

• Published in: Psychopharmacology 2011-11, Vol.218 (1), p.121-129
• Main Authors: Higley, Amanda E., Crane, Natania A., Spadoni, Andrea D., Quello, Susan B., Goodell, Vivian, Mason, Barbara J.
• Format: Article
• Language: English
• Subjects: Adult; Alcohol Drinking - psychology; Alcoholics; Alcoholism; Alcoholism - psychology; Alcoholism - rehabilitation; Ambulatory Care; Beverages; Biomedical and Life Sciences; Biomedicine; Care and treatment; Clinical outcomes; Corticosteroids; Demography; Drinking behavior; Drinking of alcoholic beverages; Drug abuse; Drug dependence; Ethanol; Female; Humans; Hydrocortisone; Hydrocortisone - metabolism; Male; Middle Aged; Neurosciences; Original Investigation; Patient outcomes; Pharmacology/Toxicology; Predictions; Prognosis; Prospective Studies; Psychiatry; Recurrence; Saliva - chemistry; Stress; Stress, Psychological - complications; Substance abuse; Substance abuse treatment; Temperance; Time Factors; Young Adult
• ISSN: 0033-3158; 1432-2072
• DOI: 10.1007/s00213-011-2355-8

Rationale Alcohol dependence is associated with high rates of recidivism. Stress has been shown to increase alcohol craving in alcohol-dependent individuals, but the association between stress-induced craving and alcoholism treatment outcome is not well understood. Objective The aim of the present study was to examine the relationship between strength of stress-induced alcohol craving in the human laboratory and subsequent drinking in a cohort of treatment-seeking, alcohol-dependent adults. Materials and methods This is a prospective study assessing stress-induced craving in the lab and subsequent treatment outcomes in alcohol-dependent subjects enrolled in a 12-week outpatient study. Stress was induced using a previously developed, individualized, audio recorded stress script and validated with objective (salivary cortisol) and subjective measures of distress. In vivo craving for alcohol was measured pre- and post-challenge using VAS. Results Subjects were 28 (16 male, 12 female) alcohol-dependent outpatients. Greater stress-induced craving was associated with a blunted salivary cortisol response, significantly shorter time to alcohol relapse, higher mean drinks per week, fewer percent days abstinent, and lower rates of complete abstinence over the study duration (all p 's