Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Investigation
  • Published:
Psychopharmacology Aims and scope Submit manuscript

Abstract

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 < 0.05). Conversely, no demographic or baseline variables were significant predictors of any outcome variable.

Conclusions

These results suggest that greater stress-related increases in alcohol craving are associated with poorer alcohol treatment outcomes. The findings support the use of stress-induced craving as a predictor of alcohol relapse propensity. Furthermore, treatments that address high stress levels and the associated high levels of alcohol craving are likely to improve treatment outcomes in alcohol dependence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

We’re sorry, something doesn't seem to be working properly.

Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

References

  • Adinoff B, Risher-Flowers D, De Jong J, Ravitz B, Bone GH, Nutt DJ, Roehrich L, Martin PR, Linnoila M (1991) Disturbances of hypothalamic-pituitary-adrenal axis functioning during ethanol withdrawal in six men. AJ Psychiatry 148:1023–1025

    CAS  Google Scholar 

  • Adinoff B, Ruether K, Krebaum S, Iranmanesh A, Williams MJ (2003) Increased salivary cortisol concentrations during chronic alcohol intoxication in a naturalistic clinical sample of men. Alcohol Clin Exp Res 27:1420–1427

    Article  PubMed  CAS  Google Scholar 

  • Adinoff B, Junghanns K, Kiefer F, Krishnan-Sarin S (2005) Suppression of the HPA axis stress-response: implications for relapse. Alcohol Clin Exp Res 29:1351–1355

    Article  PubMed  CAS  Google Scholar 

  • American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, fourth edition, text revision. In: First M (ed), American Psychiatric Association, Washington, DC

  • Baker TB, Piper ME, McCarthy DE, Majeskie MR, Fiore MC (2004) Addiction motivation reformulated: an affective processing model of negative reinforcement. Psychol Rev 111:33–51

    Article  PubMed  Google Scholar 

  • Beck AT, Steer RA, Brown GK (1996) Beck depression inventory-II. Psychological Corporation, San Antonio

    Google Scholar 

  • Berman JD, Cook DM, Buchman M, Keith LD (1990) Diminished adrenocorticotropin response to insulin-induced hypoglycemia in nondepressed, actively drinking male alcoholics. J Clin Endocrinol Metab 71:712–717

    Article  PubMed  CAS  Google Scholar 

  • Bernardy NC, King AC, Parsons OA, Lovallo WR (1996) Altered cortisol response in sober alcoholics: an examination of contributing factors. Alcohol 13:493–498

    Article  PubMed  CAS  Google Scholar 

  • Brady KT, Sonne SC (1999) The role of stress in alcohol use, alcoholism treatment, and relapse. Alcohol Res Health 23:263–271

    PubMed  CAS  Google Scholar 

  • Brandon TH, Herzog TA, Webb MS (2003) It ain't over till it's over: the case for offering relapse-prevention interventions to former smokers. Am J Med Sci 326:197–200

    Article  PubMed  Google Scholar 

  • Breese GR, Chu K, Dayas CV, Funk D, Knapp DJ, Koob GF, Le DA, O'Dell LE, Overstreet DH, Roberts AJ, Sinha R, Valdez GR, Weiss F (2005) Stress enhancement of craving during sobriety: a risk for relapse. Alcohol Clin Exp Res 29:185–195

    Article  PubMed  Google Scholar 

  • Brown SA, Vik PW, Creamer VA (1989) Characteristics of relapse following adolescent substance abuse treatment. Addict Behav 14:291–300

    Article  PubMed  CAS  Google Scholar 

  • Brown SA, Myers MG, Mott MA, Vik PW (1994) Correlates of success following treatment for adolescent substance abuse. Appl Prev Psychol 3:61–73

    Article  Google Scholar 

  • Brown RA, Lejuez CW, Kahler CW, Strong DR (2002) Distress tolerance and duration of past smoking cessation attempts. J Abnorm Psychol 111:180–185

    Article  PubMed  Google Scholar 

  • Childress AR, Hole AV, Ehrman RN, Robbins SJ, McLellan AT, O'Brien CP (1993) Cue reactivity and cue reactivity interventions in drug dependence. NIDA Res Monogr 137:73–95

    PubMed  CAS  Google Scholar 

  • Cooney NL, Litt MD, Morse PA, Bauer LO, Gaupp L (1997) Alcohol cue reactivity, negative-mood reactivity, and relapse in treated alcoholic men. J Abnorm Psychol 106:243–250

    Article  PubMed  CAS  Google Scholar 

  • Daughters SB, Lejuez CW, Bornovalova MA, Kahler CW, Strong DR, Brown RA (2005a) Distress tolerance as a predictor of early treatment dropout in a residential substance abuse treatment facility. J Abnorm Psychol 114:729–734

    Article  PubMed  Google Scholar 

  • Daughters SB, Lejuez CW, Kahler CW, Strong DR, Brown RA (2005b) Psychological distress tolerance and duration of most recent abstinence attempt among residential treatment-seeking substance abusers. Psychol Addict Behav 19:208–211

    Article  PubMed  Google Scholar 

  • Ehrenreich H, Schuck J, Stender N, Pilz J, Gefeller O, Schilling L, Poser W, Kaw S (1997) Endocrine and hemodynamic effects of stress versus systemic CRF in alcoholics during early and medium term abstinence. Alcohol Clin Exp Res 21:1285–1293

    Article  PubMed  CAS  Google Scholar 

  • Errico AL, Parsons OA, King AC, Lovallo WR (1993) Attenuated cortisol response to biobehavioral stressors in sober alcoholics. J Stud Alcohol 54:393–398

    PubMed  CAS  Google Scholar 

  • First M, Spitzer R, Gibbon M, Williams J (1996) Structured clinical interview for DSM-IV Axis I disorders, patient edition. Biometrics Research Department, New York State Psychiatric Institute, New York

  • Fox HC, Bergquist KL, Hong KI, Sinha R (2007) Stress-induced and alcohol cue-induced craving in recently abstinent alcohol-dependent individuals. Alcohol Clin Exp Res 31:395–403

    Article  PubMed  Google Scholar 

  • Funk CK, O'Dell LE, Crawford EF, Koob GF (2006) Corticotropin-releasing factor within the central nucleus of the amygdala mediates enhanced ethanol self-administration in withdrawn, ethanol-dependent rats. J Neurosci 26:11324–11332

    Article  PubMed  CAS  Google Scholar 

  • Heinz A, Beck A, Grusser SM, Grace AA, Wrase J (2009) Identifying the neural circuitry of alcohol craving and relapse vulnerability. Addict Biol 14:108–118

    Article  PubMed  CAS  Google Scholar 

  • Higgins RL, Marlatt GA (1973) Effects of anxiety arousal on the consumption of alcohol by alcoholics and social drinkers. J Consult Clin Psychol 41:426–433

    Article  PubMed  CAS  Google Scholar 

  • Higley JD, Thompson WW, Champoux M, Goldman D, Hasert MF, Kraemer GW, Scanlan JM, Suomi SJ, Linnoila M (1993) Paternal and maternal genetic and environmental contributions to cerebrospinal fluid monoamine metabolites in rhesus monkeys (Macaca mulatta). Arch Gen Psychiatry 50:615–623

    PubMed  CAS  Google Scholar 

  • Junghanns K, Backhaus J, Tietz U, Lange W, Bernzen J, Wetterling T, Rink L, Driessen M (2003) Impaired serum cortisol stress response is a predictor of early relapse. Alcohol Alcohol 38:189–193

    PubMed  CAS  Google Scholar 

  • Junghanns K, Tietz U, Dibbelt L, Kuether M, Jurth R, Ehrenthal D, Blank S, Backhaus J (2005) Attenuated salivary cortisol secretion under cue exposure is associated with early relapse. Alcohol Alcohol 40:80–85

    PubMed  CAS  Google Scholar 

  • Karlsgodt KH, Lukas SE, Elman I (2003) Psychosocial stress and the duration of cocaine use in non-treatment seeking individuals with cocaine dependence. Am J Drug Alcohol Abuse 29:539–551

    Article  PubMed  Google Scholar 

  • Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE (2005) Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62:617–627

    Article  PubMed  Google Scholar 

  • Koob GF (2003) Alcoholism: allostasis and beyond. Alcohol Clin Exp Res 27:232–243

    Article  PubMed  CAS  Google Scholar 

  • Koob GF (2008) A role for brain stress systems in addiction. Neuron 59:11–34

    Article  PubMed  CAS  Google Scholar 

  • Koob G, Kreek MJ (2007) Stress, dysregulation of drug reward pathways, and the transition to drug dependence. AJ Psychiatry 164:1149–1159

    Article  Google Scholar 

  • Koob GF, Roberts AJ, Schulteis G, Parsons LH, Heyser CJ, Hyytia P, Merlo-Pich E, Weiss F (1998) Neurocircuitry targets in ethanol reward and dependence. Alcohol Clin Exp Res 22:3–9

    Article  PubMed  CAS  Google Scholar 

  • Le AD, Harding S, Juzytsch W, Watchus J, Shalev U, Shaham Y (2000) The role of corticotrophin-releasing factor in stress-induced relapse to alcohol-seeking behavior in rats. Psychopharmacol Berl 150:317–324

    Article  CAS  Google Scholar 

  • Le AD, Kiianmaa K, Cunningham CL, Engel JA, Ericson M, Soderpalm B, Koob GF, Roberts AJ, Weiss F, Hyytia P, Janhunen S, Mikkola J, Backstrom P, Ponomarev I, Crabbe JC (2001) Neurobiological processes in alcohol addiction. Alcohol Clin Exp Res 25:144S–151S

    Article  PubMed  CAS  Google Scholar 

  • Litt MD, Cooney NL, Morse P (2000) Reactivity to alcohol-related stimuli in the laboratory and in the field: predictors of craving in treated alcoholics. Addiction 95:889–900

    Article  PubMed  CAS  Google Scholar 

  • Liu X, Weiss F (2002) Additive effect of stress and drug cues on reinstatement of ethanol seeking: exacerbation by history of dependence and role of concurrent activation of corticotropin-releasing factor and opioid mechanisms. J Neurosci 22:7856–7861

    PubMed  CAS  Google Scholar 

  • Lovallo WR, Dickensheets SL, Myers DA, Thomas TL, Nixon SJ (2000) Blunted stress cortisol response in abstinent alcoholic and polysubstance-abusing men. Alcohol Clin Exp Res 24:651–658

    Article  PubMed  CAS  Google Scholar 

  • Marlatt GA (1979) A cognitive-behavioral model of the relapse process. NIDA Res Monogr 191–200

  • Marlatt GA (1990) Cue exposure and relapse prevention in the treatment of addictive behaviors. Addict Behav 15:395–399

    Article  PubMed  CAS  Google Scholar 

  • Mason BJ, Light JM, Escher T, Drobes DJ (2008) Effect of positive and negative affective stimuli and beverage cues on measures of craving in non treatment-seeking alcoholics. Psychopharmacology (Berl) 200(1):141–50

    Article  CAS  Google Scholar 

  • Mason BJ, Light JM, Williams LD, Drobes DJ (2009) Proof-of-concept human laboratory study for protracted abstinence in alcohol dependence: effects of gabapentin. Addict Biol 14:73–83

    Article  PubMed  CAS  Google Scholar 

  • Miller PM, Hersen M, Eisler RM, Hilsman G (1974) Effects of social stress on operant drinking of alcoholics and social drinkers. Behav Res Ther 12:67–72

    Article  PubMed  CAS  Google Scholar 

  • Monti PM, Rohsenow DJ, Rubonis AV, Niaura RS, Sirota AD, Colby SM, Abrams DB (1993) Alcohol cue reactivity: effects of detoxification and extended exposure. J Stud Alcohol 54:235–245

    PubMed  CAS  Google Scholar 

  • Nesic J, Duka T (2006) Gender specific effects of a mild stressor on alcohol cue reactivity in heavy social drinkers. Pharmacol Biochem Behav 83:239–248

    Article  PubMed  CAS  Google Scholar 

  • Noone M, Dua J, Markham R (1999) Stress, cognitive factors, and coping resources as predictors of relapse in alcoholics. Addict Behav 24:687–693

    Article  PubMed  CAS  Google Scholar 

  • Pitman RK, Orr SP, Forgue DF, de Jong JB, Claiborn JM (1987) Psychophysiologic assessment of posttraumatic stress disorder imagery in Vietnam combat veterans. Arch Gen Psychiatry 44:970–975

    PubMed  CAS  Google Scholar 

  • Pohorecky LA (1991) Stress and alcohol interaction: an update of human research. Alcohol Clin Exp Res 15:438–459

    Article  PubMed  CAS  Google Scholar 

  • Pratt WM, Davidson D (2009) Role of the HPA axis and the A118G polymorphism of the mu-opioid receptor in stress-induced drinking behavior. Alcohol Alcohol 44:358–365

    PubMed  CAS  Google Scholar 

  • Rohsenow DJ, Monti PM (1999) Does urge to drink predict relapse after treatment? Alcohol Res Health 23:225–232

    PubMed  CAS  Google Scholar 

  • Shalev U, Highfield D, Yap J, Shaham Y (2000) Stress and relapse to drug seeking in rats: studies on the generality of the effect. Psychopharmacol Berl 150:337–346

    Article  CAS  Google Scholar 

  • Singleton E, Tiffany S, Henningfield J (1994) Development and validation of a new questionnaire to assess craving for alcohol: problems of drug dependence. In: Proceeding of the 56th Annual Meeting, The College on Problems of Drug Dependence. National Institute on Drug Abuse, Rockville, MD, pp 289

  • Sinha R, Fox HC, Hong KA, Bergquist K, Bhagwagar Z, Siedlarz KM (2009) Enhanced negative emotion and alcohol craving, and altered physiological responses following stress and cue exposure in alcohol dependent individuals. Neuropsychopharmacology 34:1198–1208

    Article  PubMed  CAS  Google Scholar 

  • Skinner H, Horn J (1984) Alcohol dependence scale: users guide. Addiction Research Foundation Toronto, Canada

    Google Scholar 

  • Sobell L, Sobell M (2000) Alcohol timeline followback (TFLB). In: AP Association (ed) Handbook of psychicatric measures. American Psychiatric Association, Washington, pp 477–479

    Google Scholar 

  • Sullivan JT, Sykora K, Schneiderman J, Naranjo CA, Sellers EM (1989) Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar). Br J Addict 84:1353–1357

    Article  PubMed  CAS  Google Scholar 

  • Thomas SE, Bacon AK, Randall PK, Brady KT, See RE (2011) An acute psychosocial stressor increases drinking in non-treatment-seeking alcoholics. Psychopharmacology (Berl) (in press)

  • Uhart M, Wand GS (2009) Stress, alcohol and drug interaction: an update of human research. Addict Biol 14:43–64

    Article  PubMed  CAS  Google Scholar 

  • Valdez GR, Zorrilla EP, Roberts AJ, Koob GF (2003) Antagonism of corticotropin-releasing factor attenuates the enhanced responsiveness to stress observed during protracted ethanol abstinence. Alcohol 29:55–60

    Article  PubMed  CAS  Google Scholar 

  • Volpicelli JR, Ulm RR, Hopson N (1990) The bidirectional effects of shock on alcohol preference in rats. Alcohol Clin Exp Res 14:913–916

    Article  PubMed  CAS  Google Scholar 

  • Waldrop AE, Ana EJ, Saladin ME, McRae AL, Brady KT (2007) Differences in early onset alcohol use and heavy drinking among persons with childhood and adulthood trauma. Am J Addict 16:439–442

    Article  PubMed  Google Scholar 

  • Wand GS, Dobs AS (1991) Alterations in the hypothalamic-pituitary-adrenal axis in actively drinking alcoholics. J Clin Endocrinol Metab 72:1290–1295

    Article  PubMed  CAS  Google Scholar 

  • Weiss F, Ciccocioppo R, Parsons LH, Katner S, Liu X, Zorrilla EP, Valdez GR, Ben-Shahar O, Angeletti S, Richter RR (2001) Compulsive drug-seeking behavior and relapse. Neuroadaptation, stress, and conditioning factors. Ann NY Acad Sci 937:1–26

    Article  PubMed  CAS  Google Scholar 

  • Wolffgramm J (1991) An ethopharmacological approach to the development of drug addiction. Neurosci Biobehav Rev 15:515–519

    Article  PubMed  CAS  Google Scholar 

  • Zilberman ML, Tavares H, Blume SB, el-Guebaly N (2003) Substance use disorders: sex differences and psychiatric comorbidities. Can J Psychiatry 48:5–13

    PubMed  Google Scholar 

Download references

Acknowledgments

Funding for this project was provided by NIAAA grant numbers RO1AA012602 and R37AA014028 to BJM and the Pearson Center for Alcoholism and Addiction Research.

Author information

Authors and Affiliations

  1. The Pearson Center for Alcoholism and Addiction Research, Laboratory of Clinical Psychopharmacology, The Scripps Research Institute, 10550 North Torrey Pines Road, TPC-5, La Jolla, CA, 92037, USA

    Amanda E. Higley, Natania A. Crane, Andrea D. Spadoni, Susan B. Quello, Vivian Goodell & Barbara J. Mason

Authors
  1. Amanda E. Higley
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Natania A. Crane
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andrea D. Spadoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Susan B. Quello
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Vivian Goodell
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Barbara J. Mason
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Barbara J. Mason.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Higley, A.E., Crane, N.A., Spadoni, A.D. et al. Craving in response to stress induction in a human laboratory paradigm predicts treatment outcome in alcohol-dependent individuals. Psychopharmacology 218, 121–129 (2011). https://doi.org/10.1007/s00213-011-2355-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00213-011-2355-8

Keywords

Search

Navigation