Enhanced negative emotion and alcohol craving, and altered physiological responses following stress and cue exposure in alcohol dependent individuals

Abstract

Chronic alcohol abuse is associated with changes in stress and reward pathways that could alter vulnerability to emotional stress and alcohol craving. This study examines whether chronic alcohol abuse is associated with altered stress and alcohol craving responses. Treatment-engaged, 28-day abstinent alcohol-dependent individuals (ADs; 6F/22M), and social drinkers (SDs; 10F/18M) were exposed to a brief guided imagery of a personalized stressful, alcohol-related and neutral-relaxing situation, one imagery condition per session, presented in random order across 3 days. Alcohol craving, anxiety and emotion ratings, behavioral distress responses, heart rate, blood pressure, and salivary cortisol measures were assessed. Alcohol patients showed significantly elevated basal heart rate and salivary cortisol levels. Stress and alcohol cue exposure each produced a significantly enhanced and persistent craving state in alcohol patients that was marked by increased anxiety, negative emotion, systolic blood pressure responses, and, in the case of alcohol cue, behavioral distress responses, as compared to SDs. Blunted stress-induced cortisol responses were observed in the AD compared to the SD group. These data are the first to document that stress and cue exposure induce a persistent negative emotion-related alcohol craving state in abstinent alcoholics accompanied by dysregulated HPA and physiological arousal responses. As laboratory models of stress and negative mood-induced alcohol craving are predictive of relapse outcomes, one implication of the current data is that treatments targeting decreases in stress and alcohol cue-induced craving and regulation of stress responses could be of benefit in improving alcohol relapse outcomes.

Figure 1

Differences between alcohol dependent (AD) patients and social drinkers (SDs) in (a) baseline heart rate (b.p.m.; p<0.006) and (b) baseline salivary cortisol levels (μg 100 ml; p<.03). Note that the levels represent average baseline and SE across the three laboratory sessions.

Figure 2

Mean and SE for peak and average (across 75 min and six time points postimagery exposure) alcohol craving, anxiety, behavioral distress, and emotional responses following exposure to stress (S, S’), alcohol cues (C, C’), and neutral (N, N’) conditions in alcohol-dependent (AD) vs social drinking (SD) participants. For the average responses, condition contrasts within groups are as follows: (a) alcohol craving: in the AD group, S’ >N’ (p<0.0001) and C’ >N’ (p<0.0001); in the SD, only C’ >N’, p<0.02; (b) anxiety: in the AD, S’ >N’ (p<0.0001), C’ >N’ (p<0.0001), and S’ >C’ (p<0.005) and in SD, S’ >N’ (p<0.0001), C’ >N’ (p<0.02), and S’ >C’ (p<0.0001). (c) Behavioral distress responses (BOS): in the AD group, S’ >N’ (p<0.0001), C’ >N’ (p<0.001), and S’ >C’ (p<0.01) and in the SD, S’ >N’ (p<0.0001) and S’ >C’ (p<0.0001). (d) Negative emotion: in the AD group, S’ >N’ (p<0.0001), C’ >N’ (p<0.0001),and S’ >C’ (p<0.0001) and in SD, S’ >N’ (p<0.0001) and S’ >C’ (p<0.0001). (e) Systolic blood pressure (SBP in mmHg): in the AD group, S’ >N’ (p<0.009) and S’ >C’ (p<0.02), and no differences between conditions in the SD group. The significance between group contrasts in conditions is shown in the graphs.

Figure 3

Mean and SE (adjusted for group differences in baseline) in response to stress (S), alcohol cue (C), and neutral (N) imagery exposure in alcohol-dependent individuals (AD) and social drinkers (SDs) in: (a) heart rate (b.p.m.); in the AD group, C’ >N’ (p<0.04) and C’ >S’ (p = 0.03) and in the SD, S’ >C’ (p<0.04). (b) Salivary cortisol (μg per 100 ml); in the AD group, C’ >N’ (p<0.0001) and C’ >S’ (p<0.0001) and in the SD, S’ >N’ (p = 0.06). The Significance between group contrasts in conditions is shown on the graphs.