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. 2010 Jan 1;106(1):21-7.
doi: 10.1016/j.drugalcdep.2009.07.016. Epub 2009 Sep 2.

Reactivity to laboratory stress provocation predicts relapse to cocaine

Sudie E Back  1 , Karen Hartwell, Stacia M DeSantis, Michael Saladin, Aimee L McRae-Clark, Kimber L Price, Megan M Moran-Santa Maria, Nathaniel L Baker, Eve Spratt, Mary Jeanne Kreek, Kathleen T Brady
Affiliations

Reactivity to laboratory stress provocation predicts relapse to cocaine

Sudie E Back et al. Drug Alcohol Depend. .

Abstract

Background: Cocaine dependence is a chronic relapsing disorder characterized by periods of abstinence and high rates of return to drug using behavior. Elevated levels of stress have been associated with relapse to cocaine; however, the nature of this association is not well understood.

Methods: The relationship between reactivity to three human laboratory provocations and relapse to cocaine was investigated. Participants were 53 cocaine-dependent individuals who were admitted for a 2-day inpatient stay during which a psychosocial provocation (i.e., the Trier Social Stress Task), a pharmacological provocation (i.e., administration of 1 microg/kg corticotrophin releasing hormone; CRH), and a drug cue exposure paradigm were completed. Adrenocortico-trophic hormone (ACTH), cortisol, heart rate, and subjective cocaine craving and stress were assessed at baseline and at multiple time points post-task. Participants' cocaine use was monitored for approximately 1 month following testing.

Results: The majority (72.3%) of participants relapsed to cocaine during the follow-up period. In response to the CRH and drug cue exposure, elevated subjective craving and stress were significant predictors of cocaine use during follow-up. In response to the Trier, attenuated neuroendocrine responses were significant predictors of cocaine use.

Conclusions: The findings provide further evidence of the ability of laboratory paradigms to predict relapse. The observed associations between stress reactivity and subsequent cocaine use highlight the clinical importance of the findings. Predictors of relapse may vary based on the type of provocation utilized. Interventions aimed at normalizing stress response, as measured using laboratory paradigms, may prove useful in relapse prevention.

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Figures

Figure 1
Figure 1
The estimated probability of relapse based on the mean ACTH percent change from baseline in response to the Trier Social Stress Task. The circles represent the mean percent change in ACTH from baseline for relapsers, while the squares represent the mean percent change in ACTH for abstainers. The area within the dashed lines represents the 95% confidence band.
Figure 2
Figure 2
The estimated probability of relapse based on the mean Cortisol percent change from baseline in response to the Trier Social Stress Task. The circles represent the mean percent change in Cortisol from baseline for relapsers, while the squares represent the mean percent change in Cortisol for abstainers. The area within the dashed lines represents the 95% confidence band.
Figure 3
Figure 3
Kaplan Meier Survival plot of relapse probability in response to CRH provocation. A) CRH-induced stress. B) CRH-induced craving.
Figure 3
Figure 3
Kaplan Meier Survival plot of relapse probability in response to CRH provocation. A) CRH-induced stress. B) CRH-induced craving.
Figure 4
Figure 4
Kaplan Meier Survival plot of relapse probability in response to the drug cue exposure paradigm. A) Cue-induced stress. B) Cue-induced craving.
Figure 4
Figure 4
Kaplan Meier Survival plot of relapse probability in response to the drug cue exposure paradigm. A) Cue-induced stress. B) Cue-induced craving.
See this image and copyright information in PMC

References

    1. Brady KT, Back SE, Waldrop AE, McRae AL, Anton RF, Upadhyaya HP, Saladin ME, Randall PK. Cold pressor task reactivity: predictors of alcohol use among alcohol-dependent individuals with and without comorbid posttraumatic stress disorder. Alcoholism, Clinical and Experimental Research. 2006;30:938–946. - PubMed
    1. Brady KT, McRae AL, Moran-Santa Maria M, DeSantis SM, Simpson AN, Waldrop AE, Back SE, Kreek J. Response to CRH Infusion in Cocaine-Dependent Individuals. Archives of General Psychiatry. 2009;66:422–430. - PMC - PubMed
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    1. Brown SA, Vik PW, Patterson TL, Grant I, Shuckit MA. Stress, vulnerability and adult alcohol relapse. Journal of Studies on Alcohol. 1995;56:538–545. - PubMed

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