Sinha Rajita, Fox Helen C, Hong Kwangik A, Bergquist Keri, Bhagwagar Zubin, Siedlarz Kristen M
Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA.
Neuropsychopharmacology. 2009 Apr;34(5):1198-208. doi: 10.1038/npp.2008.78. Epub 2008 Jun 18.
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.
长期酗酒与应激和奖赏通路的改变有关,这些改变可能会改变对情绪应激和酒精渴望的易感性。本研究旨在探讨长期酗酒是否与应激和酒精渴望反应的改变有关。纳入正在接受治疗的、已戒酒28天的酒精依赖个体(ADs;6名女性/22名男性)以及社交饮酒者(SDs;10名女性/18名男性),让他们接触一段简短的、有引导的意象,内容涉及个性化的应激性、与酒精相关的和中性放松情境,每次会话一种意象情境,在3天内随机呈现。评估酒精渴望、焦虑和情绪评分、行为应激反应、心率、血压和唾液皮质醇水平。酒精依赖患者的基础心率和唾液皮质醇水平显著升高。与社交饮酒者相比,应激和酒精线索暴露均使酒精依赖患者产生显著增强且持续的渴望状态,其特征为焦虑增加、负面情绪、收缩压反应增强,在酒精线索暴露时还伴有行为应激反应。与社交饮酒者组相比,酒精依赖患者的应激诱导皮质醇反应减弱。这些数据首次证明,应激和线索暴露会在戒酒的酗酒者中诱发一种与负面情绪相关的持续酒精渴望状态,并伴有下丘脑-垂体-肾上腺(HPA)轴功能失调和生理唤醒反应。由于应激和负面情绪诱导的酒精渴望的实验室模型可预测复发结果,当前数据的一个启示是,针对减轻应激和酒精线索诱导的渴望以及调节应激反应的治疗可能有助于改善酒精复发结果。