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.
Psychopharmacology (Berl). 2011 Nov;218(1):121-9. doi: 10.1007/s00213-011-2355-8. Epub 2011 May 24.
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.
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.
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.
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.
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.
酒精依赖与高复发率有关。研究表明，压力会增加酒精依赖个体对酒精的渴望，但压力引起的渴望与酗酒治疗结果之间的关系尚不清楚。
本研究旨在探讨人类实验室中应激诱导的酒精渴望强度与寻求治疗的酒精依赖成年人随后饮酒之间的关系。
这是一项前瞻性研究，评估了 12 周门诊研究中酒精依赖受试者在实验室中应激诱导的渴望和随后的治疗结果。使用以前开发的、个性化的、录音的应激脚本诱导应激，并使用客观（唾液皮质醇）和主观的压力测量来验证。使用 VAS 在挑战前后测量体内对酒精的渴望。
受试者为 28 名（16 名男性，12 名女性）酒精依赖门诊患者。更强的应激诱导渴望与唾液皮质醇反应减弱、酒精复发时间显著缩短、每周平均饮酒量增加、无饮酒天数百分比降低以及研究期间完全戒酒率降低相关（均 p<0.05）。相反，没有任何人口统计学或基线变量是任何结果变量的显著预测因子。
这些结果表明，与酒精相关的渴望增加与酒精治疗结果较差有关。这些发现支持将应激诱导的渴望作为酒精复发倾向的预测因子。此外，治疗可能会改善酒精依赖中的压力水平和相关的高水平酒精渴望，从而改善治疗结果。
