Sex moderates stress reactivity in heavy drinkers.

Psychological stress and alcohol use disorders have a well-known connection. Individual differences in stress reactivity have been an area of interest in alcohol research, particularly given the relationship between craving and stress reactivity to later relapse. The present study examines the role of sex on stress-induced alcohol craving and emotional reactivity using a guided imagery stress paradigm. Participants were 64 non-treatment seeking heavy drinkers from the community who completed a two-session protocol that included two guided imagery exposures, Stress and Neutral. Participants reported their mood and craving before and after each exposure using the Differential Emotions Scale and the Alcohol Urge Questionnaire respectively. Analyses revealed a significant Stress × Sex × Trial effect on craving [F (1,61) = 5.35; p < .05] after controlling for AUDIT scores [F (1,61) = 8.16; p < .01] such that females reported greater increases in craving from baseline to post-imagery during the stress imagery versus the neutral imagery condition, than did males. Mood reactivity analysis showed similar patterns. Specifically, there was a significant Stress × Sex × Trial effect on the anxiety subscale of the DES [F (1,61) = 15.81; p < .001] such that females reported greater increases in anxiety from baseline to post-imagery during the stress imagery versus the neutral conditions, than did males. These results suggest that female heavy drinkers were more sensitive to the effects of the stress-induction on alcohol craving and mood reactivity than males. If supported by future studies, these initial findings may help advance understanding of the mechanisms of stress and mood regulation as central to alcoholism liability and recovery in females.