Ralevski Elizabeth, Southwick Steven, Jackson Eric, Jane Jane Serrita, Russo Melanie, Petrakis Ismene
Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.
Department of Veterans Affairs, VA Connecticut Healthcare System, West Haven, Connecticut.
Alcohol Clin Exp Res. 2016 Aug;40(8):1752-60. doi: 10.1111/acer.13120. Epub 2016 Jul 1.
Alcohol dependence (AD) and post-traumatic stress disorder (PTSD) commonly co-occur, and the co-occurrence is associated with worse prognosis than either disorder absent the other. Craving is an important construct related to relapse, but the relationship between PTSD symptoms, craving, and relapse is not well understood. Several studies have documented the relationship between stress and craving in individuals without comorbid PTSD, but the effect on those with comorbid PTSD is not well known. A small literature suggests that trauma imagery affects craving. This is the first study to explore the effects of trauma-induced and stress-induced scripts on alcohol craving, affect, cardiovascular, and cortisol responses in the laboratory.
Veterans (n = 25) diagnosed with AD and PTSD who were participating in a randomized clinical treatment trial took part in this laboratory study. Baseline assessment included PTSD symptoms and drinking quantity and frequency over 3 months before study initiation. In the laboratory, participants were exposed to neutral, stressful, and trauma scripts randomly assigned. Main outcomes included craving, anxiety, mood states, salivary cortisol, and cardiovascular responses.
Both stress and trauma scripts produced greater increases in craving, negative affect, and cardiovascular reactivity, compared to neutral scripts. Trauma scripts produced significantly stronger craving for alcohol and greater cardiovascular reactivity than stress scripts. Also, trauma-induced but not stress-induced craving was positively correlated with baseline levels of drinking. There were no changes in cortisol levels from pre- to postexposure of any scripts.
The results highlight that trauma cues are more salient in inducing alcohol craving than stress cues and higher reactivity is related to more baseline drinking. This finding is consistent with clinical observations that show an association between PTSD symptoms and alcohol relapse. It also underscores the importance of adequate treatment of PTSD as reactivity related to trauma cues and reminders may be an important factor in craving and relapse.
酒精依赖（AD）和创伤后应激障碍（PTSD）常同时出现，且这种共病与比单一疾病更差的预后相关。渴望是与复发相关的一个重要概念，但PTSD症状、渴望和复发之间的关系尚未得到充分理解。几项研究记录了无PTSD共病个体中压力与渴望之间的关系，但对有PTSD共病个体的影响尚不清楚。少量文献表明创伤意象会影响渴望。这是第一项在实验室中探索创伤诱导和压力诱导脚本对酒精渴望、情绪、心血管和皮质醇反应影响的研究。
参与一项随机临床治疗试验的25名被诊断为AD和PTSD的退伍军人参加了这项实验室研究。基线评估包括PTSD症状以及研究开始前3个月的饮酒量和频率。在实验室中，参与者被随机暴露于中性、压力和创伤脚本。主要结局包括渴望、焦虑、情绪状态、唾液皮质醇和心血管反应。
与中性脚本相比，压力和创伤脚本均使渴望、负面影响和心血管反应性有更大程度的增加。创伤脚本比压力脚本产生了明显更强的酒精渴望和更大的心血管反应性。此外，创伤诱导而非压力诱导的渴望与饮酒基线水平呈正相关。任何脚本暴露前后皮质醇水平均无变化。
结果表明，创伤线索在诱导酒精渴望方面比压力线索更显著，更高的反应性与更多的基线饮酒相关。这一发现与临床观察结果一致，即PTSD症状与酒精复发之间存在关联。它还强调了充分治疗PTSD的重要性，因为与创伤线索和提示相关的反应性可能是渴望和复发的一个重要因素。
