"Alcohol cues" are reminders of drinking. Researchers already know that both stress and alcohol cues can produce cravings and relapse in abstinent alcoholics. New findings indicate that stress and cues work on the brain differently to influence craving, perhaps producing an additive effect, which may in turn decrease the chances of treatment success.
"Alcoholics frequently cite psychological stress and cues that lead to negative mood states — such as anxiety, depression, anger and confusion — as reasons for relapse to drug use," explained Helen Fox, associate research scientist at Yale University School of Medicine and corresponding author for the study.
However, added Suzanne Thomas, assistant professor of psychiatry at the Medical University of South Carolina, it appears that stress and cues might work differently in the brain to affect craving.
More specifically, said Fox, it is possible that two of the major causes of relapse in alcoholics have a very different psychobiological profile. "A clarification of these differences may help to develop more tailored therapy for both the reward and distress components of craving," she said.
Researchers exposed 20 (18 males, 2 females) treatment-seeking alcoholics to a brief five-minute guided imagery procedure that involved three conditions: a recent personal, stressful situation; a personal alcohol-cue-related situation; and a neutral, relaxing situation. One image per session was presented in random order. Alcohol craving, anxiety and emotion ratings, cardiovascular levels, and salivary assessments of the stress hormone cortisol were also measured and compared across the three conditions.
Both stress and alcohol cues appear able to produce increases in anxiety associated with alcohol craving.
However, said Fox, the specific psychobiology associated with each does indeed appear to be different. "While stress-related craving was associated with an increase in negative emotions such as anxiety, anger, fear, and sadness, cue-induced craving was associated with an anxiety or fear state and a decrease in positive mood such as joy or a relaxed state," she said.
Results also indicate differences in physiological arousal.
"In the stress-imagery condition, increased alcohol craving was accompanied by an increase in blood pressure," said Fox. "In the cue-imagery condition, increased alcohol craving was accompanied by an increase in salivary cortisol." Such differences may be important in understanding stress and alcohol-cue-related relapse susceptibility, she noted.
"We have known for several years that craving is multifaceted," added Thomas, "that is, it has several different elements, similar to how different musical notes comprise a chord. The present study suggests that the notes that result from stress and the ones that result from cues are different … and either one is sufficient to induce a detectable feeling of craving. Furthermore, prior work from animal studies suggests that together, stress and cues may produce an additive effect — a chord so compelling that resisting alcohol may feel impossible to an individual."
Both Fox and Thomas agreed that it is not news — and certainly not surprising for someone struggling to avoid drinking — that certain cues and stressful experiences can lead to an overwhelming urge to drink. What the study findings do contribute, however, is an explanation for how stress and cues may affect the brain differently to cause cravings.
"This is important for scientists who are interested in improving treatments for alcoholism," said Thomas. "For example, it might be possible to improve alcoholism treatment by attending to these differences … to develop new treatments that individually target both stress-induced and cue-induced craving to give the person in recovery the best possible chance to succeed in his or her efforts to stay sober."
Alcoholism: Clinical & Experimental Research (ACER) is the official journal of the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism. Co-authors of the ACER paper, "Stress-Induced and Alcohol Cue-Induced Craving in Recently Abstinent Alcohol Dependent Individuals," were Keri L. Bergquist, Kwang-Ik Hong, and Rajita Sinha of the Department of Psychiatry at Yale University School of Medicine. Funding is unclear.
Source: Alcoholism: Clinical & Experimental Research. February 2007.