title: Stress and drug-cue-induced craving in opioid-dependent individuals in naltrexone treatment.
abstract: BACKGROUND
  Naltrexone is a nonaddictive medication that blocks the euphoric effects of opioids. However, naltrexone treatment is associated with high rates of noncompliance and opioid relapse, possibly because it does not reduce stress and protracted withdrawal symptoms during early recovery. Prior clinical and preclinical research has indicated that both stress and drug-cue-related arousal response is associated with craving and vulnerability to relapse in a range of drug-using populations.
  
  
  OBJECTIVE
  To examine opioid craving and the subjective and cardiovascular response to stress and drug cues in naltrexone-treated opioid abusers.
  
  
  METHODS
  Eleven men and three women engaged in naltrexone treatment for opioid dependence. They were exposed to personalized stress, drug-cue, and neutral-relaxing imagery in a single laboratory session. Subjective (craving, emotion) and cardiovascular (heart rate, systolic blood pressure, and diastolic blood pressure) measures were assessed.
  
  
  RESULTS
  Stress and drug-cue-related imagery significantly increased opioid craving, anxiety, and negative emotions and significantly decreased positive emotions compared to neutral imagery. Selective emotional responses were greater in the stress condition than in the drug-cue condition. Only stress-related imagery was associated with an increased cardiovascular response.
  
  
  CONCLUSIONS
  Naltrexone-treated opioid abusers demonstrate vulnerability to stress and drug-cue-induced craving and arousal responses that may contribute to the high rates of noncompliance and relapse among opioid-dependent individuals undergoing naltrexone treatment. Pharmacological and behavioral interventions that specifically target the negative affectivity that co-occurs with drug-cue and stress-induced craving could be of benefit in improving naltrexone treatment outcomes in opioid dependence.
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511, USA. scott.hyman@yale.edu
authors.forename: Scott M
authors.initials: SM
authors.lastname: Hyman
authors.forename: Helen
authors.initials: H
authors.lastname: Fox
authors.forename: Kwang-Ik A
authors.initials: KI
authors.lastname: Hong
authors.forename: Cheryl
authors.initials: C
authors.lastname: Doebrick
authors.forename: Rajita
authors.initials: R
authors.lastname: Sinha
mesh_terms: D000328:Adult; D001007:Anxiety / Q000188:drug therapy / Q000209:etiology; D016739:Behavior, Addictive / Q000188:drug therapy* / Q000209:etiology; D001794:Blood Pressure / Q000187:drug effects; D003463:Cues; D004644:Emotions / Q000187:drug effects; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D019018:Imagery, Psychotherapy; D008297:Male; D009271:Naltrexone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000188:drug therapy / Q000503:physiopathology / Q000523:psychology; D013315:Stress, Psychological / Q000188:drug therapy* / Q000209:etiology
chemical_list: D009292:Narcotic Antagonists; D009271:Naltrexone