title: Craving in response to stress induction in a human laboratory paradigm predicts treatment outcome in alcohol-dependent individuals.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: 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.
authors: Amanda E
authors: AE
authors: Higley
authors: Natania A
authors: NA
authors: Crane
authors: Andrea D
authors: AD
authors: Spadoni
authors: Susan B
authors: SB
authors: Quello
authors: Vivian
authors: V
authors: Goodell
authors: Barbara J
authors: BJ
authors: Mason
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