title: Impact of acute guanfacine administration on stress and cue reactivity in cocaine-dependent individuals.
abstract: BACKGROUND
  Stress and drug-paired cues increase drug craving and noradrenergic activity in cocaine-dependent individuals. Thus, medications that attenuate noradrenergic activity may be effective therapeutic treatment options for cocaine-dependent individuals.
  
  
  OBJECTIVE
  To examine the impact of acute administration of the α2 adrenergic receptor agonist guanfacine on responses to multiple risk factors for relapse in cocaine-dependent individuals.
  
  
  METHODS
  In a double-blind, placebo-controlled study, cocaine-dependent individuals (n = 84), were randomized to receive either 2 mg guanfacine (n = 50) or placebo (n = 34). Within each treatment arm, subjects were randomized to either a stress (guanfacine n = 26; placebo n = 15) or a no-stress (guanfacine n = 24; placebo n = 19) group. Participants in the stress group performed the Trier Social Stress Test. Subjects in each group were exposed to a neutral cue and then to cocaine-related cues. Plasma cortisol and subjective responses were compared between the four groups.
  
  
  RESULTS
  The no-stress guanfacine group reported greater craving in response to cocaine cues as compared to the neutral cue (p < 0.001). The guanfacine stress group reported greater subjective stress at the neutral cue than at baseline (p = 0.032). The cocaine cue increased subjective stress in the guanfacine (p < 0.001) no-stress group. There were no effects of guanfacine on cortisol levels in either the stress or no stress groups (all p > 0.70).
  
  
  CONCLUSIONS
  This study found no effects of a single 2 mg dose of guanfacine on reactivity to stress and cues alone or on the interaction of stress and drug cues. In cocaine-dependent individuals an acute 2 mg dose of guanfacine may not be an effective therapeutic treatment strategy.
authors.affiliation: Departments of Psychiatry and Behavioral Neurosciences .
authors.forename: Megan M
authors.initials: MM
authors.lastname: Moran-Santa Maria
authors.forename: Nathaniel L
authors.initials: NL
authors.lastname: Baker
authors.forename: Viswanathan
authors.initials: V
authors.lastname: Ramakrishnan
authors.forename: Kathleen T
authors.initials: KT
authors.lastname: Brady
authors.forename: Aimee
authors.initials: A
authors.lastname: McRae-Clark
mesh_terms: D058647:Adrenergic alpha-2 Receptor Agonists / Q000494:pharmacology*; D000328:Adult; D019970:Cocaine-Related Disorders / Q000097:blood / Q000523:psychology*; D003463:Cues; D004311:Double-Blind Method; D005260:Female; D016316:Guanfacine / Q000494:pharmacology*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D008875:Middle Aged; D013315:Stress, Psychological / Q000097:blood / Q000523:psychology*
chemical_list: D058647:Adrenergic alpha-2 Receptor Agonists; D016316:Guanfacine; D006854:Hydrocortisone
keywords: Cocaine; cocaine cues; guanfacine; stress