title: Trauma- and Stress-Induced Response in Veterans with Alcohol Dependence and Comorbid Post-Traumatic Stress Disorder.
abstract: 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.
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.|Department of Veterans Affairs, VA Connecticut Healthcare System, West Haven, Connecticut.|Mental Illness Research and Clinical Center, VA Connecticut Healthcare System, West Haven, Connecticut.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Ralevski
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.|Department of Veterans Affairs, VA Connecticut Healthcare System, West Haven, Connecticut.|Mental Illness Research and Clinical Center, VA Connecticut Healthcare System, West Haven, Connecticut.
authors.forename: Steven
authors.initials: S
authors.lastname: Southwick
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.|Department of Veterans Affairs, VA Connecticut Healthcare System, West Haven, Connecticut.
authors.forename: Eric
authors.initials: E
authors.lastname: Jackson
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.|Department of Veterans Affairs, VA Connecticut Healthcare System, West Haven, Connecticut.|Mental Illness Research and Clinical Center, VA Connecticut Healthcare System, West Haven, Connecticut.
authors.forename: Jane Serrita
authors.initials: JS
authors.lastname: Jane
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Melanie
authors.initials: M
authors.lastname: Russo
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.|Department of Veterans Affairs, VA Connecticut Healthcare System, West Haven, Connecticut.|Mental Illness Research and Clinical Center, VA Connecticut Healthcare System, West Haven, Connecticut.
authors.forename: Ismene
authors.initials: I
authors.lastname: Petrakis
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology*; D066249:Craving / Q000502:physiology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology*; D014728:Veterans / Q000523:psychology*
keywords: Alcohol Dependence; Laboratory Paradigm; Post-Traumatic Stress Disorder; Stress-Induced Craving; Trauma-Induced Craving