Effect of Stress on Precipitants to Alcohol Relapse

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Approximately 75% of alcoholics relapse within 12 months of attempted abstinence. Several risk factors for relapse have been identified, including stress, alcohol-associated cues (e.g., driving by the bar; seeing alcohol advertisements), and a priming dose of alcohol (the attempt to have "just one"). A recent cognitivebehavioral model of relapse proposes a dynamic system where risk factors interact to heighten the likelihood of relapse. Historical data from clinical studies and more recent results from controlled preclinical studies support this dynamic model of relapse, whereby one risk factor, such as stress, can increase the strength of another risk factor, such as cues, to induce reinstatement. Clinical laboratory studies enable investigators to examine the issue of interplay between risk factors in a methodologically rigorous manner. Using a clinical laboratory paradigm and non-treatment-seeking alcoholics, the proposed project will investigate whether a social stressor potentiates the strength of (1) alcohol cues (Experiment 1) and (2) an initial drink of alcohol (Experiment 2). The internal validity of the stressor will be confirmed with physiologic, neuroendocrine, and subjective measures. Response to cues and to alcohol will be measured using multi-modal, empirically-supported indices of appetitive response, motivation to drink, cognitive interference, and actual alcohol consumption (in Experiment 2). Primary analyses will address whether responses to cues and/or an alcohol "prime" are enhanced by stress (vs. nostress) and, importantly, whether this effect differs by gender. Exploratory analyses will examine whether person-centered characteristics (e.g., anxiety sensitivity, severity of alcohol dependence, family history of alcoholism, and propensity to drink in response to stress) predict in whom the main hypotheses are supported. The project will increase understanding about how risk factors interact to induce relapse, and may help direct future treatment approaches to reduce relapse in alcoholics. It will also suggest whether for men and women stress differentially alters the strength of known relapse risk factors (cues and an initial priming drink), an understudied issue that also has important treatment implications.