Effect of Stress on Precipitants to Alcohol Relapse

大约75%的酗酒者在尝试戒酒后12个月内复发。以下几个风险因素 已确定复发，包括压力、与酒精有关的线索(例如，开车经过酒吧；看到 酒精广告)，以及引爆剂酒精(试图只喝一杯)。最近的一种认知行为 复发模型提出了一个动态系统，在这个系统中，风险因素相互作用，以提高 复发的可能性。临床研究的历史数据和临床前对照研究的最新结果 研究支持这种复发的动态模型，根据该模型，一个风险因素，如压力，可以增加 另一个风险因素的强度，如提示，导致复职。 临床实验室研究使研究人员能够检查风险因素之间的相互作用问题 方法严谨的态度。使用临床实验室范例和不寻求治疗 对于酗酒者，这个拟议的项目将调查社会应激源是否会增强(1) 酒精提示(实验1)和(2)最初的酒精饮料(实验2)。的内部有效性。 应激源将通过生理、神经内分泌和主观测量来确认。对暗示的反应 而对酒精的反应将使用多模式的、有经验支持的食欲反应指数来衡量， 饮酒动机、认知干扰和实际饮酒(实验2)。主要 分析将讨论对暗示和/或酒精“启动”的反应是否会因压力而增强(与无压力相比)。 重要的是，这种影响是否因性别而异。探索性分析将检验 以人为中心的特征(例如，焦虑敏感度、酒精依赖的严重程度、 酗酒和对压力的饮酒倾向)预测了谁是主要的假设 支持。 该项目将增加对风险因素如何相互作用以导致复发的理解，并可能有所帮助 未来减少酗酒者复发的直接治疗方法。它还将建议是否为男性和 女性压力不同地改变了已知的复发风险因素(线索和初始启动)的强度 饮酒)，这是一个未被研究的问题，也具有重要的治疗意义。

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.