Effect of Stress on Precipitants to Alcohol Relapse

大约75%的酗酒者在尝试戒酒后的12个月内复发。的几种风险因素 已经确定了复发，包括压力，酒精相关的线索（例如，开车经过酒吧;看到 酒精广告），以及启动剂量的酒精（试图“只喝一杯”）。最近的认知行为 复发模型提出了一个动态系统，其中风险因素相互作用， 复发的可能性临床研究的历史数据和对照临床前研究的最新结果 研究支持这种复发的动态模型，其中一个风险因素（例如压力）可以增加复发率 另一个风险因素的强度，如线索，诱导恢复。 临床实验室研究使研究人员能够检查在一个危险因素之间的相互作用的问题， 严格的方法论。使用临床实验室范例和非寻求治疗 酗酒者，拟议的项目将调查是否社会压力增强的力量（1） 酒精提示（实验1）和（2）初始饮酒（实验2）。的内部有效性 将通过生理、神经内分泌和主观测量来确认应激源。对线索的反应 和酒精将使用多模态，食欲反应的药物支持指数来测量， 饮酒动机、认知干扰和实际饮酒量（实验2）。初级 分析将解决对线索和/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。探索性分析将检查是否 以人为中心的特征（例如，焦虑敏感性，酒精依赖的严重程度，家族史 酒精中毒，和倾向于饮酒，以应对压力）预测谁的主要假设是 supported. 该项目将增加对风险因素如何相互作用导致复发的理解，并可能有助于 指导未来的治疗方法，以减少酗酒者的复发。它还将表明，男性和 女性压力差异性地改变了已知复发风险因素（线索和初始启动）的强度 饮酒），这是一个未充分研究的问题，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.