Trauma‐ and Stress‐Induced Response in Veterans with Alcohol Dependence and Comorbid Post‐Traumatic Stress Disorder. (1st July 2016)

• Record Type: Journal Article
• Authors: Ralevski, Elizabeth; Southwick, Steven; Jackson, Eric; Jane, Jane Serrita; Russo, Melanie; Petrakis, Ismene
• Is Part Of: Alcoholism. Volume 40:Number 8(2016)
• Page Start: 1752
• Page End: 1760
• Publication Date: 2016-07-01
• Subjects: Trauma‐Induced Craving -- Stress‐Induced Craving -- Post‐Traumatic Stress Disorder -- Alcohol Dependence -- Laboratory Paradigm; Alcoholism -- Periodicals; Alcoholism -- Periodicals; Alcoolisme; Electronic journals; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 616.861005
• DOI: 10.1111/acer.13120
• Languages: English
• ISSNs: 0145-6008

Abstract

Abstract : Background: 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. Methods: 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. Results: 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. Conclusions: 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. Abstract : This is the first study to explore the effects of trauma‐induced and stress‐induced cues on alcohol craving, and its relationship to drinking in individuals with PTSD and comorbid AUD. Trauma cues produced strongest craving for alcohol and were positively correlated with baseline levels of drinking. The results highlight that trauma cues are more salient in inducing craving than stress cues and underscore the importance of adequate treatment of PTSD as trauma reminders may be an important factor in craving and relapse.