Post-traumatic stress disorder (PTSD) and alcohol dependence (AD) are two of the most common and debilitating disorders diagnosed among American military veterans. AD and PTSD often occur together, and this co-occurrence has a worse prognosis than either disorder alone. Alcohol craving is related to relapse, but the relationship between PTSD symptoms, craving, and relapse is not well understood. This study is the first to explore the effects of trauma-induced and stress-induced imagery on alcohol craving, affect, and cardiovascular and cortisol responses in a laboratory setting.
Researchers examined 25 veterans who had been diagnosed with AD and PTSD and were participating in a randomized treatment trial. At baseline, participants' PTSD symptoms and drinking quantity and frequency during the three-month pretreatment period were assessed. During the session, the participants were exposed to neutral, stressful, and traumatic imagery in random order. The main outcomes included craving, anxiety, mood states, salivary cortisol, and cardiovascular responses.
Both stress and trauma cues produced greater increases in craving, negative affect (anxiety, fear, anger), and cardiovascular reactivity when compared to neutral cues. Traumatic images produced significantly stronger craving for alcohol and greater cardiovascular reactivity than stressful images. Also, trauma-induced but not stress-induced craving was positively correlated with baseline levels of drinking. These findings are consistent with prior observations of a relationship between PTSD symptoms and alcohol relapse.
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