Key result
Sequential exposure to psychosocial stress and alcohol cues induced significantly higher cortisol levels (p < 0.001), subjective stress (p < 0.001), and alcohol craving (p < 0.001) compared to physical stress and a control condition in individuals with alcohol use disorder.
Why the study?
The physiological and psychological interactions between stress and alcohol cues and their effects on daily craving and consumption in real-life situations were not understood.
Does psychosocial stress compared to physical stress or control increase alcohol craving, subjective stress, and cortisol levels in individuals with alcohol use disorder?
RCT (n=121)
Block-wise randomization
Yes
Does psychosocial stress compared to physical stress or control increase alcohol craving, subjective stress, and cortisol levels in individuals with alcohol use disorder?
Effect estimate: F(10,580) = 10.819
p-value: p=<0.001
Psychosocial stress combined with alcohol cues significantly increases cortisol, subjective stress, and craving compared to physical stress, with cortisol levels predicting real-life alcohol consumption over 1 year.
Psychosocial stress plus alcohol cues may heighten craving in AUD; leaves open whether targeting individual stress reactivity reduces real-world consumption.
Stress- and alcohol cues trigger alcohol craving and alcohol consumption in alcohol use disorder (AUD). However, their interactions on a physiological and psychological level and their effects on daily alcohol craving and alcohol use in real-life situations are not understood yet. We conducted a randomized-controlled experimental study to compare the effects of psychosocial stress against physical stress and a control intervention, each followed by an alcohol cue-exposure, on alcohol craving, subjective stress and saliva cortisol levels (main outcomes) in N = 121 individuals with AUD and collected data on daily alcohol use and craving during a 1-year ambulatory assessment phase. We applied linear mixed models to compare the effects of experimental interventions on the main outcomes and the relative contributions of the observed changes on the main outcomes to predicting stress and alcohol craving during the experiment and alcohol use and craving during the ambulatory assessment phase. Sequential exposure to psychosocial stress and alcohol cues induced higher cortisol levels (F(10,580) = 10.819, p < 0.001), subjective stress (F(2,117) = 10.520, p < 0.001) and alcohol craving (F(6,348) = 4.313, p < 0.001) compared to the exposure to physical stress and the control condition. Subjective stress reactivity was the most influential predictor of craving during the experiment (F(1,92) = 9.43, p = 0.003) and during the ambulatory phase (β = 0.16, p = 0.039) while cortisol levels predicted alcohol consumption in real-life settings (β = 9.76, p = 0.043). Our results highlight the impact of psychosocial stress on cue-induced craving and subjective and neuroendocrine stress responses and demonstrate links between subjective and neuroendocrine stress-reactivity and alcohol craving and alcohol use in real-life settings.
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Zaiser et al. (2025) conducted an RCT in Alcohol Use Disorder (AUD) (n=121). Psychosocial stress (Trier Social Stress Test) and alcohol cue-exposure vs. Physical stress (endurance exercise bike) or control condition, and alcohol cue-exposure was evaluated on Saliva cortisol levels (neuroendocrine stress response) (F(10,580) = 10.819, p=<0.001). Sequential exposure to psychosocial stress and alcohol cues induced significantly higher cortisol levels (p < 0.001), subjective stress (p < 0.001), and alcohol craving (p < 0.001) compared to physical stress and a control condition in individuals with alcohol use disorder.
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