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. 2019 Sep;24(5):1096-1108.
doi: 10.1111/adb.12665. Epub 2018 Aug 9.

Craving, cortisol and behavioral alcohol motivation responses to stress and alcohol cue contexts and discrete cues in binge and non-binge drinkers

Sara K Blaine  1 , Nisheet Nautiyal  2 , Rachel Hart  1 , J B Guarnaccia  3 , Rajita Sinha  1
Affiliations

Craving, cortisol and behavioral alcohol motivation responses to stress and alcohol cue contexts and discrete cues in binge and non-binge drinkers

Sara K Blaine et al. Addict Biol. 2019 Sep.

Abstract

Alcohol use disorders are associated with high craving and disruption of stress biology, but their role in behavioral alcohol motivation is less clear. We examined the effects of craving and cortisol responses on behavioral alcohol motivation to stress, alcohol cue and neutral-relaxing context cues, in addition to discrete alcohol cues, in demographically matched binge/heavy (BH) and moderate (MD) social drinkers. Subjects participated in a 3-day laboratory experiment of provocation by three personalized guided imagery contexts and discrete alcohol cues followed by the 'alcohol taste test' (ATT) to assess behavioral motivation, as measured by ATT intake. Post-ATT alcohol effects on craving and cortisol responses were also examined. Results indicate BH consumed significantly more alcohol than MD in the ATT. Stress and alcohol cue contexts, relative to neutral, led to significantly greater ATT intake across both groups, which also correlated positively with self-reported alcohol use in past 30 days. Stress and alcohol context and discrete alcohol cues each significantly increased alcohol craving, more so in the BH than MD, and significantly predicted greater ATT intake in BH only. The BH showed significantly lower cortisol responses than MD overall and blunted cortisol responses to cues predicted significantly greater ATT intake in the stress condition for BH and in the alcohol cue condition for MD. Higher ATT intake predicted greater cortisol response and higher craving post-ATT, and these effects were moderated by group status. In sum, findings suggest a role for sensitized context-induced craving and blunted cortisol responses in increased behavioral motivation for alcohol.

Keywords: HPA axis; alcohol intake; binge drinking; cortisol; stress, alcohol cues.

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Figures

Figure 1
Figure 1
Two phase experimental study procedures. A two-phase experiment assessed the effects of environmental context (induced by stress, alcohol cue and neutral imagery) and discrete alcohol cues (tray of two beers and cup of ice water) on subjective craving, cortisol and implicit behavioral motivation for alcohol via the alcohol taste test (ATT) in Phase I, and ATT alcohol intake effects on craving and cortisol in Phase II
Figure 2
Figure 2
Group, Condition and Recent Drinking effects on ATT intake. (a) BH drinkers showed higher ATT intake than MD drinkers across conditions (P’s < 0.001). (b) Greater ATT alcohol intake was found in the stress (P < 0.05) and alcohol cue (P < 0.05) relative to the neutral-relaxing conditions across both groups. (c) The amount of alcohol consumed during the ATT was positively associated with the self-reported number of alcoholic drinks consumed in the last month on the Cahalan QFVI (P < 0.01). Note: *P < 0.05, **P < 0.01, ***P < 0.001, values reported in (a) and (b) are mean + standard error (M + SE)
Figure 3
Figure 3
Craving responses to cues and alcohol intake. (a) Craving was higher in response to stress and alcohol cues than to neutral imagery (P’s < 0.01). MD drinkers show a greater craving in response to alcohol cue imagery and stress cue imagery than to neutral (P’s < 0.001). In all conditions, craving increased for the MD group with the presentation of the discrete cue, the beer tray (P < 0.05). (b) BH relative to MD drinkers showed higher overall alcohol craving, P < 0.01, and significantly higher craving levels in response to alcohol cue and stress imagery (P’s < 0.05) than to neutral imagery that is not further increased with the presentation of the discrete cue. For BH drinkers, craving in the neutral condition increased in response to the beer tray, P < 0.001. (c) Higher craving did not lead to greater alcohol intake in MD drinkers. Regression lines for MD drinkers are stunted by the small range of craving scores. (d) For BH drinkers, craving in response to the stress/discrete cue and neutral-relaxing/discrete cue conditions led to significantly higher alcohol intake in those conditions (P’s < 0.001). Note: *P < 0.05, **P < 0.01, ***P < 0.0001, values reported in (a) and (b) are M + SE
Figure 4
Figure 4
Cortisol responses to cues and alcohol intake. (a) MD drinkers show no change in cortisol from baseline to imagery and then reduction after the presentation of the discrete alcohol cue in all conditions (P < 0.05). (b) BH drinkers show an overall blunted cortisol response relative to MD drinkers (P < 0.001). BH drinkers showed no differences in cortisol responses to imagery across conditions and no further changes after discrete cue presentation. (c) Blunted cortisol responses to alcohol cues led to high alcohol intake in MD drinkers, (P < 0.01). (d) Blunted cortisol levels in the stress condition led to higher alcohol intake BH drinkers (P < 0.01). Note: This experiment occurred in the afternoon, when cortisol levels are naturally dropping due to the diurnal cycle. *P < 0.05, **P < 0.01, ***P < 0.0001, values reported in (a) and (b) are M + SE
Figure 5
Figure 5
Effect of alcohol intake on craving and cortisol levels (Phase II)(a) Craving decreased over the hour post-ATT in all participants, but remains significantly higher in the BH group than the MD group (P < 0.01). (b) Craving decreased with higher alcohol intake in MD drinkers but dropped less and was sustained with increasing alcohol intake in the BH drinkers (P < 0.01). (c) Cortisol levels initially increased in all participants in response to alcohol intake, but more quickly and to higher levels in BH drinkers than MD drinkers (P < 0.001). (d) Greater alcohol consumption was associated with lower levels of cortisol in MD drinkers but was not associated with a lower cortisol levels for BH drinkers over time (P < 0.01). Additionally, (b) and (d) use a median split for illustration purposes, but craving and cortisol were measured as continuous variables in all analyses. Note: *P < 0.05, **P < 0.01, ***P < 0.0001, values reported are M + SE.
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