Suzanne E. Thomas

Objective:Stress evokes thoughts about alcohol and enhances alcohol’s rewarding value in drinkers who use alcohol to cope with negative affect. The present study extends prior research by examining...

Objective: Social anxiety may maintain alcohol dependence through increased reactivity to stressful events, a propensity to drink to cope with stressful events, or both. The current study is a secondary analysis of an existing data set that examined differences between individuals with alcohol dependence and concurrent high and low social anxiety in objective and subjective stress reactivity to a laboratory stressor (Trier Social Stress Test [TSST]), as well as consumption of alcohol following the stressor. Methods: Forty participants with alcohol dependence (20 women) were randomly assigned to the TSST condition as part of the parent study. Post hoc analysis of social anxiety measures yielded high (n = 19) and low (n = 21) social anxiety groups. Participants completed the TSST, followed by a small dose of their favorite alcoholic beverage (target blood alcohol concentration 0.03 g/dL) to prime subsequent laboratory drinking. Participants received a sham beer taste test of 2 glasses (710 mL total) of beer. Differences between high and low social anxiety groups were assessed via subjective and objective (mean arterial pressure, serum cortisol) reactivity to the TSST and consumption of alcohol during the taste test (total mLs consumed, mLs/kg of body weight, and likelihood of consuming all the beer available). Results: No differences emerged in either objective or subjective measures of stress reactivity between high and low social anxiety groups. There were also no differences between social anxiety groups in amount of alcohol consumed during the taste test. Conclusions: No differences were observed between high and low social anxiety participants with concurrent alcohol dependence on stress reactivity or alcohol consumption following a stressor. Given that all participants in this study had alcohol dependence, negative results may suggest that heightened stress reactivity and drinking to cope are more relevant to the development of alcohol dependence and that other factors may maintain alcohol use once dependence has developed.

Background: Facilitating stress resilience in future physicians is an important role of medical educators and administrators. We developed and piloted an extracurricular program on stress management with first year medical students.Methods: Presentations on topics related to mental health, help-seeking, and stress resilience were presented (one topic per session). Attendance was voluntary. Attendees were requested to complete anonymous evaluations following each presentation. Primary outcome variables were rates of agreement that the presentation (1) was interesting, (2) provided valuable information, and (3) provided information relevant for the student’s future practice as a physician.Results: Each of the seven topics was attended on average by approximately half of the student body. Evaluations were positive in that presentations were interesting and provided information useful to maintaining balance during medical school (all had ? 85% rates of agreement). Evaluations by students were variable (41% - 88% rates of agreement) on whether each presented information relevant for future practice.Conclusions: The results indicate that first-year medical students value explicit guidance on ways to bolster stress resilience and self-care during medical school. It is important to clarify with each presentation how the information is relevant to their future practice as a physician.

Rationale Although studies suggest that stress is an important reason for relapse in alcoholics, few controlled studies have been conducted to examine this assumption. Evidence of stress-potentiated drinking would substantiate this clinical observation and would contribute to the development of a model that would be valuable to alcohol treatment research. Objectives The hypothesis was tested that an acute psychosocial stressor, the Trier Social Stress Test (TSST), increases alcohol consumption in non-treatment-seeking alcoholics. Methods Seventy-nine alcohol-dependent participants (40 women) were randomly assigned to receive the TSST or a no-stress condition. Immediately afterward, all participants received an initial dose of their preferred alcoholic beverage to achieve a target blood alcohol concentration of 0.03 g/dl (to prime subsequent drinking in the laboratory). Participants then participated in a mock taste test of two glasses of beer. Primary dependent measures were whether s/he drank all of the beer available (yes/no) and total amount of beer consumed (milliliters). Results Stressed participants were twice as likely as non-stressed participants to drink all of the beer available, a significant effect. Although the stressed group drank more milliliters than the non-stressed group, this effect failed to reach significance, likely due to ceiling effects. There were no significant stress group × gender effects on either outcome. Conclusions This study supports that stress-potentiated drinking is valid and can be modeled in a clinical laboratory setting.

Background: Relapse risk factors, such as psychological stress and alcohol cues, are often encountered together. Understanding how they interact has the potential to improve alcoholism treatments. This study was conducted to examine whether an acute psychosocial stressor enhanced alcohol cue reactivity in non‐treatment‐seeking alcoholics. Methods: Seventy‐nine alcohol‐dependent individuals (39 women) randomly received either the Trier Social Stress Test or a no‐stress control condition. Stress reactivity was measured with serum adrenocorticotropic hormone and cortisol, mean arterial blood pressure, and subjective distress. Immediately following the stress manipulation, participants held and sniffed a neutral cue then their preferred alcoholic beverage. Cue reactivity was measured by 2 subjective measures of craving following each cue. Additionally, general craving was assessed with the Alcohol Urge Questionnaire at the beginning and end of the laboratory procedure. Results: The stress manipulation showed internal validity on all measures of stress reactivity. There was not a main effect of stress nor a stress × cue interaction on either cue reactivity measure. As expected, there was a main effect of cue (alcohol > neutral cue) on both measures of cue reactivity. General craving increased during the challenge, but not differently by stress group. Magnitude of stress reactivity was not associated with magnitude of cue reactivity, and all results were independent of gender. Conclusion: In this well‐controlled clinical laboratory study of non‐treatment‐seeking alcoholics, an acute psychological stressor did not make an alcohol cue a more potent urge‐inducing stimulus, and stress had no effect on general alcohol craving.

Individuals with social anxiety disorder and co-occurring alcohol problems report using alcohol to cope with anxiety symptoms. Interventions that reduce both social anxiety and drinking are needed. Paroxetine, an FDA-approved medication to treat social anxiety disorder, reduces anxiety in individuals with co-occurring alcohol problems. To examine whether effective treatment of social anxiety with paroxetine reduces drinking in dual-diagnosed individuals who endorse using alcohol to cope. A 16-week, double-blind, randomized controlled trial of paroxetine was conducted. Participants (placebo n = 22; paroxetine n = 20) met DSM-IV diagnostic criteria for social anxiety disorder and alcohol abuse or dependence. Participants were seeking treatment for social anxiety, not for the alcohol problem. Alcohol use outcomes were measured with conventional quantity/frequency measures and novel measures of drinking to cope. Paroxetine improved social anxiety more than placebo. Paroxetine reduced self-reported reliance on alcohol for self-medication purposes, but was not different than placebo in changing quantity and frequency drinking or the proportion of drinking days that were identified as coping-related. Exploratory analyses revealed that for the placebo group, drinking during the trial was correlated with social anxiety severity, whereas for the paroxetine-treated group, drinking was uncoupled from social anxiety severity. Successfully treating social anxiety symptoms with paroxetine does not reduce drinking in dual-diagnosed individuals who are not seeking treatment for alcohol problems. Paroxetine does, however, reduce reliance on alcohol to engage in social situations, and may change the reasons why one drinks (such that drinking occurs for other reasons besides coping with anxiety). These results have implications for staging of social anxiety and alcohol treatment in individuals with the co-occurring disorders presenting to a mental health or primary care provider.

Aims: Medications, when combined with psychosocial therapy, can improve treatment outcomes in alcoholics; however, medications are not widely utilized in community-based addiction treatment centres. Of interest is how non-medical addiction treatment professionals in these facilities view adjunctive pharmacotherapies for alcoholism. The present report focuses on baseline data collected during the course of an educational intervention project and explores predictors of positive attitudes about adjunctive pharmacotherapies among community addiction counselors and administrators. Methods: Questionnaires were administered to 84 counselors and administrators at six community-based addiction treatment centres in South Carolina. Demographic data were collected, and knowledge and attitudes regarding the value of pharmacotherapies in the treatment of alcoholism were assessed. Correlation coefficients were explored, and follow-up multiple regression analyses were conducted to examine variables that predict scores reflecting the degree to which one values adjunctive pharmacotherapies for alcoholism. Results: Respondents had little knowledge of naltrexone, with average test scores reflecting no better than chance performance. In addition, most participants believed that adjunctive pharmacotherapy is ineffectual. Higher valuation of adjunctive pharmacotherapy was related to knowledge about naltrexone, having a post-baccalaureate degree, and years of experience in the addictions treatment field. Conclusions: These data support that more widespread use of adjunctive pharmacotherapy for alcoholism may be impeded by the fact that addictions counselors, who are often the first contact for treatment-seeking individuals, have a lack of knowledge and a lack of confidence in the effectiveness of such treatments. Directed educational interventions are warranted for this population.