Approximately 75% of alcoholics relapse within 12 months of attempted abstinence. Several risk factors forrelapse have been identified, including stress, alcohol-associated cues (e.g., driving by the bar; seeingalcohol advertisements), and a priming dose of alcohol (the attempt to have 'just one'). A recent cognitivebehavioralmodel of relapse proposes a dynamic system where risk factors interact to heighten thelikelihood of relapse. Historical data from clinical studies and more recent results from controlled preclinicalstudies support this dynamic model of relapse, whereby one risk factor, such as stress, can increase thestrength of another risk factor, such as cues, to induce reinstatement.Clinical laboratory studies enable investigators to examine the issue of interplay between risk factors in amethodologically rigorous manner. Using a clinical laboratory paradigm and non-treatment-seekingalcoholics, the proposed project will investigate whether a social stressor potentiates the strength of (1)alcohol cues (Experiment 1) and (2) an initial drink of alcohol (Experiment 2). The internal validity of thestressor will be confirmed with physiologic, neuroendocrine, and subjective measures. Response to cuesand to alcohol will be measured using multi-modal, empirically-supported indices of appetitive response,motivation to drink, cognitive interference, and actual alcohol consumption (in Experiment 2). Primaryanalyses will address whether responses to cues and/or an alcohol 'prime' are enhanced by stress (vs. nostress)and, importantly, whether this effect differs by gender. Exploratory analyses will examine whetherperson-centered characteristics (e.g., anxiety sensitivity, severity of alcohol dependence, family history ofalcoholism, and propensity to drink in response to stress) predict in whom the main hypotheses aresupported.The project will increase understanding about how risk factors interact to induce relapse, and may helpdirect future treatment approaches to reduce relapse in alcoholics. It will also suggest whether for men andwomen stress differentially alters the strength of known relapse risk factors (cues and an initial primingdrink), an understudied issue that also has important treatment implications.

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National Institute on Alcohol Abuse and Alcoholism (NIAAA)
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Special Emphasis Panel (ZAA1-HH (60))
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Medical University of South Carolina
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