Stress-induced craving and stress response in cocaine dependent individuals

Abstract

Two laboratory studies were conducted to examine the effects of acute psychological stress on craving and stress reactivity in cocaine abusers. In the first preliminary study, we examined the effects of a speech stressor task and a personalized stress imagery task on self-reported craving and emotional state in ten cocaine abusers. Both stressors led to significant decreases in neutral and joy states, and significant increases in fear ratings as compared to baseline ratings. In addition, the stress imagery condition led to significant increases in cocaine craving and sadness and anger ratings, as compared to baseline. Thus, the personalized stress imagery task appeared to be more effective than the speech stress task in inducing craving in the laboratory. The second study examined the effects of stress imagery as compared to neutral imagery on cocaine craving, subjective anxiety and physiological responses in a second group of ten cocaine abusers. The stress imagery task once again produced significant increases in cocaine craving along with increases in heart rate, salivary cortisol and subjective anxiety ratings. These data are the first to document that acute psychological stress consistently increases craving for cocaine in cocaine abusers. The studies also provide a promising method for examining the association between stress and drug craving in the laboratory.

Altered HPA Axis Responsivity to Metyrapone Testing in Methadone Maintained Former Heroin Addicts with Ongoing Cocaine Addiction

“…Recently, Sinha et al have described a human experimental paradigm demonstrating personalized stress imagery-induced cocaine craving, associated with significant increases in cortisol in cocaine-dependent patients, extending the previously well-documented association between psychological stress and HPA axis activation (Sinha et al 1999). The HPA axis hyper-responsivity to metyraponeinduced removal of glucocorticoid negative feedback in the present study suggests that endogenous opioidergic dysfunction may be involved in the mechanism of perpetuation of, and relapse to, cocaine addiction, and reinforces lines of inquiry into novel pharmacological treatments.…”

Elevation of Glucocorticoids is Necessary but not Sufficient for the Escalation of Cocaine Self-Administration by Chronic Electric Footshock Stress in Rats

“…These data suggest that, at least in a subpopulation of cocaine users, stressful life events may act as precipitating factors for cocaine abuse and/or addiction. This interpretation is supported by findings that the presentation of personalized stress imagery to abstinent cocaine-dependent individuals in a laboratory setting directly elicits drug craving (Sinha et al, 1999(Sinha et al, , 2000.…”

Blockade of mesolimbic dopamine D3 receptors inhibits stress-induced reinstatement of cocaine-seeking in rats

“…Stress provokes craving and relapse to drug-seeking behavior in abstinent cocaine addicts (Sinha et al 1999;Sinha 2001). Stress also reliably reinstates drug-seeking in animals after extinction of heroin-taking, cocaine-taking, nicotine-taking, or alcohol-taking behavior (Shaham et al 2000a).…”

“…Relapse to drug taking behavior in abstinent addicts can be triggered by addictive drugs, stress, or drug-associated environmental cues (Carter and Tiffany 1999;Sinha et al 1999). These three classes of triggers also reinstate extinguished drug-seeking in animals (Shalev et al 2002).…”