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Anxiety, not stress, affects drinking in alcohol use disorder

Recent findings indicated stronger associations between anxiety and alcohol-related measures among heavy drinkers with alcohol use disorder, compared with stress.

“Stress and anxiety are widely considered to be causally related to alcohol craving and consumption, as well as the development and maintenance of alcohol use disorder. Etiological explanations have been grounded in theories that alcohol is used to reduce tension/ dampen stress responses, or self-medicate,” Mary E. McCaul, PhD, of Johns Hopkins University School of Medicine, and colleagues wrote. “However, numerous preclinical and human studies examining effects of stress or anxiety on alcohol use and alcohol-related problems have been equivocal, showing positive, negative, or no relationship.”

To determine if anxiety and perceived stress are predictors of recent drinking, alcohol craving and social stress response among heavy drinkers, researchers evaluated 87 individuals with alcohol use disorder who were heavy drinkers. Beck Anxiety Inventory (BAI), Anxiety Sensitivity Index (ASI-3) and the Perceived Stress Scale (PSS). A subset of participants (n = 30) underwent alcohol abstinence on the Clinical Research Unit and received alcohol craving measures twice daily. On day 4, participants completed the Trier Social Stress Test and cortisol and alcohol craving measurements.

Higher BAI scores were associated with lower drinking frequency and reduced drinks/drinking day. Conversely, higher ASI-3 scores were positively associated with Alcohol Use Disorders Identification Test total scores and alcohol use disorder symptom and problem subscale measures.

Higher BAI and ASI-3 scores, but not PSS scores, were associated with greater self-reported alcohol craving during early alcohol abstinence.

PSS scores were not associated with most measures of alcohol craving or stress reactivity.

“Our findings suggest that the current level of clinical anxiety symptoms is a robust predictor of stress responsivity and alcohol craving. In future research, it could be of interest to expand the assessment measures to include other state/trait factors such as negative affectivity. It also will be important to examine different types of stressors (eg, social vs. performance) to more fully understand these relationships,” the researchers concluded. – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.