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Negative Affect and Smoking Lapses: A Prospective Analysis.By Shiffman, Saul; Waters, Andrew J.Journal of Consulting and Clinical Psychology, Vol 72(2), Apr 2004, 192-201.doi:10.1037/0022-006X.72.2.192Relapse is a central problem in smoking treatment. Data collected at the time of relapse episodes indicate that stress andnegative affect (NA) promote relapse, but retrospective data are potentially biased. The authors performed a prospectiveanalysis of stress and NA prior to initial lapses in smokers (N = 215). Day-to-day changes in stress (daily negative andpositive events and Perceived Stress Scale scores) and NA (multiple momentary affect ratings) did not predict lapse risk on

the following day. However, within the lapse day itself, NA was already significantly increasing hours before lapses, but onlyfor episodes attributed to stress or bad mood. Thus, rapid increases in NA, but not slow-changing shifts in stress and NA,were associated with relapse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

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Journal ArticleStress and drug-cue-induced craving in opioid-dependent individuals in naltrexone treatment.By Hyman, Scott M.; Fox, Helen; Hong, Kwang-Ik A.; Doebrick, Cheryl; Sinha, RajitaExperimental and Clinical Psychopharmacology, Vol 15(2), Apr 2007, 134-143.doi:10.1037/1064-1297.15.2.134Background: Naltrexone is a nonaddictive medication that blocks the euphoric effects of opioids. However, naltrexonetreatment is associated with high rates of noncompliance and opioid relapse, possibly because it does not reduce stress andprotracted withdrawal symptoms during early recovery. Prior clinical and preclinical research has indicated that both stress

and drug-cue-related arousal response is associated with craving and vulnerability to relapse in a range of drug-usingpopulations. Aims: To examine opioid craving and the subjective and cardiovascular response to stress and drug cues innaltrexone-treated opioid abusers. Method: Eleven men and three women engaged in naltrexone treatment for opioiddependence. They were exposed to personalized stress, drug-cue, and neutral-relaxing imagery in a single laboratorysession. Subjective (craving, emotion) and cardiovascular (heart rate, systolic blood pressure, and diastolic blood pressure)measures were assessed. Results: Stress and drug-cue-related imagery significantly increased opioid craving, anxiety, andnegative emotions and significantly decreased positive emotions compared to neutral imagery. Selective emotionalresponses were greater in the stress condition than in the drug-cue condition. Only stress-related imagery was associatedwith an increased cardiovascular response. Conclusions: Naltrexone-treated opioid abusers demonstrate vulnerability tostress and drug-cue-induced craving and arousal responses that may contribute to the high rates of noncompliance andrelapse among opioid-dependent individuals undergoing naltrexone treatment. Pharmacological and behavioral interventionsthat specifically target the negative affectivity that co-occurs with drug-cue and stress-induced craving could be of benefit inimproving naltrexone treatment outcomes in opioid dependence. (PsycINFO Database Record (c) 2010 APA, all rightsreserved)

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Journal ArticleSex steroid hormones, stress response, and drug craving in cocaine-dependent women: Implications for relapsesusceptibility.By Sinha, Rajita; Fox, Helen; Hong, Kwang-Ik; Sofuoglu, Mehmet; Morgan, Peter T.; Bergquist, Ken T.Experimental and Clinical Psychopharmacology, Vol 15(5), Oct 2007, 445-452.doi:10.1037/1064-1297.15.5.445Cocaine dependence is associated with an enhanced sensitivity to stress and drug craving. Increases in stress-inducedcraving and hypothalamic-pituitary-adrenal reactivity are also predictive of cocaine relapse outcomes. More important, sexdifferences in these responses have also been reported. To further understand the basis of the sex differences, the authorsexamined the influence of sex steroid hormones on subjective and physiological stress responses and drug craving incocaine-dependent women. Women who had low progesterone levels (n=5) were compared with those with highprogesterone levels (n=5) and with those with moderate levels of estradiol and progesterone (n=9) in their responses duringexposure to stress, cocaine cues, and neutral imagery conditions. The high progesterone group showed significantly lower

stress-induced and drug cue-induced cocaine craving ( p

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Journal ArticleA stress-coping profile of opioid dependent individuals entering naltrexone treatment: A comparison with healthycontrols.By Hyman, Scott M.; Hong, Kwang-Ik A.; Chaplin, Tara M.; Dabre, Zubaida; Comegys, Allison D.; Kimmerling, Anne; Sinha,Rajita

Psychology of Addictive Behaviors, Vol 23(4), Dec 2009, 613-619.doi:10.1037/a0017324Background: Stress is known to increase addiction vulnerability and risk of relapse to substance use. Purpose & Method: Wecompared opioid dependent individuals entering naltrexone treatment (n = 57) with healthy controls (n = 75) on measures ofstress, coping, and social support and examined the relative contribution of group membership, coping, and social support tostress within the sample. Analyses of variance (ANOVA) and covariance (ANCOVA), and stepwise multiple regression wereconducted. Results: Compared with controls, opioid dependent subjects reported greater stress, less use of adaptive coping,but comparable use of maladaptive/avoidant coping. No group differences were found with respect to social support.Perceived stress was predicted by group membership, low social support, and greater use of maladaptive/avoidant coping,and the prediction by social support and maladaptive/avoidant coping did not differ by group. Conclusion: Opioid dependentindividuals entering naltrexone treatment experience higher levels of stress and report less use of adaptive coping strategieswhen compared with controls. Group membership, maladaptive/avoidant coping, and social support independently contributeto perceived stress. Findings suggest that novel treatment approaches that decrease maladaptive/avoidant coping andimprove social support are important aspects of decreasing stress during early recovery from opioid addiction. (PsycINFODatabase Record (c) 2010 APA, all rights reserved)

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First PostingPredictors of Risk for Smoking Relapse in Men and Women: A Prospective Examination.By Nakajima, Motohiro; al'Absi, MustafaPsychology of Addictive Behaviors, Feb 20 , 2012, No Pagination Specified.doi:10.1037/a0027280The current study examined whether prequit trait negative mood and smoking motives have different predictive patterns ofsmoking relapse in men and women. Thirty-three female (mean age SEM: 34.9 2.5) and 38 male (mean age SEM: 37.1 2.3) smokers interested in smoking cessation completed forms on smoking history, negative mood (i.e., depression,anxiety, and anger), stress, and smoking motives. Participants also provided samples for measurement of cotinine andcarbon monoxide. Then, they set a quit date and were required to abstain from smoking at least for 24 hours. Participantswere followed up for 12 months postcessation to measure their smoking status. Cox proportional hazard models revealedthat motivation to reduce craving was a unique predictor of smoking relapse in men, while depressive mood, anxiety, anger,

and perceived stress were predictive of time to relapse among women. These findings remained significant after statisticallycontrolling for smoking-related variables, providing preliminary evidence that different factors may be associated withnicotine withdrawal and smoking relapse in men and women. (PsycINFO Database Record (c) 2012 APA, all rights reserved)Stress, habits, and drug addiction: A psychoneuroendocrinological perspective.By Schwabe, Lars; Dickinson, Anthony; Wolf, Oliver T.Experimental and Clinical Psychopharmacology, Vol 19(1), Feb 2011, 53-63.doi:10.1037/a0022212It is well known that stress is a significant risk factor for the development of drug addiction and addiction relapse.Remarkably, the cognitive processes involved in the effects of stress on addictive behavior remain poorly understood.Here it is proposed that stress-induced changes in the neural circuits controlling instrumental action provide apotential mechanism by which stress affects the development of addiction and relapse vulnerability. Instrumentalaction can be controlled by two anatomically distinct systems: a goal-directed system that involves learning of action-outcome associations, and a habit system that learns stimulusresponse associations. The transition from initialvoluntary drug use to subsequent involuntary, compulsive drug use represents a switch from goal-directed to habitualcontrol of action. Recent evidence indicates that this switch from goal-directed to habit action can be prompted bystress and stress hormones. We argue (i) that acute stressors reinstate habitual responding to drug-related cues and

thus trigger relapse to addictive behavior, and (ii) that prolonged or repeated stress may accelerate the transition fromvoluntary to involuntary drug use and thus promote the development of addiction. The suggested mechanismencompasses cognitive processes that may contribute to the effects of stress on addictive behavior and could haveimportant implications for the treatment of addiction and the prevention of relapse. (PsycINFO Database Record (c)2011 APA, all rights reserved)

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