Academic journal article Alcohol Research: Current Reviews

Effects of Alcohol Dependence and Withdrawal on Stress Responsiveness and Alcohol Consumption

Academic journal article Alcohol Research: Current Reviews

Effects of Alcohol Dependence and Withdrawal on Stress Responsiveness and Alcohol Consumption

Article excerpt

Although stress is known to be an important contributing factor to alcohol abuse and alcoholism, the interaction between stress and alcohol drinking behavior, as well as the mechanisms underlying this interaction in the context of dependence are complex and not well understood. On the one hand, alcohol is an effective anxiety-reducing agent (i.e., anxiolytic). Hence, motivation for drinking may be related to its ability to alleviate stress, including stress associated with periods of abstinence following bouts of heavy drinking (Cappell and Greeley 1987; Sayette 1999). On the other hand, alcohol itself can serve as a stressor, activating the hypothalamic-pituitary-adrenocortical (HPA) axis, which constitutes a major component of the hormonal (i.e., neuroendocrine) stress response (Smith and Vale 2006). Furthermore, chronic alcohol exposure and withdrawal experiences not only produce robust perturbations in the HPA axis but also engage neuroendocrine-independent (i.e., extrahypothalamic) brain stress systems that influence drinking behavior in a dynamic and complex manner (Koob and Kreek 2007).

The relationship between stress and alcohol drinking is complicated by a host of alcohol-related factors (e.g., history of use, level and pattern of drinking, or timing of accessibility of alcohol in relation to stress experience) as well as stress-related factors (e.g., type, chronicity, intermittency, predictability, and controllability) that intersect with a number of biological variables (e.g., genetics, age, and sex). For example, clear individual differences exist in sensitivity to, perception of, and responsiveness to stress and alcohol, and both clinical and preclinical evidence indicate that genetic factors help shape the nature of the relationship between stress and alcohol drinking (Clarke et al. 2008; Uhart and Wand 2009). The dynamic interaction of these biological and environmental variables along with experiential factors plays a critical role in defining subjective aspects of stress (i.e., the perception and appraisal of a stressful event) and alcohol intoxication. These subjective effects, in turn, shape the impact of stress on alcohol drinking and of alcohol consumption on stress responsiveness.

Despite the complex interaction between stress and alcohol consumption, it generally is acknowledged that stressful life events prominently influence alcohol drinking and, in particular, relapse (Brady and Sonne 1999; Sinha 2001, 2008). Several animal models have been developed to study the influence of stress on alcohol consumption. However, reviews of this literature have found equivocal results regarding the circumstances and manner in which stress modulates alcohol drinking (Becker et al. 2011; Pohorecky 1990; Sillaber and Henniger 2004). The discrepancies in results no doubt relate to the aforementioned plethora of variables that influence the reciprocal relationship between stress and alcohol. Nevertheless, researchers continue to focus on stress associated with chronic alcohol exposure and withdrawal experiences and recently have directed attention to stress-alcohol interactions in alcohol-dependent subjects (Becker et al. 2011; Heilig et al. 2010; Pohorecky 1990; Sillaber and Henniger 2004).

This article provides an overview of clinical studies and studies involving animal models of alcohol dependence that demonstrate both prolonged alcohol exposure and repeated periods of abstinence constitute potent stressors to the organism. Studies conducted in rodents, monkeys, and humans are described that highlight the impact of chronic alcohol exposure and withdrawal on neuroendocrine and brain stress pathways, as well as how activation of these brain stress systems, which are closely linked to brain reward systems, alter motivation to drink. Finally, evidence will be presented that stress associated with alcohol dependence not only compromises the ability to mount an appropriate behavioral response to a subsequent stress challenge, but also alters the ability of stress challenges to modulate drinking in the dependent state. …

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