Psychophysiological Stress Reactivity as a Determinant in Co-occurring Alcohol Use and Anxiety Disorders: Diagnosis and Alcohol Use Outcomes


Comorbid AUD+AnxD is a significant barrier to successful AUD treatment. Converging evidence implicates overlap in dysregulation of systems governing stress response (HPA, ANS, CNS) for symptom development in AUD and AnxD. However, this must be systematically demonstrated in comorbid AUD+AnxD. We will assess markers of multi-system biological stress regulation (at rest and in response to laboratory challenge) in alcohol use disorder (AUD) inpatients with and without co-occurring anxiety disorder (AnxD), as well as those with AnxD who do versus do not receive a cognitive behavioral treatment that specifically targets comorbid AUD-AnxD. Laboratory measures include 1) cortisol (to assess the hypothalamic–pituitary–adrenal axis system [HPA] function; 2) heart rate variability (to assess autonomic nervous system [ANS] function), and 3) threat-potentiated startle (to assess central nervous system [CNS] function). Laboratory assessments will occur at the following times: 1) shortly after AUD treatment admittance (Visit 2: Pre-Treatment), 2) immediately following the 4-week AUD treatment (Visit 3: Post-Treatment), 3) 1 month following AUD treatment (Visit 4: 1-Month Follow-Up), and 4) 4 months following AUD treatment (Visit 5: 4-Month Follow-Up). Self-reported alcohol intake will be assessed at baseline as well as at the 1- and 4-Month Follow-Ups to determine whether laboratory stress measures predict treatment outcomes. A single laboratory assessment of healthy controls will serve as a normative reference for characterizing patient laboratory responses in terms of dysregulation and re-regulation.

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18 Years to 65 Years old
Inclusion Criteria:
Ability to provide informed consent Between the ages of 18 and 65 Diagnostic and Statistical Manual diagnosis of a Panic Disorder, Generalized Anxiety Disorder, or Social Anxiety Disorder within the past 30 days (AUD+AnxD group only). Primary alcohol use disorder diagnosis and alcohol use in the 30 days preceding the study (AUD alone and AUD+AnxD groups only). Inpatient treatment at Lodging Plus primarily for alcohol (vs. other drug with nicotine accepted) dependence (AUD alone and AUD+AnxD groups only). A minimum of a sixth-grade reading level. Healthy controls, same criteria absent AUD and AnxD diagnosis of an alcohol and/or anxiety disorder Lives within proximity to the Twin Cities (e.g., within about an hour's drive) or willing to drive to Fairview for the purpose of attending follow-up visits Willingness to provide contact information to confirm follow-up appointments
Exclusion Criteria:
Lifetime history of psychosis or mania Cognitive impairment, physical impairment, or chronic medical illness that precludes study participation Primary PTSD as determined by qualifying assessment Females currently pregnant Exposure to antipsychotic medication for a total duration >16 weeks. Prior head injury leading to >30 minutes of unconsciousness. Cognitive impairment that impedes study participation. Healthy controls with a history of any major medical or psychiatric disorders (e.g., schizophrenia, depression, heart disease, or stroke). Suicide intent or attempt in the past 30 days Cardiovascular health issues Thyroid Disease History of severe neurological illness such as chronic seizure disorder (e.g, epilepsy) or stroke Brain tumor and/or implants in the skull cavity (e.g., plate in the skull) Pacemaker

Alcohol Use Disorder, Anxiety Disorder/Anxiety State, Stress Disorder, Hypothalamic Pituitary Adrenal, Drinking to Cope

Stress Study -
Justin Anker
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