Effect of stress on the relationship between relief-seeking and cue-induced alcohol craving and anxiety: A virtual reality cue exposure study

Objective: Stress is well-known to increase alcohol craving and alcohol cue-induced anxiety in individuals with alcohol use disorder (AUD). While previous research suggests that individuals who drink for relief experience strong alcohol cravings and associated anxiety, the interaction between stress and relief-seeking motives in predicting craving and anxiety responses to alcohol cues is not well understood. Using a virtual reality cue exposure paradigm, this study investigated the moderating role of stress on the relationship between relief-seeking motives and cue-induced alcohol craving and anxiety. We hypothesised that individuals with AUD who report high relief-seeking motives would show greater cue-induced craving and anxiety when exposed to a psychosocial stressor, compared to those not exposed to the stressor. Method: Forty-nine participants were randomised into stress (n = 24) or no-stress (n = 25) exposure groups. Participants completed the Habit, Reward, and Fear Scale to measure drinking motives and visual analogue scales to measure cue-induced alcohol craving and anxiety. Heart rate and subjective stress were measured throughout the session. Results: Stress moderated the relationship between relief-seeking motives and cue-induced alcohol craving ((3 = 1.90, p = .015); those with high relief-seeking motives exhibited greater cue-induced alcohol craving when stressed ((3 = 1.65, p = .011). Stress did not moderate the relationship between relief-seeking motives and cue-induced anxiety ((3 = 1.55, p = .148). Conclusion: Individuals with high relief-seeking motives exhibit greater cue-induced alcohol craving when stressed, highlighting their increased vulnerability to harmful drinking and relapse, particularly during stressful situations. Further research is required to elucidate the cognitive-affective mechanisms of relief-driven drinking to inform more targeted interventions for these at-risk individuals.