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Abstract
Psychological distress and alcohol cues are commonly-cited antecedents of drinking and relapse. Exposure to both stress and alcohol cues have been shown to increase subjective craving as well as augment value-based decision making. However, the combined effects of stress and craving remain unclear. This study investigated changes in craving and behavioral economic indices of incentive value following a laboratory stress induction and a subsequent alcohol cue exposure in a sample of 84 adult heavy drinkers. Behavioral economic measures included an alcohol purchase task (APT), monetary delayed reward discounting (DDT), and an intertemporal cross-commodity task for alcohol and monetary rewards (AMCP). As hypothesized, stress significantly increased subjective craving and also increased the incentive value of alcohol on the AMCP and APT. Exposure to alcohol cues did not significantly increase incentive value beyond the effects of stress, despite a significant additive increase in subjective craving. Impulsivity on the DDT was not affected by either the stress induction or alcohol cue exposure. Stress-related increases in value on the AMCP were partially mediated by increased demand on the APT. Finally, coping motives moderated the effects of stress on the AMCP such that individuals who drink to cope showed the greatest change in value following stress. These results converge with prior research that suggests that acute psychosocial stress increases motivation for alcohol; however, this study extends this literature by showing that behavioral economic measures of incentive value also increase under stress. Implications for treatment interventions and existing models of stress-induced drinking and relapse are discussed.