Psychosocial Stress Increases Craving for Alcohol in Social Drinkers: Effects of Risk-Taking

BackgroundExposure to stress and trait impulsivity are independent predictors of relapse in recovering alcoholics, but potential mechanisms that link these two risk-factors in terms of their putative additive or interactive contributions to relapse are not known. The aim of this study was to use a model of stress-induced relapse to test the hypothesis that acute psychosocial stress increases craving for alcohol in social drinkers. We also tested the hypothesis that change in craving could be explained by variability in impulsivity and risk-taking.MethodsParticipants completed questionnaires to assess drinking behaviour (Alcohol Dependence Questionnaire [ADQ]; and an Alcohol Use Disorders Identification Test [AUDIT]), craving (Desires for Alcohol Questionnaire [DAQ] and impulsivity (Barrett Impulsiveness Scale [BIS]). Participants also completed two computer tasks to assess risk-taking and impulsivity, the Balloon Analogue Risk Test (BART) and a continuous performance task (CPT). Participants then underwent the Trier Social Stress Test (TSST), and completed a final DAQ to assess post-stress craving.ResultsParticipants showed an increase in craving following exposure to the TSST. In addition, risk-taking was positively correlated with change in craving.ConclusionsOur data suggests that acute psychosocial stress increases subjective craving in social drinkers, but that the effects may be trait-dependent, with stress-induced increases in craving correlated with risk-taking.

Recovering alcoholic

This paper examines the competing construals of the phrase recovering alcoholic, which, as a Membership Categorization Device (Sacks 1992), serves to fulfill a commitment to an identity category and at the same time evokes other category-bound activities, often with unintended consequences. Former problem drinkers are routinely referred to by themselves and others as recovering alcoholics, yet they are not ‘recovering’ in the canonical sense of the word, and they participate in a behavior – not drinking – which is a negation of the behavior that originally qualified them as alcoholics. This use of the relatively new identity marker recovering alcoholic may discourage a problem drinker from attempting sobriety, as it implies an unbounded, never-ending period of recovery, unlike recovery from other diseases (and, oddly, unlike the full recovery proffered by Alcoholics Anonymous).

Social Influence Processes and Health Outcomes in Alcoholics Anonymous

Social influence processes play an important role in the recovery process for alcoholics who affiliate with Alcoholics Anonymous (AA). Group norms at AA emphasize the sharing of stories about past difficulties with alcohol, the circumstances that led a person to join AA, and how life has changed since achieving sobriety. These narratives serve to increase collective identity among AA members via shared experiences and to reinforce AA ideology. In discussions and interpersonal interactions at AA meetings, AA ideology is also communicated and reinforced through AA literature and the discussion of central tenets, such as the Twelve Steps and Twelve Traditions, the idea that alcoholism is a progressive disease, and the need to be active in one’s sobriety. Moreover, AA meetings provide an opportunity for recovering alcoholics to find others who share similar experiences, an opportunity for greater social comparisons to other alcoholics than are typically available in primary social networks, and group-suggested role obligations that influence commitment to AA and long-term sobriety. These social influence processes have been linked to important health outcomes, including longer abstinence from alcohol use than with other treatment options, reduced stigma associated with alcoholism, reduced stress/depression, increased self-efficacy, and the acquisition of coping skills that are important to the recovery process.

Conclusion

This concluding chapter highlights the distinctive feature of the three cases—their claim that a suprahuman presence was involved in the emergence process—and discusses its implications for understanding emergent groups and the creative process. It argues that each of these suprahuman “presences” was motivated by an expansive vision and was intent on guiding the human collaborators toward a goal—a restored church, a fellowship of recovering alcoholics, and a metaphysical training program. Belief in these presences and their interest in guiding the group not only stabilized the process and structured the group, but also supported claims regarding the authorship of the key texts and the ultimate origins of the group. The chapter also considers key aspects of Emile Durkheim's Elementary Forms of the Religious Life.