Stress- and cue-elicited craving and reactivity in marijuana-dependent individuals

Rationale Cue-elicited craving and stress responses have been identified as predictors of relapse in drug dependence, but little research exists on the contribution of these factors to marijuana use specifically. Objectives The aims of the present study were to evaluate (1) responses to a psychological stressor, (2) responses to marijuana-related cues, and (3) if an exposure to a psychological stressor augmented craving subsequently elicited by marijuana-related cue exposure in marijuanadependent individuals. Methods Subjective (craving, stress), neuroendocrine (adrenocorticotropic hormone (ACTH), cortisol), and physiologic responses to the presentation of neutral and marijuana cues were assessed after randomization to a stress (Trier Social Stress Task (TSST)) or non-stress control condition in marijuana-dependent individuals. Outcome measures were assessed at baseline, post-stressor/pre- neutral cue, postneutral cue, and post-marijuana cue. Results Eighty-seven participants completed procedures (stress group, n=45; non-stress group, n=42). The stress group had a significant increase over the non-stress group in stress rating (p<0.001), craving (p=0.028), cortisol (p< 0.001), and ACTH (p<0.001) after the completion of the TSST. An increased craving response for all participants was seen following the presentation of the marijuana cues (p=0.005). Following the TSST or non-stress condition, the non-stress group had an increase in craving to marijuana cues as compared to neutral cues (p=0.002); an increase in craving was not observed in the stress group (p=0.404). Conclusions Marijuana cue exposure and a social stressor increased craving in marijuana-dependent individuals. Completion of the TSST did not increase craving response to subsequent marijuana cue exposure.