It is important to note study limitations. Because this was a prospective follow-up study, assessments of relapse were conducted at 3 points at follow-up and not weekly. While we obtained self-reported alcohol use data and urine alcohol assessments at day 14, 30, and 90 of the follow-up period, prospective daily or weekly assessments of drinking with objective drinking measures were not conducted. Despite these drawbacks, the current study used a well-controlled experimental study to assess alcohol craving, anxiety, and HPA axis function in response to stress, alcohol cue, and relaxing conditions, combined with a prospective follow-up design with an average 93% follow-up rate, to demonstrate that stress-related pathophysiology plays a significant role in motivation to drink and in alcohol relapse risk.
