There are significant implications of the current findings for poor treatment retention and high rates of alcohol relapse observed in the treatment of alcohol dependence. First, the current results show specific levels of adrenal sensitivity and provoked alcohol craving that predict surviving subsequent relapse and those that suggest high relapse risk. If validated in future studies, these measures could serve as clinical markers of relapse risk to identify those alcohol-dependent individuals entering treatment who are most likely to relapse and drop out of alcohol treatment. Such assessments could inform clinicians of the need to tailor their interventions toward targeting reduction of stress and anxiety in relaxed and provoked states, which in turn could impact HPA axis responsivity and stress-induced and cue-induced alcohol craving. Second, while there are several approved medications in the treatment of alcohol dependence, very few specifically address stress dysregulation, anxiety, and high levels of associated stress- or alcohol cue-induced alcohol craving. For example, while naltrexone hydrochloride decreases alcohol-induced craving, to our knowledge, its effects in decreasing stress-induced alcohol craving have not been shown in human studies. The
