Both clinical lore and laboratory research suggests that stress is associated with alcohol intake during treatment and with relapse risk after treatment. However, there has been limited research directly testing mediators of this association and the role that craving plays in the link between stress and alcohol intake during daily life in AUD. This study is the first to directly measure the mediating effect of craving on the link between daily stress exposure and prospective assessment of next-day drinking in two studies with separate samples of outpatient treatment engaged adults with AUD. Findings indicate that participants’ abstinence and their reductions in drinking were jeopardized by stress-related craving. On days that individuals experienced a stressor, they reported greater alcohol craving that night. Craving, in turn, predicted an increased likelihood of drinking and greater amount of alcohol consumed on the following day. Furthermore, the finding of stress-related craving mediating next-day alcohol use was replicated in two separate treatment-seeking samples and remained significant even when accounting for same day drinking. The consistency of the findings across two separate studies and samples speaks to the stability and validity of the results.
