Biopsychosocial Assessment of a Mindfulness-Oriented Cognitive Intervention for Alcohol Dependent Adults

This review presents a conceptual integration of formerly discrete theories of stress appraisal, neurobiological allostasis, automatic cognitive processing, and addictive behavior to explain how alcohol misuse and dependence is maintained and re-activated by stress. We outline a risk chain in which psychosocial stress initiates physiological arousal, perseverative cognition, and negative affect that in turn triggers automatized schema to compel alcohol consumption. This implicit cognitive process then leads to attentional biases towards alcohol, subjective experiences of craving, paradoxical rebound effects of urge suppression, and palliative coping through drinking. When palliative coping relieves distress, it results in negative reinforcement conditioning that perpetuates the cycle by further sensitizing the system to future stressful encounters. This conceptual framework has implications for development and implementation of innovative behavioral interventions such as mindfulness training that may disrupt cognitive-affective mechanisms underpinning stress-precipitated dependence on alcohol.