Perceived Social Support Moderates the Response to Stress and Alcohol Cues During Early Abstinence From Alcohol

Alcohol addiction is associated with maladaptive stress responses that heighten craving and relapse risk during early abstinence. While perceived social support (PSS) is theorized to act as a stress buffer, its influence on acute stress responses during early abstinence remains poorly understood.

Fifty-eight treatment-seeking individuals with alcohol dependence (45 males [77.6%] and 13 females [22.4%]) completed the Interpersonal Support Evaluation List (ISEL) upon entry into an inpatient treatment program. After 4 weeks of abstinence, a 3-day experiment was conducted exposing participants to neutral, stress, or alcohol cue conditions using brief personalized imagery exposure, presented in randomized, counterbalanced order. Subjective craving, mood, cardiovascular function, salivary cortisol, and Stroop performance were assessed at baseline, immediately following imagery exposure, and at various recovery time points. Linear mixed-effects models tested ISEL scores as moderators.

Lower PSS was associated with higher nicotine craving during alcohol cue exposure and greater negative mood during stress. Both groups exhibited blunted cortisol responses to stress; however, individuals with lower perceived support showed greater attenuation in blood pressure responses. Higher perceived support was associated with better Stroop performance across conditions. No group differences were observed in recovery trajectories.

PSS selectively moderates acute stress and cue reactivity during early abstinence, with lower support associated with a selective maladaptive behavioral and physiological profile. These findings suggest that social support confers modest, domain-specific resilience to acute psychological stress, highlighting its potential as a clinically relevant adjunct to more intensive treatment approaches during early abstinence from alcohol dependence.