National epidemiological data estimate that 92.2% of Black people with alcohol use disorder (AUD) are not receiving treatment (SAMHSA, 2022). Among Black adults who do seek treatment, they are less likely to be retained in treatment relative to White adults (Jordan et al., 2022, Mennis et al., 2019, Sahker et al., 2020), and report lower treatment satisfaction relative to other groups (Tonigan, 2003). To improve treatment utilization, retention, and satisfaction among Black people with AUD, researchers suggest that treatment address issues relevant to minoritized groups, such as racial stress (Haeny et al., 2021, Zemore et al., 2018), given extensive research demonstrating the link between racial discrimination (a form of racial stress) and alcohol use among Black people (Gerrard et al., 2012, Hurd et al., 2014, Mattingly et al., 2022, Desalu et al., 2019, Desalu et al., 2019).

Craving is a diagnostic criterion for AUD (American Psychiatric Association, 2013) and a major target in many alcohol interventions (Heidari et al., 2017, Kiani et al., 2019, Carroll, 1998). Therefore, understanding the factors that trigger alcohol craving can be key in understanding and developing effective alcohol treatments. Stress is a major precipitant of alcohol craving and subsequent use (Martins et al., 2022, Sinha, 2001, Blaine et al., 2018). Minoritized stress models purport that Black people experience unique stressors related to their racial identity, including racial stress (Harrell, 2000, Clark et al., 1999). Racial stress can be described as physiological, behavioral, and emotional response to stimuli that tax resources and threaten the individual based on perceived race (Holmes et al., in press). Examples of racial stressors unique to Black people include assumptions of inherent low intelligence, laziness, aggression, dependence (“welfare queens”), sexual objectification (“Jezebels”), obedient (“mammies”), and the strong and the angry Black woman stereotypes (Hotchkins, 2016, Lewis and Neville, 2015, Sue et al., 2008). One study found that the association between general stress and alcohol craving was stronger among Black adults relative to White adults who drink alcohol (Pedersen et al., 2022), though this study did not investigate racial stressors specifically. Another study found that baseline reports of racial discrimination were positively correlated with alcohol craving among Black young adults following exposure to videotapes of racial discrimination rated as extremely stressful (Desalu et al., 2021). This study also found that some components of racial identity (i.e., the level of importance attributed to racial group membership; Sellers et al., 1997), buffered whereas others exacerbated the impact of vicarious racial discrimination on alcohol craving among Black young adults. These findings are consistent with prior evidence of the differential impact of racial identity on health outcomes (e.g., Romero et al., 2014; Stein et al., 2014; Torres and Ong, 2010; Yip, 2018; Yip et al., 2019), though findings are mixed depending on the racial and ethnic groups and the health outcome examined. Specifically, some studies find that those in the earlier stages of their racial identity development (exploration; i.e., exploring one’s racial identity [e.g., seeking to know more about Black history]) are more negatively impacted by experiences of racism whereas more developed racial identity (commitment; i.e., having committed to one’s racial group membership [e.g., feeling a strong attachment to the Black community]) is protective against the harmful effects of racism on health outcomes (Romero et al., 2014, Stein et al., 2014, Torres and Ong, 2010, Yip, 2018, Yip et al., 2019). Other studies find that among Black young adults, racial identity exploration and commitment are protective against the harmful effects of racism on alcohol problems (Zapolski and Deppermann, 2023, Buckner et al., 2022, Byer-Tyre et al., 2022); however, none of these studies have examined the impact of racial identity on alcohol craving specifically. Therefore, racial identity is important to consider in relation to alcohol craving among Black adults.

Personalized imagery procedures could be applied to further elucidate the relationship between racial stressors and alcohol craving for Black people with AUD. Standardized personalized imagery procedures are a validated, structured approach to investigate the impact of stress and alcohol cues on craving and subsequent alcohol use (Sinha, 2001, Sinha et al., 2009, Blaine et al., 2018). These procedures are based on Lang’s theory of emotional learning (Lang, 1979) and entail eliciting stimulus and response context details about specific emotional events and developing personalized imagery scripts to elicit emotional responses to prior events. Personalized imagery procedures have been validated demonstrating that acute provocation of stressful events via imagery provokes the same emotional and physiologic responses as if the event occurred in the moment (Lang et al., 1980, Martins et al., 2022, Miller et al., 1987, Blaine et al., 2018, Lang et al., 1983; Sinha, 1996, Sinha and Tuit, 2012, Sinha, 2001, Sinha, 2009). Further, prior research demonstrates that people with substance use disorders (SUD) have a dysregulated physiological response to stress (e.g., Lovallo et al., 2000; Martins et al., 2022; Sinha, 2001), and personalized imagery stress procedures have been validated by showing a blunted physiologic response in individuals with SUD (e.g., Sinha et al., 2011, Sinha et al., 2006; Sinha et al., 2009; Wemm et al., 2019). Prior research has also established the incremental validity of personalized imagery procedures over existing stress procedures in eliciting craving and emotional response (Sinha et al., 1999). While personalized imagery procedures have not been used to elicit racial stress or examine the impact of racial stress on alcohol outcomes, imagery procedures more broadly have been used in experimental studies to examine the impact of racial stress on substance use cognitions (Stock et al., 2011). Using personalized imagery procedures to examine the impact of racial stressors on alcohol craving among Black people may inform approaches for tailoring treatment for this group. The objective of the present study was to adapt the personalized imagery procedures to assess racial stressors and to test the validity of the adapted procedures in a pilot study investigating the impact of racial stress on alcohol craving and reactivity among Black adults with AUD. We hypothesized that personalized racial stress imagery would result in increased alcohol craving and emotional responses and show blunted physiological reactivity relative to neutral/relaxing imagery. We also explored the impact of racial identity, gender, and income on the association between racial stress and alcohol craving.