title: Adrenocortical sensitivity, moderated by ongoing stress, predicts drinking intensity in alcohol-dependent men.
abstract: Allostatic load from both environmental stressors and persistent glucocorticoid secretion has been associated with disease severity in alcohol dependence. Heightened relapse risk and/or drinking severity, in particular, may be a reaction to alcohol- and withdrawal-induced changes in physiological stress response systems coupled with ongoing life stress, although their shared contributions upon drinking severity have not been assessed. To investigate the combined contribution of hypothalamic-pituitary-adrenal (HPA) reactivity and environmental stressors (e.g., ongoing life stress) to relapse severity in alcohol-dependent men following treatment, plasma adrenocorticotropin (ACTH) and cortisol were obtained in 4-6 weeks abstinent alcohol-dependent men (n=41) following a psychosocial stressor [the Trier Social Stress Test (TSST)] and two pharmacological provocations [ovine corticotropin releasing factor (oCRH) and cosyntropin]. Following treatment discharge, drinking outcomes (primary outcome: drinks per drinking day (DDD); secondary outcomes: total drinks and drinking days) were assessed weekly and ongoing life stress was assessed biweekly for 24 weeks following treatment discharge. Generalized estimating equation models of drinking severity were fit with basal and stimulated ACTH and cortisol concentrations as predictors and ongoing life stress as the moderator. Greater levels of life stress were independently associated with greater drinking intensity (DDD and total drinks) but not frequency (days drinking). Higher basal cortisol:ACTH or provoked cortisol:ACTH ratios were strongly associated with greater post-treatment DDD in individuals who experienced higher levels of ongoing stress. In conclusion, ongoing life stress is associated with post-treatment drinking intensity in alcohol dependent men; stress also strengthens the relationship between adrenocortical sensitivity and post-treatment drinking. Physiological measures of allostatic load and environmental stressors conjointly increase relapse intensity.
authors.affiliation: VA North Texas Health Care System, Dallas, TX, USA; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA. Electronic address: Bryon.adinoff@utsouthwestern.edu.
authors.forename: Bryon
authors.initials: B
authors.lastname: Adinoff
authors.affiliation: David Leonard Statistical Consulting, Wichita Falls, TX, USA.
authors.forename: David
authors.initials: D
authors.lastname: Leonard
authors.affiliation: Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Julianne
authors.initials: J
authors.lastname: Price
authors.affiliation: Department of Psychiatry, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
authors.forename: Martin A
authors.initials: MA
authors.lastname: Javors
authors.affiliation: Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Robrina
authors.initials: R
authors.lastname: Walker
authors.affiliation: Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: E Sherwood
authors.initials: ES
authors.lastname: Brown
authors.affiliation: Fairway Family Medicine, Carrollton, TX, USA.
authors.forename: Hong
authors.initials: H
authors.lastname: Xiao
authors.affiliation: Center for Behavioral Health Research, University of Tennessee, Knoxville, TN, USA; Department of Pediatrics and Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Uma
authors.initials: U
authors.lastname: Rao
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood*; D000328:Adult; D000437:Alcoholism / Q000097:blood / Q000503:physiopathology; D004327:Drinking Behavior / Q000502:physiology*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007030:Hypothalamo-Hypophyseal System / Q000098:blood supply / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000098:blood supply / Q000503:physiopathology; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000097:blood / Q000503:physiopathology; D055815:Young Adult
chemical_list: D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone
keywords: Alcoholism; Cortisol; HPA; Relapse; Stress