Attenuated Salivary Cortisol Secretion Under Cue Exposure Is Associated With Early Relapse

Junghanns, Klaus; Tietz, U.; Dibbelt, L.; Kuether, M.; Jurth, R.; Ehrenthal, Dieter; Blank, S; Backhaus, Jutta

doi:10.1093/alcalc/agh107

Cited by 85 publications

(67 citation statements)

References 34 publications

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“…Blunted stress-related cortisol response in abstinent alcoholics has been previously documented (Errico et al, 1993;Bernardy et al, 1996;Lovallo et al, 2000;Junghanns et al, 2003;Adinoff et al, 2005), with lower responses in those who relapsed vs those who did not (Adinoff et al, 2005;Junghanns et al, 2005). Current findings are consistent with these data and extend them by documenting a significant negative correlation between high basal levels and lower stress-related cortisol responses.…”

Section: Discussionsupporting

confidence: 86%

Enhanced Negative Emotion and Alcohol Craving, and Altered Physiological Responses Following Stress and Cue Exposure in Alcohol Dependent Individuals

Sinha

Fox

Hong

et al. 2008

Neuropsychopharmacol

400

383

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Chronic alcohol abuse is associated with changes in stress and reward pathways that could alter vulnerability to emotional stress and alcohol craving. This study examines whether chronic alcohol abuse is associated with altered stress and alcohol craving responses. Treatment-engaged, 28-day abstinent alcohol-dependent individuals (ADs; 6F/22M), and social drinkers (SDs; 10F/18M) were exposed to a brief guided imagery of a personalized stressful, alcohol-related and neutral-relaxing situation, one imagery condition per session, presented in random order across 3 days. Alcohol craving, anxiety and emotion ratings, behavioral distress responses, heart rate, blood pressure, and salivary cortisol measures were assessed. Alcohol patients showed significantly elevated basal heart rate and salivary cortisol levels. Stress and alcohol cue exposure each produced a significantly enhanced and persistent craving state in alcohol patients that was marked by increased anxiety, negative emotion, systolic blood pressure responses, and, in the case of alcohol cue, behavioral distress responses, as compared to SDs. Blunted stress-induced cortisol responses were observed in the AD compared to the SD group. These data are the first to document that stress and cue exposure induce a persistent negative emotion-related alcohol craving state in abstinent alcoholics accompanied by dysregulated HPA and physiological arousal responses. As laboratory models of stress and negative mood-induced alcohol craving are predictive of relapse outcomes, one implication of the current data is that treatments targeting decreases in stress and alcohol cue-induced craving and regulation of stress responses could be of benefit in improving alcohol relapse outcomes.

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Section: Discussionsupporting

confidence: 86%

Enhanced Negative Emotion and Alcohol Craving, and Altered Physiological Responses Following Stress and Cue Exposure in Alcohol Dependent Individuals

Sinha

Fox

Hong

et al. 2008

Neuropsychopharmacol

400

383

View full text Add to dashboard Cite

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“…To further explore the relationship between cortisol reactivity and relapse, the cortisol response to an alcohol cue-exposure (CE) and subsequent relapse was assessed in 32 alcohol-dependent men and women (Junghanns et al, 2005). Six CE experiments were performed over a threeweek period.…”

Section: Blunted Hpa Axis Response Is Associated With An Increased Rimentioning

confidence: 99%

Suppression of the HPA Axis Stress‐Response: Implications for Relapse

Adinoff

Junghanns

Kiefer

et al. 2005

Alcoholism Clin & Exp Res

181

161

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This article presents the proceedings of a symposium held at the meeting of the International Society for Biomedical Research on Alcoholism (ISBRA) in Mannheim, Germany, in October 2004. This symposium explored the potential role of hypothalamic-pituitary-adrenal (HPA) axis dysregulation upon relapse. HPA axis stimulation induces the release of the glucocorticoid cortisol, a compound with profound effects upon behavior and emotion. Altered stress-responses of the HPA axis in abstinent alcohol-dependent subjects, therefore, may influence their affective and behavioral regulation, thus impacting their potential for relapse. Bryon Adinoff began the symposium with a review of HPA axis dysfunction in alcohol-dependent subjects, including recent studies from his lab demonstrating an attenuated glucocorticoid response to both endogenous and exogenous stimulation in one-month abstinent men. Klaus Junghanns presented his work demonstrating that a blunted ACTH or cortisol response to subjective stressors (social stressor or alcohol exposure) is predictive of a return to early drinking. The final two presenters examined the interaction between naltrexone and HPA responsiveness in alcohol-dependent or at-risk subjects, as naltrexone induces an increase in ACTH and cortisol. Falk Kiefer discussed the relationship between basal HPA axis responsivity and clinical outcome following treatment with naltrexone or acamprosate. Plasma ACTH significantly decreased over the course of the study in the medication groups, but not the placebo group. Lower basal concentrations of ACTH and cortisol were associated with quicker relapse in the placebo group only. Suchitra Krishnan-Sarin described her preliminary work, in which family-history positive (FH+) and family history negative (FH-) subjects were administered naltrexone, followed by an assessment of alcohol-induced craving. The cortisol response to alcohol was significantly and inversely related to craving in the FH+, but not the FH-, subjects. Alterations in HPA axis responsivity may therefore have a negative impact upon clinical outcome in alcohol-dependent subjects, and disinhibition of the axis with medication may have therapeutic potential. KeywordsAdrenal Cortex; Alcoholism; Pituitary-Adrenal System; Naltrexone Hypothalamic-pituitary-adrenal (HPA AXIS) activation is a key component of the physiological response to stress, particularly stress accompanied by anxiety or fear. Stress initiates a cascade of events, beginning with central nervous system stimulation of

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“…While some studies did not find a positive correlation between subjective i.e. conscious craving and relapse (Drummond & Glautier, 1994;Grüsser et al, 2004;Junghanns et al, 2005;Kiefer et al, 2005;Litt et al, 2000;Rohsenow et al, 1994), others did show significant correlations (Bottlender & Soyka, 2004;Cooney et al, 1997;Heinz et al, 2005b;Ludwig & Wikler, 1974;Monti et al, 1990). In contrast, changes in physiological parameters, including neuronal activation measured with functional imaging, seem to be more closely connected to relapse (Abrams et al, 1988;Braus et al, 2001;Drummond & Glautier, 1994;Grüsser et al, 2004;Rohsenow et al, 1994).…”

Section: Risk Of Relapsementioning

confidence: 98%