CLINICAL STUDY: Cortisol concentrations, stress‐coping styles after withdrawal and long‐term abstinence in alcohol dependence

Abstract

Alcohol-dependent patients face a substantial risk of relapse after detoxification. A major risk factor for relapse is stress which is reflected biologically by various physiological changes that include an activation of the hypothalamic-pituitary-adrenal (HPA) axis and release of glucocorticoids. The prospective study examined cortisol concentrations and stress-coping styles in relation to abstinence 1 year following discharge from treatment. Cortisol concentrations were measured in the plasma of 46 alcohol-dependent patients (12 women) on initial presentation for treatment (day 1), and again in plasma and in cerebrospinal fluid (CSF) after 6 weeks of abstinence (day 40). These results were compared with those of 26 age- and sex-matched, healthy control subjects. After withdrawal, the patients completed a comprehensive baseline assessment including a stress-coping questionnaire (Stressverarbeitungsfragebogen SVF120) and were monitored for 1 year after discharge. Negative stress-coping styles (e.g. flight, resignation) positively correlated with higher cortisol concentration in plasma and in CSF after withdrawal (day 40). Compared with relapsers after 1 year, abstainers had significantly lower levels for cortisol in CSF, whereas the stress-coping styles did not differ between abstainers and relapsers in this sample. These findings suggest that relatively stable personality traits like stress-coping styles have no measurable influence on abstinence. The lower cortisol concentration in CSF as an indicator for HPA axis functioning is associated with long-term abstinence in detoxified alcoholics.

Social Factors but Not Stress-Coping Styles Predict Relapse in Detoxified Alcoholics

“…Walter et al [40] found correlations between positive stress coping styles and biological stress parameters like higher cortisol levels in alcoholics. With reference to a relation between cortisol levels and relapse, Junghanns et al [41] found that a weaker cortisol response to a stress stimulus in alcohol-dependent patients is related to an increased relapse risk.…”

Cortisol Response To Interpersonal Stress in Young Adults With Borderline Personality Disorder: A Pilot Study

“…In other psychiatric disorders, an association between higher cortisol levels and negative stress-coping styles has been described [26]. This pilot study investigated the associations between BPD diagnosis and cortisol course after a stressful interpersonal interaction between mother and young adult offspring.…”

The Impact of Diacetylmorphine on Hypothalamic-Pituitary-Adrenal Axis Activity and Heroin Craving in Heroin Dependence

“…Most notably, fMRI scanning has been demonstrated to be a stressful experience associated with elevated cortisol concentrations in healthy persons and depressive patients [44,45,46]. In substance use disorders, psychosocial stress is generally considered to be a predictive factor for relapse [19,47,48]. …”

“…On the other hand, recent studies suggest that substance use disorders are associated with elevated cortisol levels and depressive symptoms [17]. The increased HPA axis activity might constitute a vulnerability to the development of substance use disorders and relapse, and this relationship seems to be influenced by stressful life experiences [18,19]. …”