Junghanns K, Tietz U, Dibbelt L, Kuether M, Jurth R, Ehrenthal D, Blank S, Backhaus J
Department of Psychiatry and Psychotherapy, University of Lüebeck, Ratzeburger Allee 160, 23538 Lüebeck, Germany.
Alcohol Alcohol. 2005 Jan-Feb;40(1):80-5. doi: 10.1093/alcalc/agh107. Epub 2004 Nov 18.
To test whether the risk of relapse in alcohol dependence is predicted by the subjective experience of cue exposure (CE) and/or cortisol reactivity to alcohol cues.
Salivary cortisol and self-ratings of 'tension' and 'desire to drink' were measured in 32 detoxified alcohol-dependent inpatients during CE sessions conducted in the first and third week of motivation enhancement therapy. Subjects completed the Toronto Alexithymia Scale (TAS-20) and the Abbreviated Alcohol Expectancy Questionnaire (B-AEQ) towards the end of the inpatient treatment to measure emotional self-awareness and the expected positive effects of alcohol.
Six weeks after the end of the inpatient treatment, 15 patients were abstinent. Relapse was verified or was presumed for 17 patients. Those who had relapsed had shown an attenuated response to CE in the third week as an inpatient but did not differ from abstainers in terms of subjective reaction to cues. Subjective ratings of CE were not related to salivary cortisol or relapse but showed several associations with factors one and two of the TAS-20. The expectancy of enhanced social contacts by using alcohol (factor 1 of the B-AEQ) correlated negatively with the decline in salivary cortisol during the CE session in the third week of treatment. Subjective ratings of CE correlated with Alexithymiascores.
Alcoholic patients who use alcohol to enhance their social contacts typically lack hypothalamo-hypophysical-pituitary-adrenocortical (HPA) reactivity in the early period of abstention. They are at an increased risk of early relapse and perhaps use alcohol to increase cortisol secretion again.
检验线索暴露（CE）的主观体验和/或对酒精线索的皮质醇反应性是否能预测酒精依赖的复发风险。
在动机增强治疗的第一周和第三周进行的CE环节中，对32名已戒酒的酒精依赖住院患者测量了唾液皮质醇以及“紧张”和“饮酒欲望”的自我评分。患者在住院治疗结束时完成了多伦多述情障碍量表（TAS - 20）和简化酒精预期问卷（B - AEQ），以测量情绪自我意识和酒精的预期积极效果。
住院治疗结束六周后，15名患者保持戒酒。17名患者被证实或被推测复发。那些复发的患者在住院第三周时对CE的反应减弱，但在对线索的主观反应方面与戒酒者没有差异。CE的主观评分与唾液皮质醇或复发无关，但与TAS - 20的因素一和因素二有若干关联。通过饮酒增强社交接触的预期（B - AEQ的因素1）与治疗第三周CE环节中唾液皮质醇的下降呈负相关。CE的主观评分与述情障碍得分相关。
利用酒精增强社交接触的酒精患者在戒酒早期通常缺乏下丘脑 - 垂体 - 肾上腺皮质（HPA）反应性。他们早期复发的风险增加，可能会再次使用酒精来增加皮质醇分泌。
