Brady Kathleen T, Back Sudie E, Waldrop Angela E, McRae Aimee L, Anton Raymond F, Upadhyaya Himanshu P, Saladin Michael E, Randall Patrick K
Medical University of South Carolina, Charleston, South Carolina 29425, USA.
Alcohol Clin Exp Res. 2006 Jun;30(6):938-46. doi: 10.1111/j.1530-0277.2006.00097.x.
The association between stress and alcohol dependence has been well established. Abnormalities in stress reactivity and hypothalamic-pituitary-adrenal axis (HPA) function may be involved in the mechanistic connection between stress and the initiation, development, and/or maintenance of alcohol dependence. Posttraumatic stress disorder (PTSD) commonly co-occurs with alcohol dependence and is characterized by HPA axis abnormalities. This study investigated the relationship between subjective and neuroendocrine stress reactivity to the cold pressor task (CPT) and prospective alcohol use among individuals with alcohol dependence, with and without comorbid PTSD.
Participants were 63 individuals with (a) alcohol dependence only (n=35) or (b) comorbid alcohol dependence and PTSD (n=28). Participants completed the CPT, a widely used physical laboratory stressor. Subjective stress, craving, adrenocorticotrophin (ACTH), and cortisol were measured before, immediately after, and at 5, 30, 60, and 120 minutes after the CPT. Alcohol use during 1 month following testing was also assessed.
For the alcohol-only group, change in craving immediately following the CPT and craving during the 120-minute recovery phase were predictive of follow-up alcohol use. For the alcohol/PTSD group, change in craving was not predictive of follow-up use. Baseline drinking was, however, predictive of followup alcohol use for the alcohol/PTSD group. For the alcohol-only group, a blunted ACTH response coupled with a higher change in craving following the CPT was associated with significantly greater frequency and intensity of drinking during the follow-up phase.
These preliminary findings demonstrate significant differences between the alcohol-only and the alcohol/PTSD group in predictors of relapse. For the alcohol-only group, reactivity to an acute laboratory stressor may be predictive of subsequent alcohol use. This was not true for the alcohol/PTSD group. Although preliminary, the findings may help shed light on the mechanistic relationship between stress reactivity and increased risk for alcohol relapse and dependence in individuals with and without other Axis I comorbidity.
压力与酒精依赖之间的关联已得到充分证实。压力反应性和下丘脑 - 垂体 - 肾上腺轴（HPA）功能异常可能参与了压力与酒精依赖的起始、发展和/或维持之间的机制联系。创伤后应激障碍（PTSD）常与酒精依赖共病，其特征为HPA轴异常。本研究调查了有或无共病PTSD的酒精依赖个体对冷加压试验（CPT）的主观和神经内分泌应激反应与未来酒精使用之间的关系。
参与者为63名个体，其中（a）仅患有酒精依赖（n = 35）或（b）患有酒精依赖合并PTSD（n = 28）。参与者完成了CPT，这是一种广泛使用的实验室物理应激源。在CPT前、后即刻以及CPT后5、30、60和120分钟测量主观压力、渴望、促肾上腺皮质激素（ACTH）和皮质醇。还评估了测试后1个月内的酒精使用情况。
对于仅患有酒精依赖的组，CPT后即刻渴望的变化以及120分钟恢复阶段的渴望可预测随访期间的酒精使用情况。对于酒精/PTSD组，渴望的变化不能预测随访期间的酒精使用情况。然而对于酒精/PTSD组，基线饮酒量可预测随访期间的酒精使用情况。对于仅患有酒精依赖的组，ACTH反应迟钝以及CPT后渴望变化较大与随访期间饮酒频率和强度显著增加相关。
这些初步发现表明，仅患有酒精依赖的组和酒精/PTSD组在复发预测因素方面存在显著差异。对于仅患有酒精依赖的组，对急性实验室应激源的反应性可能预测随后的酒精使用情况。对于酒精/PTSD组则并非如此。尽管是初步研究结果，但这些发现可能有助于阐明应激反应性与有或无其他轴I共病个体酒精复发和依赖风险增加之间的机制关系。
