Department of Public and Community Health, School of Public Health, University of Maryland, College Park, MD 20742, United States.
Drug Alcohol Depend. 2009 Dec 1;105(3):202-8. doi: 10.1016/j.drugalcdep.2009.06.026. Epub 2009 Aug 26.
Substance abuse treatment programs are often characterized by high rates of premature treatment dropout, which increases the likelihood of relapse to drug use. Negative reinforcement models of addiction emphasize an individual's inability to tolerate stress as a key factor for understanding poor substance use treatment outcomes, and evidence indicates that dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis contributes to an individual's inability to respond adaptively to stress. The aim of the current study was to examine whether HPA axis response to stress is predictive of treatment retention among a sample of drug users in residential substance abuse treatment.
Prospective study assessing treatment retention among 102 individuals enrolled in residential substance abuse treatment. Participants completed two computerized stress tasks, and HPA axis response to stress was measured via salivary cortisol at five time points from baseline (pre-stress) to 30 min post-stress exposure.
The main outcome measures were treatment dropout (categorical) and total number of days in treatment (continuous). A significantly higher salivary cortisol response to stress was observed in treatment dropouts compared to treatment completers. Further, Cox proportional hazards survival analyses indicated that a higher peak cortisol response to stress was associated with a shorter number of days to treatment dropout.
Results indicate that a higher salivary cortisol level in response to stress is associated with an inability to remain in substance abuse treatment. These findings are the first to document a biological marker of stress as a predictor of substance abuse treatment dropout, and support the development and implementation of treatments targeting this vulnerability.
物质滥用治疗计划通常以高比例的提前治疗退出为特征，这增加了药物使用复发的可能性。成瘾的负强化模型强调个人无法承受压力是理解不良物质使用治疗结果的关键因素，有证据表明，下丘脑-垂体-肾上腺（HPA）轴的失调导致个体无法对压力做出适应性反应。本研究的目的是检验 HPA 轴对压力的反应是否能预测接受住院物质滥用治疗的吸毒者的治疗保留率。
前瞻性研究评估了 102 名接受住院物质滥用治疗的个体的治疗保留率。参与者完成了两项计算机化的应激任务，并在基线（应激前）到应激暴露后 30 分钟的五个时间点通过唾液皮质醇测量 HPA 轴对压力的反应。
主要的结果测量是治疗退出（分类）和治疗总天数（连续）。与治疗完成者相比，治疗退出者的应激后唾液皮质醇反应明显更高。此外，Cox 比例风险生存分析表明，应激时皮质醇峰值反应越高，治疗退出的天数就越少。
结果表明，对压力的唾液皮质醇水平升高与无法继续接受物质滥用治疗有关。这些发现首次记录了应激的生物标志物作为物质滥用治疗退出的预测因素，支持针对这种脆弱性的治疗的发展和实施。
