Rubio Gabriel, Marín Marta, Martín-Arriscado Arroba Cristina, Rubio-Escobar Enrique, Arias Francisco, Torregrosa Abraham B, Manzanares Jorge
Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.
Departamento de Psiquiatría, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
Front Psychiatry. 2025 Jun 18;16:1613169. doi: 10.3389/fpsyt.2025.1613169. eCollection 2025.
Salience and cortisol response following exposure to alcohol-related stimuli (ARS) are considered markers of vulnerability and status in alcohol use disorders (AUD). Negative emotionality may also maintain alcohol consumption by negative reinforcement. What happens to these parameters once sustained symptom remission has been achieved is unknown. This study investigated changes in these variables after 2 years of outpatient treatment and compared them with a healthy control group.
Patients with AUD (n=154) were assessed at baseline (T0) and after 2 years of treatment (T2). Salience was determined by the magnitude of the startle reflex when subjects were exposed to pictures of alcoholic beverages and scenes related to alcohol consumption. Salivary cortisol was measured before and after this exposure. Negative emotionality was assessed using anxiety, depression, and impulsivity scales. A group of 138 healthy controls was selected based on sample characteristics. Changes in patient (case) population variables at T0 and T2 were assessed using the Student's t-test for related samples. A repeated measures variance model (RMMM) was also fitted to the logarithmic values over time.
Startle reflex response and salivary cortisol levels before and after ARS viewing did not change significantly in men or women between T0 and T2. Post-exposure salivary cortisol changes were lower in the male group and in those who consumed alcohol during the treatment period. Scores on negative emotionality scales decreased significantly from T0 to T2. At the end of the study (T2), patients still had altered salience values, cortisol reactivity and negative emotionality compared to the control group.
The absence of changes in these neurobiological markers confirms the chronicity of moderate-severe AUD and the risk of relapse despite the end of treatment. These findings question the duration of alcohol dependence approaches and suggest the need to look for longer-term intervention alternatives.
接触酒精相关刺激（ARS）后的显著性和皮质醇反应被认为是酒精使用障碍（AUD）易感性和状态的标志物。负性情绪也可能通过负强化维持酒精消费。一旦实现持续症状缓解，这些参数会发生什么变化尚不清楚。本研究调查了门诊治疗2年后这些变量的变化，并将其与健康对照组进行比较。
对AUD患者（n = 154）在基线（T0）和治疗2年后（T2）进行评估。通过受试者接触酒精饮料图片和与饮酒相关场景时惊跳反射的幅度来确定显著性。在此暴露前后测量唾液皮质醇。使用焦虑、抑郁和冲动量表评估负性情绪。根据样本特征选择了一组138名健康对照者。使用相关样本的学生t检验评估患者（病例）群体变量在T0和T2的变化。还对随时间变化的对数值拟合了重复测量方差模型（RMMM）。
在T0和T2之间，男性和女性在观看ARS前后的惊跳反射反应和唾液皮质醇水平均无显著变化。男性组和治疗期间饮酒者的暴露后唾液皮质醇变化较低。从T0到T2，负性情绪量表得分显著降低。在研究结束时（T2），与对照组相比，患者的显著性值、皮质醇反应性和负性情绪仍有改变。
这些神经生物学标志物没有变化，证实了中重度AUD的慢性特征以及尽管治疗结束仍有复发风险。这些发现对酒精依赖治疗方法的持续时间提出了质疑，并表明需要寻找长期干预替代方案。
