HPA axis response to psychological stress and treatment retention in residential substance abuse treatment: a prospective study.
HPA axis response to psychological stress and treatment retention in residential substance abuse treatment: a prospective study.
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DOI：
10.1016/j.drugalcdep.2009.06.026
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发表时间：
2009-12-01
影响因子：
4.2
通讯作者：
Sinha R
中科院分区：
文献类型：
--
作者：
Daughters SB;Richards JM;Gorka SM;Sinha R
药物滥用治疗方案的特点往往是过早退出治疗的比例很高，这增加了吸毒复发的可能性。成瘾的负强化模型强调个人无法忍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）轴的失调导致个人无法适应压力。本研究的目的是检查HPA轴对压力的反应是否可以预测住院药物滥用治疗中药物使用者的治疗保留率。前瞻性研究，评估102名住院药物滥用治疗者的治疗保留情况。参与者完成了两个计算机化的压力任务，HPA轴的压力反应通过唾液皮质醇在5个时间点从基线（压力前）到30分钟后的压力暴露。主要结局指标为治疗脱落（分类）和治疗总天数（连续）。与治疗完成者相比，在治疗退出者中观察到对应激的唾液皮质醇反应显著更高。此外，考克斯比例风险生存分析表明，较高的峰值皮质醇反应的压力与较短的天数治疗脱落。结果表明，较高的唾液皮质醇水平在应对压力是与无法保持在药物滥用治疗。这些发现首次记录了压力的生物标志物作为药物滥用治疗退出的预测因素，并支持针对这种脆弱性的治疗的开发和实施。
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.
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影响因子：
4.2
作者：
Linehan, MM;Dimeff, LA;Kivlahan, DR
通讯作者：
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25
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