Cold pressor task reactivity: Predictors of alcohol use among alcohol-dependent individuals with and without comorbid posttraumatic stress disorder
Cold pressor task reactivity: Predictors of alcohol use among alcohol-dependent individuals with and without comorbid posttraumatic stress disorder
复制标题
DOI：
10.1111/j.1530-0277.2006.00097.x
复制
发表时间：
2006-06-01
影响因子：
3.2
通讯作者：
Randall, Patrick K.
中科院分区：
文献类型：
--
作者：
Brady, Kathleen T.;Back, Sudie E.;Randall, Patrick K.
压力和酒精依赖之间的联系已经得到了很好的证实。应激反应性和下丘脑-垂体-肾上腺轴（HPA）功能异常可能参与应激与酒精依赖的发生、发展和/或维持之间的机制联系。创伤后应激障碍（PTSD）通常与酒精依赖共同发生，其特征是HPA轴异常。本研究调查了有或无合并PTSD的酒精依赖个体对冷压任务（CPT）的主观和神经内分泌应激反应与预期酒精使用之间的关系。参与者是63名(a)仅酒精依赖（n=35）或(b)酒精依赖和PTSD共病（n=28）的个体。参与者完成了CPT，这是一种广泛使用的物理实验室压力源。分别在CPT前、后、5分钟、30分钟、60分钟和120分钟测量主观应激、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。对于只喝酒的那一组，在CPT之后的渴望变化和在120分钟的恢复阶段的渴望变化预示着后续的酒精使用。对于酒精/创伤后应激障碍组，渴望的变化并不能预测后续使用。然而，基线饮酒量可以预测酒精/创伤后应激障碍组的后续酒精使用情况。对于纯酒精组，ACTH反应减弱，加上CPT后渴望的更高变化，与随访阶段饮酒频率和强度显著增加有关。这些初步研究结果表明，纯酒精组和酒精/创伤后应激障碍组在预测复发方面存在显著差异。对于纯酒精组，对急性实验室应激源的反应性可能预示着随后的酒精使用。酒精/创伤后应激障碍组的情况并非如此。虽然是初步的，但研究结果可能有助于阐明应激反应与酒精复发和依赖风险增加之间的机制关系，无论有无其他轴I合并症。
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.