Blunted stress cortisol response in abstinent alcoholic and polysubstance-abusing men

Background: This study tested cortisol responses to a psychological stresso r in controls (CT) versus patients who were diagnosed as alcohol dependent (AD) or alcohol and stimulant dependent (ADSD) by DSM-IV criteria and who w ere abstinent for 3 to 4 weeks from alcohol and illicit drugs. Alcohol incr eases cortisol secretion acutely and during withdrawal. However, there is l ittle information about abnormalities of hypothalamic-pituitary-adrenocorti cal (HPA) reactivity in recovering alcoholics. Methods: Accordingly, we tested HPA function in the laboratory between 7:00 and 9:30 AM on control versus stress days. Stress consisted of a 20-min pu blic speaking challenge with preparation and delivery of two short speeches , ostensibly evaluated for quality of delivery, whereas control involved re laxing for the same period. Cortisol was measured in saliva collected at ba seline, stress or control, and recovery period, and also at home at 9:00 PM on one of the two days. Results: The three groups did not differ in diurnal patterns of cortisol se cretion on the rest day and 9:00 PM sample, which indicated that AD and ADS D patients had intact diurnal HPA regulation at rest. During speech stress, the CT subjects showed the expected cortisol increase (p < 0.0001), wherea s neither AD nor ADSD patients responded significantly. Cortisol values wer e not accounted for by covariates such as depression, posttraumatic stress disorder, glucose metabolism, or anthropometric or demographic characterist ics. Conclusions: The apparent stress hyporesponsiveness of the AD and ADSD pati ents suggests a persistent disruption of HPA function, perhaps due to incom plete recovery from prior abuse, or to a preexisting alteration in neural s ystems that regulate HPA responses to stress.