Salivary cortisol measurements during a medically assisted alcohol withdrawal

Previous studies using plasma cortisol estimations have suggested that hypo thalmo-pituitary-axis (HPA) activation occurs in alcohol-dependent patients during alcohol withdrawal. The present study set out to confirm this findi ng using salivary cortisol assays, which are a better indicator of plasma f ree cortisol, the fraction which exerts its physiological effects. Nine alc ohol dependent patients provided four saliva samples (at 10 a.m., 2 p.m., 6 p.m. and 10 p.m.) on days 1, 3 and 7 of a medically assisted alcohol withd rawal (corresponding to 1, 3 and 7 days following the last drink, respectiv ely). Withdrawal symptom severity, craving and mood disturbance were also m easured. A group of non-alcohol-dependent individuals, without psychiatric or medical disorder, gave four samples at the same times on one day only. M ean daily cortisol levels in our alcohol-dependent population, as calculate d by the area under the cur ve (AUC), decreased significantly over time (me an AUC (nmol/l/hour) on day 1 = 149, on day 7 = 85.7, p = 0.009) and were s ignificantly higher than controls on each day (mean AUC in controls = 28.3, p = 0.001). The cortisol response showed a similar temporal trend to withd rawal symptom severity and mood disturbance. This is consistent with previo us studies measuring plasma cortisol in alcohol withdrawal. However, the ma gnitude of the effect in our study was greater, and in contrast to some pre vious studies, levels were far from normal by day 7. The comparatively low cortisol response in our one mildly dependent patient suggests that there m ay be a relationship between dependence severity and the size of the cortis ol response to withdrawal. Salivary cortisol sampling could prove to be a u seful prognostic tool, with implications for subsequent withdrawal symptom severity, mood disturbances, risk of relapse and alcohol-related cognitive decline. There are implications for developing new treatments for alcohol w ithdrawal but more studies are needed.