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Stress, Hypothalamic-pituitary-adrenal (HPA) Dysfunction, and Relapse in Alcoholism

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ClinicalTrials.gov Identifier: NCT00744588
Recruitment Status : Completed
First Posted : September 1, 2008
Last Update Posted : January 3, 2013
Dallas VA Medical Center
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Information provided by (Responsible Party):
Bryon H Adinoff, University of Texas Southwestern Medical Center

Brief Summary:

This proposal is part of the INIA Stress Consortium. This study will

  1. explore the contributions of lifetime trauma, recent stress, and alcohol use on stress-hormone axis disruption in treatment seeking, one-month abstinent, alcohol-dependent subjects
  2. assess the combined contributions of stress-hormone axis disruption and episodic stress on the risk of prospective drinking following treatment
  3. determine the role of neurosteroids in alcohol use.

Condition or disease
Alcohol Dependence

Detailed Description:

The hypothalamic-pituitary-adrenal (HPA) system is suggested as a key biologic link in stress-induced relapse. The HPA axis provides a regulatory feedback network between the brain and the body's behavioral and physiologic responses to stress, recovery, and adaptation. Both trauma and chronic alcohol use produce persistent disturbances in the HPA response to stress. The chronic use of alcohol may also impair the stress-induced release of neurosteroids, compounds that directly modulate central nervous system activity. Thus, altered cortisol and neurosteroid responsiveness during abstinence may impair the central nervous system's ability to mount an appropriate response to environmental stressors, heightening the probability of relapse. However, the relationship between stress, relapse, and HPA axis disturbances remains tentative. In the proposed study, the investigators will assess the contribution of trauma, stress, and alcohol use upon pituitary-adrenocortical functioning in alcohol dependence. The relative contribution of adrenocortical disruption and episodic stress to prospective drinking behaviors will then be determined.

Hypothesis: We hypothesize (1) that lifetime trauma, recent stress, and chronic alcohol use will additively contribute to HPA axis disruption, (2) alterations in glucocorticoid and neurosteroid release as well as episodic stress will predict a return to drinking.

Methods: One hundred treatment-seeking, one-month abstinent, alcohol-dependent subjects will be studied. Standardized assessments will be used to assess childhood and adult trauma as well as recent (six months) stress. Pituitary-adrenal (including ACTH (adrenocorticotropin), cortisol, and neurosteroids) responses to both neuroendocrine [ovine corticotropin releasing hormone (oCRH), cosyntropin, and dexamethasone] and experiential (public speaking) challenges will be measured. Drinking behavior and episodic stress will be prospectively assessed for six months following neuroendocrine assessment.

Significance: If our hypotheses are supported, a definitive connection between previous trauma, biological stress response mechanisms, and ongoing stress upon prospective drinking behavior will be demonstrated. The identification of a specific biologic mechanism that underlies this association will provide a fertile framework for the development of targeted pharmacological interventions to decrease relapse in this vulnerable population. In addition, elucidating the concurrent contributions of stress-response biologic systems and externals stressors will provide the therapist and patient with a constellation of specific risk factors for focused treatment.

Study Type : Observational
Actual Enrollment : 75 participants
Observational Model: Case-Only
Time Perspective: Cross-Sectional
Official Title: Stress, HPA Dysfunction, and Relapse in Alcoholism
Study Start Date : August 2007
Primary Completion Date : August 2011
Study Completion Date : March 2012

Resource links provided by the National Library of Medicine

U.S. FDA Resources

alcohol dependence
Alcohol-dependent subjects currently being treated in an inpatient treatment facility.

Primary Outcome Measures :
  1. Examine the contributions of previous trauma, recent stress, and chronic alcohol use to the stress-hormone axis reactivity in one-month abstinent alcohol-dependent subjects. [ Time Frame: one month ]

Secondary Outcome Measures :
  1. Assess the ability of stress-hormone axis reactivity and ongoing stress to predict subsequent drinking behavior following treatment discharge. [ Time Frame: Six months ]

Biospecimen Retention:   Samples With DNA
serum plasma whole blood urine

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 60 Years   (Adult)
Sexes Eligible for Study:   Male
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population
Inpatient treatment facility for substance use disorders.

Inclusion Criteria:

  • Diagnosis of alcohol dependence

Exclusion Criteria:

  • Medical or psychiatric disorders that may effect stress-hormone axis functioning.
  • Medications that may effect stress-hormone axis functioning.
  • English speaking.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00744588

United States, Texas
UT Southwestern Medical Center at Dallas
Dallas, Texas, United States, 75390-8564
Sponsors and Collaborators
University of Texas Southwestern Medical Center
Dallas VA Medical Center
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Principal Investigator: Bryon Adinoff, MD UT Southwestern Medical Center at Dallas and VA North Texas Health Care System

Responsible Party: Bryon H Adinoff, Professor, University of Texas Southwestern Medical Center
ClinicalTrials.gov Identifier: NCT00744588     History of Changes
Other Study ID Numbers: AA016668
U01AA016668 ( U.S. NIH Grant/Contract )
First Posted: September 1, 2008    Key Record Dates
Last Update Posted: January 3, 2013
Last Verified: January 2013

Keywords provided by Bryon H Adinoff, University of Texas Southwestern Medical Center:
substance abuse
alcohol dependence
hypothalamic-pituitary-adrenal (HPA) system
corticotropin-releasing Hormone (CRH)
pituitary-adrenal system

Additional relevant MeSH terms:
Disease Attributes
Pathologic Processes
Alcohol-Related Disorders
Substance-Related Disorders
Chemically-Induced Disorders
Mental Disorders
Epinephryl borate
Corticotropin-Releasing Hormone
Adrenergic alpha-Agonists
Adrenergic Agonists
Adrenergic Agents
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action
Physiological Effects of Drugs
Adrenergic beta-Agonists
Bronchodilator Agents
Autonomic Agents
Peripheral Nervous System Agents
Anti-Asthmatic Agents
Respiratory System Agents
Vasoconstrictor Agents
Hormones, Hormone Substitutes, and Hormone Antagonists