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Objective: During the alcohol withdrawal period, it is known that there are some alterations in the stress response system such as increased basal cortisol levels, reduced basal adrenocorticotropic hormone (ACTH) levels, and blunted ACTH and cortisol responses to stress tests in the alcohol-dependent patients. In this study, our purpose was to investigate the probable alterations in the responses of the HPA axis to psychological stress during the late alcohol withdrawal in alcohol-dependent males.
Methods: This study included 23 male patients with alcohol dependence and alcohol withdrawal according to DSM-IV-TR diagnostic criteria and 20 healthy male volunteers as a control group. In order to determine the severity of alcoholism, the Michigan Alcoholism Screening Test (MAST) was performed in the first week of hospitalization. The Clinical Institute Withdrawal Assessment for Alcohol (CIWA-A) scale was applied on the 1st, 8th, 21st and 28th days to determine the severity of withdrawal during follow-up. The Trier Social Stress Test (TSST) was used in order to evaluate responses to psychological stress in the patients and the controls. TSST was performed on patients on the 28th day of hospitalization. This is a test standardized to measure the stress response by creating a social stress in the laboratory. Basal serum levels of cortisol, ACTH, dehydroepiandrosterone-sulfate (DHEAS) and prolactin and the responses of these hormones to psychological stress were measured during the late withdrawal period (28th day of the withdrawal) in the alcohol-dependent males and in healthy controls. Blood samples from the subjects were collected for hormonal measurements at 15 minutes before and at 0, 30, 60, 90, 120 minutes after the social stress test. Peak, Δ and area under the curve (AUC) values of the hormones following stress were calculated.
Results: Values of basal, peak, and AUC prolactin were statistically significantly higher in patients than in controls, and values of basal, peak, AUC cortisol and peak DHEAS were statistically significantly lower in patients than in controls. Δ and AUC ACTH responses were also significantly lower in the patients.
Conclusion: ACTH, DHEAS and cortisol responses to psychological stress were found to be decreased in the late withdrawal period of the alcoholic patients compared to the controls, while prolactin responses were higher. Inadequate cortisol, ACTH and DHEAS responses to psychological stress during the late withdrawal period in the patients might have resulted from damages on the brain areas which are the parts of the stress-response cycle.