[Stress Response in Persons with Alcohol Addiction in the Context of Abstinence Duration and Disease Severity]

Stress increases the risk of developing and maintaining alcohol addiction. Mechanism for reacting to, and coping with, stress in persons with alcohol addiction are an important factor enabling them to maintain abstinence in everyday life. Also of Relevance for abstinence, and in particular craving for alcohol, is the severity of the dependence. Numerous studies have focused on the duration of abstinence, but not on the severity of the disease.

This study investigates if, in addition to abstinence duration, also the severity of the alcohol addiction influences stress responsiveness and ability to cope with stress. Another objective is to ascertain in which patients such an influence can be found. The results can shed light on the complex bidirectional relationship between alcoholism and stress, but are also potentially useful in treating patients with this disease.

In a cross-sectional design, 64 alcohol-dependent patients and 30 healthy controls were examined. The alcoholics sample was divided in two groups according to a duration of abstinence of seven days and, 70 days. Each group was further divided in a subgroup of individuals with mild to moderate alcohol addiction and in a subgroup of patients with severe alcohol addiction (A7-severe and A70-severe). Using the Trierer Social Stress Test (TSST), all participants were subjected to acute stress. Parameters measured were salivary cortisol, skin conductance -response, heart rate, addiction-related variables (addiction severity, duration of alcohol abuse, drinking quantity, craving, liver enzymes, family history of alcoholism, number of therapies, smoking), psychopathological variables (anxiety, depression, live events, personality disorders), acute and long-term stress coping, and level of strain on everyday life.

In patients with severe addiction, the reaction to stress is weaker and slightly retarded, but also of a longer duration than that patients with mild and moderate addiction and of healthy controls. This is independent of the length of abstinence (7 days and 70 days). In severely ill patients, strategies for coping with acute stress differed from those of the other groups in that they consisted in stronger flight and avoidance responses, a stronger need for social support, and a more intense mental preoccupation. Increased levels of social tension, lack of social recognition, and isolation indicated chronic stress. Patients with severe alcohol addiction also showed a more pronounced familial predisposition, stronger craving, increased anxiety, a longer history of alcohol abuse, and a higher frequency of incisive life events than patients with mild to moderate alcohol addiction.

The results indicate that a more differentiated evaluation of stress responsiveness and stress coping in persons with an alcohol addiction not only length of abstinence, but also severity of disease have to be taken into account. Further research is necessary to adjust treatment accordingly.