Attenuated cortisol response to biobehavioral stressors in sober alcoholics

Sober alcoholics show an attenuated hormonal response to pharmacological agents that normally stimulate the hypothalamic-pituitary-adrenocortical (HPAC) axis. To determine if this same result would be found using biobehavioral stressors, 52 detoxified (mean = 32 days) male alcoholics and 30 male nonalcoholic controls were given two moderately aversive tasks (mental arithmetic and cold pressor test). Three samples of blood were drawn during a 2.5-hour prestressor baseline, a fourth immediately following the stressors and a fifth, 20 minutes later. At each of these times, subjects were asked to report their degree of distress. Serum cortisol concentrations did not differ between groups at baseline or immediately following the stressors, but 20 minutes later alcoholics had significantly lower concentrations than controls. The groups did not differ on their degree of self-reported distress in response to the stressors. Thus, while alcoholics appeared to affectively experience stressful events in a manner similar to that of controls, they had an attenuated cortisol response. A possible pathophysiological mechanism for this dysregulation is discussed in addition to the potential existence of a premorbid condition.