Remarkably, after accounting for the effects of other significant demographic and clinical characteristics on outcome, we found that high adrenal sensitivity, particularly in the neutral, relaxing condition (but also at baseline and in the stress condition), increased relapse risk up to 2.5 times, suggesting that individuals who demonstrated the highest cortisol responsivity to corticotropin (adrenal sensitivity) during the neutral, relaxing condition showed the shortest time to alcohol relapse and return to heavy drinking. For example, as shown in Figure 6, alcohol-dependent patients with neutral-state cortisol to corticotropin ratios more than 1.5 had a less than 18% chance of surviving alcohol relapse on day 30, while those with a cortisol to corticotropin ratio at or less than 0.1 had a 60% chance of surviving relapse at day 30. With these significant differences in relapse risk on the basis of relaxed-state morning levels of adrenal sensitivity, it is possible that specific levels of resting-state adrenal sensitivity, and not provoked HPA axis response, could serve as a biomarker for identifying alcohol relapse risk during treatment.
