Using a controlled experimental approach combined with a prospective clinical outcomes design, the current results indicate high morning levels of corticotropin, a lack of stress- and cue-related cortisol and corticotropin response, increased neutral, relaxed- and cue-induced anxiety, and significantly increased stress- and alcohol cue-induced craving in 1-month-abstinent, treatment-engaged alcohol-dependent inpatients relative to matched social drinking controls. More importantly, cortisol to corticotropin ratios representing a marker of adrenal sensitivity and high alcohol craving were most significantly predictive of subsequent time to alcohol relapse outcomes while increased anxiety levels were associated with lower rates of aftercare treatment engagement. These findings provide direct evidence of stress-related pathophysiology during protracted alcohol abstinence as relevant to subsequent alcoholism relapse risk.
