Putting findings from study 1 and study 2 together, it appears that individuals with increased cortisol release (adrenal sensitivity) in response to high corticotropin levels were most susceptible to a shorter time to relapse and return to heavy drinking. This was most strongly observed in the neutral, relaxing condition, where controls showed significantly lower levels of corticotropin than alcohol-dependent patients. These data suggest that controls were able to relax and decrease their HPA axis reactivity during relaxing imagery, but alcohol-dependent patients, and particularly those who relapsed, were not able to relax and decrease their HPA axis responses in a relaxing imagery condition. Further support for the interpretation that alcohol-dependent patients had a lower ability to relax or decrease HPA axis function under relaxed conditions comes from their higher levels of reported anxiety in the neutral, relaxed condition relative to controls. Significant positive correlations between neutral-state anxiety levels and corticotropin and cortisol levels in each of the stress, cue, and neutral, relaxing conditions were also observed. These data are consistent with the notion of higher allostatic load in subjective, neuroendocrine, and
