Previous studies have shown lower cortisol levels in relapsed alcohol-dependent patients compared with those who remained abstinent in very early recovery and at a 6 months’ assessment.17-19,43 Although the current findings of higher neutral, relaxed-state cortisol to corticotropin ratios or cortisol levels in the stress condition predicting shorter time to alcohol relapse may seem contrary to previous work, it is important to consider the methodological differences between the previous studies and the current study. The previous studies used a stress challenge condition but no neutral or relaxing control condition. Thus, while baseline levels were considered, HPA axis responses during a controlled relaxed manipulation were not conducted. These studies also did not include a socially drinking control group to fully assess whether basal- or neutral, relaxed-state HPA axis measures were different from the control group. On the other hand, both relaxed- and challenge-state assessments were included in the current study and results specifically highlight 2 aspects of HPA axis dysfunction, namely, higher morning baseline corticotropin and neutral, relaxing-state corticotropin levels and lack of provoked HPA response to stress, the latter being
