HPA axis response to psychological stress and treatment retention in residential substance abuse treatment: A prospective study
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Introduction Substance abuse treatment programs are often characterized by high rates of premature treatment dropout, which increases the likelihood of relapse to drug use. Negative reinforcement models of addiction emphasize an individual's inability to tolerate stress as a key factor for understanding poor substance use treatment outcomes, and evidence indicates that dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis contributes to an individual's inability to respond adaptively to stress. The aim of the current study was to examine whether HPA axis response to stress is predictive of treatment retention among a sample of drug users in residential substance abuse treatment.Method Prospective study assessing treatment retention among 102 individuals enrolled in residential substance abuse treatment. Participants completed two computerized stress tasks, and HPA axis response to stress was measured via salivary cortisol at five time points from baseline (pre-stress) to 30 min post-stress exposure.Results The main outcome measures were treatment dropout (categorical) and total number of days in treatment (continuous). A significantly higher salivary cortisol response to stress was observed in treatment dropouts compared to treatment completers. Further, Cox proportional hazards survival analyses indicated that a higher peak cortisol response to stress was associated with a shorter number of days to treatment dropout.Conclusions Results indicate that a higher salivary cortisol level in response to stress is associated with an inability to remain in substance abuse treatment. These findings are the first to document a biological marker of stress as a predictor of substance abuse treatment dropout, and support the development and implementation of treatments targeting this vulnerability.
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A higher salivary cortisol level in response to stress is associated with higher drop-out rates in treatment.
“Interestingly, a higher salivary cortisol level in response to stress has been associated with higher drop-out rates in treatment [179].”
From Food Addiction and Psychosocial Adversity: Biological Embedding, Contextual Factors, and Public Health Implications (2020) · cites this paper as [179]
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- Authors
- Daughters, S. B., Richards, J. M., Gorka, S. M., & Sinha, R.
- Affiliations
- University of Maryland, College Park (US)
- Yale University (US)
- Corresponding author
- Daughters, Stacey B.
- Venue
- Drug and Alcohol Dependence
- Publisher
- Elsevier BV
- Published
- 2009-12
- Volume
- 105
- Issue
- 3
- Pages
- 202-208
- ISSN
- 0376-8716 (ISSN-L)
- PMC
- PMC3774292
- OpenAlex
- W2048424875
- Cited by
- 64
- References
- 42
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 3 · 2023: 2 · 2022: 2 · 2021: 6 · 2020: 5 · 2019: 5 · 2018: 5 · 2017: 5 · 2016: 3 · 2015: 4 · 2014: 4 · 2013: 5 · 2012: 1
- FWCI
- 2.01
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Drug and Alcohol Dependence (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Drug Abuse (R01-DA19405, P50DA016556, K02DA017232, R01DA019405, R21DA022741)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Keywords
- hypothalamic-pituitary-adrenal axis, psychological stress, treatment retention, salivary cortisol, stress response, relapse, biomarkers, residential addiction treatment
- MeSH terms
- Adult, Aged, Mental Disorders, Female, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Male, Middle Aged, Patient Dropouts, Pituitary-Adrenal System, Prospective Studies, Residential Treatment, Saliva, Stress, Psychological, Treatment Failure, Substance-Related Disorders
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