From allostasis to addiction: Cortisol dysregulation, daily stress and relations with 9-year alcohol and substance use disorder severity in community adults.
Nonlinear interactions between cortisol indices and daily stressor severity appear to predict 9-year alcohol use disorder and substance use disorder severity, with cortisol area under the curve emerging as the most robust indicator.
Abstract
Background
AND
Aims
Diurnal cortisol dysregulation and daily stressor severity may jointly forecast long-term alcohol use disorder (AUD) and substance use disorder (SUD) severity, yet most evidence is cross-sectional and relies on single cortisol indices. This study examined whether three cortisol indices nonlinearly interacted with daily stressor severity to predict 9-year AUD and SUD severity.
Design
Longitudinal observational study with a 9-year follow-up. Analyses were not pre-registered.
Setting
Community-based sample in the United States of America.
Participants
1617 community-dwelling adults aged 33-83 years at baseline.
Measurements
Ecological momentary assessments of salivary cortisol and daily stressor severity were collected at baseline. AUD and SUD severity were self-reported at baseline and 9-year follow-up. Cortisol indices included diurnal cortisol slope, cortisol awakening response and area under the curve (AUC).
Findings
Parametric hurdle Poisson models yielded null main effects and interactions (all P > 0.050). Generalized additive models with negative binomial family revealed three statistically significant nonlinear interactions: diurnal cortisol slope × stress predicting AUD severity [effective degrees of freedom (edf) = 2.09, χ2 = 12.56, P = 0.005], cortisol awakening response × stress predicting SUD severity (edf = 2.88, χ2 = 11.60, P = 0.019) and AUC × stress predicting AUD severity (edf = 4.08, χ2 = 16.34, P = 0.006). Adjusting for age, sex, education, income and race nullified all three interactions; however, AUC × stress interaction → AUD remained statistically significant after controlling for anxiety and depression.
Conclusions
Nonlinear interactions between cortisol indices and daily stressor severity appear to predict 9-year alcohol use disorder and substance use disorder severity, with cortisol area under the curve emerging as the most robust indicator. Findings are predictive rather than causal. Cognitive-behaviorally based prevention programs targeting stress and cortisol regulation may mitigate substance use risk.
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BACKGROUND
Dissociation is a transdiagnostic symptom and hypothesized to serve as a short-term regulatory mechanism in response to emotional stress. The present study examined the momentary dynamics between dissociation, negative affect, and cortisol in the day-to-day lives of adolescent psychiatric inpatients.
METHODS
Forty-eight adolescents (mean age: 15.85 years, SD: 1.15, 81% female) were recruited from psychiatric inpatient units. Following a diagnostic baseline assessment, participants completed twelve signal-contingent ecological momentary assessments per day over five consecutive days, each separated by one hour, reporting on dissociation and negative affect. Salivary cortisol was sampled concurrently. Data were analysed using Residual Dynamic Structural Equation Modelling.
RESULTS
No significant cross-lagged effects between dissociation and negative affect emerged. However, a significant contemporaneous association indicated that these variables co-occurred (st.est. = 0.236, 95%-CI: 0.191-0.280). Neither emotion regulation difficulties, borderline personality disorder nor childhood trauma assessed at baseline significantly moderated the cross-lagged or contemporaneous effects. A small cross-lagged effect of the cortisol × dissociation interaction on negative affect emerged (st.est. = -0.056, 95%CI: -0.081 to -0.028), indicating that higher levels of dissociation in combination with elevated cortisol levels predicted lower subsequent negative affect.
DISCUSSION
These findings provide partial support for theoretical conceptualization of dissociation as a marker for emotion dysregulation and underscore the need for studies employing combined psychological and biological assessments with higher sample frequencies than a one-hour interval to more precisely capture the short-lived temporal dynamics among dissociation, affect, and endocrine stress responses.
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