Is There an Association Between Salivary Cortisol and Dropping Out of Inpatient Substance Addiction Treatments? A Prospective Repeated Measures Study

Abstract

Several studies have found an association between salivary cortisol levels and dropping out of inpatient substance addiction treatment programs. The results are mixed due to variations in the study design and the lack of standardized routines for cortisol assessment. The aim of this study was to investigate whether there was (1) an association between salivary cortisol levels and dropping out from inpatient substance addiction treatments; (2) higher predictive validity for dropout in one of the cortisol indexes: Area Under the Curve with respect to ground (AUCG) or Daily Cortisol Slope (DCS); (3) an interaction effect with time for each cortisol index; and (4) different dropout rates for sex and patients in short-term versus long-term treatment programs. This was a prospective, repeated-measures observational study. Patients (n = 173) were recruited from 2 inpatient facilities in the central region of Norway between 2018 and 2021. Salivary cortisol was measured 4 times during the treatment period, with 8 samples collected over 2 consecutive days at each time point. Cortisol levels were calculated using the cortisol indices AUCG and DCS. Dropout was used as the outcome measure at each time point. Associations were calculated using a logistic linear regression. The results suggest a main effect of AUCG, whereby higher levels reduce dropout risk (OR = 0.92, P = .047). An interaction with time in treatment also revealed a higher dropout risk (OR = 1.09, P = .044) during week 4 of the treatment, depending on the AUCG. These results support using AUCG as the recommended index when assessing cortisol, and that the relationship between cortisol levels and length of treatment should be further investigated.

Identification of Novel Loci and Cross-Disorder Pleiotropy Through Multi-Ancestry Genome-Wide Analysis of Alcohol Use Disorder in Over One Million Individuals

“…Interestingly, the multi-ancestry meta-analysis revealed pathways of relevance to the neuroimaging findings in AUD ( 36 ) and to our cell type analysis, including the substantia nigra, frontal cortex and nucleus accumbens. The association with the hypothalamus, a region that regulates liquid intake, could be related to the consumption component of AUD, in line with our previous findings associating hypothalamus with both alcohol consumption and AUD loci ( 33 ) and with experimental data regarding altered hypothalamic-pituitary-adrenal axis after chronic alcohol exposure ( 37 ). The current findings further illustrate the complementarity of the tissue-level and cell-level bioinformatic approaches to open therapeutic avenues in AUD ( 38 , 39 ).…”

A Prospective Biopsychosocial Repeated Measures Study of Stress and Dropout from Substance Addiction Treatment

“…Procedures for sampling and analyzing cortisol were the same as reported in Bohle et al 52 In short, all sampling was performed over two consecutive days, 4 times a day for each timepoint (T1-4). Samples were gathered using a saliva collection device (Sarstedt Nümbrecht, Germany) that consisted of a cotton swab and a sampling vessel.…”

“… 51 A limitation of previous research is the lack of repeated measures and a standardized protocol for sampling and calculation of salivary cortisol measures. Of the few prospective studies, 27 , 38 , 42 , 52 a study conducted by Jaremko et al 38 is of special interest due to the fact that it combined biological and psychosocial variables when assessing dropout risk. This study found that abnormal cortisol measures increased dropout risk and elevated psychological distress and poor treatment engagement in those who dropped out.…”