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Clinical study tests alcohol role in stress-reduction

by Ann Lacy
Special to The Catalyst
Following the destruction of the World Trade Center towers on Sept. 11, some people prayed more.  Others spent less. 

And a great many people drank a good deal more.

It doesn’t take a scientist to recognize these responses to a stressful situation. Anecdotally, everyone knows that many people reach for a drink following exposure to a stressful situation.

“In the clinical arena, however, the relation between stress and alcohol use has been more difficult to characterize.  For example, human laboratory studies have not uniformly supported a prominent theory called the tension-reduction hypothesis of alcohol use, which posits that people use alcohol to reduce stress,” according to Kathleen Brady, M.D., Ph.D.

In order to better understand the relationship between stress and alcohol use, Brady, an investigator with the Institute of Psychiatry Alcohol Research Center, is studying abnormalities in stress response which may induce or exacerbate alcohol use disorders, post-traumatic stress disorders, or a combination of the two. 

Her project, which began in January 2000, is  funded  by the Charleston Alcohol Research Center under a three-year grant from the National Institutes of Health. 

The study examines dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, one of the main hormonal systems involved in the stress response and also implicated in the pathophysiology of alcohol use disorders.

Brady recruits subjects for her study through newspaper advertisements and in-treatment centers in Charleston and Dorchester counties and at MUSC. At present there are 60 to 70 men and women participating in the study with a projected maximum of 180 people. The participants are divided into four groups: people with certified psychiatric diagnoses of post traumatic stress disorder (PTSD), those with alcohol use disorder, people afflicted with  a combination of the two syndromes, and a control group with neither disorder. 

Both PTSD and alcohol use disorder are certified psychiatric diagnoses. Men and women suffering from PTSD have experienced a severe trauma and subsequently manifest a constellation of symptoms including an inability to put the traumatic event out of their minds, hypervigilance, sleep problems, and avoidance of people, places, or things reminding them of the traumatic event.  Alcohol use disorder is characterized by the use of alcohol to the point where it interferes with an individual’s ability to function in some significant capacity.

Subjects are admitted to the General Clinical Research Unit (GCRC - an NIH-funded unit at the general hospital) the evening prior to testing to ensure control of their diet and sleep as well as to guarantee the absence of stress. The following morning, researchers take the subjects’ vital signs, insert IVs and perform baseline neuroendocrine studies. The participating men and women are next subjected to a physical or psychological stress. 

The physical trauma involves keeping one’s hand in ice water for two minutes. 

The psychological trauma, which is actually one of collective mankind’s greatest fears, involves giving a five-minute impromptu speech before a group of strangers. Following these stresses, for one hour the reactivity of the subject's stress axis is measured, blood samples are drawn, vital signs are taken, and subjective level of comfort is evaluated.

The subjects then leave the clinical setting and return home to go about their normal lives. For the next week, half of the subjects in each of the four groups take the drug naltrexone while the other half receive a matching placebo. The study participants then return to the GCRC, spend the night and once again undergo the same stress task procedure.

The drug naltrexone, which is administered to some of the participants, is an effective opiate blocker. It works by binding to opiate receptors in brain cells, thereby blocking the effects that alcohol molecules have on them.  This decreases alcohol craving and relapse in alcohol-dependent individuals.  Opiate antagonists like naltrexone also have effects on HPA axis function, one of the main hormonal systems involved in the stress response. 

Once the study results have been tabulated, Brady hopes to obtain “some idea about how the stress axis is changed and if that change differs depending on social or physical stressors.”  The study will enable her to learn more of the mechanisms of response to traumatic stress and to alcohol.

Brady explained: “This project is designed to build upon our ongoing research in the area of PTSD and alcohol use disorders by further exploration of the neurobiologic interface between alcoholism and PTSD. This study may provide valuable information about the role of the HPA axis and the opiate system in stress-induced relapse.”