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Ligabue KP, Schuch JB, Scherer JN, Ornell F, Roglio VS, Assunção V, Rebelatto FP, Hildalgo MP, Pechansky F, Kessler F, von Diemen L. Increased cortisol levels are associated with low treatment retention in crack cocaine users. Addict Behav 2020; 103:106260. [PMID: 31901885 DOI: 10.1016/j.addbeh.2019.106260] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 11/13/2019] [Accepted: 12/15/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Dysregulation of the hypothalamic-pituitaryadrenal (HPA) axis has been associated with craving and early relapse among individuals with substance use disorders. However, no association has been postulated regarding treatment retention and prognosis in crack cocaine users. OBJECTIVE Our aim was to investigate the association between morning salivary cortisol levels and treatment retention in crack cocaine users. METHODS 44 male crack cocaine users were recruited from a detoxification unit. Saliva collection was performed in the morning of the second treatment day. Substance use profile was assessed using the Addiction Severity Index. RESULTS The median length of stay in inpatient treatment was 7 days (IQR 3-16). Treatment retention was associated with cortisol levels (r = -0.324; p = 0.032), especially in the group with positive family history. Moreover, treatment retention was correlated with age (r = 0.333, p = 0.027), and number of days of tobacco use (r = 0.332, p = 0.028) and crack use (r = 0.327, p = 0.031). A Cox regression model was performed and showed that inpatients with above normal cortisol levels (≥0.69 µg/dL) presented a worse prognostic related to treatment retention (HR = 2.39, CI95% 1.1-5.1, p = 0.024). CONCLUSION Several factors could contribute to increased cortisol levels in these patients, e.g. craving, dysregulation of the HPA axis, chronic drug use, stress due to confinement, and substance abstinence. Nevertheless, our findings could guide further studies about new biomarkers in crack cocaine use disorder, since HPA axis dysregulation at the time of treatment admittance may be a prognostic marker for treatment retention.
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Affiliation(s)
- Karina P Ligabue
- Center for Drug and Alcohol Research and Collaborating Center on Alcohol and Drugs, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Jaqueline B Schuch
- Center for Drug and Alcohol Research and Collaborating Center on Alcohol and Drugs, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Juliana N Scherer
- Center for Drug and Alcohol Research and Collaborating Center on Alcohol and Drugs, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Felipe Ornell
- Center for Drug and Alcohol Research and Collaborating Center on Alcohol and Drugs, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Vinícius S Roglio
- Center for Drug and Alcohol Research and Collaborating Center on Alcohol and Drugs, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Vanessa Assunção
- Center for Drug and Alcohol Research and Collaborating Center on Alcohol and Drugs, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Fernando P Rebelatto
- Center for Drug and Alcohol Research and Collaborating Center on Alcohol and Drugs, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Maria Paz Hildalgo
- Laboratory of Chronobiology and Sleep, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Department of Psychiatry and Legal Medicine, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Flavio Pechansky
- Center for Drug and Alcohol Research and Collaborating Center on Alcohol and Drugs, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Department of Psychiatry and Legal Medicine, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Felix Kessler
- Center for Drug and Alcohol Research and Collaborating Center on Alcohol and Drugs, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Department of Psychiatry and Legal Medicine, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Lisia von Diemen
- Center for Drug and Alcohol Research and Collaborating Center on Alcohol and Drugs, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Department of Psychiatry and Legal Medicine, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
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