Treatment Dropout Linked With Elevated Stress Response

A stress-related biological marker in saliva can predict how long a drug user will remain in treatment. In a recent study of men and women entering a residential treatment center, scientists measured salivary cortisol—a hormone that is released in stressful situations and is associated with the "fight or flight" response—just before participants performed two laboratory tasks designed to induce stress. The researchers repeated the measurement immediately after task completion and then at three 10-minute intervals.

Prior to the tasks, cortisol levels were similar for the 21 patients who subsequently dropped out of treatment and the 81 patients who completed it. Thirty minutes after the stressor, however, individuals who later dropped out of treatment had cortisol levels that were 3.5 times higher than those of individuals who remained in treatment for their entire 30- or 60-day contract duration. Further, for each unit of increase in cortisol after the tasks, there was a four-fold increase in risk for dropping out of the treatment program on any given day. The findings also confirmed that participants who had indicated on a standard questionnaire that they had trouble dealing with stressful situations were most likely to leave treatment prematurely. Study leader Dr. Stacey B. Daughters of the University of Maryland suggests that patients with problems tolerating stress may benefit from evidence-based treatments that focus on coping with negative emotions.

Drug and Alcohol Dependence 105(3):202–208, 2009. [Full Text]