Researchers Seek to Predict Stress-Induced Substance Abuse Relapse

With more than two thirds of people relapsing after starting treatment for substance use disorders, researchers are looking for ways to predict a person’s susceptibility to return to drug or alcohol use. Researchers at the Yale Stress Center in New Haven, CT, are developing biological markers of recovery to predict who will relapse, and when.

Having validated markers to measure a person’s risk of relapse could help doctors better predict who is at highest risk and tailor treatments for them, says Rajita Sinha, PhD, Director of the Yale Stress Center. For instance, a doctor might recommend an extended stay in residential treatment, or more intense behavioral treatment for patients who are likely to relapse.

While much is known about the effects of stress on addiction, much less is understood about how stress affects a person’s risk of relapse and jeopardizes recovery, according to Dr. Sinha. “When the regions of the brain involved in regulating stress are not working well, it increases a person’s vulnerability to relapse,” she says. “We want to find those neural and biological measures that predict whether this will occur.”

She and her colleagues are testing a number of biological measures of stress in people with various substance use disorders, including cocaine addiction and alcoholism. They are studying patients who are discharged from inpatient substance abuse treatment, to see if and when they relapse. The researchers are looking for links between relapse and biological markers including high levels of the chemical cortisol and high blood levels of a protein called brain-derived neurotrophic factor (BDNF), as well as brain atrophy in specific regions of the brain.

In a recently published study in the Archives of General Psychiatry, Dr. Sinha found several markers of increased risk of alcohol relapse, including high morning levels of the hormone corticotrophin. Another recent study, published in Biological Psychiatry, found high levels of BDNF in cocaine-dependent patients was predictive of an early relapse.

Dr. Sinha’s lab is also studying treatments to reduce stress-induced substance abuse. One recent pilot study found an older drug for hypertension called prazosin appears to decrease stress-induced alcohol craving. “We are also identifying newer drugs that could help those most susceptible to stress,” she notes. “But first we need to validate biological markers so we know who will benefit from these treatments.”