Heavy alcohol users Vs. Addicts – Stress response

I can’t even count how many times I’ve talked about the difference between alcohol or drug users and alcoholics or addicts (see here, here, and here for some examples and keep reading). The quick summary: Many people use drugs and many abuse them at times, a small percentage meet criteria for addiction at some point in their life and an even smaller percentage is the type of addict we’ve been taught to think of – chronically relapsing and seemingly incapable of quitting no matter how crappy their life gets.

One of the main reasons we study drug and alcohol abuse is because of the huge health impact of this stuff – we spend billions and billions of dollars every year on health-care that is directly or indirectly related to the abuse of nicotine, alcohol, and pretty much every other drug on earth (marijuana can certainly help some conditions but heavy use of marijuana can bring its own consequences). One of the major players in these health problems is the effect of alcohol and drug use on stress in the body. Stress increases death rates in several ways including: Heart attacks, strokes, cancer, and more.

Well, a recent study in Amsterdam looked at alcohol (yes, you read that right, the Dutch care about more than weed) consumption, alcohol addiction (alcoholism) diagnosis, and effects on the body’s stress system, also known as the HPA (Hypothalamic-Pituitary-Adrenal) Axis. If nothing else, the study helped confirm that an alcoholism diagnosis is not necessarily the same as an indication of heavy drinking and that excessive drinking is no bueno, regardless of whether it meets addiction criteria or not.

Alcohol drinking, alcoholism, and stress regulation

A very simple cortisol graph showing reduced levels during sleep with peaks upon wakingI’m not going to go into this in detail (look here and here for more) but just as our brains and bodies have systems for decision making, they also have complex stress management systems. The latter rely heavily on hormones, including Cortisol, to keep our bodies in the right states whether those be fight, flight, or reading a book before sleep (see figure on left for over-simplified cortisol levels throughout the day in a normal person). We’re supposed to have the most cortisol right upon waking with constant reductions throughout the day until we fall asleep, and back again. Individuals with mental health disorders like anxiety and depression have substantially different cortisol level patterns throughout the day and are less effective at regulating cortisol (in case you needed another reason why our biology affects our states of being and behavior).

The dutch study tested cortisol levels at 7 different times throughout the day after giving their subjects a 4 hour battery of tests. They also assessed their cardiac functioning by assessing different measures related to heart beat regulation that allows for adapting across challenging situations by affecting the sympathetic nervous system (excitatory processes) and parasympathetic nervous system (inhibitory processes).

They looked at these measures as a way of assessing the relative functioning of the HPA Axes’ of different groups. Specifically, they looked at:

  1. Non-drinkers
  2. Moderate drinkers (less than 3 drinks per day)
  3. Heavy drinkers (more than 3 drinks per day)
  4. Non alcoholics
  5. Remitted alcoholics (met criteria for alcoholism previously but not in past 12 months)
  6. Current alcoholics.

One of the most interesting findings, as far as I’m concerned, was that among remitted alcoholics the average amount of drinking was around 1.3 drinks per day with a lot of variability, a little higher than that of moderate drinkers (0.8 drinks per day) but lower than that of heavy drinkers (4.0 drinks per day). I see this as a little more proof that people who met criteria for alcoholism at one point don’t necessarily abstain forever and don’t necessarily continue to have drinking problems (per Moderation Management, spontaneous remission, or some other means of stopping their alcoholic drinking).*

You can blame improper diagnostic criteria, a continuum of addiction severity, or anything else as far as I’m concerned but as I pointed out in my first paragraph, we’ve talked about this topic repeatedly and I see no end coming soon. The bottom line is that meeting criteria for alcoholism at one point in life tells me something, but far from everything, about a person’s drinking habits or drinking problems later in life.

But back to stress. As you might have already guessed, since it is heavy drinking that causes serious dysregulation of the body’s stress response, what the researchers found was that meeting criteria for alcoholism now, or in the past, didn’t have any major effect over their participants’ HPA functioning. Instead, all that mattered was how heavy their drinking was now. Heavy drinkers had higher waking cortisol levels, higher night-time cortisol, and increased sympathetic (excitatory) control. In short – heavy drinkers were less able to regulate their stress and excitation response, likely leading to increased stress on their bodies.

As a side note, this study also found that if anything, moderate drinking conferred health benefits when it came to stress over not-drinking at all – far from the first study to note this but another set of reinforcing evidence that drinking alcohol is not in itself bad for you while over-drinking is.

So – Drinking a lot of alcohol causes disruptions to your body’s stress regulation system that will likely increase the likelihood of heart problems, depression, anxiety, and more. Those disruptions are there whether you meet criteria for alcoholism or not.

Obviously, there are many alcoholics who drink a lot of alcohol, but there are also people who meet (now or in the past) criteria for alcoholism who are binge drinkers and therefore don’t drink daily and have lower “drink numbers.” As we mentioned before, addiction is not about quantity, in fact, the criteria for addiction barely mentions quantity – when it states that addicts consume “more than intended” or that tolerance creates a state where an person needs greater quantity to reach the same effect of the drug. Drinking or using a lot of drugs or alcohol does not an addict make.

*Note: Given the variability in the remitted-alcoholics groups their is little doubt that some of them had stopped drinking while others drank to excess. Additionally, it should be pointed out that alcohol abuse was not assessed in this sample, so it could still be a problem for at least some of those now-drinking past-alcoholics.


Lynn Boschloo, Nicole Vogelzangs, Carmilla M.M. Licht, Sophie A. Vreeburg, Johannes H. Smit, Wim van den Brink, Dick J. Veltman, Eco J.C. de Geus, Aartjan T.F. Beekman, Brenda W.J.H. Penninx (2011). Heavy alcohol use, rather than alcohol dependence, is associated with dysregulation of the hypothalamic-pituitary-adrenal axis and the autonomic nervous system. Drug and Alcohol Dependence 116, 170–176.

Heather M. Burke, Mary C. Davis, Christian Otte, David C. Mohr, (2005).  Depression and cortisol responses to psychological stress: A meta-analysis, Psychoneuroendocrinology, Volume 30, Issue 9, Pages 846-856.

About Addiction: Addiction Treatment, distress, kids with drugs, and your brain

This week our wrap-up includes articles about addiction, sometimes in kids, and the stress that can often accompany them As usual, we’ll educate you in 30 seconds flat and give you a window to this week’s hot stories.

Addiction treatment access

Boston Globe – Read about the often sad reality of American soldiers who become addicted to medications prescribed to them during service by medical staff and are then left holding the tab when it comes time to pay. Hopefully this practice is a thing of the past now that TRICARE, the military’s heath-insurance provider is allowing for future claims.  This should speed up the process and reimburse addicted service members for the out-of-pocket costs they have previously owed when they were using these drugs.

Addiction Inbox– Check out Charlie Lloyd’s account of the devastating effect of drug addiction stigma on treatment seeking. If we want to help, and not simply reinforce, the problem we must focus on education about addiction and not scare tactics.

Youth and drugs/addiction

Fox News– A two year old Indonesian boy has finally kicked his habit of smoking two packs a cigarettes a day. The toddler apparently first obtained the cigarettes from his father and became addicted quickly. Gives a whole new meaning to starting early…

The Vancouver Sun– Lindsey Lohan has opened up about her addiction in an interview with Vanity Fair. Lindsay conducted this interview before she went to serve her jail sentence and admitted that her actions were irresponsible and that she is addicted to prescription pills. LiLo would like to put the past behind her and get her career back. Good luck.

UPI– A Hawaiian man is suing a video games creator claiming that it lead to an addiction that left him unable to bathe, eat, dress, or wake during the day. Smallwood claims he spent more than 20,000 hours on his addiction and believes that the game should issue a warning that it may cause addiction because Smallwood still has a “compulsive urge and need” to play the game.

Body, brain, (di)stress, and death

Psypost – Young adults who get fewer than eight hours of sleep have a greater risk of developing  psychological mental  distress as well as depression and anxiety. This distress increased 14% for each hour lost in a night’s sleep. Get those ZZZZZZZZ’s !!!

Neurodynamics – A great read if you want to learn about the way in which the brain responds to stress. The amygdala,  the hippocampus, and the prefrontal cortex all play important parts, and this article will help you understand why and how.

Time– Abstainers apparently have shorter life expectancies than moderate drinkers. While the effect is similar to the reduced life-span of heavy drinkers, it’s a quirky finding that keeps showing up. There are a slew of suggestions and interesting ideas if you follow this article all the way to the study itself. The bottom line – Light and moderate drinkers likely do better than abstainers or heavy drinkers (alcoholics?) in the long run, even when a whole bunch of other factors are accounted for.

Breaking the cycles-What would you do if a police officer pulled you over and arrested you for driving under the influence if you BAC was not .08? This is a reality and the reason for the DUI is  the inability to drive a car with the same caution characteristic of a sober person. This inability to drive as carefully as a sober person is determined by the manner in which the car was driven, the physical signs and symptoms of the driver and the driver’s performance on field sobriety tests. This definitely give a new meaning to being careful when you have a few drinks and drive home.