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Interactions among the brain, the pituitary gland, and the adrenal glands (i.e., the hypothalamic-pituitary-adrenal [HPA] axis) help regulate the body's response to stress. The adrenal hormone cortisol plays a key role in stress reduction through its effects on multiple body systems. Excessive cortisol activity during both chronic alcohol administration and withdrawal may underlie some of the clinical complications of alcoholism, including increased risk of infectious diseases; bone, muscle, and reproductive system changes; altered energy metabolism; and disorders of mood and intellect. Despite excessive cortisol levels during intoxication and withdrawal, however, the HPA axis becomes less responsive to stress during abstinence, potentially resulting in an impaired capacity to cope with relapse-inducing stressors. KEY WORDS: AOD withdrawal syndrome; physiological stress; hypothalamic-pituitary axis; pituitary-adrenal axis; cortisol; AOD abstinence; chronic AODE (alcohol and other drug effects); corticotropin RH; arginine; vasopressin; adrenocorticotropic hormone; secretion; metabolic disorder; AODR (alcohol and other drug related) disorder; mood and affect disturbance; personality disorder; infection; drug therapy; literature review
Stress is a ubiquitous and unavoidable experience of daily life whether it arises from the external environment (e.g., a job interview or traffic accident) or from within the body (e.g., an infection or a panic attack). The body has powerful mechanisms to cope with stress. Among these mechanisms is a hormone called cortisol, which is produced and secreted by the adrenal glands, located atop the kidneys (see figure 1). Without cortisol a human or animal cannot respond appropriately to different types of physical or mental stress. However, because cortisol affects a wide range of critical physiological processes, the activity of cortisol must be tightly controlled by the body.
Cortisol secretion is regulated by interactions among three structures: the hypothalamus, the pituitary gland, and the outer layer (i.e., cortex) of each adrenal gland (see figure 1). These three structures, collectively known as the hypothalamic-pituitary-adrenal (HPA) axis, provide a regulatory network linking the brain with the body's behavioral and physiological responses to stress.
Alcohol consumption disrupts this regulatory balance. Excessive cortisol secretion occurs during both chronic alcohol consumption and alcohol withdrawal. This heightened secretion rate may alter energy metabolism, mental status, the structural integrity of bone and muscle tissue, and the body's ability to resist infection. In addition, abstinent alcoholics exhibit a diminished ability of the HPA...