Heavy alcohol use, rather than alcohol dependence, is associated with dysregulation of the hypothalamic-pituitary-adrenal axis and the autonomic nervous system

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

Research output: Contribution to journalArticleAcademicpeer-review

55 Citations (Scopus)


BACKGROUND: Heavy alcohol use as well as alcohol dependence (AD) have been associated with dysregulation of the hypothalamic-pituitary-adrenal (HPA)-axis and the autonomic nervous system (ANS). However, the relative contribution of alcohol use and AD is unclear.

METHODS: Baseline data were derived from 2947 persons of the Netherlands Study of Depression and Anxiety (NESDA), including non-drinkers (n=498), moderate drinkers (n=2112) and heavy drinkers (n=337). We also distinguished between persons with no lifetime DSM-IV AD (n=2496), remitted AD (> 1 year; n = 243), and current AD (≤ 1 year; n=208). ANS measures included ECG-based heart rate (HR), respiratory sinus arrhythmia (RSA, high RSA reflecting high cardiac parasympathetic control) and pre-ejection period (PEP, high PEP reflecting low cardiac sympathetic control). HPA-axis measures included the cortisol awakening response (area under the curve with respect to the ground [AUCg] and increase [AUCi]), evening cortisol and a 0.5mg dexamethasone suppression test, all measured in saliva.

RESULTS: Heavy drinkers showed higher basal cortisol levels (AUCg: p=.02; evening cortisol: p=.006) and increased cardiac sympathetic control (higher HR: p=.04; lower PEP: p=.04) compared to moderate drinkers. Persons with current or remitted AD did not differ from persons without lifetime AD on any of the HPA-axis or ANS indicators (all p>.33). Similar patterns of HPA-axis and ANS activity across alcohol use groups were found in persons with and without lifetime AD.

CONCLUSIONS: Our findings suggest that current heavy alcohol use, rather than current or remitted AD, is associated with hyperactivity of the HPA-axis and increased cardiac sympathetic control.

Original languageEnglish
Pages (from-to)170-176
Number of pages7
JournalDrug and alcohol dependence
Issue number1-3
Early online date16 Feb 2011
Publication statusPublished - 1 Jul 2011


  • Adult
  • Alcohol Drinking/epidemiology
  • Alcoholism/epidemiology
  • Autonomic Nervous System/physiopathology
  • Databases, Factual
  • Electrocardiography/drug effects
  • Ethanol/pharmacology
  • Female
  • Heart Rate/drug effects
  • Humans
  • Hydrocortisone/metabolism
  • Hypothalamo-Hypophyseal System/physiopathology
  • Male
  • Middle Aged
  • Netherlands
  • Pituitary-Adrenal System/physiopathology
  • Saliva
  • Surveys and Questionnaires
  • Time Factors

Cite this