(Newswise) — Among people in treatment for alcohol dependence, the severity of withdrawal symptoms during early alcohol abstinence may be affected by the life adversity they have experienced, a small study suggests. “Cumulative adversity” is the sum of an individual’s challenging and traumatic life circumstances. This chronic wear and tear is associated with a range of health outcomes—including substance use disorders, where the effects of stress are known to underpin craving and relapse.
Early abstinence is associated with shifts in mood, anxiety, sleep patterns, cardiovascular function, and other physiological processes. While acute alcohol withdrawal is well understood, early abstinence symptoms and their impact on treatment are not, and they may be key to clinical outcomes.
For the study in Alcohol: Clinical & Experimental Research, investigators worked with data from 34 participants undergoing inpatient alcohol treatment, categorized into high-adversity and low-adversity groups, and 38 light social drinkers (controls). They examined cravings, withdrawal symptoms, mood, and cardiovascular measures during the patients’ initial three to four weeks of abstinence, and assessed whether cumulative adversity influenced the severity and trajectory of their withdrawal.
When admitted to treatment, the high-adversity patients reported, among other adverse circumstances, an average of 15.2 traumatic life events, compared to 6.1 in low-adversity patients and 5.3 in controls.
Those with higher cumulative adversity had more severe abstinence symptoms (on all measures) compared with the control group, and (on most measures) compared with the low-adversity participants. The high-adversity patients reported more anger/hostility, fatigue/inertia, confusion/bewilderment, and withdrawal symptoms than those with lower adversity, even after accounting for recent alcohol and tobacco use, and began treatment with more intense alcohol cravings.
Although these heightened symptoms resolved, they may be important indicators of clinical outcomes, including relapse, dropping out of treatment, and medication effectiveness. Cardiovascular measures were within the normal range for both patient groups. However, differences included a slightly elevated and persistent heart rate pattern among the high-adversity participants compared to the low-adversity group. This, too, may flag greater vulnerability to craving and relapse.
The findings suggest that cumulative adversity may influence individual responses to starting alcohol abstinence, contributing to a combination of symptoms that may be associated with outcomes. Cumulative adversity and tracking early abstinence symptoms may therefore help inform personalized treatment approaches for alcohol use disorder. Traumatic stress may have a particularly disruptive impact, underlining the importance of addressing trauma early in recovery.
Additional research is needed.
