0001 for the upper row, P<.01 for the lower row; N=11 for each group). The extent to which the stress response of the alcohol-dependent patients is impaired can be seen from the consistently higher stimulation of their epinephrine levels on all of the 6 days of assessment as compared with control subjects at the time point when the intravenous Inhibitors,research,lifescience,medical cannula was inserted (at 7 AM). Figure 4. Diurnal profile of epinephrine during course of alcohol abstinence (see text

for details). Personalty disorder and chronicity of addiction as potent independent predictors of an unfavorable treatment outcome A central issue of therapy research is to estimate the intensity of treatment Inhibitors,research,lifescience,medical needed on the basis of addiction severity of individuals. This approach is based on the assumption that patients whose addiction is less severe than others’ might also benefit from less intensive treatment, whereas patients whose addiction

is more severe need a more intensive therapy. However, it is far from clear which variables within the broad range of substance use data constitute the essential features of addiction severity14,69,86 The OLITA setting prepared the ground for a prospective longitudinal study that examined which components Inhibitors,research,lifescience,medical of addiction severity predict time to relapse for a subsample

of 112 patients during 4-year follow-up.108 Among the various analyzed sociodemographic, psychiatric, and alcoholism-related patient characteristics, Inhibitors,research,lifescience,medical only the presence of a personality disorder (Wald=7.83, df=1, P= .005) and chronicity Inhibitors,research,lifescience,medical of addiction (Wald=5.17, df=1, P=.023) were independently associated with a decrease of cumulative 4-year abstinence probability. Chronicity was defined as the Luminespib mouse percentage of a patient’s lifetime that he or she has been addicted (ie, duration of dependence divided by age at the beginning of therapy). As illustrated in Figure 5, patients with a comorbid personality disorder and/or higher chronicity of addiction had a lower abstinence probability all and a shorter time to relapse than patients without personality disorder and/or with lower chronicity The four abstinence curves differ significantly (Breslow statistic=10.36, P=.02). Pairwise single comparisons of abstinence curves show that patients with both predictors are more at risk to relapse (.53, N=25, black line) than patients with no personality disorder and only low chronicity (.93, N=14, red line) (Breslow statistic=5.5, P=.02). Abstinence curves of patients who are handicapped only by personality disorder (.59, N=23, green line) or only by high chronicity (.