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Prog Neuropsychopharmacol Biol Psychiatry. 2014 Jan 3;48:220-8. doi: 10.1016/j.pnpbp.2013.10.011. Epub 2013 Oct 23.

Dysregulated responses to emotions among abstinent heroin users: correlation with childhood neglect and addiction severity.

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Drug Prevention and Health Branch, Division for Operations, United Nation Office on Drugs and Crime, 1400 Vienna, Austria.


The aim of this paper was to investigate the subjective responses of abstinent heroin users to both neutral and negative stimuli and the related hypothalamus-pituitary-adrenal reactions to emotional experience in relationship to their perception of childhood adverse experiences. Thirty male abstinent heroin dependents were included in the study. Emotional responses and childhood neglect perception were measured utilizing the State-Trait Anxiety Inventory Y-1 and the Child Experience of Care and Abuse Questionnaire. Neutral and unpleasant pictures selected from the International Affective Picture System and the Self-Assessment Manikin procedure have been used to determine ratings of pleasure and arousal. These ratings were compared with normative values obtained from healthy volunteers used as control. Blood samples were collected before and after the experimental sessions to determine both adrenocorticotropic hormone and cortisol plasma levels. Basal anxiety scores, cortisol and adrenocorticotropic hormone levels were higher in abstinent heroin users than in controls. Tests showed that anxiety scores did not change in controls after the vision of neutral slides, whilst they did in abstinent heroin addicts, increasing significantly; and increased less significantly after the unpleasant task, in comparison to controls. Abstinent heroin users showed significantly higher levels of parent antipathy and childhood emotional neglect perception than controls for both the father and the mother. Plasma adrenocorticotropic hormone and cortisol levels did not significantly increase after unpleasant slide set viewing among addicted individuals, because of the significantly higher basal levels characterizing the addicted subjects in comparison with controls. Multiple regression correlation showed a significant relationship between childhood neglect perception, arousal reaction, impaired hypothalamus-pituitary-adrenal axis response and addiction severity. Early adverse experiences seem to affect the entire interaction between hyper-arousal, reduced hormonal response to stress and addiction severity. Our findings, although obtained in a small number of subjects, indicate a significant link between the perception of parental style/care/support during childhood and the ability to cope with stressful emotional stimuli in adulthood and addiction severity.


ACTH; ASI; Addiction; Addiction Severity Index; Adverse childhood experiences; CECA-Q; CRF; Child Experience of Care and Abuse Questionnaire; DSM; Diagnostic and Statistical Manual of Mental Disorders; Emotional responses; GEE; Generalized Estimating Equation; HPA; HPA axis; IAPS; International Affective Picture System; SAM; SCI; SIDP-IV; STAI; Self-Assessment Manikin; State-Trait Anxiety Inventory; Structural Clinical Interview; Structured Interview for DSM IV Personality Disorders-IV; Vulnerability; adrenocorticotropic hormone; corticotrophin releasing factor; hypothalamus-pituitary-adrenal

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