Cortisol as a Biomarker of Alcohol Use in Combat Veterans: A Literature Review and Framework for Future Research

Yvette Z. Szabo, Tessa Breeding, Christina Hejl, Rakeshwar S. Guleria, Steven M. Nelson, Laura Zambrano-Vazquez

Research output: Contribution to journalReview articlepeer-review

6 Scopus citations


Objective: Alcohol use and alcohol use disorders (AUDs) are an increasing concern among veterans, particularly those from recent conflicts in Iraq and Afghanistan. The study of biomarkers in alcohol use and AUD has moved to enhancing the understanding of the development and maintenance of AUDs, as well as investigating its association with clinical severity and potential predictors of treatment response. Cortisol, a glucocorticoid known as a stress hormone, has been linked with both stress and trauma, as well as increased alcohol suppression effects. Method/Results: The present review summarizes existing literature and presents suggestions for future research to evaluate whether cortisol may be a possible biomarker of alcohol use disorder risk in combat veterans. Specifically, aspects of combat deployments and high levels of PTSD, coupled with the stress of reintegration may dysregulate cortisol and increase risk to AUD. There may also be bidirectional impacts, such that alcohol is used as a coping mechanism and can dysregulate hypothalamic pituitary adrenal (HPA) axis functioning and cortisol. Conclusions: In the context of this framework, cortisol may serve as a biomarker for the development of AUD, as well as a biomarker of risk or relapse. This review ends with both theoretical and clinical implications, as well as directions for future research.

Original languageEnglish (US)
Pages (from-to)322-335
Number of pages14
JournalJournal of Dual Diagnosis
Issue number3
StatePublished - Jul 2 2020
Externally publishedYes

Bibliographical note

Funding Information:
Dr. Szabo?s work on this study was supported in part by the Department of Veterans Affairs Office of Academic Affiliations Advanced Fellowship Program in Mental Illness Research and Treatment, the Medical Research Service of the Central Texas Veterans Healthcare System, and the VISN 17 Center of Excellence for Research on Returning War Veterans. This work was supported in part by Career Development Award Number IK1 RX003122 from the United States (U.S.) Department of Veterans Affairs Rehabilitation Research and Development (RR&D) Service. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government. The authors would like to acknowledge Abigail Herschbach for her assistance in formatting and technical editing.

Publisher Copyright:
© 2020 Taylor & Francis Group, LLC.


  • Cortisol
  • Veterans
  • alcohol abuse
  • alcohol use
  • biomarker
  • combat
  • stress
  • trauma


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