Longitudinal associations between diurnal cortisol slope and alcohol use across adolescence: A seven-year prospective study

Summary A large body of research has linked hypothalamic–pituitary–adrenal (HPA) axis function and alcohol consumption, including work suggesting that flatter diurnal cortisol slopes are associated with greater alcohol use. A lack of longitudinal studies and a focus on adult and alcoholic populations leaves unclear whether such associations are also present in younger, non-clinical populations and whether flatter diurnal slopes are a consequence of or preexisting risk factor for alcohol use; however, theory suggests such associations may be mutually reinforcing. In a longitudinal, community sample of 200 (55% female) adolescents, the current study demonstrates that flatter diurnal cortisol slope at age 11 predicts higher levels of alcohol use from ages 15–18, and that heavier alcohol use in turn predicts further flattening of diurnal cortisol rhythm at age 18.5. This is the first study to demonstrate a longitudinal chain of associations between diurnal cortisol slope and alcohol use. Findings support contemporary theoretical models of the neurobiological processes underlying alcohol use and can inform future research on risk factors for and consequences of underage drinking.