{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T13:29:34Z","timestamp":1787059774876,"version":"build-2736575974"},"reference-count":89,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Addiction"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and aims<\/jats:title>\n                    <jats:p>Diurnal cortisol dysregulation and daily stressor severity may jointly forecast long\u2010term alcohol use disorder (AUD) and substance use disorder (SUD) severity, yet most evidence is cross\u2010sectional and relies on single cortisol indices. This study examined whether three cortisol indices nonlinearly interacted with daily stressor severity to predict 9\u2010year AUD and SUD severity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Longitudinal observational study with a 9\u2010year follow\u2010up. Analyses were not pre\u2010registered.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Community\u2010based sample in the United States of America.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>1617 community\u2010dwelling adults aged 33\u201383\u2009years at baseline.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>Ecological momentary assessments of salivary cortisol and daily stressor severity were collected at baseline. AUD and SUD severity were self\u2010reported at baseline and 9\u2010year follow\u2010up. Cortisol indices included diurnal cortisol slope, cortisol awakening response and area under the curve (AUC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>\n                      Parametric hurdle Poisson models yielded null main effects and interactions (all\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&gt;\u20090.050). Generalized additive models with negative binomial family revealed three statistically significant nonlinear interactions: diurnal cortisol slope \u00d7 stress predicting AUD severity [effective degrees of freedom (edf)\u2009=\u20092.09, \u03c7\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200912.56,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.005], cortisol awakening response \u00d7 stress predicting SUD severity (edf\u2009=\u20092.88, \u03c7\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200911.60,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.019) and AUC\u2009\u00d7 stress predicting AUD severity (edf\u2009=\u20094.08, \u03c7\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200916.34,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.006). Adjusting for age, sex, education, income and race nullified all three interactions; however, AUC \u00d7 stress interaction \u2192 AUD remained statistically significant after controlling for anxiety and depression.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Nonlinear interactions between cortisol indices and daily stressor severity appear to predict 9\u2010year alcohol use disorder and substance use disorder severity, with cortisol area under the curve emerging as the most robust indicator. Findings are predictive rather than causal. Cognitive\u2010behaviorally based prevention programs targeting stress and cortisol regulation may mitigate substance use risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/add.70575","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T13:10:21Z","timestamp":1787058621000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["From allostasis to addiction: Cortisol dysregulation, daily stress and relations with 9\u2010year alcohol and substance use disorder severity in community adults"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2023-3173","authenticated-orcid":false,"given":"Nur Hani","family":"Zainal","sequence":"first","affiliation":[{"name":"Department of Psychology National University of Singapore  Singapore"},{"name":"Yeo Boon Khim Mind Science Centre National University of Singapore  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