Stress and drug abuse

DEFINITION: Stress, a physiological reaction of the body to tension, is commonly associated with the body’s fight-or-flight response. Stress is associated with drug use, which is the maladaptive pattern of use of a substance.

Background

Stress has long been associated with drug abuse. The connection has been especially strong with drug relapse, and it also has been linked with the initiation of drug use. Correlations have been found between stressful life events and the use of substances. The higher rates of substance use by vulnerable populations have been attributed to the higher rates of stress from discrimination and socioeconomic disadvantage that group members often experience. Additional stressors that group members are disproportionately exposed to are violent and criminal environments.

Research has found that most people are affected by stressful events of great intensity. What is not well understood is why people react to stress differently. Also unclear are the determining factors for these differences. An additional area in need of investigation is why some persons react to stress by using drugs specifically.

Ethnographic researchers found that after life-threatening, stressful, catastrophic events, such as Hurricane Katrina in 2005, the acts of terrorism of September 11, 2001, and the COVID-19 pandemic, individuals with an addiction show a greater demand for drugs. Similarly, stress under conditions of war combat has led to elevated levels of substance use and subsequent addiction in the military community. The implication is that some persons cope with stressful events by self-medicating with drugs.

Stress has been associated with the use of several different types of drugs. Studies have demonstrated, for example, that under laboratory-induced stress, animals were prone to relapse and to self-administer amphetamines, heroin, cocaine, alcohol, and nicotine. Also, individuals who abuse cocaine reported more cravings for cocaine and alcohol when cued with imagery that was considered stressful versus imagery that was considered neutral.

Stress and substance abuse have a two-way relationship. Stressful events are known to trigger substance use in much of the population, but it is also important to note that substance use, addiction, and substance use disorders also lead to stress. Financial, relationship, legal, and employment challenges may all result from substance use. As these resulting pressures mount, the stress they cause is amplified by the effects of drugs or alcohol. Then, individuals are inclined to use more drugs or alcohol to escape the stress created, beginning the cycle again.

Brain Science Research

While many studies have demonstrated a correlation between stress and drug use, the mechanism by which the two are intertwined is unclear. Research on humans and nonhuman animals has shed light on how this mechanism might work. Discoveries in brain science have been especially exciting.

Research indicates that people experiencing chronic stress struggle with the regulation of stress-induced corticotropin-releasing factor (CRF), which stimulates hormonal responses (adrenocorticotropin and glucocorticoids) as part of the fight-or-flight (stress) response. In such a case, the hormones and, thus, the person’s biophysiological responses do not return to normal (homeostasis) once the stress is over. This process enhances a person’s susceptibility to stress-related illnesses and drug use. An impaired hormonal regulatory system that renders a person chronically hypersensitive may lead them to cope with that impairment by self-medicating with drugs. The body’s naturally occurring opioid peptides inhibit the release of the CRF and, thus, suppress the fight-or-flight response under normal circumstances when no threat is present or when the cause for alarm has ended.

Opioids, such as heroin, morphine, and methadone, act similarly to opioid peptides, which may explain their self-medicating properties, which dull stressful emotions for some people. However, during periods of absence from the drugs (withdrawal), hypersensitivity to stress returns at even greater levels, as does the need to self-medicate with the opiates. Cocaine operates similarly. Methadone maintenance is theorized to be effective for heroin addiction by helping to stabilize the self-regulatory system.

Persons with post-traumatic stress disorder also have a propensity for drug abuse, possibly because of a problem with their hormonal system not properly self-regulating. Challenges for researchers and clinicians working in psychology and addiction medicine include developing better treatment and prevention programs that teach healthier stress-management strategies to those persons vulnerable to stress-induced drug use. Additionally, identifying those individuals who are most susceptible to addiction resulting from stress continues to be a challenge.

Bibliography

Al’Absi, Mustafa. Stress and Addiction: Biological and Psychological Mechanisms. Academic, 2007.

Bride, Brian E., and Samuel A. MacMaster. Stress, Trauma, and Substance Use. Routledge, 2009.

Guarnotta, Emily. "The Connection Between Stress and Substance Abuse." Oxford Treatment Center, 7 Mar. 2023, oxfordtreatment.com/substance-abuse/co-occurring-disorders/stress. Accessed 20 Sept. 2024.

“Post-Traumatic Stress Disorder and Addiction.” Addiction Center, 29 July 2024, www.addictioncenter.com/dual-diagnosis/post-traumatic-stress-disorder. Accessed 20 Sept. 2024.

Sinha, Rajita. “Chronic Stress, Drug Use, and Vulnerability to Addiction.” Annals of the New York Academy of Sciences, vol. 1141, 2008, pp. 105–30.

Stewart, Sherry H., and Patricia Conrod. Anxiety and Substance Use Disorders. Springer, 2008.