Stress and Addiction
Stress is the brain’s response to change, which alters the body’s homeostatic, or natural balanced, state. Each person has a particular stable rate at which their body functions and their brain chemistry rests. External changes, or stress, impact this state. Stress can be positive and negative, mild and severe, and short-term or chronic. Examples of events that can cause stress include riding a roller coaster, pressure at work, traveling or moving, winning a competition, marriage or divorce, starting a new job, being fired, a daily commute, being in a car crash or an accident, the death of a loved one, financial difficulties, watching scary movies, being the victim of trauma, or witnessing a traumatic event.
The National Institute on Mental Health (NIMH) reports that there are three main types of stress: routine stress, stress that is the response to sudden change, and stress that is traumatic. Routine stress is just that – a person’s response to everyday life obligations, including school, work, family, and other daily life events. Stress that comes up as a the result of a sudden and significant change, such as illness, divorce, or loss of a job, is in response to noteworthy events in a person’s life. Traumatic stress occurs as the result of being involved in, or witness to, any particular event during which a person feels a real threat for major injury or death, such as war, natural disaster, major accident, or assault.
In most situations, stress is transient, which means that it is short-lived, and the body soon returns to normal after the stressor has passed. In other cases, stress can be chronic. Reoccurring stress can be a risk factor for negative coping mechanisms that can be self-destructive, such as substance abuse. Drugs and alcohol can dampen the stress response and provide a temporary respite. Continuing to use drugs and/or alcohol as coping mechanisms for stress can increase a person’s vulnerability to addiction.
The American Society of Addiction Medicine (ASAM) cites stress and the inability of a person to cope naturally as potential risk factors for addiction. The National Survey on Drug Use and Health (NSUDH) publishes that one out of every 12 adults in the United States suffered from addiction to drugs and/or alcohol in 2014. As addiction is a chronic disease, affecting pathways and circuitry in the brain, stress can play a role in both its onset and the perpetuation of addiction. By learning new and healthy ways to manage stressors, both addiction and stress may be controlled.
The Brain and Body’s Response to Stress
When someone feels stress, the amygdala sends a signal to the hypothalamus. The amygdala is a region in the brain that helps to regulate and process emotions, and the hypothalamus uses the automatic nervous system to send signals throughout the body on how to function. It can tell the body to ramp up its response to danger, for example, or to slow down if the stressor is perceived as mild. When the stressor is deemed significant, the brain then releases corticotropin-releasing factor (CRF) into the bloodstream, which signals the pituitary gland to release adrenocorticotropin hormone (ACTH). These hormones activate the adrenal glands to then produce cortisol, which is often called the “stress hormone.” Cortisol activates the body’s “fight-or-flight” reaction to stress and autonomic functions of the central nervous system, and many of the brain’s chemical messengers, called neurotransmitters, are impacted.
Heart rate speeds up; focus, alertness, energy levels, and memory functions improve; body temperature, respiration, and blood pressure increase; muscles tense; and immune system functions may be heightened. All of these are the body’s response to stress, and they are aimed at helping a person survive.
Stress isn’t always bad. In fact, it can be an important response to a dangerous situation, thus enhancing survival. However, chronic exposure to unregulated stress can have many negative psychological and physical side effects. According to Mayo Clinic, stress can cause:
- Muscle tension
- Gastrointestinal upset
- Sleep issues
- Chest pain
- Changes in sex drive
- Lack of motivation
- Appetite fluctuations
- Episodes of anger, aggression, hostility, and potentially violence
- Increased drug, tobacco, and alcohol use
Chronic stress can lead to serious health concerns as well, such as diabetes, heart disease, hypertension, depression, and anxiety disorders. Traumatic stress can become an issue when intrusive thoughts, flashbacks, and the stress reaction continue after the danger has passed and lead to post-traumatic stress disorder (PTSD).
PTSD is the result of being witness to, or the victim of, an intense traumatic event wherein the individual feels that they are in a potentially life-threatening situation. After the event, the stress response remains active and doesn’t shut off like it should. Alcohol and drug use is commonly associated with PTSD as the US Department of Veterans Affairs (VA) reports that one out of every three military veterans who seeks treatment for addiction also suffers from co-occurring PTSD.
Drugs and Alcohol as Tools for Stress Management
Stressors, both external ones, like job stress, and internal ones, like anxiety, can make it more likely that a person will not only turn to drugs or alcohol to cope, but also increase their vulnerability to developing problematic substance abuse. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) publishes research indicating that stress is a common indicator of a risk factor for developing an alcohol use disorder. Alcohol is a central nervous system depressant that stimulates both the production of dopamine and gamma-aminobutyric acid, or GABA. Other central nervous system depressants include benzodiazepine mood-stabilizing or sedative/tranquilizer drugs (e.g., Xanax, Ativan, Klonopin, and Valium), and opioid drugs like heroin and prescription painkillers (e.g., Vicodin, fentanyl, and OxyContin).
Both GABA and dopamine are neurotransmitters that act as the brain’s chemical messengers. Dopamine signals happiness and helps with mood regulation while GABA has a sedative effect, thus slowing down the stress response. In the short-term, these side effects can be desirable as alcohol and depressant drugs can then relieve stress and promote feelings of pleasure.
When alcohol or drug use is perpetuated, natural brain chemistry is disrupted, however. Dopamine and GABA are no longer moved around the brain and produced in the same amounts as they were before alcohol was introduced. Alcohol dependence may set in. When alcohol then leaves the bloodstream, withdrawal symptoms can occur as levels of these neurotransmitters dip. When this happens, anxiety and stress can actually be increased, leading a person to potentially feel the need to drink more alcohol to assuage the heightened stress and difficult physical and emotional symptoms of withdrawal.
Addiction is the inability to control use of alcohol or drugs. Individuals take more drugs, more often than they intended to and are unable to stop once they start. Alcohol and/or drugs often become the number one priority in a person’s life. Finances, personal relationships, work, school, social priorities, and family obligations all begin to suffer as a result. What may have started as a method of self-medication for difficult emotions or high levels of stress can end up making these feelings worse and creating more problems. The National Institute on Drug Abuse (NIDA) warns that high levels of stress can increase substance abuse and also cause a person to keep abusing drugs and or alcohol as a result.
Age, Stress, and Addiction
Parts of the brain that are involved in the stress response, and also in mood regulation, memory formation, learning, and reward processing, are not fully developed until a person is 25, making the brain malleable and vulnerable in childhood, adolescence, and young adulthood, Psychology Today reports. Drug and alcohol abuse, as well as exposure to high levels of stress, at a young age can actually impact regions of the brain that are still developing.
The National Child Traumatic Stress Network (NCTSN) publishes that as many as one out of every four children in the United States suffers from at least one traumatic event before they turn 16, and as many as one out of every eight 17-year-old individuals has suffered from PTSD at some point in their lifetime. Chronic stress and negative thought patterns can damage developing parts of the brain, increasing the risk for mental health disorders like mood or anxiety disorders later in life, Psychology Todaywarns.
Adolescents are also especially vulnerable to drug and alcohol abuse, as regions of the prefrontal cortex, which regulate impulse control and risk-taking behaviors, are not yet fully formed. In 2015, nearly a quarter of high school seniors had abused illicit drugs in the past month and over 35 percent drank alcohol, according to the Monitoring the Future (MTF) survey published by NIDA. NCTN further warns that one out of five American teenagers between the ages of 12 and 17 engages in abusive or problematic drug and/or alcohol abuse annually.
Using drugs and alcohol at a young age makes it more likely that a person will suffer from addiction. The 2013 NSDUH reports higher incidence of addiction to both marijuana and alcohol in those who started using the substances before age 14 as opposed to those who waited until age 18 to try them. The journal the Annals of the New York Academy of Sciences publishes information linking early exposure to trauma, stress, and chronic stress to an enhanced predisposition to addiction. Thus, using drugs and/or alcohol to manage stress is especially harmful in teenagers and young adults whose brains are not completely developed, potentially opening the door to more issues later in life.
Getting Help for Both Addiction and Stress
Since substance abuse, addiction, and stress are so closely linked together, treatment plans are integrated and provide simultaneous methods for managing both disorders. By helping to provide healthy coping mechanisms for stress and tools for managing triggers and stressors as they arise, a more balanced emotional state can be achieved, which can help to prevent relapse and enhance addiction recovery.
Cognitive Behavioral Therapy (CBT) works with individuals to recognize negative thoughts and destructive patterns of behavior as well as to develop new ways for managing and improving them. Triggers are defined, underlying stressors are explored, and coping mechanisms are developed through group, family, and individual therapy sessions. Pharmacological tools are often helpful for treating high levels of stress and anxiety as well, in order to help rebalance brain chemistry while healing takes place. Medications are best used as part of a complete treatment program that uses both behavioral methods and pharmacology.
Holistic methods work well for managing stress and preventing a return to drug or alcohol use. For example, mindfulness meditation and yoga are methods of helping individuals to improve balance between the mind, body, and soul and for naturally decreasing levels of stress. Negative perceptions of oneself can increase levels of stress and make someone more vulnerable to relapse. By learning to be more aware of thoughts, emotions, and the body’s response to them, individuals using mindfulness meditation techniques may be more equipped to manage stress and negative emotions, the journal Substance Abusepostulates. These methods can be performed anywhere and in any situation, without the need for specialized equipment.
Exercise, healthy amounts of sleep, and nutritious meals also go a long way in recovery from both stress and addiction. Massage therapy, acupuncture, chiropractic care, creative and art therapy, and other complementary forms of medicine can enhance traditional treatment measures for addiction and stress management. By helping to control levels of stress, individuals may be less likely to feel they need drugs or alcohol, and by decreasing substance use, stress often also decreases.