Research shows that there is a connection between a person experiencing stress and then initiating into drug abuse or relapsing. At present, there are several such research studies in circulation throughout the field of addiction science. Rather than speak in generalities, addiction science researchers and clinicians (including psychiatrists and therapists) rely on the discrete findings of studies in order to understand addiction and develop methodologies to treat it. For the lay public, one approach is therefore to consider the insights from some of these studies.
Stress and Its Connection to Drug Abuse
Stress arises in different situations and with different consequences. When a person experiences a short-term stressor, like having to take an exam, some uncomfortable feelings will likely emerge. Long-term stress, such as going through a divorce or experiencing grief after a death, can lead to serious health problems. Traumatic events, such as experiencing a terrorist attack or a natural disaster can cause a host of serious health troubles, one of which is the development of post-traumatic stress disorder (PTSD).
Stress is unique in that on the one hand, it can give a person the requisite focus and strength to get through a difficult situation. However, when stress is persistent or arises from a seriously troubling experience, the stress manifests new, severe problems. Drug addiction can be one such severe problem.
The National Institute on Drug Abuse (NIDA), explains how stress works in the body. At the outset, it is helpful to note that people have different levels of stress thresholds, so not everyone is the same in this respect. When people experience stress, a chain of biological events takes place that involves the release of brain and body chemicals. In reaction to a stressor in the environment, the brain complex known as the hypothalamus releases corticotropin-releasing hormone (CRH), which may also be referred to as corticotropin-releasing factor (CRF). The corticotropin then travels through the blood to the pituitary gland in the brain and triggers the release of the hormone adrenocorticotropic. This hormone then travels to the adrenal glands (above the kidneys) and triggers the release of additional hormones, including cortisol. If the stress continues, this entire biological cycle repeats, but it usually ends when the person is away from the stressor.
Studies posit that individuals who abuse drugs may have lower thresholds of stress tolerance. This theory would explain, at least in part, why some people initiate into and maintain drug abuse while others do not. Another theory is that drug abuse can weaken a person’s stress tolerance, thus disposing them to re-engage in drug use (i.e., relapse) in response to a mild stressor, like a paycheck being late or an argument with a loved one. There are likely to be biological and environmental factors involved in a person’s stress tolerance level.
Research on heroin and prescription opioid abuse suggests that use of these drugs can stop the natural stress cycle from occurring. In other words, a person who experiences acute stress may initiate into opioid abuse to get relief from this feeling. It’s a simple but dangerous calculation — if a person feels stressed and opioids provide a break, then drug use becomes a way of coping (while creating a host of new psychological, biological, social, and emotional problems). The connection between stress and addiction only bolsters the fact that addiction is a disease.
Facts on Stress and Drug Addiction
An overview of the findings from different studies illuminates the different facets of the relationship between stress and substance abuse. NIDA provides the public with the following snapshot of research conclusions from various on-topic studies:
- People who are exposed to stress face a greater likelihood of abusing alcohol and other drugs as well as being more likely to experience relapse after a period of abstinence.
- A review of a collection of studies found that high stress was a predictor of continued use of opiates, such as heroin. From an abstinence maintenance standpoint, this means that individuals in recovery from opiate abuse need to learn stress-reduction strategies and have their survival needs met through personal efforts and case management services, as necessary.
- In animal studies, even when animals were not previously exposed to illicit drugs, the introduction of stressors into their environment increased their likelihood to self-administer drugs (e.g., such as pushing on a simple lever that releases a narcotic in lab experiments).
- Stress is a delicate biological phenomenon. Acute stress can improve memory. However, chronic stress can impair memory and cognitive functioning (the brain’s thought-processing and thought-making structures).
- There is an overlap between the circuits in the brain that respond to stress and those that respond to drug use. This shared circuitry only bolsters the linkage between stress and drug abuse.
- In the case of cocaine abuse, in one study, individuals who were in recovery from this drug experienced a sharp increase in cravings for cocaine and alcohol when they were exposed to stressors and drug cues (like images related to drug use). However, when these same study participants were exposure to relaxing images, their cravings decreased.
- In the case of cigarette smokers, a nationwide study found that after nicotine users achieved abstinence, their ability to maintain it depended in great part on their skillfulness regarding stress management. In other words, those who had poorer coping strategies in the face of stress relapsed at a greater rate than those who had stronger coping skills.
- Animal studies demonstrate the strong connection between stress and drug relapse, particularly when the drugs are alcohol, cocaine, heroin, and nicotine.
It bears discussing the aftercare process at this juncture. To provide a brief background for those individuals who are new to the drug recovery landscape, there are three main phases of recovery: detoxification, primary treatment for the addiction, and aftercare. Unlike the first two phases, which typically occur in a rehab facility, the aftercare process is largely self-directed because it begins after graduation from a rehab program (though a rehab program can help a person to develop an aftercare strategy before the end of the program and hence get a solid start to this critical phase).
A main key to the aftercare process is supportive services. Support can come in countless ways and includes social networks and a cluster of services that fall under the category of case management. Some individuals in aftercare have the financial means to take care of their survival needs, while others — possibly as a result of the drug abuse — will need support with the basics, such as housing, money, childcare, transportation, job placement help, and educational training. At the same time, individuals in aftercare will have an entire recovery regimen to engage in that may include residence in a sober living home, continuing individual therapy, ongoing group therapy meetings, and group recovery meetings (such as through Narcotics Anonymous or an alternative).
It may not seem like it at first blush, but all of the research discussed in this article regarding stress and recovery maintenance makes clear that meeting one’s personal and survival needs during aftercare is really just as critical as continuing to engage in recovery-oriented services. With these points in mind, it is helpful to look more closely at the connection between stress and relapse.
Stress and Relapse
As the Huffington Post reports, researchers at Brown University in the area of addiction science and neurology have made an important discovery. They have identified, at least in rats, the exact area of the brain that plays a critical role in drug relapse due to stress (among other factors). This area is called the ventral tegmental area (VTA). The great takeaway from this finding is that scientists may be able, going forward, to develop treatments that can work on this area of the brain to prevent a stress-induced relapse. The study did not conclude why relapse occurs but gained exceptional insight into how it happens.
Stated simply, stress affects the strength of the synapses (those areas where chemical messengers travel from one neuron to another) in the VTA, where dopamine neurons are active (among other places in the brain as well). Stress, it is now understood, stimulates kappa opioid receptors in the VTA. Thus, blocking these receptors, at least in rats addicted to cocaine, has been shown to help prevent a relapse after the rats are detoxed from this powerful stimulant drug. The chemical that has been shown to block the kappa opioid receptors in the VTA, and thus potentially ward off a relapse, is called nor-BMI. This chemical is slated to be tested in humans with the hope that it will offer the public the first relapse prevention drug in history.
Taking this study together with the earlier point made about the need for case management and supportive services and people during aftercare, it is evident that a lot of effort must go into avoiding relapse after recovery. It should not come as a surprise because many individuals who have decades of sobriety under their belts are clear that recovery is a lifelong process – one they embrace as a necessity as well as a blessing. Recovery, over the long-term, is not expressly about avoiding relapse. Rather, stated in the positive, recovery is about developing skills and using available supportive services to build a strong blueprint for living a drug-free and personally fulfilling life.