Stress Regulation and Addiction

Research on stress and the factors associated with stress, such as addiction, has been prevalent over the last few years, with a focus on stress and its association with the development of addiction and addiction relapse. In the previous two decades, there has been a significant increase in the understanding of the underlying mechanisms for the association between stress and addiction. Researchers have found that there is evidence of changes at molecular and cellular levels that are associated with chronic stress and addiction ^[1].

In this article, we will explore the link between stress and addiction, which is important for treating these issues effectively to ensure that addiction is avoided.

Stress and Addiction: Is there a link?

Stress is a state of worry caused by a challenging circumstance or situation. It is a normal human response that forces one to problem-solve and face threats. Every person has experienced stress to some degree at some point. 

How stress is dealt with is important in determining how it affects mental well-being ^[2]. While some find healthy coping mechanisms (such as exercise), others may turn to less healthy alternatives, such as substances, which may pave the way for addictions and other dangerous behaviors.

According to The American Society of Addiction Medicine, addiction is defined as a treatable, chronic disease where a person uses substances or engages in behaviors that are compulsive and cause harmful consequences without being able to stop ^[3]. 

Many researchers have found evidence of a link between chronic stress and the use of addictive substances. Stressors, such as physical abuse, sexual abuse, childhood neglect, domestic violence in the home, or a dysfunctional family, may be associated with the risk of developing an addiction ^[4]. 

Can stress lead to addiction? 

Stress is considered a significant source of allostatic load (a measure of chronic stress ^[5]. Stress causes progressive, long-term changes within the brain, which can make a person more prone to drug use. In this drug-prone state, a person may experience symptoms such as cravings. Addictive substances and stress can result in an allostatic overload, which is responsible for the changes in the brain that are involved in most of the significant features of addiction ^[6].

Are people with addictions more susceptible to stress?

Because stress and substance abuse are mediated by the same neural circuits (pathways in the brain), these two conditions often co-occur. This means that not only can stress cause addiction, but addiction also increases a person’s risk of developing mental health conditions, such as stress and anxiety ^[7]. 

People who are addicted to substances typically face additional stressors that may aggravate their need to use substances or engage in other dangerous behaviors. Because of addiction, substance-dependent persons may face negative consequences, such as financial instability, unemployment, relationship strain, or health problems, which can significantly increase their overall stress levels ^[8].  

The Cycle of Stress and Addiction

Researchers have found that there are high rates of co-occurring substance use disorder and chronic stress diagnoses, which suggests that there is a relationship between substance use and stress. Because of the vast amount of research, we know that there is a link between chronic stress, trauma exposure, and the risk of developing addiction, but researchers have found that the link is deeper. Stress and addiction are a vicious cycle; abstinence from drug use can lead to increased stress, making addicts even more vulnerable to the effects of stress and the risk of relapse to cope with stress ^[9]. 

Can stress cause relapse in those recovering from addiction?

Relapse is an important facet of drug addiction, and it remains the most challenging problem when treating drug abuse. Studies specifically focused on alcohol relapse after treatment have found that highly stressful events increase the risk of relapse. This occurs because stress is associated with increased cravings and the urge to use substances. 

Chronic substance use can result in changes in the brain’s reaction to stress and the associated reward pathways. These modifications may alter a substance-dependent person’s response to stress, specifically the motivation to use substances, which increases the risk of relapse ^[10]. These studies, and many others like these, suggest that stress is one of the leading causes of relapse in those recovering from addiction.

Another study suggested that three types of events may induce relapse after extended periods of abstinence: an environment previously associated with drug-taking, re-exposure to the drug, and acute exposure to a stressful event. This same study found that even brief exposure to a stressor is enough to induce a relapse into drug-seeking behaviors. Remember that substance abuse also increases an addict’s susceptibility to stress, which in turn increases their susceptibility to relapse after a period of abstinence. 

This stress/substance abuse and relapse cycle highlights the importance of treating a substance-dependent person’s mental health conditions, including stress and anxiety, along with their substance abuse problems^[11]. 

Incorporating Stress Management in Your Addiction Recovery

Stress management is incredibly important for addiction recovery. Here are some stress management techniques that can be incorporated into an addiction recovery journey to prevent the risk of relapse:

1. Enough Quality Sleep 

Sleep deprivation is an increasingly common condition affecting mood and performance, not just physiological functioning. Sleep is necessary to regulate hormones like cortisol and melatonin^[12]. Cortisol (the stress hormone) is responsible for the fight-or-flight response. 

Poor sleep is associated with dysregulated cortisol levels and increasing stress levels. Research has found that when a person has more than one night of poor sleep (<5 hours), cortisol is more poorly regulated, leading to increased cortisol levels and heightened stress and anxiety^[13].

2. Yoga and Meditation

Exercise can alleviate stress by lowering cortisol levels, increasing endorphin production, and increasing the amount of oxygenated blood reaching the brain. Yoga may have additional benefits. By elevating gamma-aminobutyric acid (GABA) levels, yoga is associated with better mood and decreased anxiety^[14].

Meditation is defined as practicing focused attention. It involves consciously focusing on breathing and being in the moment without judging. There are many meditation types, each aiming to achieve deep relaxation and awareness ^[15]. For those suffering from addiction, one study found that as the brain and body became more sensitive to healthy pleasures, cravings were reduced. 

The same study found that people who used meditation were nearly twice as likely as those treated with psychotherapy to have stopped misusing opioids nine months later ^[16].

3. Mindfulness-Based Stress And Anxiety Management Tools

Stress can be managed through mindfulness-based stress reduction (MBSR). MBSR is a structured group program that uses mindfulness meditation to reduce the symptoms of psychiatric disorders. MBSR (a non-faith-based program that requires no previous training or knowledge) helps participants adopt mindfulness practices and focus on the current moment ^[17]. Research has found that MBSR can reduce anxiety symptoms in as little as two months ^[18]. 

Another method of mindfulness is dialectical behavioral therapy (DBT). Dialectical behavior therapy is a type of therapy that was first used to treat borderline personality disorder. DBT combines cognitive behavioral therapy with the Eastern Zen philosophy of acceptance. Group therapy sessions comprise four components: core mindfulness and distress tolerance (as components of acceptance) and emotional regulation and interpersonal effectiveness (as components of change) ^[19].

4. Reading

One study found that reading was as effective as yoga and humor in reducing stress over 30 minutes. The same study also found that reading reduced blood pressure and heart rate over 30 minutes. These results suggest that reading can positively impact physical and psychological health ^[20].

5. Laughter

One meta-analysis of ten studies comprising 814 participants found that laughter therapy effectively reduced stress in adults ^[21]. Humor stimulates many systems that decrease stress hormones, such as cortisol and epinephrine, and increase activation of the mesolimbic dopaminergic reward system ^[22].

Can medication alleviate stress and addiction?

Many medications are approved for stress management, which may help to reduce a person’s risk of developing an addiction. Conversely, some medicines may help a person manage addiction and, in turn, reduce a person’s levels of stress. 

As the mechanisms for stress and addiction are so similar, many of these approved medications overlap and can be used for the management of both. 

Some examples are:

Medication	Stress	Addiction	Both Stress and Addiction
Benzodiazepines[23]	✓
Antidepressants (SSRIs)[24]	✓	✓	✓
Antidepressants (MAOIs)[25]	✓
Beta-Blockers[26]	✓	✓	✓
Opioid partial agonist-antagonists[27]		✓
Opiate antagonists[28]		✓
Carbamate derivatives[29]		✓
Antidepressants (NDRIs)[30]	✓	✓	✓
Nicotinic receptor partial agonist[31]		✓

Conclusion

The same pathways in the brain process stress and substance abuse, and as a result, these two conditions often co-occur. Because of these overlaps, stress and addiction frequently form a vicious cycle, with one feeding into the other. Ensuring good sleep, incorporating mindfulness practices, reading, and laughter as part of a daily routine may help to reduce stress and decrease the risk of addiction and addiction relapse. 

As stress and addiction make use of the same neural circuits, many medications designed to treat either stress or addiction may be used to treat both of these conditions, making treatment options vast.