What is the relationship between stress and drug abuse?

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 and the acts of terrorism of September 11, 2001, street addicts show a greater demand for drugs. Similarly, stress under conditions of war combat has led to elevated levels of substance use and subsequent addiction among soldiers and other military personnel. 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, cocaine abusers reported more cravings for cocaine and alcohol when cued with imagery that was considered stressful versus imagery that was considered neutral.

Brain Science Research

While many studies have demonstrated a correlation between stress and drug use, the science has not been able to explain the mechanism by which the two are intertwined. Research on humans and nonhuman animals has shed new light on how this mechanism might work. New discoveries in brain science have been especially exciting.

Persons under chronic stress have been found to have problems with the regulation of stress-induced corticotropin releasing factor (CRF), which stimulates hormonal responses that are a part of the fight-or-flight (stress) response. In such a case, the hormones and thus the person’s biophysiological responses are not returning to normal (to homeostasis) once the stress is over. This process is thought to enhance a person’s susceptibility to stress-related illnesses and drug use. An impaired hormonal regulatory system that renders a person chronically hypersensitive may lead that person to cope with that impairment by self-medicating with drugs. The body’s naturally occurring opioid peptides function to inhibit the release of the CRF and, thus, to 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 the opioid peptides and may thus explain their self-medicating properties, which dull stressful emotions for some persons. 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 is thought to operate 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 appear to have a propensity for drug abuse, possibly because of a problem with their own hormonal system not properly self-regulating. Challenges for researchers and clinicians working in psychology and addiction include developing better treatment and prevention programs that teach healthier stress-management strategies to those persons vulnerable to stress-induced drug use.

Bibliography

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

Bride, Brian E., and Samuel A. MacMaster. Stress, Trauma, and Substance Use. New York: Routledge, 2009. Print.

“Post Traumatic Stress Disorder and Addiction.” DualDiagnosis.org. DualDiagnosis.org, 2015. Web. 9 Nov. 2015.

Sinha, Rajita. “Chronic Stress, Drug Use, and Vulnerability to Addiction.” Annals of the New York Academy of Sciences 1141 (2008): 105–30. PDF file.

Stewart, Sherry H., and Patricia Conrod. Anxiety and Substance Use Disorders. New York: Springer, 2008. Print.