Stress is a key risk factor in addiction initiation, maintenance, relapse, and thus treatment failure (Sinha & Jastreboff, 2013). Stressful life events combined with poor coping skills may impact risk of addiction through increasing impulsive responding and self-medication. While it may not be possible to eliminate stress, we need to find ways to manage it.
Stress normally refers to adversity or hardship such as poverty or grief. Biologically, stressful events cause a rise in blood levels of stress hormones (such as cortisol). Fight-or-flight is the normal response to stress. That is, all the blood goes to the muscles so that you’re ready for action.
It is important to distinguish between chronic and normal stress. Moderate and challenging stressors with limited duration are perceived to be pleasant. In fact, some individuals seek “stressful” situations (sensation-seekers or seeking out novel and highly stimulating experiences) that promote the release of stress hormones. However, intense, unpredictable, prolonged stressors (e.g., interpersonal conflict, loss of loved ones, unemployment) produce learned helplessness and depressive-like symptoms. Chronic stress increases the risk for developing depression, the common cold, influenza, tension headaches, grinding teeth, or clenching the jaw and tensing the neck and shoulders (McEwen, 2003).
Trauma in early childhood is a key factor for making people more vulnerable in later life (Keating, 2017). The link from early adversity to later life problems runs through social epigenetics. High levels of stress experienced in early life can cause methylation of key genes that control the stress system. That is, early adversity alters our genetics. When this happens, we live in a constant state of emergency.
The workplace is another context that provides almost routine exposure to chronic stress. Work related stress may include factors such as the demands of the job, the ability to have control over decisions and the degree of social support within the workplace. People in jobs where they don’t perceive themselves to have a lot of control are susceptible to developing clinical anxiety and depression, as well as stress-related medical conditions like ulcers and diabetes (Marmot, 2006).
The stressful event or circumstance itself is not harmful. What matters is how the person appraises (interprets) the stressor and how he or she copes with it. One can use reappraisal as a coping strategy by viewing situations differently (e.g., it is no longer a big deal). One can also cope with stress by smoking, drinking, and overeating. What is important is the meaning that the event or circumstance has for the individual (Lazarus, 2006).
There is solid evidence for the link between chronic stress and the motivation to abuse addictive substances (Al'Absi, 2007). For instance, research in human studies shows that adverse childhood experiences such as physical and sexual abuse, neglect, domestic violence, and family dysfunction are associated with increased risk for addiction. People with an unhappy marriage, dissatisfaction with employment, or harassment, also report increased rates of addiction.
The experience of adverse rearing during childhood and adolescence (childhood abuse and neglect) indirectly increases risk for addiction through decreased self-control (Lovallo, 2013). Young adults at risk for substance abuse are known to have decreased self-control and emotional control. Their addictive behavior is the result of their experiences and the environments in which they were brought up.
The greater the number of stressors an individual is exposed to, the greater the later chances of addiction. The economist Deaton (2015) shows that less-educated white Americans who struggle in the job market in early adulthood are likely to experience a “cumulative disadvantage” over time, with health and personal problems that often lead to drug overdoses, alcohol-related liver disease, and suicide.
One explanation for the strong linkage between stress and addiction is the self-medication theory, which suggests that the person may use drugs to cope with tension associated with life stressors or to relieve symptoms of anxiety and depression resulting from a traumatic event. Thus, drug use functions as a means to regulate affect and soothe psychological distress.
High emotional stress is associated with loss of control over impulses and an inability to delay gratification. Chronic stress decreases gray matter volume in the brain region that is associated with cognitive control and stress regulation. The part of the prefrontal cortex that is involved in deliberative cognition is shut down by stress. The stressed brain loses the ability to be reflective, and become automatic. Stressed people are prone to give in to their impulses (e.g. smoking, overeating, alcohol and prescription drug abuse) as a way of coping with daily stress (Grant et al., 2011).
In sum, more stressful life events and poor coping strategies may impact risk of addiction. This explains the importance of better understanding how stress works and skill development (e.g., learning stress prevention and tolerance) in addiction treatments.
Al'Absi Mustafa (2007). Stress and Addiction: Biological and Psychological Mechanisms (2007) Academic press.
Deaton, Angus. (2105), The Great Escape: Health, Wealth, and the Origins of Inequality. Princeton University Press.
Grant, J. E., Donahue, C. B., & Odlaug, B. L. (2011). Overcoming Impulse Control Disorders: A Cognitive - Behavioral Therapy Program (Workbook). New York, NY: Oxford University Press
Keating DP (2017), Born Anxious: The lifelong impact of early life adversity-and how to break the cycle? New york: St Martin Press.
Lazarus R, Lazarus, B (2006) Coping with Aging. New York: Oxford press
Lovallo W. R. (2013). Early life adversity reduces stress reactivity and enhances impulsive behavior: Implications for health behaviors. International Journal of Psychophysiology, 90, 8–16.
Marmot, M. G. (2006). Status syndrome: A challenge to medicine. Journal of the American Medical Association, 295, 1304–1307
McEwen, B. S. (2003). Early life influences on life-long patterns of behavior and health. Mental Retardation and Developmental Disabilities Research Reviews, 9(3), 149-154
Sinha R, Jastreboff AM. Stress as a common risk factor for obesity and addiction. Biol Psychiatry. 2013;73(9):827–835.