The Link Between Stress and Relapse

Stress. The word that no one likes, but everyone experiences. Mild stress is something most people encounter every day, be it an upcoming work deadline, a date with someone you really want to impress, or simply not knowing which outfit to wear out. Most people cope with this and get on with their lives. However, chronic stress can come with a myriad of problems, both short-term and long-term. What does stress mean for people suffering from addiction problems, and moreover, does stress have a relationship with relapse?

What happens to a stressed brain?

Most people can give you a description of what stress feels like, but what is actually happening inside your brain to cause those feelings? As previously mentioned, mild stress is fairly universal and isn’t a cause for concern for your everyday person. However, prolonged and serious stress can have radical effects on the physical and mental health of the sufferer, such as increased cortisol levels¹, depression, weight gain, physical changes in the brain, and teeth grinding to name but a few².

Whist the brain is a singular organ, it is best to be thought of as a series of connected machines with each part doing an individual job. When someone is stressed the amygladia, which is the part of the brain which controls the body’s “fight or flight mechanism” activates, sending a signal to release large amounts of cortisol from the adrenal glands. This controls blood pressure, helps one’s body to metabolise glucose more effectively, reduce inflammation³. However, whilst it is doing that, energy is being diverted from other parts of the brain, which is why it is thought that chronic stress is linked to so many health conditions. Prolonged exposure to cortisol is also linked to digestive problems, insomnia, and a weakening of the immune system which can result in increased risk of illnesses⁴.

How do addict’s brains differ from non-addicts?

Whilst there are many schools of thought as to the causes of addiction, ranging from traumatic experiences to genetics ⁵, it is fairly universally accepted that addict’s brains have been re-wired to compulsively seek the dopamine (the “good feeling” chemical) release that drugs, alcohol, or any other type of addictive behaviour can release. Over time the brain becomes desensitised to this release, leading the addict to seek the same feeling over and over again⁶.

What role does stress play in drug addiction?

Stress has been shown to be a key determiner in whether people become addicts. One study found that stress from negative life events such as a familial death, prolonged stress due to physical or sexual abuse, and cumulative stress resulting from factors such as gender, socioeconomic status, and race can be a factor in an individual becoming more vulnerable to addiction⁷

One study found that the two key elements which were most effective in provoking a relapse in rats which had a history of self-administering drugs were re-exposure to the drug, and environmental stress. It was discovered that mechanism of action that a stress relapse causes was different to that of a substance induced relapse⁸.

Studies of humans have yielded similar results, with one researcher finding that within for four weeks of stopping alcohol, alcoholics had higher levels of cortisol and increased heart rates compared to non-alcoholics, and that upon stress exposure would display increased cravings for alcohol. The alcoholics also displayed a higher allostatic load (the “wear and tear” on the body which increases as stress is experienced) than the non-alcoholics, which would infer that their emotional response is less regulated than those of the non-alcoholics⁹.

This increased stress response could be explained by the fact that most abused drugs act on the same neural pathways as stress to the point that they can be considered pharmalogical stressors. As they brain is increasingly exposed to these it adapts to accommodate them, which then changes the way it responds to stress when it is not being influenced by drugs ¹⁰. The one exception to this rule are opiate drugs, which cause a reduction in cortisol.

A good example of environmental stress resulting in addiction is the Vietnam war. Approximately 10-25% of soldiers fighting became addicted to heroin whilst exposed to the horrors of war. All were forced to detox and pass a drugs test before they flew home, but only 10% of the addict population relapsed upon returning home. This would indicate that drug use was a response to the stress of war. Studies later performed on these soldiers would expose them to historical stressful situations such as the sound of gunfire, which would elicit drug cravings in the soldiers¹¹. This is good news for addicts seeking recovery, as it suggests that whilst addiction can change the way the brain works, it is possible to recover from this given the right support.