In Treating Addiction, Account for the Role of Stress

The numbers from the National Institutes of Health (NIH) show that addiction killed more than 70,000 Americans in 2017, and over 75% of people entering addiction treatment programs developed their substance use disorders by the age of 17. More than one-tenth of the patients in treatment programs became addicted by the age of 11. The way addiction interacts with a child's or emerging adult’s brain development means these childhood addictions pose potential damage to the way they process stress, and a stronger likelihood of recurrence of the disease in later years. It’s important for us to understand how stress affects addiction, how it affects recovery, and how best to treat patients who have comorbid diagnoses with other mental health issues such as post-traumatic stress disorder (PTSD).

Much like cancer, addiction appears in many forms and levels of severity, and can be triggered or manifested through a variety of common life stressors or environmental factors. Just like cancer, treating addiction doesn’t guarantee it’s gone for good. The risk of the disease presenting itself again is always present, and can be exacerbated if measures aren’t put in place to prevent recurrence. One of the most important is stress management. Our brain continues to develop well into our 20s, and one of the latest parts of our brain to develop is the amygdala, or the part of the brain that manages strong emotions such as those triggered by stress.

Unfortunately, many of the pathways related to addiction share a connection with our pathways for stress. A study by Rajita Sinha, PhD (How Does Stress Lead to Risk of Alcohol Relapse?) discovered that stress-related mechanisms play a large role in controlling cravings and recurrence of the disease. Gabor Maté, MD (Addiction: Childhood Trauma, Stress and the Biology of Addiction) found that a high percentage of patients with substance use disorder had previously experienced “physical, sexual, and emotional abuse.” The study went on to say that our three major brain systems related to addiction (the opioid attachment-reward system, the dopamine-based incentive-motivation apparatus and the self-regulation areas of the prefrontal cortex) all malfunction under the disease, as does a potential fourth system: the stress-response system.

So the majority of individuals suffering with addiction experience the disease for the first time between the ages of 11 and 17, when their brain is most vulnerable to both stress and addiction. As such, any recovery program should focus on stress management and addiction recovery simultaneously. Studies have shown that an addicted brain physically responds to stress in a very different way than a sober brain would. Likewise, studies have shown that stress may be a critical factor in long-lasting recovery. Stress responses can even influence “motivation to consume alcohol” (as stated in the Sinha study), and stress-related mechanisms are so clearly intertwined with addiction that they can actually serve as warning signs for potential recurrence of addiction post-recovery.

Dealing with stress and related disorders is becoming more and more vital in recovery programs as we’re discovering just how often these illnesses are comorbid in emerging adults. The National Center for Biotechnology Information (NCBI) found that around half of individuals seeking treatment for substance use disorders meet criteria for PTSD. PTSD is the type of disorder that can severely overload the body’s typical ways of dealing with stress, which in turn makes us much more susceptible to a recurrence of addiction. Treating one without the other leaves patients half-cared for, and vulnerable to an outbreak from either.

Considering the average individual had his/her first experience with the disease by the age of 17, when the brain is still being developed, it should come as no surprise that addiction and stress are so intertwined. We need to continue to understand the interplay between stress and addiction, among other comorbid disorders.