Researchers have long recognized the strong correlation between stress and substance abuse, particularly relapse to substance abuse. In the wake of 9/11, our awareness of the role that stress can play in increasing ones' vulnerability to substance abuse is more important than ever. Exposure to stress is among the most common human experiences. It also is one of the most powerful triggers for relapse to substance abuse in addicted individuals, even after long periods of abstinence.

The National Institute of Drug Abuse (NIDA) has released a Community Alert Bulletin to provide the public with information on current research about stress and its relationship to substance abuse. A disorder called Post-traumatic Stress Disorder (PTSD) may develop in people after exposure to a severe traumatic event - such as the terrorist attacks of September 11, 2001. PTSD is a diagnosable psychiatric disorder that is a known risk factor for substance abuse and addiction. Because the terrorist attacks were witnessed on television by millions of people across the world, it is likely that many of us may already know colleagues, friends, patients, or family members who may be experiencing behavioral and readjustment problems.

Stress - What is It?
  • Stress is a natural part of life. It's hard to define because it means different things to different people. However, it's clear that most stress is a negative feeling rather than a positive feeling. Stress is a reaction to physical, mental or emotional conditions, changes and demands in our lives.
  • There are three types of stress according to the American Psychological Association: acute stress, episodic stress and chronic stress. Acute stress is the most common type. It comes from current or recent demands and pressures, or the anticipation of demands and pressures. The most common symptoms are emotional distress, muscular problems, stomach problems, elevation in blood pressure, rapid heartbeat, and sweaty palms. Typically, symptoms are short term. Acute stress can be found in anyone's life and it is highly treatable and manageable.
  • Episodic stress is acute stress that is suffered more frequently. It generally results from having a disordered life full of chaos and crisis. People suffering episodic stress are always in a rush, take on too much, and can't organize all of the self-imposed demands and pressures. People with this type of stress are often short-tempered, irritable, anxious, and tense. Treatment for episodic stress can work, but sufferers are often resistant to change.
  • Chronic Stress is stress that grinds away and wears people down day after day, year after year. It destroys bodies, minds and lives. This stress can come from poverty, dysfunctional families, unhappy marriages, or problem jobs and careers. Chronic stress stems from situations in which someone feels trapped, with no hope of a resolution.
  • Stress is a normal reaction to life for people of all ages. It is caused by our body's instinct to protect itself from emotional or physical pressure or, in extreme situations, from danger.
  • Stressors differ for each of us. What is stressful for one person may or may not be stressful for another; each of us responds to stress in an entirely different way. How a person copes with stress - by reaching for a beer or cigarette or by heading to the gym - also plays an important role in the impact that stress will have on our bodies.
  • Individuals who experience prolonged reactions to stress that disrupt their daily functioning may benefit from consulting with a trained and experienced mental health professional.
Source: the types of stress information is adapted from the American Psychological Association web site.

The Body's Response to Stress
  • Stress activates adaptive responses. It releases the neurotransmitter norephinephrine, which is involved with memory. This may be why people remember stressful events more clearly than they do nonstressful situations.
  • Stress also increases the production of a hormone in the body known as corticotropin releasing factor (CRF). CRF is found throughout the brain and initiates our biological response to stressors. During all negative experiences, certain regions of the brain show increased levels of CRF. Interestingly, almost all drugs of abuse have also been found to increase CRF levels, which suggests a neurobiological connection between stress and drug abuse.
  • Mild stress can actually improve our attention and increase our capacity to store and integrate important and life-protecting information. But if stress is prolonged or chronic, those changes can become harmful.
Stress as risk factor for Substance Abuse
  • Stressful events can influence the use of alcohol or other drugs. Stress is a major contributor to the initiation and continuation of addiction to alcohol or other drugs, as well as to relapse or a return to drug use after periods of abstinence.
  • Exposure to severe stress in childhood may increase the likelihood of substance abuse. Psychosocial stressors early in life, such as parental loss, child abuse, have been associated with increased risk for depression, anxiety, impulsive behavior, and substance abuse in adulthood.
Prevention
  • Relying on one's support network of friends and family, or exercise or any other healthy behavior to relieve stress can reduce the desire to use alcohol or drugs.
  • Avoiding environmental triggers, recognizing psychosocial and emotional triggers, and developing healthy behaviors to handle life's stresses are an important tool in drug use reduction and prevention.
  • Learning techniques that foster coping skills, problem-solving skills, and social support can help individuals reduce or eliminate their drug use.
  • Some people may need medications for stress-related symptoms or for treatment of depression and anxiety. Physicians should be aware of what medications their patients are taking but should not discourage the use of medical prescriptions to help alleviate stress.
What is PTSD?
  • Post-traumatic Stress Disorder (PTSD) is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened.
  • PTSD can result from many kinds of tragic incidents in which the patient was a witness, victim, or survivor, including violent or personal attacks, natural or human-caused disasters, or accidents.
  • Symptoms of PTSD can include re-experience of the trauma; emotional numbness; avoidance of people, places, and thoughts connected to the event; and arousal, which may include trouble sleeping, exaggerated startle response, and hypervigilance.
PTSD is a risk factor for Substance Abuse
  • Of individuals with substance use disorders, 30 to 60 percent meet the criteria for underlying PTSD.
  • In most cases, substance use begins after the exposure to trauma and the development of PTSD, meaning that PTSD a risk factor for substance abuse. More severe forms of PTSD increase the risk of substance abuse.
  • Children who witness or are exposed to a traumatic event and are clinically diagnosed with PTSD have a greater likelihood for developing later drug and/or alcohol use disorders. Early intervention to help ensure these children do not develop substance abuse patterns is critical.
How to help Someone Suffering from PTSD and Drug Abuse
  • Patients who are experiencing the symptoms of PTSD should see their physician or health care provider. Health care professionals should be reminded that PTSD frequently co-occurs with depression, anxiety disorders, and alcohol or other substance abuse.
  • If treatment is necessary, it is important that both PTSD and substance abuse are treated.
  • In some cases, medications such as the antidepressant sertraline have been shown to be helpful in treating patients who suffer from PTSD and substance use disorders.
  • Although there is no standardized, effective treatment developed for individuals with this disorder, studies show that patients who suffer from PTSD can improve with cognitive behavioral therapy, group therapy, or exposure therapy, in which the patient gradually and repeatedly relives the frightening experience under controlled conditions to help him or her work through the trauma.
  • Exposure therapy is thought to be one of the most effective ways to manage PTSD. It has not yet been widely used with other co-occurring disorders, but recent studies suggest that some individuals with both PTSD and cocaine addiction can be successfully treated with exposure therapy.