The Connection Between Stress Regulation and Addiction

Over the past two decades, research into stress and addiction has uncovered significant insights into how these two conditions interact at molecular, cellular, and behavioral levels. Chronic stress not only increases the risk of addiction but also plays a critical role in relapse, making it essential to understand this connection for effective treatment.

Stress and Addiction: Is There a Link?

Stress is a natural psychological and physical response to challenging situations, prompting individuals to adapt and problem-solve. Nearly everyone experiences stress at some point in life, but how one copes with it plays a critical role in shaping their mental well-being ^[1]. While some individuals adopt healthy coping strategies like exercise or mindfulness, others may resort to maladaptive behaviors such as substance use, which can increase the risk of addiction and other harmful outcomes ^[2].

The American Society of Addiction Medicine defines addiction as a treatable chronic condition marked by the compulsive use of substances or engagement in behaviors despite harmful consequences ^[3]. Prolonged or unresolved stress is often a driving force behind addiction, particularly when it stems from early life trauma. Research shows that stressors such as childhood neglect, physical or sexual abuse, domestic violence, or growing up in a dysfunctional household significantly increase the risk of developing substance use disorders ^[4]. Addressing these underlying stressors is essential to both prevention and long-term recovery.

Can Stress Lead to Addiction?

Chronic stress plays a significant role in the development and persistence of addiction by disrupting the brain’s reward systems. One key concept researchers use to explain this is “allostatic load,” the cumulative burden placed on the body and brain from repeated or prolonged stress exposure ^[5].

Over time, chronic stress alters how the brain processes reward and emotion, heightening vulnerability to cravings and substance use as individuals seek relief from distress. This creates a harmful cycle: stress increases the urge to use substances, and substance use further dysregulates the brain. These interconnected effects highlight the importance of treating stress and addiction together for more effective, lasting recovery outcomes ^[6].

Are People With Addictions More Susceptible to Stress?

Stress and substance abuse are mediated by the same neural circuits (pathways in the brain). Therefore, these two conditions are deeply interconnected and often co-occur. Not only can stress cause addiction, but addiction also increases a person’s risk of developing mental health conditions, such as stress and anxiety ^[7]. 

Furthermore, individuals with substance use disorders often face additional stressors, such as financial instability or strained relationships, that exacerbate their dependency on substances as a coping mechanism. This dual burden highlights the importance of addressing external stressors alongside addiction treatment to break the cycle effectively ^[8].

The Cycle of Stress and Addiction

The relationship between stress and addiction is cyclical: chronic stress increases vulnerability to substance use, while abstinence from substances heightens sensitivity to stress, creating a risk of relapse. Studies reveal that even brief exposure to stressful events can trigger cravings and drug-seeking behaviors in recovering individuals. 

This vicious cycle makes addicts even more vulnerable to the effects of stress and the risk of relapse, to cope with that stress, which again highlights the importance of comprehensive treatment plans that address both substance dependency and any underlying mental health conditions that may impact stress perception ^[9]. 

Can Stress Cause Relapse in Those Recovering From Addiction?

Relapse is a critical facet of drug addiction, and it remains the most challenging problem when treating drug abuse. Studies specifically focused on alcohol relapse after treatment have found that highly stressful events increase the risk of relapse. This occurs because stress is associated with increased cravings and the urge to use substances ^[10]. 

Chronic substance use can change how the brain reacts to stress and affect the associated reward pathways. These modifications may alter a substance-dependent person’s response to stress, specifically the motivation to use substances, which increases the risk of relapse ^[10] . These studies, and many others like these, suggest that stress is one of the leading causes of relapse in those recovering from addiction.

Another study suggested that three types of events may induce relapse after extended periods of abstinence: an environment previously associated with drug-taking, re-exposure to the drug, and acute exposure to a stressful event. This same study found that even brief exposure to a stressor is enough to induce a relapse into drug-seeking behaviors. Remember that substance abuse also increases an addict’s susceptibility to stress, which in turn increases their susceptibility to relapse after a period of abstinence ^[10]. 

This cycle of stress, substance abuse, and relapse emphasizes the need to treat a substance-dependent person’s mental health conditions, including stress and anxiety, along with their substance abuse problems. 

Incorporating Stress Management in Your Addiction Recovery

Effective stress management is a vital component of sustained addiction recovery. Addressing stress not only supports emotional stability but also reduces the risk of relapse. By incorporating healthy coping techniques into daily routines, individuals can build resilience and regain control over their responses to life’s challenges. Below are several stress management strategies that can complement addiction treatment and promote long-term recovery:

Enough Quality Sleep 

Sleep deprivation is an increasingly common condition affecting mood and performance, not just physiological functioning. Sleep is necessary to regulate hormones like cortisol and melatonin ^[11]. Cortisol (the stress hormone) is responsible for the fight-or-flight response. 

Poor sleep is associated with dysregulated cortisol levels and increased stress levels. Research has found that when a person has more than one night of poor sleep (<5 hours), cortisol is more poorly regulated, leading to increased cortisol levels and heightened stress and anxiety ^[12].

Yoga and Meditation

Exercise is one of the most effective tools for managing stress in addiction recovery. It helps regulate cortisol levels, boosts endorphin production, and improves blood flow to the brain, collectively supporting emotional balance. Yoga offers additional advantages. By increasing levels of gamma-aminobutyric acid (GABA), a neurotransmitter linked to mood regulation, yoga has been shown to reduce anxiety and improve overall mental well-being.

Meditation, which involves focusing the mind and observing thoughts without judgment, is another powerful technique. Practicing meditation helps individuals stay grounded and calm in the present moment. Studies show that meditation can enhance sensitivity to natural sources of pleasure, which may reduce the intensity of drug cravings. One study even found that individuals who practiced meditation were nearly twice as likely to stop misusing opioids within nine months compared to those who received psychotherapy alone.

Mindfulness-Based Stress And Anxiety Management Tools

Stress can be managed through mindfulness-based stress reduction (MBSR). MBSR is a structured group program that uses mindfulness meditation to reduce the symptoms of psychiatric disorders. MBSR (a non-faith-based program that requires no previous training or knowledge) helps participants adopt mindfulness practices and focus on the current moment. Research has found that MBSR can reduce anxiety symptoms in as little as two months.

Another method of mindfulness is dialectical behavioral therapy (DBT). Dialectical behavior therapy is a type of therapy that was first used to treat borderline personality disorder. DBT combines cognitive behavioral therapy with the Eastern Zen philosophy of acceptance. Group therapy sessions comprise four components: core mindfulness and distress tolerance (as components of acceptance) and emotional regulation and interpersonal effectiveness (as components of change) ^[13].

Reading

A study found that reading was as compelling as yoga and humor in reducing stress over 30 minutes. The same study also found that reading reduced blood pressure and heart rate over 30 minutes. These results suggest that reading can positively impact physical and psychological health.

Laughter

One meta-analysis of ten studies comprising 814 participants found that laughter therapy effectively reduced adult stress. Humor stimulates many systems that decrease stress hormones, such as cortisol and epinephrine, and increase activation of the mesolimbic dopaminergic reward system.

Can Medication Alleviate Stress and Addiction?

Medications can play a valuable role in managing both stress and addiction, especially when symptoms are severe or persistent. Several drugs are approved to treat anxiety and stress-related disorders, which may indirectly reduce the risk of developing an addiction. Likewise, medications used to treat substance use disorders can help stabilize mood and reduce stress levels by alleviating withdrawal symptoms and curbing cravings.

Because the biological pathways for stress and addiction often overlap, particularly those involving neurotransmitters like dopamine and norepinephrine, many of these medications serve dual purposes. This overlap allows clinicians to use targeted treatments that support both stress relief and addiction recovery, enhancing the overall effectiveness of a comprehensive treatment plan. Below are some common medications used to treat stress and addiction. 

Medication	Stress	Addiction	Both Stress and Addiction
Benzodiazepines	✓
Antidepressants (SSRIs)	✓	✓	✓
Antidepressants (MAOIs)	✓
Beta-Blockers	✓	✓	✓
Opioid partial agonist-antagonists		✓
Opiate antagonists		✓
Carbamate derivatives		✓
Antidepressants (NDRIs)	✓	✓	✓
Nicotinic receptor partial agonist		✓

Final Thoughts 

Stress and addiction are deeply intertwined, sharing neural pathways that create a cycle of dependency and relapse. Chronic stress not only increases the risk of addiction but also exacerbates the challenges faced during recovery, making stress management an essential component of effective addiction treatment.

Addressing stress as a fundamental part of addiction recovery requires a holistic approach that combines behavioral strategies, therapeutic interventions, and medical support. Incorporating mindfulness, quality sleep, yoga, meditation, and simple activities like reading or laughter can significantly reduce stress and support long-term sobriety. Additionally, medications designed to target both stress and addiction offer promising solutions for individuals struggling with these overlapping conditions.

By understanding the connection between stress and addiction, individuals can take proactive steps to break the cycle and regain control over their lives. However, professional help is crucial to navigating this complex relationship, ensuring that both stress and substance use disorders are treated comprehensively for lasting recovery and improved well-being.