NIDA - NIDA Community Drug Alert Bulletin - Stress & Substance Abuse

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NIDA Community Drug Alert Bulletin - Stress & Substance Abuse

Stressful

events can

profoundly

influence

initiation,

continuation,

and relapse

of drug,

alcohol, and

tobacco use.

Friends, Colleagues and Parents;

The National Institute on Drug Abuse (NIDA) has

developed this Community Drug Alert Bulletin to

update you on current research about stress and its

relationship to substance abuse. Given the recent

spate of natural disasters in this country and their

tragic human aftermath,our awareness of the effects

ofstress in increasing vulnerability to substance abuse

must be especially keen.

Researchers have long recognized the strong

correlation between stress and substance abuse,

particularly in prompting relapse. Although exposure to

stress is a common occurrence for many of us,it is

also one of the most powerful triggers for relapse to

substance abuse in addicted individuals - even after

long periods of abstinence.

People can experience post-traumatic stress disorder

(PTSD) - a diagnosable psychiatric disorder and a

known risk factor for substance abuse and addiction -

following direct or indirect exposure to severe

traumatic events, such as war, the terrorist attacks of

September 11, 2001, or natural disasters. NIDA is

therefore encouraging more studies on the topic of

stress and drug abuse and addiction prevalence. We

are also focusing more attention on developing

science-based interventions to help those who are

particularly vulnerable better cope with stress.

We hope you will find this information useful as you

continue to deal with drug abuse issues in your

community. Identifying potential substance abuse

problems early and referring patients to professionals

with expertise in drug abuse counseling and treatment

will be beneficial to all involved. We all must focus on

restoring our emotional well-being, develop healthy

ways to manage stress, and avoid turning to drugs or

other substances to escape stressful realities of the

day.

Sincerely,

Nora D. Volkow, M.D.

Director

National Institute on Drug Abuse

CDAB Home

Information on Stress &

Substance Abuse

What is Stress?

The Body's Response to

Stress

Stress and Substance

Abuse

Stress, Drugs, and

Vulnerable Populations

What is PTSD?

PTSD and Substance Abuse

Helping Those Who Suffer

from PTSD and Drug Abuse
NIDA - NIDA Community Drug Alert Bulletin - Stress & Substance Abuse

http://archives.drugabuse.gov/StressAlert/stressalert.html[05/03/12 11:53:05 AM]

What is Stress?

Stress is a term that is hard to define because it means different things to

different people. Stress is a normal occurrence in life for people of all

ages. The body responds to stress in order to protect itself from emotional

or physical distress 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, and each of us responds to stress in

different ways. 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.

By using their own support systems, some people are able to cope

effectively with the emotional and physical demands brought on by

stressful and traumatic experiences. However, individuals who experience

prolonged reactions to stress that disrupt their daily functioning may

require treatment by a trained and experienced mental health professional.

The Body's Response to Stress

The stress response is mediated by a highly complex,integrated network

that involves the central nervous system, the adrenal system, the immune

system, and the cardiovascular system.

Stress activates adaptive responses. It releases the neurotransmitter

norepinephrine, which is involved in memory. This may be one reason why

people remember stressful events more clearly than they do nonstressful

situations.

Stress also increases the release of a hormone known as corticotropinreleasing factor (CRF). CRF is found throughout the brain and initiates our

biological response to stressors. During all stressful 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, suggesting a

neurobiological connection between stress and drug abuse.

Mild or acute stress may cause changes that are useful. For example,

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, the changes it produces can become harmful.

Stress and Substance Abuse

Stressful events can profoundly influence the abuse of alcohol or other

drugs. Stress is a major contributor to the initiation and continuation of

alcohol or other drug abuse, as well as to substance abuse relapse after

periods of abstinence.

Stress is one of the major factors known to cause relapse to smoking,

even after prolonged periods of a smoke-free lifestyle.

Children exposed to severe stress may be more vulnerable to drug abuse.

A number of clinical and epidemiological studies show a strong association

between psychosocial stressors early in life (e.g., parental loss, child

abuse) and an increased risk for depression, anxiety, impulsive behavior,

and substance abuse in adulthood.

Stress, Drugs, and Vulnerable Populations
NIDA - NIDA Community Drug Alert Bulletin - Stress & Substance Abuse

http://archives.drugabuse.gov/StressAlert/stressalert.html[05/03/12 11:53:05 AM]

Stressful experiences increase the vulnerability of an individual to relapse

to drug use, even after prolonged abstinence.

Individuals who have achieved abstinence from drugs must continue to

sustain their abstinence by avoiding environmental triggers, recognizing

their psychosocial and emotional triggers, and developing healthy

behaviors to handle life's stresses.

A number of relapse prevention approaches have been developed to help

clinicians address relapse. Treatment techniques that foster coping skills,

problem solving skills, and social support play a role in successful

treatment.

Physicians should be aware of which medications their patients are taking.

Some people may need medications for stress-related symptoms or for

treatment of depression and anxiety.

What is PTSD?

Post-traumatic stress disorder (PTSD) is an anxiety disorder that can

develop in some people after exposure to a terrifying event or ordeal in

which grave physical harm occurred or was threatened.

Generally, PTSD has been associated with the violence of combat.

However, PTSD is not limited to battlefield soldiers. PTSD can result from

tragic incidents in which people become witnesses, victims, or survivors of

violent personal attacks, natural or human-caused disasters, or accidents.

PTSD can develop in people of any age, including children and adolescents.

Symptoms of PTSD can include re-experiencing the trauma; emotional

numbness; avoidance of people, places, and thoughts connected to the

event; and hyperarousal, which may involve sleeping difficulties,

exaggerated startle response, and hypervigilance.

It is not uncommon for people to experience some or all of these

symptoms after exposure to a traumatic event; however, if the symptoms

persist beyond 1 month and are associated with impaired functioning, then

PTSD may be diagnosed.

PTSD and Substance Abuse

Emerging research has documented a strong association between PTSD

and substance abuse. In some cases, substance use begins after the

exposure to trauma and the development of PTSD, thus making PTSD a

risk factor for drug abuse.

Early intervention to help children and adolescents who have suffered

trauma from violence or a disaster is critical. 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.

Among individuals with substance use disorders, 30 to 60 percent meet

the criteria for comorbid PTSD.

Patients with substance use disorders tend to suffer from more severe

PTSD symptoms than do PTSD patients without substance use disorders.

Helping Those Who Suffer from PTSD and Drug Abuse

Healthcare professionals must be alert to the fact that PTSD frequently cooccurs with depression, other anxiety disorders, and alcohol and other

substance abuse. Patients who are experiencing the symptoms of PTSD

need support from physicians and healthcare providers to develop coping
NIDA - NIDA Community Drug Alert Bulletin - Stress & Substance Abuse

http://archives.drugabuse.gov/StressAlert/stressalert.html[05/03/12 11:53:05 AM]

skills and reduce substance abuse risk.

The likelihood of treatment success increases when these concurrent

disorders are appropriately identified and treated.

For substance abuse there are effective medications and behavioral

therapies.

For symptoms of PTSD, some antianxiety and antidepressant medications

may be useful.

Several behavioral treatments can help individuals who suffer from PTSD.

Improvements have been shown with some forms of group therapy and

with cognitive-behavioral therapy, especially when it includes an exposure

component for trauma victims. Exposure therapy allows patients to

gradually and repeatedly re-experience the frightening event(s) under

controlled conditions to help them work through the trauma. Exposure

therapy is thought to be one of the most effective ways to manage PTSD,

when it is conducted by a trained therapist.

Although not widely used for comorbid PTSD and substance abuse, several

studies suggest that exposure therapy may be helpful for individuals with

PTSD and comorbid cocaine addiction.

Seeking Safety is another example of a cognitive-based behavioral

treatment, tested mainly among women with comorbid PTSD and

drugabuse. It is currently being evaluated among different populations for

its efficacy.

Treatment of patients with comorbid PTSD and addictions will vary, and for

some patients, successful treatment may require initial inpatient

hospitalization.

Finally, support from family and friends can play an important role in

recovery from both disorders.

This publication may be reprinted without permission. Published in January,

2002, updated February, 2006

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