After a long week of being a graduate student, there is nothing I like doing more than grabbing some drinks with a group of friends. While most Americans do this every so often there comes a point where this behavior begins to spiral out of control. Some individuals might no longer go out once a month, but it may escalate to once a week, escalating even further to grabbing a drink every day. Also, in most cases, the amount of drinks consumed do not stop at one but can increase to five or even ten drinks. An even scarier idea is that graduate students are not the only ones that could be using substances to cope with stress. Adolescents and college students are turning to the bottle, more so than individuals their same age that are not attending college (Substance Abuse and Mental Health Services Administration, 2015). So why is it that those who tend to be under more stress turn to substances such as alcohol?
In order to answer this question, we first need to understand the underlying neurological mechanisms that guide the pleasure we receive when using such substances. Sapolsky (2004) does a great job taking us through the neurochemistry of pleasure. To no surprise, we learn that the pleasure pathway is really guided by the neurotransmitter dopamine. The ventral tegmentum area (VTA) and nucleus accumbens (NaCC) are important brain regions in dopaminergic projection. From the VTA and NaCC, dopamine will then project to the frontal cortex, anterior cingulate cortex, and amygdala, which will ultimately affect our behaviors. It is this pleasure pathway, in particular, that is affected by substance abuse. For example, when an individual becomes addicted to a substance, they will develop tolerance to that substance. This happens because when the substance is inside the body, dopamine (depending on which drug) begins pouring out of cells a thousand times more than normal. The neurons receiving the dopamine are not used to receiving so much of the neurotransmitter at once so they begin to become less sensitive to dopamine. So, in order for an individual to feel that same high that they did when they first tried the drug, they need more of it. Thus, an endless cycle of desensitizing your neurons every time you use, happens. Throughout Sapolsky’s chapter, there are many references to studies using rats that show stress increases the likelihood of self-administering a drug. Not only does stress increase the odds of abusing a drug, it can also make withdrawal worse, and relapse a lot more likely if an individual were to quite (Sapolsky, 2004). So now that we have a general idea of the pathways responsible for addiction, we can come back to contemplate why substance use happens more often in certain populations than others.
Hoffmann (2016) sought to understand the theoretical pathway that guides the increase or decrease of substance use across one of the most important stages of life, adolescence to early adulthood. A key theory Hoffmann had regarding why adolescence may be more prone to taking substances is the idea that many stressful life events happen over this already stressful time period that may drive an adolescent to use substances in order to cope with such stressful events. In other words, the cumulation of stressful events can increase the likelihood of substance use in the future. There are theoretical frameworks that bolster Hoffman’s hypothesis, such that adolescents may be more sensitive to what they perceive as stressful situations (Agnew, 1997). While the author provides clear reasoning behind his hypothesis, the results presented in the article showed that for some adolescent users, it was not the cumulative stress itself that drove these individuals to use, but the combination of stress and peer substance use (Hoffmann, 2016).
Another important group that has been shown to be more prone to using substances to cope with experiencing an extremely stressful event are those with posttraumatic stress disorder (PTSD). Unfortunately, we are seeing that close to half of the men and women who meet the criteria for lifetime PTSD will have a substance use disorder. While those with PTSD think using substances will help them “cope” with their PTSD, using substances does the exact opposite. Substance use increases symptoms of PTSD and is a predictor of poorer treatment response (Ouimette, Finney, & Moos, 1999). Bowen, De Boer, and Bergman (2017) focused on understanding if mindfulness played a mediating role in the relationship between PTSD symptoms and how dependent individuals were on substances. The authors found that those who showed greater PTSD symptom severity had lower levels of mindfulness which increased the severity of substance dependence (Bowen, De Boer, & Bergman, 2017).
So while we are all stressed out, there are always better ways to cope with the stress. For example, while I like drinking with my friends to release stress, it may be better that instead of drinking we could play sports together or play video games together. By improving the way we manage our stress, we lower our chances of developing unhealthy coping habits (Lipschitz, Paiva, Redding, Butterworth, a& Prochaska, 2015).
Agnew, R. (1997). Stability and change over the life course: A strain theory explanation.In T. P. Thornberry (Ed.), Developmental theories of crime and delinquency (pp. 101-132). New Brunswick, NJ: Transaction Publishers.
Bowen, S., De Boer, D., & Bergman, A.L. (2017). The role of mindfulness as approach-based coping the the PTSD-substance abuse cycle. Addictive Behaviors, 64, 212-216.
Hoffman, J.P. (2016). Cumulative stress and substance use from early adolescence to emerging adulthood. Journal of Drug Issues, 46(3), 267-288.
Lipschitz, J.M., Paiva, A.I., Redding, C.A., Butterworth, S., and Prochaska, J.O. (2015). Co-occurrence and coaction of stress management with other health risk behaviors. Journal of Health Psychology. 20(7), 1002-1012.
Ouimette, P.C., Finney, J. W., & Moos, R.H. (1999). Two-year posttreatment functioning and coping of substance abuse patients with posttraumatic stress disorder. Psychology of Addictive Behaviors, 13(2), 105-114.
Sapolsky, R.M. (2004) Why zebras don’t get ulcers: A guide to stress, stress related diseases, and coping. New York: W.H. Freeman.
Substance Abuse and Mental Health Services Administration (SAMHSA). 2015 National Survey on Drug Use and Health (NSDUH). Table 6.84B—Tobacco Product and Alcohol Use in Past Month among Persons Aged 18 to 22, by College Enrollment Status: Percentages, 2014 and 2015. Available at: https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015.htm#tab6-84b.