Substance Abuse and Stress

As Sapolsky (2004) points out, we live a fast-paced world with addictive qualities at every turn. As a society, we are constantly scrolling through social media, eating sugary and high fat processed foods, and even Netflix wants us to binge watch our favorite shows by continuously playing them back to back and making it that much harder to walk away. Although we can begin to understand addictive qualities through our daily experiences, for some individuals alcohol and drugs bring the quality of addiction to a whole different level. Sapolsky does a great job of detailing the neurological components that can lead to addiction, including the role of dopamine. He also highlights the role of environmental triggers that lead to addictive behaviors. However, what was most interesting to me was the consideration of how stress is tied to addictive behaviors, and considering ways in which we might be able to intervene.

It is no secret that substance abuse often results from coping with stress. As Sapolsky puts it, “Drugs of abuse make you feel less stressed.” However, in a recent study by Hoffman (2016), there were mixed results in whether high levels of cumulative stress led to increases in substance abuse from early adolescence into emerging adulthood. For some groups, cumulative stress was a risk factor for increased substance use, while in others the strongest predictor was peer use. Interestingly, the comparisons made were across a sample of individuals from low socioeconomic status. Therefore, conclusions were not entirely convincing, as it would seem this is a particularly stressed set of individuals to make comparisons between.

Individuals who exhibit poor stress management often have greater risks of multiple negative health behaviors, such as partaking in less exercise, smoking, and having high fat diets (Lipschitz et al., 2015).  Therefore, it is important to examine stress management interventions as a starting point to altering negative substance abuse behaviors.  One study examined the impact of stress management via mindfulness training intervention on substance abuse outcomes (Bowen, De Boer, & Bergman, 2016). The particular population of interest in this study was individuals with PTSD, in part due to the high rate of comorbidity with substance abuse. The authors highlighted that mindfulness is typically inversely related to addictive behaviors, and positively related to approach-based coping and positive PTSD outcomes. Therefore, the objective of this study was to better understand the relationships between PTSD, substance abuse, and mindfulness as an intervention. Results demonstrated that higher mindfulness was related to lower severity of dependence in substance abuse. Additionally, higher levels of PTSD symptoms were associated with lower levels of mindfulness, and in turn more severe substance abuse. Within the mindfulness practices, awareness and nonjudgment were significant mediating factors between PTSD symptoms and substance abuse.

So what does all of this actually mean? Well, for starters, we can be doing more to support individuals who depend on substances. If we have the knowledge that the awareness and nonjudgment aspects of mindfulness training are particularly helpful, then we should be thinking of ways to integrate mindfulness training into relapse prevention and rehabilitation programs. I often feel that more holistic treatments can be threatening to pharmaceutical companies that provide the medications, or even to the on-site therapists that go through cognitive behavioral practices with addicted individuals. After all, restructuring a rehabilitation system can take a lot of work, and can mean that some of the parties who were previously making money may lose some of their profits. However, if we can view mindfulness as another part of the balancing act of treatment, rather than as a replacement, then it seems that it could be integrated in a more seamless way. Eventually, this could mean a lesser need for pharmaceuticals, but it seems unlikely that pharmaceuticals would be replaced altogether. It seems that what pharmaceuticals currently offer is a biological way of rebalancing and reconfiguring neurological chemicals. And yet, it also seems possible that pharmaceuticals could be a starting point in the most severe stages of substance abuse and slowly be replaced with mindfulness strategies that can take on a longer-term role as a coping strategy.

References

Bowen, S., De Boer, D., & Bergman, A. L. (2017). The role of mindfulness as approach-based coping in the PTSD-substance abuse cycle. Addictive Behaviors, 64, 212-216. doi:10.1016/j.addbeh.2016.08.043

Hoffmann, J. P. (2016). Cumulative stress and substance use from early adolescence to emerging adulthood. Journal of Drug Issues, 46(3), 267-288. doi:10.1177/0022042616638492

Lipschitz, J. M., Paiva, A. L., Redding, C. A., Butterworth, S., & Prochaska, J. O. (2015). Co-occurrence and coaction of stress management with other health risk behaviors. Journal of Health Psychology20(7), 1002-1012.

Sapolsky, R. M. (2004). Why zebras don’t get ulcers. New York: WH Freeman.

2 thoughts on “Substance Abuse and Stress

  1. I really liked your closing paragraph. I too think that pharmaceuticals could potentially be a starting point in the development of substance abuse. Additionally, it doesn’t help that some substances have been approved as treatment options for individuals with PTSD. Something that I really don’t support. Being a researcher can be hard when some of the research out there for your population of interest supports the use of once illegal substances as now treatment options. It is absurd to me and goes against my beliefs when there are other treatment options such as mindfulness and CBT that could potentially be more beneficial to the individual with PTSD.

  2. These are all great points, Keri! I thought you did an especially good job of bringing up current issues in the treatment of people suffering from drug use disorders, and with the health care provided to these individuals. There is some debate about whether or not changing the “disorder” in “drug use disorder” to “disease” might bring drug abuse and addiction to the forefront of medicine, and also provide individuals with better insurance coverage if they do seek help for an addiction. Obviously, this is not sufficient to provide patients with better care, but do you think considering drug abuse a disease could move us in the right direction?

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