Tense. Pressured. Stressed out. The one word that sums up our experience in the modern world: stress. We feel it when what is going on around us is more than we can deal with. There is no shortage of things to be stressed about: finances, global warming, political issues, raising kids, health challenges, school or work expectations, traffic, and the list could go on. There is another thing that is true about our modern world:
Stress makes us sick – it impacts our physical, emotional, and mental health in profound ways. It makes us feel and do things that aren’t always in our best interest.
People often try to “manage” their stress by using alcohol, cannabis, or prescription sedatives like Xanax. But that strategy often backfires and makes the problem of stress worse. Stress makes substance use worse. And substance use makes stress worse. Much worse.
Things get messy when stress and substance misuse collide.
Sources of Stress
Acute stressors are the short-term situations that have a clear and immediate cause of stress – things like a traffic jam, a brief illness, an argument with a loved one, or a work-related deadline. Our bodies are well-adapted to handle these (hopefully) short-lived experiences. When it’s over, our stress levels can return to a normal baseline.
There are also chronic stressors – the kind of challenges that don’t resolve easily or quickly. Chronic stressors include financial difficulties, unhealthy work environments, painful relationships, long-term insomnia, or the lack of social support. Prolonged stress is what tends to tax our ability to cope. It’s also much more difficult for our system to handle these types of chronic stress well, especially when they continue for long periods.
Besides acute and chronic stressors, there is also anticipatory stress – the place where stress and anxiety meet. We humans have a unique ability to experience a stress response just thinking about a potential stressor like finances or an upcoming job interview.
How Our Brain & Body Responds to Stress
Our autonomic nervous system is involved in our response to stress. When we experience a stressful situation, the sympathetic branch of our nervous system gets activated – the branch responsible for mobilization, vigilance, and our fight or flight response to a threat. Our body releases hormones including cortisol and adrenaline that help mobilize the energy we need to deal with the stressor.
This branch of our autonomic nervous system acts much like the gas pedal. When our body initiates a stress response (when the gas pedal is activated), the body also reacts by slowing down some of the systems that are not needed when dealing with an immediate stressor. Things like digestion and our immune system are turned off or lowered in a stress response.
The other branch is our parasympathetic system - it acts as the brake by promoting calming processes that include rest, digestion, growth, healing, and energy storage. It is also the branch that enables us to have calming and restorative connection with others. We need this part activated to maintain health.
Ideally, stressors are meant to subside allowing our system to ease off on the gas pedal and then let the brake system to do its job. But what happens when the stressors continue? What happens when our nervous system keeps the “gas pedal” engaged for extended periods? We start to experience the negative impacts of chronic stress. And the result isn’t good.
The Downside of Stress
The negative impacts of stress affect all aspects of our lives. Here are just some of the ways stress shows up:
Irritability or anger
Lack of motivation
Isolation and disconnection in relationships
Tension-reduction behaviours like eating or smoking
Increased substance use
We are exposed to staggering amounts of stressors if we add them all up. When our overall stress load is high, it makes it difficult to respond well to “gas pedal” moments. A high stress-load can interfere with our ability to handle some of the more minor stressors appropriately. That’s why people find themselves yelling at a slow driver or being irritable with a misbehaving toddler.
We don’t just reacting to the stress of the moment but all of the stress our whole nervous system is holding.
Past trauma also impacts our stress response. People who experienced childhood trauma often don’t respond to stress the ways others do. When stressed, they may react in emotional ways, see harm where none was intended, or seem more emotionally reactive than the situation might otherwise deserve. Early exposure to traumatic experiences also increases a person’s sensitivity to stress as an adult.
Trauma experienced as a child “tunes” the brain and the nervous system to be particularly sensitive to stress.
How Stress Impacts Substance Use
Here are some important things to consider about how stress affects substance use patterns:
Men with high-stress jobs are at a higher risk for addiction, but the chances are even higher when their work is physically demanding as well.
For middle-aged women, it is stressful life experiences such as divorce or the death of a loved one that increase the risk of substance dependence.
Although teenagers experiment with cannabis for many reasons, stress relief is the most common reason their use continues or escalates. It is the most common substance teens use for stress relief.
The risk of addiction increases when substances are used to cope with stress.
Stress makes relapse more likely for a person in recovery from substance misuse.
There is a clear link between stress and people self-medicating with substances like alcohol and cannabis. One of the underlying assumptions about substance misuse is that it often begins as a survival strategy – it’s used to turn down the noise on some of the uncomfortable impacts of stress like irritability and worry. Often, substances are used to help manage insomnia.
People tend to use alcohol, cannabis, opiates, or benzodiazepines because it makes the distressing symptoms of stress “better”.
The Self-Medication Hypothesis (SMH) was developed over 30 years ago by Edward Khantzian. It views substance use as a way of medicating overwhelming emotions and experiences including those of chronic stress. Khantzian came to the conclusion that the heart of addictive disorders is suffering, not a “reward” or the seeking of pleasure – it is about self-medicating distress and feeling overwhelmed. He believes that substance misuse and addiction problems are less about pleasure seeking, reward, or self-destructiveness than they are about human psychological vulnerabilities. Khantzian asked this question:
"What does that this substance do for you?" – an important question to ask when looking at the connection between chronic stress and substance misuse.
When we approach substance use and addiction from this perspective, it helps us have a better sense of what helps support people who wish to address these issues.
Substance Use Doesn’t “Solve” Stress - It Just Numbs It
Using substances to manage stress is a losing battle. Temporarily numbing the negative impacts of stress does nothing to help resolve what is causing this tension in the first place. It also stops someone from learning healthier and more adaptive ways to handle ongoing challenging life circumstances.
Let’s go back to the gas and brake pedal analogy. Stress is a gas pedal response. The sympathetic nervous system (gas pedal) is turned on and often stays on for extended periods. Substance use doesn’t turn if off … it just medicates or numbs the symptoms of stress.
Research shows that substances actually turn up the stress-response in our bodies – they are not a healthy way of dealing with stress.
Rather than helping us turn down the gas pedal and then engage the brake pedal, substances just medicate or numb the stress responses. It’s kind of like throwing the emergency brake on while the engine is revving. And this makes a mess of our nervous system which only increases the desire to numb out and not feel.
“It’s difficult to get enough of something that doesn’t quite work.” Vincent Felitti
There are healthier ways of dealing with stress, but it requires an acknowledgement that the quick fix of substances are not beneficial in the long run. What are these healthier ways? They include things like exercise, meditation, mindfulness, yoga, laughter, play, and meaningful connections with loved ones. Seeking out the support of a therapist can also help you identify better ways of coping with the stressors in your life.
Want to learn more about the connection
between stress & substance misuse?
I have a series that provides a more in-depth look at how the nervous system function and how stress can set the stage for substance misuse and addiction disorders.
The Vortex Model of Addiction. It’s a model that helps us understand how our nervous system responds to chronic stress, anxiety, and traumatic experiences as well as the process of addiction. It also speaks to the journey of healing and the process of recovery.