Stress and addiction have a complicated relationship. Stress has a major influence on addiction risk and relapse risk so understanding stress and how to manage it are crucial for staying sober long term. Broadly speaking, stress is any sort of demand put on your body or mind. When you think of stress, the first thing that may come to mind may be having too much work and too little time, or having too little money and too many bills. These are certainly common forms of stress but stress can also include running a mile as fast as you can, going a whole day without eating, or living with a violent person. Stress is also highly subjective. What one person finds stressful another may find exciting or boring.
Research has shown that stress increases your addiction risk in a number of ways. Perhaps the biggest way has to do with stress you experienced in childhood. Chronic stress in childhood is especially damaging because of the effect it has on developing brains. Adverse childhood experiences, or ACEs, include experiences like sexual, physical, or emotional abuse, witnessing domestic violence, having your parents get divorced, having a parent with a substance use disorder, and other stressful experiences. These have been linked to many mental and physical health problems in adults. Studies show that people who have five or more ACEs are between seven and ten times more likely to have a substance use problem.
ACEs affect you in a number of different ways. One especially important way is that they alter how you respond to stress as an adult. People who suffered abuse or neglect as children often become either overactive or underactive to stress as adults. Both cause problems. If you overreact to stress, you are more likely to experience non-threatening events as threatening and experience more stress overall. If you under react to stress, you may become more impulsive and prone to substance use issues.
If a stressful childhood environment increases your risk for addiction, adult stress is often the proximate cause of substance use. Research shows that chronic stress and overwhelming individual stressors lead to increased use of drugs and alcohol. This is even evident in lab animals. For example, mice that are subjected to physical stress or isolation are more likely to self-administer opioids. Alcohol, in particular, changes your reactivity to stress by increasing the effects of the inhibitory neurotransmitter GABA and reducing the effect of the stimulatory neurotransmitter glutamate. This has the temporary effect of making you physiologically incapable of feeling stressed, which is why so many people reach for a drink at the end of a hard day. Benzodiazepines work in a similar way. However, the effect is temporary, so if you get in the habit of relying on drugs and alcohol as a way of coping with stress, you may develop an addiction. In addition to relieving the psychological and physical symptoms of stress, the physiological changes caused by chronic stress may also enhance the effects of certain drugs, making repeated use more appealing.
Stress and Relapse
The relationship between stress and relapse is also complicated. Many people identify stress as their biggest relapse trigger. This makes sense in terms of what we discussed above. If you have been in the habit of using drugs and alcohol to cope with stress, possibly for years or even decades, it only makes sense that a major stressor during recovery will immediately make you think of drugs are alcohol. This is especially true of stressors that feel overwhelming so that you don’t feel like you have any control over the situation. This kind of stress is most similar to the kinds of trauma and chronic childhood stress that are most associated with substance use disorders.
However, the picture is slightly more complicated than that. While stress is a major cause of cravings, it is certainly not the only cause and sometimes even happy events can lead to relapse. One study of people recovering from cocaine addiction found that men were more likely to relapse after positive experiences, then rationalize it after the fact, while women were more likely to relapse following negative emotions or interpersonal conflict. The women in this study were also far more likely to relapse impulsively, whereas the men tended to think it over first. It’s also worth noting, that although this study was specifically of people recovering from cocaine addiction–which isn’t the first drug that comes to mind when you want to relieve stress–at least one study has found similar patterns for both cocaine and alcohol relapse following stress.
Tips for Managing Stress
Given the major role stress plays in addiction and relapse, learning positive ways to cope with stress should be one of your top priorities for recovery. As we’ve seen, much of our response to stress is determined by childhood experiences. In other words, to some degree, adverse childhood experiences make dysfunctional responses to stress part of your personality and therefore hard to change. Typically, this shows up as high neuroticism in terms of the five-factor personality model. While that may sound discouraging, it does appear that you can make meaningful change to your stress response if you are willing to make a consistent effort. The following are some of the ways you can feel less stress and better cope with the stress you do have.
Examine your assumptions
One of the best ways to deal with stress more productively is to enter therapy. A skilled therapist can help you untangle the mess of personal history, maladaptive behaviors, and faulty assumptions that make life feel more stressful than it needs to be. One of the primary ways therapy does this is helping you identify and challenge your cognitive distortions. These are subtle ways of interpreting the world that seem accurate to us but actually cause us unnecessary pain.
The central insight of cognitive behavioral therapy, or CBT, is that our thoughts mediate between events and our emotional reactions and it’s our thoughts, not what happens to us, that make us feel bad. For example, say you stop by your boss’s office to ask a question and she snaps at you, “Not now!” The most common reaction to this is probably negative, ranging from slightly miffed, to panic, or possibly even depression. The incident in itself is not a big deal but your brain can easily turn it into a big deal. You might think, “She finds me annoying and is too busy to pretend she likes me,” an example of mind reading and personalization. Or you might think, “I’ll probably get fired and end up homeless,” an example of jumping to conclusions and catastrophizing.
In reality, the incident probably had little or nothing to do with you. Your boss’s best friend or spouse might have come in at the moment and gotten the same abrupt response you did. Yet your interpretation, typically based on meager evidence, made you feel offended or anxious. One major way to reduce stress in your life is to identify your assumptions about the things that stress you out and ask if they are really true.
Another common approach to stress is a strategy called reappraisal. Reappraisal is similar to identifying cognitive distortions in that you are making yourself aware of the ways your thinking affects your stress response. However, reappraisal is slightly different in that you’re choosing the more positive of two compelling interpretations of an event.
For example, if you are about to give a presentation or speech, you are likely to experience a number of stress-related symptoms, including increased heart rate, butterflies in your stomach, rapid breathing, sweating, and so on. You might notice some of these symptoms and think, “Oh, no, I’m stressed and panicking,” which only makes you feel worse. However, you can also experience these same symptoms and reframe it as, “I’m excited because I get to talk about something I’m interested in and the people here want to hear what I have to say.” In other words, the symptoms of stress and excitement are the same but your interpretation makes a huge difference.
This is especially important because we’re all used to hearing about how stress can cause heart disease, high blood pressure, depression, insomnia, more frequent illnesses, and a host of other ailments. It’s normal to feel like stress in itself is bad and something to be avoided. In reality, we can’t avoid all stress and we wouldn’t want to. Learning to take a positive view of stress–to see it as a sign of excitement or as an opportunity to test your limits and become stronger–turns a liability into an asset.
Practice setting boundaries
Setting and maintaining boundaries is an important skill for addiction recovery, not least because it helps reduce stress. Having good boundaries simply means that you are able to protect your time, personal space, values, and autonomy and you extend the same respect to other people. In other words, you don’t coerce or manipulate others and you don’t let others coerce or manipulate you.
If you are good at maintaining boundaries, you can say no when you someone asks you to do something that either you don’t have time for or you don’t feel comfortable with. We all have a limited number of hours in the day and if you try to fit too much in, you’re going to feel stressed, especially when low priority errands and favors encroach on more important matters. As for things you are not comfortable with, these can feel especially stressful since we end up wrestling with our own conscience and continue to do so after the deed is done. When you are good at maintaining boundaries, you can focus on your priorities without feeling conflicted or guilty.
Manage your priorities
Speaking of priorities, having clear priorities is a great way to manage your time and energy. As noted, we only have a limited amount of time each day, so it’s crucial to do the most important things first. These should be things that relate to your values and long-term goals. For example, when you first leave treatment, your top priority should be maintaining your sobriety as you transition back to normal life. Perhaps your plan involves attending a 12-step meeting every day for a few months in addition to other things like exercise, mediation, journaling, and so on. The way you prioritize your recovery then, would be to schedule your 12-step meeting first thing, then fit in your other obligations around that.
Most of us can’t get to more than three big things on a regular basis. So, you might decide your priorities for the day include going to your 12-step meeting, going to work, and spending some defined amount of time with your family. You can probably manage that most days while fitting other odds and ends wherever you have time. When you do the big things first, you feel less bad about those low-priority items that inevitably get delayed or ignored.
As noted above, stress, in itself, isn’t bad. In fact, stress is an essential part of life. It keeps us moving and growing. It keeps us from getting bored and complacent. When framed in the right way, even a fairly stressful situation can be an opportunity for personal growth. The problem is chronic stress. Our stress adaptations only evolved to be useful in the short term–to win a fight or escape from a bear, for example. Chronic stress is what causes us to break down physically and mentally.
The solution is to adopt a pattern of stress and recovery. In other words, take breaks. These can be short, regular breaks. For example, you’ve been working hard for an hour or so and it’s time to rest for a few minutes. Maybe take some slow deep breaths or take a short walk to stretch your legs. You also need daily and weekly breaks. Make sure you’re taking a little time at the end of each day to decompress. Take a hot bath, watch some funny videos, listen to music, or do whatever else helps you forget the stress of the day.
In other words, think of stress the way you would think of learning or exercise. Although studying or working out are necessary for improvement, that improvement actually happens during the rest periods, especially while you sleep. If you study or work out constantly, you’ll just get sick and exhausted. The same is true for stress. It can stimulate growth but the growth happens during the breaks, when you’re recovering.
Exercise is one of the most powerful ways to cope with stress. There are now quite a few studies linking exercise to better mental health in general. For example, one study that included data from more than a million people found that people who exercise regularly had 43 percent fewer days of poor mental health in the past month. There is also promising new research suggesting that regular exercise can reduce your risk of relapse.
There are a number of ways researchers suggest exercise improves mental health but one of the primary mechanisms seems to be that regular exercise reduces stress. Exercise releases mood-boosting hormones including endorphins, endocannabinoids, serotonin, and brain-derived neurotrophic factor, which actually grows brain cells. Studies have also found that regular exercise can change the structure of the brain in a way that reduces our reactivity to stress. In particular, aerobic exercise such as running, biking, and swimming seem to affect the brain’s hypothalamic-pituitary-adrenal, or HPA, axis, which connects to several areas of the brain involved with mood, motivation, and threat recognition.
Connect with other people
Finally, connecting to other people is crucial for coping with stress in a healthy way. This is one reason there is so much emphasis on family and group cohesion in addiction treatment programs, including 12-step programs. As social creatures, we understand on an instinctive level that our survival depends on other people. That’s one reason chronic loneliness is such a worrying trend in rich countries. Spending time with people who support us and care about us is one of the most positive ways to manage stress. Just being around people you like improves your mood but it also gives you access to more resources for solving problems. Your friends and family can give you a hand when you need it and having a larger network increases your possibilities. Even if you don’t have to ask for help, just knowing help is available reduces your stress. Finally, talking to other people in recovery is an opportunity to process the stress in your life, especially stress related to recovery, in a healthy way.
Managing stress is a crucial recovery skill and it’s one you can definitely get better at with practice. You just have to learn the right skills and find the right social support. It’s also important to remember that stress isn’t inherently bad. It can be an opportunity to grow if you react to it the right way. At Steps Recovery Centers, we understand that recovery from addiction is a complex process and that no one succeeds alone. We offer a range of treatment options to best suit your unique situation. To learn more about our programs, call us today at 385-236-0931 or explore our website.