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The Impact of Stress on Substance Abuse

Stress is an inevitable part of life that affects everyone. While some people may find stress motivating, for most individuals, it can be uncomfortable and overwhelming. When stress becomes unmanageable or persists for an extended period, it can lead some to resort to unhealthy coping mechanisms such as substance abuse. Although substances may provide temporary relief from stress, they can contribute to a vicious cycle of increased stress and further substance use in the long term, which can be challenging to overcome.

What is Stress?

Stress is a psychological and physiological response to what the brain perceives as being dangerous and/or threatening. When the stress response is triggered, our bodies release stress hormones (i.e. – cortisol, adrenaline). These hormones then trigger the “fight or flight” response. This response prepares the body to deal with the stressor, whether that be a physical threat or an emotional challenge. However, chronic stress can lead to prolonged activation of this response, leading to a range of negative health outcomes, including substance abuse.

What is Substance Abuse?

Substance abuse, also known as substance use disorder, refers to a consistent pattern of alcohol and/or drug use that results in significant distress or negative effects in various areas of life such as work, school, relationships, and physical or mental health. Commonly abused substances include over-the-counter legal substances such as nicotine and alcohol, prescription medications, as well as illegal drugs such as cocaine, heroin, and methamphetamine. Among all substances, alcohol is the most commonly abused.


Certain signs and symptoms can point to the presence of a substance use disorder including:

  • Needing increased amounts of drugs or alcohol to achieve the desired “high”
  • Persistent attempts to cut down or quit using drugs or alcohol, but being unsuccessful in doing so.
  • Spending an increasing amount of time using, obtaining, or recovering from substance use.
  • Continuing to use drugs or alcohol despite experiencing negative consequences in various areas of life, such as work, school, relationships, and health.
  • Experiencing strong cravings or urges to use the substance.
  • Engaging in risky behaviors while under the influence, such as driving under the influence or having unsafe sex.
  • Experiencing withdrawal symptoms when trying to quit or reduce substance use, which can include physical symptoms (e.g. shaking, sweating, nausea) and psychological symptoms (e.g. anxiety, irritability, depression).


The Stress and Substance Abuse Cycle


Stress and substance abuse often have a reciprocal relationship, with each feeding into the other and creating a vicious cycle that can be difficult to break. As mentioned earlier, stress triggers the release of stress hormones such as cortisol and adrenaline, which prepare the body to deal with a perceived threat. In the short term, this response can help get through a difficult situation. However, when stress becomes chronic, the prolonged activation of the stress response can have negative effects on physical and mental health, leading some to turn to substances to cope.

Conversely, the negative effects of substance abuse on a person’s life can contribute to increased stress levels. Research indicates individuals who use drugs and alcohol experience increased levels of stress when compared to those who do not. And substance use can impair a person’s ability to cope with stress, which can lead to more substance use. So, whether a person uses drugs and alcohol to cope with stress first, or the drug/alcohol use comes first, contributing to the spike in stress, the potential for this to create a vicious cycle is evident.

Intervening in the cycle of substance abuse and stress, it is vital to address the underlying cause(s) contributing to the cycle and learn about healthy coping skills and tools. There are a range of therapeutic modalities that may be appropriate in treating the cycle of substance abuse and stress (depending on the individual and their specific needs), as well as lifestyle changes, and at times, medication.

Strategies for Coping with Stress and Substance Abuse 

It is important to note that not all individuals who experience stress turn to substance abuse, and not all individuals who abuse substances do so as a result of stress. However, stress can be a significant risk factor for substance abuse, particularly for those who have a genetic predisposition to addiction or who have experienced trauma or adverse childhood experiences.

There are several effective strategies for managing stress without turning to substance use. These include exercise, meditation, deep breathing, and talking to a trusted friend or therapist. It is important for individuals to develop healthy coping mechanisms for stress and to seek professional help if needed to avoid the negative effects of substance abuse on their lives and overall well-being.

Additionally, it is important for policymakers and healthcare providers to recognize the link between stress and substance abuse and to develop interventions that address both issues. This could include increasing access to mental health services, promoting healthy lifestyle changes, and implementing policies that reduce stressors in individuals’ lives, such as improving working conditions and providing social support.

Combining stress management techniques with substance abuse treatment can be effective in breaking the cycle of addiction. For example, individuals in recovery may benefit from learning and practicing mindfulness-based stress reduction techniques to manage their stress levels and reduce the likelihood of relapse.

Addressing the Challenges 

Substances like alcohol, opioids, and benzodiazepines can provide temporary relief from stress and anxiety. They can also activate the brain’s reward system, which reinforces the behavior and increases the likelihood of repeated use. However, prolonged substance use can lead to physical and psychological dependence, which can further exacerbate stress and contribute to the development of a substance use disorder.

One of the challenges in addressing the cycle of stress and substance abuse is that both issues often require different forms of treatment. Stress management may involve cognitive-behavioral therapy (CBT), relaxation techniques, or other stress-reducing interventions. Substance abuse treatment may involve detoxification, medication-assisted treatment, or behavioral therapies such as motivational interviewing or contingency management.


In conclusion, stress and substance abuse are closely linked, and it is important to address both issues to break the cycle of addiction and improve overall well-being. Through effective stress management techniques and professional support, individuals can develop healthy coping mechanisms and reduce their risk of substance abuse.

Sources Cited 

  • American Psychiatric Association Publishing. “Substance-Related and Addictive Disorders.” DSM Library (Psychiatry Online).
  • American Psychiatric Association. “Diagnostic and statistical manual of mental disorders (5th ed.).” American Psychiatric Publishing. 2013.
  • Hasin, Deborah S et al. “DSM-5 criteria for substance use disorders: recommendations and rationale.” The American Journal of Psychiatry vol. 170,8: 834-51.
  • NIH Organization. National Institutes of Health. June 4, 2018.
  • Duffing TM, Greiner SG, Mathias CW, Dougherty DM. Stress, substance abuse, and addiction. Curr Top Behav Neurosci. 2014;18:237-63. doi: 10.1007/7854_2014_276. PMID: 24510301.
  • National Institute of Mental Health
  • National Institute on Drug Abuse. (2020, June). Drugs, brains, and behavior: The science of addiction.
  • S. Department of Health and Human Services. Office of Disease Prevention and Health Promotion. (2022, April 8). Manage Stress. The basics: Causes of stress.

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