Navigating Relapse and Resuming Treatment with Resilience

Addiction to alcohol and other drugs (AODs) is a complex problem influenced by various factors, including psychological and physiological components. One significant factor that plays a crucial role in the initiation, continuation, and relapse of AOD use is stress. Stress is considered a major contributor to the vulnerability to initial AOD use, initiation of AOD abuse treatment, and relapse in recovering AOD users. In this comprehensive guide, we will explore the relationship between stress and addiction, the neurobiological connections between stress and addiction, and the role of stress management in AOD abuse treatment.

The Relationship Between Stress and Addiction

Numerous studies have demonstrated an association between stress and AOD use. However, establishing a causal relationship between the two has proven challenging. While stress-inducing factors in everyday life can potentially lead susceptible individuals to initiate or relapse to alcohol use, the relationship between stress and AOD use is complex and multifaceted.

Stress and AOD Use Initiation

Animal studies have shown that exposure to both acute and repeated stress can increase an animal’s potential for initiating AOD self-administration. However, the timing of the stressor and AOD exposure is crucial. For acute stress to induce AOD administration, the stressful event and AOD exposure must occur within a short interval. Psychological stress alone can also increase drug self-administration in animals, highlighting the significance of stress-induced changes in the brain’s reward pathways.

Stress and AOD Use Reinstatement

Stressful experiences can contribute to the reinstatement of AOD use after a period of abstinence. Studies have found that a single stressful experience can induce resumption of drug use in animals with a history of AOD self-administration. Stress-induced reinstatement of AOD use is a well-documented phenomenon and is often used as an experimental manipulation to study relapse. Chronic stressors and acute stressful events can both contribute to the reinstatement of AOD use.

Effects of Alcohol Exposure on the Response to Stress

Previous alcohol exposure can influence an individual’s response to stress. Animal studies have shown that alcohol exposure interferes with an organism’s ability to adapt to repeated stress. For example, rats exposed to alcohol during a period of repeated restraint stress showed decreased food intake compared to control rats. Alcohol exposure appeared to impair the rats’ ability to adapt to the stressor.

The Neurobiological Connections Between Stress and Addiction

Stress and addiction share common neurochemical systems, including the serotonin, dopamine, and opiate peptide systems, as well as the hypothalamic-pituitary-adrenal (HPA) axis. These interconnected systems play a significant role in the vulnerability to addiction and the response to stress.

The Stress Response and the HPA Axis

The stress response involves complex behavioral, biological, and emotional reactions initiated by the perception of a potentially harmful or distressing event. The HPA axis, which consists of the hypothalamus, pituitary gland, and adrenal glands, plays a crucial role in coordinating the body’s response to stress. Stress-induced changes in the HPA axis can lead to the release of stress hormones, including cortisol, which regulate various physiological responses to stress.

Neurotransmitters and Reward Pathways

Neurotransmitters, such as serotonin and dopamine, are involved in controlling the stress response and mediating the reinforcing effects of AODs. Stress can increase the activity of dopaminergic brain systems involved in motivation and reward, potentially enhancing the organism’s responsiveness to the effects of AODs. Serotonin also plays a role in the relationship between stress and AOD use, with studies showing that alcohol administration increases brain serotonin metabolism in animals.

Interplay Between Stress and Reward Pathways

The interplay between stress and reward pathways in the brain is complex. Stress-induced changes in neurotransmitter activity can modulate the brain regions involved in mediating the reinforcing effects of AODs. Animal studies have suggested that stress modifies the motivational and reinforcing effects of AODs, potentially increasing an individual’s vulnerability to addiction. However, the relationship between stress and addiction is multifaceted and influenced by various factors.

The Role of Stress in Addiction Development and Treatment

Stress and the Development of Alcoholism

Clinical studies have indicated that both acute and chronic stress may play a role in the development of alcohol use disorders. Occupational stress, such as high demands and low control in the workplace, has been associated with higher drinking levels and an increased risk of alcohol use disorders. The relationship between stress and alcohol consumption in women remains controversial, with some studies suggesting a connection between coping styles and stress-related alcohol consumption.

Stress and Treatment Initiation

Stressful events often serve as a catalyst for individuals with alcohol use disorders to seek treatment. Alcoholics experiencing chronic hardships or acute stressful events are more likely to perceive their drinking problems as severe and seek help. The presence of social resources, problem-solving skills, and coping strategies can influence an individual’s decision to seek treatment.

Stress and Relapse

Stressful life events and chronic stressors can contribute to relapse in individuals recovering from AOD abuse. The stress-vulnerability hypothesis suggests that severe stressors, combined with the presence or absence of protective and risk factors, mediate relapse. Studies have shown that patients who experienced more severe stress before treatment had a higher risk of relapse. Factors such as coping skills, social support, and self-esteem play a crucial role in resilience to stress-induced relapse.

Stress Management in AOD Abuse Treatment

The incorporation of stress management techniques in AOD abuse treatment can reduce the risk of relapse and promote successful recovery. Both pharmacotherapy and psychosocial therapy play important roles in stress management during treatment.


Pharmacological management during times of stress can help reduce the risk of relapse to AOD use. Selective serotonin reuptake inhibitors (SSRIs), which increase serotonin activity in the brain, have shown promise in reducing alcohol consumption and mitigating the effects of stress on alcohol consumption. Opioid antagonists, such as naltrexone, can also prevent relapse in detoxified alcoholics by interfering with the rewarding effects of AODs.

Psychosocial Therapy

Psychosocial therapy approaches, such as cognitive restructuring, problem-solving skills training, and social support systems, are integral components of AOD abuse treatment. These techniques aim to enhance healthy coping strategies, improve problem-solving abilities, and maximize social support networks. Studies have shown that patients who received supplemental skills training and social network development after treatment showed greater improvement in various areas, including coping with stress and avoiding AOD use.


Stress plays a significant role in addiction and relapse, influencing the initiation, continuation, and treatment of AOD abuse. The neurobiological connections between stress and addiction involve various neurotransmitter systems and the HPA axis. Stress management techniques, including pharmacotherapy and psychosocial therapy, are essential in reducing the risk of relapse and promoting successful recovery. By understanding the complex relationship between stress and addiction, individuals grappling with substance abuse can navigate their journey towards resilience and long-term recovery. Remember, seeking help and support is the first step towards a healthier, addiction-free life.

Additional Information: Addiction is a treatable condition, and seeking professional help from addiction treatment centers and support groups can provide valuable resources and guidance. If you or someone you know is struggling with addiction, reach out for help. You are not alone, and there are resources available to support you on your journey to recovery. Call us today at 833-820-2922.