Role of stress in addiction relapse

Tenzin Tsokyi

Drug addiction is characterized as a chronic, recurrent disorder in which obsessive drug seeking and use continue despite substantial negative consequences (Camí & Farré, 2003). Addiction relapse, on the other hand, is generally defined as drinking alcohol or resuming drug use after a period of abstinence. The conceptual definition of relapse is a failure to maintain desired behavior change. (Dimeff & Marlatt, 1995). Across the studies, it is shown that relapse is triggered by both biological and psychological factors such as interruptions in dopamine balance, societal pressure, and individual mental state. According to Sinha (2007), stress is considered one of the foremost reasons or paramount factors that have been linked to an increased chance of relapse with alcohol and drugs. Hence, this blog, in particular, will explore how stress-related factors can influence addiction relapse. 

Both discrete and chronic stressors have a role in the development of drug and alcohol addiction. These stressors further contribute to the relapse of people recovering from dependence. Self-report measures and survey studies have shown that alcoholics and drug abusers mostly attribute stress as a reason for relapse. In recent years, there is also growing recognition from neuroscience and preclinical research stating that the dysregulation of brain stress and reward networks may play a crucial role in addiction relapse (Weiss, 2005). In a study that is conducted to better understands the relation between increased distress with drug craving and relapse, it suggests that in the case of cocaine dependence, stress- and drug cue-induced distress states induce a similar compulsive drug-seeking state that is linked with relapse vulnerability (Sinha, 2007).

Moreover, research from Cardenas et al. (2006), has also shown and documented the chronic alcohol-correspondent structural brain changes in parietal, frontal, and temporal cortical regions associated with stress. The result suggests the level of gray-matter volume impairments in these regions implicated in emotion regulation, impulse control, and abstraction abilities could serve as helpful neurological markers of relapse risk. In addition to that, Sinha et al. (2007), studied the functional response to stress and structural brain changes through fMRI.  They found that individuals who are alcohol dependent showed significantly noticeable activity in the insula, ventromedial prefrontal cortex, and also specific regions of the cerebellum and thalamus. 

Experiments are further conducted to substantiate the role of stress pathways in the drug-craving state and in relapse vulnerability. To study the factors that can induce drug-taking behavior under certain periods of abstinence, researchers have used an animal model of relapse.  In that experiment, rats are taught to self-administer medications intravenously by pressing one of two levers in their trials. From the experiments, they discovered that re-exposure to the medication and exposure to a brief period of stress are the two most effective ways to re-establish response after both short and extended drug-free intervals (Braddy et al. 1999). This experiment indicates an important role for stress pathways in the drug-craving state and in relapse vulnerability. 

Additionally, the type of stressor also influences the relation between stressor and addiction relapse. The time period of the stressor; whether it has occurred before or after treatment and its severity is shown to affect the degree of relapse (Braddy et al. 1999). 

Despite severe stress, addicts can still remain abstinent from drugs and alcohol only when the psychosocial domains such as social networks, coping skills) are improved. This can be explained by the vulnerability-stress hypothesis or stress-diathesis model. According to the stress-diathesis model, the link between stress and relapse is determined by predisposition factors and stressful conditions (Brown et al. 1990). This hypothesis posits that every physical and mental disorder is developed from the interaction between genetic or predisposition factors along with the influence of stressful situational factors. Hence, studies that have sought to investigate this topic have shown that enhancing healthy coping methods and problem-solving techniques, as well as maximizing social support systems, are critical components of successful treatment (Braddy et al. 1999)

In conclusion, stress has been a common factor in causing negative life experiences when it exceeds the threshold of eustress. Similarly, in the case of addiction relapse, stress has been a crucial determinant of relapse depending on the severity and duration of stress. Moreover, recent neuroscience findings and experiments in animals, also add to the role of stress and the neural pathway of stress in addiction relapse. Stress-diathesis model added the significance or role of situational factors in the process of individual refraining from alcohol or drug addiction. This has further led to the diffusion of accountability of relapse among biopsychosocial factors. Therefore, these findings and results described how stress is connected with the process of conquering addiction, relapse, and later, preventing relapse.

References

Brady, K. T., & Sonne, S. C. (1999). The role of stress in alcohol use, alcoholism treatment, and relapse. Alcohol research & health : the journal of the National Institute on Alcohol  Abuse and Alcoholism, 23(4), 263–271.

Brown SA, Vik PW, McQuaid JR, Patterson TL, Irwin MR, Grant I. Severity of psychosocial stress and outcome of alcoholism treatment. Journal of Abnormal Psychology. 1990;99:344–348

Camí, J., & Farré, M. (2003). Drug Addiction. New England Journal of Medicine, 349(10), 975–986.    https://doi.org/10.1056/nejmra023160 

Cardenas, V. A., Studholme, C., Gazdzinski, S., Durazzo, T. C., & Meyerhoff, D. J. (2007). Deformation-based morphometry of brain changes in alcohol dependence and abstinence. NeuroImage, 34(3), 879–        887. https://doi.org/10.1016/j.neuroimage.2006.10.015 

Dimeff, L. A., & Marlatt, G. A. (1995). Relapse prevention. In R. K. Hester, & W. R.    

Miller   (Eds.), Handbook of alcoholism treatment approaches (2nd ed., pp. 176 – 194). Boston: Allyn and Bacon. 

Maisto, S. A., Pollock, N. K., Cornelius, J. R., Lynch, K. G., & Martin, C. S. (2003). Alcohol relapse as a function of relapse definition in a clinical sample of adolescents. Addictive Behaviors, 28(3), 449–459.     https://doi.org/10.1016/s0306-4603(01)00267-2 

Sinha, R. (2007). The role of stress in addiction relapse. Current Psychiatry Reports, 9(5), 388–395.           https://doi.org/10.1007/s11920-007-0050-6 

Weiss, F. (2005). Neurobiology of craving, conditioned reward and relapse. Current Opinion in       Pharmacology, 5(1), 9–19. https://doi.org/10.1016/j.coph.2004.11.001