Life Gets Messy When Stress and Substance Use Collide
SELF-MEDICATING STRESS
Tense. Pressured. Stressed out. The one word that sums up our experience in our modern world: stress. We especially feel it when we can’t deal with what is going on around us. Of course, 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. But, 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" this pressure 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.
Life gets messy when stress and substance use collide.
Sources of Stress
Acute stressors are short-term situations with a clear and immediate cause of stress. For example, a traffic jam, a brief illness, an argument with a loved one, or a work-related deadline are all sources of acute stress. Our bodies are well-adapted to handle these (hopefully) short-lived experiences. Once the situation is resolved, our stress level is meant to return to its 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. Unfortunately, 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, 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 and 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, it's like the gas pedal is activated. While some things in our body increase (heart rate or blood pressure), the body also reacts by slowing down some of the systems not needed when dealing with an immediate stressor. Things like digestion and our immune system are turned off or lowered in stress.
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 a 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 the gas pedal and let the brake system 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:
Physical Symptoms
Fatigue
Insomnia
Headaches
Muscle pain
Stomach upset
Emotional Symptoms
Anxiety
Irritability or anger
Depression
Restlessness
Lack of motivation
Behavioural Symptoms
Avoidance
Isolation and disconnection in relationships
Decreased self-care
Tension-reduction behaviours like eating or smoking
Increased substance use
If we add them all up, we are exposed to staggering amounts of stressors. It is difficult to respond well to "gas pedal" moments when our overall stress load is high. A high stress load can interfere with our ability to appropriately handle some of the more minor stressors. 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. Often, people who experience childhood trauma don't respond to stress the ways others do. Instead, 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, stressful life experiences such as divorce or the death of a loved one 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. In fact, cannabis 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 a substance use disorder.
SELF-MEDICATING STRESS
There is a clear link between stress and self-medicating with substances like alcohol and cannabis. One underlying assumption about problematic substance use is that it often begins as a survival strategy. Addictive substances or behaviours are quite "effective" at decreasing 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 chronic stress. Khantzian concluded 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 better understand 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 it 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. So what are these healthier ways? They include 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.
Do you want to learn more about the connection between stress and problematic substance use?
I have an article 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 is a model that helps us understand how our nervous system responds to chronic stress, anxiety, traumatic experiences, and the process of addiction. It also speaks to the journey of healing and the process of recovery.
Click to link below to read this helpful article.
Want more information on the Vortex Model of Addiction?
This article offers a more in-depth look at the model and how it relates to substance use and addiction disorders.