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Tackling the Cycle of Chronic Stress and Addiction

The U.S. is one of the top ten most stressed out countries in the world, with young Americans between the ages of 15 and 49 harboring the most stress (Ray, J., 2019).

Even more concerning is how this tension affects our overall mental and physical wellbeing. Unfortunately, stress is also a significant risk factor in drug initiation, addiction, and relapse. To tackle the cycle of stress and substance use disorders (SUD) in a person, we must look at all the elements causing the repetitive sequence in an individual.

In this article, we will explore genetic, environmental and cognitive factors leading to addiction, including the latest research highlighting how stress can increase predisposition to SUD through changes in neuronal activity in the brain. Finally, we look at why we need to understand a person’s cognitive orientation during addiction recovery. And why this untapped method helps form a more comprehensive treatment plan in stopping the cycle of stress and addictive behavior.

 

Latest Research on Stress, the Microglia, and Addiction

Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits and genetics. We know that the part of the prefrontal cortex that is involved in cognition is shut down by stress, and as a result – the stressed brain loses the ability to be reflective and begins to run on autopilot. Stressed people are prone to give in to impulses like smoking, overeating, alcohol, and prescription drug abuse to cope with this stress (Grant et al., 2011). With this understanding, new research out of Temple University is exploring the potential links between stress, microglial activity in the brain, and vulnerability to addiction.

Authors Anna McGrath and Lisa Briand suggest that both stress and substance misuse can increase microglial alterations, which can then lead to changes in synaptic plasticity (the ability of synapses to strengthen or weaken over time). Researchers believe these alterations in synaptic plasticity may contribute to later vulnerability to SUD. The study focused on three components of synaptic plasticity: spine density, brain-derived neurotrophic factor (BDNF), and α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor expression. They reviewed the specific roles these components played in addiction, stress, and development, as well as possible mechanisms by which microglia could regulate their function. While this review concentrates primarily on cocaine neuroadaptations, it’s important to note that different drugs can produce various neuroadaptations (McGrath and Briand, 2019).

The key findings are very promising and included:

  • Both stress and misuse of drugs alter synaptic plasticity (spine density), BDNF, and AMPA receptor expression.
  • Given that microglia play such an active role in synaptic changes during normal development and learning, there is potential for microglia to not only influence stress and drug responses through inflammation but also by regulation of synaptic plasticity (McGrath and Briand, 2019).
  • Stress can change the microstructure of the brain in a way that predisposes a person to drug abuse as well as the individual’s ability to abstain from drug or alcohol use.

If microglia activity can be studied for both their inflammatory processes but also as synaptic regulators, clinicians will develop a clearer understanding of the link between stress and addiction – hopefully leading to more effective treatment.

Stress and the Environment

Now that researchers are forming a clearer picture of the effects of stress in the brain and its link to addiction, it’s equally important to examine how the environment and stress play a role in substance use disorders. First, there needs to be a distinction between common everyday stressors such as children and other daily tasks, and chronic stress. Chronic stressors tend to include intense, sudden, or prolonged issues such as the death of a loved one, challenging relationships, work stress, or unexpectedly losing a job. There is substantial evidence that links chronic stress and the desire to use substances (Al’Absi, 2007). For example, if a person is dealing with a divorce, this stressful environment can lead to feelings of anxiety, making the individual more susceptible to addiction. This type of chronic stress can also influence how a person looks at the world or cognitive orientation.

The Role of Cognitive Orientation

Our beliefs, expectations, and thoughts powerfully influence our feelings and perspective of the world around us (cognitive orientation) – and subsequent behavior. The chronic stress of an event like a divorce can result in negative and inaccurate thoughts or beliefs that, if not addressed, can result in a cognitive collision or continually experiencing mental discord such as anxiety. The truth is, a divorce in and of itself is not harmful. What matters is how the person interprets the stressor and how he or she copes with it (Lazarus and Delongis, 2006).

During a divorce, a person may think, “I’m going to die alone” or “I’ll never be able to support myself.” If this inaccurate view or perception of the world is not corrected, it can lead to mental health disorders such as anxiety or depression. These views and feelings of anxiety mixed with a person’s everyday stressors such as parenting can lead to substance use and addiction. By understanding a person’s cognitive orientation, or how someone perceives the world during addiction treatment, chronic stress can be reduced, and long-term healing can begin.

Breaking the Cycle of Stress and Addiction

A high percentage (40-60%) of patients relapse within their first year of recovery and many variables contribute to these rates, including stress. The healthcare community is ramping up research on how genetics and environmental factors play critical roles in SUD and the causes of relapse. But these factors are only part of the story. Understanding how a person’s cognitive orientation leads to stress will give a complete picture needed to treat the whole patient. By creating specific tests to understand a person’s cognitive orientation or traits during addiction treatment – and forming an individualized plan to address these inaccurate perceptions and beliefs – can addiction professionals adequately tackle the cycle of stress and the addictive behavior. Combining these tools and techniques can help lead the patient to a healthier worldview and life in recovery.

 

References:

Al’Absi, M. (2007). Stress and Addiction: Biological and Psychological Mechanisms. London: Academic Press.

Grant, J. E. et al. (2011). Overcoming Impulse Control Disorders: A Cognitive – Behavioral Therapy Program (Workbook). New York: Oxford University Press

Lazarus R.S., Delongis, A. (1983). Psychological stress and coping in aging. American Psychologist. 38(3):245-254.

McGrath, A.G., L.A., Briand (2019). A potential role for microglia in stress- and drug-induced plasticity in the nucleus accumbens: A mechanism for stress-induced vulnerability to substance use disorder. Neuroscience and Biobehavioral Reviews. 107: 360-369.

Ray, J. (2019, April 25). “Americans’ stress, worry, and anger intensified in 2018.” Retrieved from https://news.gallup.com/poll/249098/americans-stress-worry-anger-intensified-2018.aspx