Topics in Treatment: Stress and Addiction

Early Stress and the Development of Substance Use Disorders

Researchers are increasingly focused on studying the effects of Adverse Childhood Experiences (ACEs) on the development of crucial central nervous system components that modulate responses to stress. Children and early adolescents exposed to ACEs are at increased risk of developing substance use disorders (SUDs). ACEs include traumatic experiences such as child abuse and neglect, sexual assault, and extreme poverty, among others.

Neurobiological and psychosocial approaches to how ACEs lead to disordered substance use suggest they alter neural mechanisms in ways that diminish an individual’s ability to efficiently regulate stress.

The Substance Abuse and Health Services Administration (SAMHSA) reports that in 2015, 1.1 million adolescents (age 12-17) required treatment for a substance use disorder. That number was over four times greater for young adults (age 18-25): 5.3 million, or one out of every seven.

The dramatic jump in substance abuse from adolescence to young adulthood may be understood as the confluence of typical adolescent behavioral characteristics with exposure to chronic early stress and/or trauma.

Adolescence, Brain Development, Stress, and Substance Use Initiation

In humans – and in most mammals – novelty-seeking and risk-taking behavior peaks during adolescence. One potentially risky behavior that often occurs during human adolescence is initiation of substance use. Research shows that initiation of drug use in adolescence is associated with addiction later in life. These two factors – the adolescent trait of risk-taking/novelty seeking plus early initiation of drug use leading to later disordered use – may explain why we see a dramatic increase of addiction in young adults.

Adolescence is also a period when vital systems of the brain and central nervous system mature. Two systems that have a significant impact on behavior are the Sympathetic Nervous System (SNS) and the hypothalamic-pituitary-adrenal (HPA) axis. The HPA axis regulates responses and adaptations to stressors in the environment, while the SNS generates the body’s fight or flight response. Both systems are integral to regulating responses to stressors in our environment, including chronic or unpredictable stress that comes from interacting with others or our social environment.

Individuals with a compromised ability to adapt to and regulate responses to unpredictable stress, such as adolescents exposed to chronic or traumatic stressors – ACEs – have an increased risk of developing SUDs. HPA and/or SNS dysregulation present in individuals who misuse substances can also lead to a further maladaptive stress response. Animal studies show that if various systems involved in modulating stress are disrupted or altered, withdrawal and craving symptoms increase in intensity. In humans, these alterations are thought to increase the likelihood of relapse or continued disordered use.

Intervention Strategies for Stress and SUDs

Research into specific pharmaceutical interventions to remediate stress response systems altered by ACEs may be an important step toward treating or preventing SUDs in the future.

In the meantime, preventing and successfully treating SUDs that develop due to chronic stress or ACEs requires, among other things, finding effective ways of reducing acute stress in an individual’s environment.

A variety of currently existing psychotherapies and mindfulness-based interventions prove useful in treatment.

For example, individuals coping with negative experiences – ranging from acute, abrupt, and intense stress such as sexual assault to chronic stress such as divorce or unemployment – find cognitive behavioral therapy (CBT) valuable to successful treatment. CBT helps individuals cultivate new skills and techniques that reduce stress and promote efficient emotional processing. CBT therapists may introduce techniques that help a patient manage thoughts related to the persons, situations, or events that create stress.

Individuals receiving CBT may also learn useful breathing techniques that can directly affect biological stress response systems in positive ways and allow them to process stress and its associated negative emotions productively.

Mindfulness-based stress reduction interventions (MBSRIs) – which are often included in CBT sessions, if the therapist is trained in them – help individuals cope with stress by focusing on breathing techniques aimed at recruiting the autonomic nervous system to reduce the stress response. MBSRIs also help change harmful thinking patterns—including the way individuals assess currently stressful situations—that promote greater relaxation and acceptance.

Awareness and Prevention

Moving forward, we encourage public health campaigns aimed at preventing SUDs in adolescence and young adulthood to include an intentional focus on raising awareness about the impact of chronic and traumatic stress on the developing adolescent brain. The dual threat of typical risk-seeking behaviors and structural changes in stress response systems as a result of exposure to ACEs in adolescents and young adults means they’re vulnerable to developing a SUD. Therefore, treatment providers, policy makers, and members of the community can help pay more attention to ACEs that may intensify drug-seeking behaviors.