How Does Stress Affect Substance Abuse?

According to the American Psychological Association (APA), many Americans report feeling a stress level higher than what they believe is healthy. On average, in 2019, Americans felt that on a scale of 1-10 (where 10 is the most stress) a stress level around 3.9 is healthy. However, the average stress level they reported feeling lingered a whole point higher at 4.9.1 Unfortunately, close to 60% also felt that they received inadequate emotional support in the previous year.1

Health Effects of Stress

a woman suffering from ongoing stress

Stress is normal and, in some scenarios, it can be healthy and motivating. For example, brief periods of stress can help you perform better at work or in competition. But chronic stress can negatively impact your health in numerous ways.2 The APA states that the longer stress goes on, the worse it is for you.2 Ongoing stress can lead to problems such as:2,3

  • Tension and migraine headaches.
  • Back pain and other musculoskeletal problems.
  • High blood pressure.
  • Coronary arterial disease and other vascular inflammation.
  • Increased risk of heart attack and stroke.
  • Worsening of respiratory conditions such as asthma.
  • Chronic fatigue.
  • Obesity.
  • Diabetes.
  • Gastrointestinal problems/disease.
  • Sexual and reproductive problems in both men and women.

Stress and Addiction

Stress is a known risk factor for substance use disorders (SUD).4 There is a great deal of evidence to show that our vulnerability to developing an addiction to one or more substances can be affected by:4

  • Negative, stressful life events such as parental divorce or parental substance misuse.
  • Abuse (physical, emotional, or sexual).
  • Mood and anxiety disorders.

Research shows that exposure to some of these types of stressors can impact certain brain structures and functions thought to also influence the way substances of abuse affect people, potentially explaining in part why they increase a person’s susceptibility to addiction down the line.5

The total amount of stressful situations a person encounters in their life is important as well. Cumulative adversity or stress has been shown to have an impact on an individual’s risk of becoming substance-dependent at some point.4

How Is Addiction Related to Stress?

Stress may contribute to drug use, but drug use may also contribute to stress. Certain drugs of abuse including cocaine, amphetamines, alcohol, and nicotine activate not just the brain’s reward pathways but their stress pathways, as well. Withdrawal from drugs and alcohol can also activate physiological stress responses.4

Of course, living in active addiction is also a recipe for stress. With addiction often comes issues that can further compound the stress in a person’s life, such as:5,6

  • Health problems.
  • Financial losses.
  • Relationship conflict and/or dissatisfaction.
  • Family instability.
  • Unintended pregnancy.

For those in recovery from addiction, exposure to stress is also a risk factor for relapse.4

Post-Traumatic Stress and Substance Use

Post-traumatic stress disorder (PTSD) commonly co-occurs with substance use disorders. PTSD is a mental health disorder that may develop after exposure to a traumatic event, such as a violent assault, natural disaster, or military combat.7 The symptoms of PTSD may include:7

  • Flashbacks, nightmares, and intrusive thoughts related to the trauma.
  • Avoidance of people, places, or objects that serve as reminders of the traumatic event.
  • Changes in mood, such as heightened worry, guilt, or depression.
  • Cognitive issues such as trouble remembering the event or feeling the world is not real (derealization).
  • Hypervigilance.
  • Insomnia.
  • Sudden angry outbursts.

Treatment-seeking individuals who suffer from PTSD may be up to 14 times more likely to have substance use disorders than those without. Other studies have found that, among patients who seek addiction treatment, as many as 60% have been diagnosed with PTSD at some point in their lifetime.8 Several hypotheses have been considered to help explain the prevalent co-occurrence of PTSD and SUD; attempts to self-medicate symptoms with alcohol or drugs may account for some instances of this comorbidity. 8,9  However, while substances may provide a sense of short-term relief, they tend to worsen PTSD symptoms overall.9

Healthy Stress Management Techniques

leaning on loved ones for support is a great stress management technique

It may be tempting to reach for a drink or to other substances to manage stress, but this can put you on a dangerous road to addiction if it becomes your primary method of coping. Healthy alternatives to substances for managing feelings of stress and anxiety include:10

  • Getting exercise. The Anxiety and Depression Association of America states that this is one of the most-recommended methods of stress reduction by healthcare professionals.11
  • Eating healthy. Consuming nutritious, well-balanced meals can make you feel better overall.
  • Getting enough rest. Sleeping enough is essential to keeping stress levels at bay. It’s also important to let yourself take a break when you need it.
  • Taking a media/news break. While it’s good to stay informed, a constant stream of bad news and/or angry social media posts is unlikely to help your stress levels.
  • Leaning on loved ones for support. Talk to people close to you and ask for help when you need it.

The above tips can help you manage moderate levels of stress, but if you’re suffering from issues like PTSD, depression, or anxiety, you may need the help of a professional. There is absolutely no shame in asking for help. Today, there are so many options for support. You can access therapy in-person, by phone, or even through mobile apps.

If you’ve found yourself leaning on alcohol or drugs to alleviate stress and you need help, there are numerous treatment options, from outpatient therapy to inpatient rehab. Laguna Treatment Hospital offers hospital-based detox, inpatient rehab, and partial hospitalization programs for those seeking help with addiction. Our co-occurring disorder treatment addresses not only substance use but mental health issues such as PTSD and anxiety disorders. At Laguna, you’ll receive integrated treatment to manage all of the issues that are creating distress and upheaval in your life.

Our team also works with you to create an aftercare and relapse prevention plan to equip you with the tools and support to stay sober when you leave treatment—a time when you may face numerous stressors and triggers. To learn more about our programs and our 90-day brand promise that guarantees you can return to treatment if you relapse, call us at now.


  1. American Psychological Association (2019). Stress in America: Stress and Current Events. Stress in America™ Survey.
  2. American Psychological Association. (n.d.). How stress affects your health.
  3. American Psychological Association. (2018). Stress Effects on the Body.
  4. Sinha R. (2008). Chronic stress, drug use, and vulnerability to addictionAnnals of the New York Academy of Sciences1141, 105–130.
  5. U.S. Department of Health and Human Services (HHS), Office of the Surgeon General, Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: HHS, November 2016.
  6. Daley D. C. (2013). Family and social aspects of substance use disorders and treatment. Journal of food and drug analysis21(4), S73–S76.
  7. National Alliance on Mental Illness. (2017). Posttraumatic Stress Disorder.
  8. McCauley, J. L., Killeen, T., Gros, D. F., Brady, K. T., & Back, S. E. (2012). Posttraumatic Stress Disorder and Co-Occurring Substance Use Disorders: Advances in Assessment and Treatment. Clinical psychology : a publication of the Division of Clinical Psychology of the American Psychological Association19(3), 10.1111/cpsp.12006.
  9. U.S. Department of Veterans Affairs. (n.d.). PTSD and Substance Abuse in Veterans.
  10. Centers for Disease Control and Prevention. (2019). Coping with Stress.
  11. Anxiety and Depression Association of American. (n.d.). Physical Activity Reduces Stress.
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