Around one in five Americans experience extreme stress, and stress has been closely linked to addiction in a multitude of studies. Stress Awareness Month aims to shine the spotlight on stress, to help us all think about ways to reduce our stress and, in the process, to help us move away from poor coping mechanisms for stress like using alcohol or drugs. Stress is ultimately unavoidable, but if the statistics on stress and addiction teach us anything, it\u2019s that how you cope with stress really does matter. Stress: The Basics Stress can be understood most simply through the \u201cfight or flight\u201d response: It\u2019s the body\u2019s response to a perceived threat, which prepares us for either running away from the threat or dealing with it head on. When you\u2019re stressed, your heart rate gets faster, your breathing rate increases and your brain activity increases. In the short term, particularly when faced with a genuine threat, stress can be very beneficial \u2014 the early human who got stressed at the sound of a predator\u2019s growl was more likely to survive than the one who sat around the campfire relaxing. In the long term, though, stress can have many negative effects. Stress lowers your immunities, suppresses your digestive system, impacts your reproductive system and produces symptoms like headaches, depression, anger and irritability. The immune-system impairment associated with stress means you\u2019re more likely to get the flu or the common cold, and they will be more severe when you do get them. Over time, stress can lead to heart disease, high blood pressure, depression and anxiety disorders, and it contributes to many other conditions, including addiction. In the modern world, obviously dangerous stressors (like a growling, hungry predator or life-threatening situations) are much less common, but more everyday things like work- or family-related pressure, financial concerns and negative life changes (like losing your job or getting divorced) can cause ongoing stress. The body isn\u2019t very good at keeping the responses to these modern stressors proportionate to their overall risk, so even minor events can produce severe stress. Statistics on Stress On a scale of 1 to 10 \u2014 with one being \u201clittle or no stress\u201d and ten being \u201ca great deal of stress\u201d \u2014 Americans are reporting decreasing levels of stress, from an average score of 6.2 in 2007 down to 4.9 in 2012. However, 72 percent say that their stress level has either stayed the same or gotten worse in the past five years, and 80 percent say the same about their stress levels over the past year. Despite apparently living less stressful lives overall, it clearly doesn\u2019t feel that way to us. Additionally, 60 percent report trying to decrease their stress in the past five years, but over half of them say they\u2019re still trying to accomplish that goal. In 2012, 20 percent of Americans reported extreme levels of stress (defined as a score of eight, nine or ten on the scale), with this proportion being relatively stable (although slightly decreasing) since 2009. About seven in ten Americans report physical and non-physical symptoms of stress, most commonly irritability, fatigue, a sense of being overwhelmed and changes in sleeping habits. Additionally, over a third of respondents say they overeat in response to stress. Stress and Addiction Stress is widely cited as one of the main contributing factors to addiction. In the survey discussed above, for example, 13 percent reported using alcohol as a method to manage stress. The relationship between drinking and stress is a fairly complex one, but many people report drinking in response to stress. The relationship depends on many factors, though, such as the individual\u2019s genetic makeup, his or her sense of control over the stressor, his or her expectations about the effect of alcohol on stress and whether other support is available to guard against the effects of stress. In both human and animal research, early stressful experiences have been shown to influence both stress levels and the chance of drinking to cope with stress. The impact of alcohol on stress is often claimed to be positive, but the evidence shows that alcohol actually creates a stress response through its effects on the body\u2019s hormone levels. While low doses of alcohol may reduce stress, the overall impact is far from positive. For other drugs \u2014 like cocaine and heroin \u2014 there is much stronger evidence that repeated use heightens the body\u2019s sensitivity to stress, meaning that while stress is decreased while the substance is having an effect, during withdrawal it leads to greater stress levels than in non-drug-users. This contributes to cravings, and the experience is closely tied to the potential for relapse. Stress has also been associated with relapse in already established alcoholics. One study looked at a group of men who completed an inpatient treatment program for alcoholism but then experienced stress unrelated to alcohol use. The findings showed that those who relapsed experienced twice as much severe and prolonged stress as the ex-alcoholics who were able to avoid relapse. This \u2014 and other conclusive findings about stress and relapse \u2014 led the authors of the study to suggest that the biggest impact of stress on starting to drink is for those who\u2019ve been abstinent for some time. All taken together, the evidence indicates that stress can lead people to drink alcohol or take other drugs, and that this drug or alcohol use in itself can actually worsen the stress. This easily turns into a vicious cycle if the response to the substance-induced stress is to use more substances, but without additional support it can seem hard to find a way out. Managing Stress to Protect Against Relapse It\u2019s clear that stress is both unavoidable and closely associated with substance abuse, so what can you do to protect against its effects? Aside from finding professional help for your addiction and (as part of the process) your stress, many things, including exercise (as little as 30 minutes a day of gentle walking has been shown to be effective), making time for relaxing activities each day, staying in touch with (and reaching out to) friends and family who can offer support, learning to prioritize important and unimportant tasks (to avoid feeling overwhelmed) and avoiding dwelling on problems can be effective strategies. The main thing to remember is that even if using substances might make you feel better in the short term, in the long term it will worsen the problem and ultimately do you a lot of harm. Learning healthier ways to cope is the only way to break the cycle.