The Impact of Stress on Alcoholism Recovery

Essentially all adults in the modern world are intimately familiar with stress, a reaction in the mind and body that produces effects such as increases in normal blood pressure and heart rate, as well as an increased susceptibility to the distorting influence of anxiety and fear. For several reasons, alcoholics typically have unusually elevated stress levels, both during active alcohol use and during the process of alcoholism recovery. Current evidence indicates that this elevated stress can lower an individual’s ability to resist alcohol cravings during recovery, and subsequently increase risks for the onset of an alcohol relapse.

The Biological Nature of Stress

In the human body, stress is related to chemical changes that take place in both the nervous system and a network of glands and other structures called the endocrine system, which produces vital substances known as hormones. The nervous system plays its part when two neurotransmitting chemicals – called epinephrine and norepinephrine – spark heightened levels of activity inside the sympathetic nervous system, an involuntary nerve network that gives the brain control over key aspects of normal function in the heart, lungs, blood vessels, eyes, and a number of other essential organs. The endocrine system plays its part when a specific hormone released in a portion of the brain called the hypothalamus triggers a chemical chain reaction that ultimately results in the release of another hormone in the adrenal glands, called cortisol, which doctors commonly refer to as the body’s main stress hormone. Under the influence of epinephrine, norepinephrine, and cortisol, the body produces its classic stress response, known popularly as the evolutionary “fight-or-flight” response. Specific aspects of this response that stem from chemical changes in the sympathetic nervous system include increased heart and breathing rates, narrowing of the blood vessels and a related increase in blood pressure, and increased blood flow to the body’s large muscles. Specific aspects of fight-or-flight that stem from the heightened production of cortisol include an increase in the supply of the body’s main energy source (glucose), suppression of hunger in the digestive system, and a boost in the body’s ability to repair damaged tissues.

Alcoholism and the Stress Response

By definition, alcoholics drink enough alcohol to damage a variety of organ systems. In the endocrine system, this damage manifests in part as interference with the body’s natural ability to lower its cortisol levels and turn the hormone-related portion of the stress response to its “off” position. In some alcoholics, this situation leads to the onset of a disorder called pseudo-Cushing syndrome, which occurs when alcohol-related changes in normal endocrine function cause cortisol-related distortions in a number of different tissues and organs throughout the body. However, even in the absence of pseudo-Cushing syndrome, cortisol elevations in alcoholics can lead to the impairment of basic brain functions such as the ability to make decisions, properly focus attention or effectively make or recall memories, according to the results of a study published in 2010 in the journal Alcoholism: Clinical & Experimental Research. 

Effects on Alcoholism Recovery

The authors of the study published in Alcoholism: Clinical & Experimental Research also concluded that cortisol levels remain significantly elevated in people who stop drinking and go through the acute (short-term) stages of alcohol withdrawal. This conclusion supports the findings of a study review issued in 2010 by the National Institute on Alcohol Abuse and Alcoholism, which noted that recovering alcoholics with pseudo-Cushing syndrome regularly experience symptoms of the syndrome that are actually worse than the symptoms that occur during active heavy drinking. While the effects of pseudo-Cushing syndrome typically fade away after several months of sustained alcohol abstinence, elevations in cortisol output can linger in recovering alcoholics for much longer periods of time, whether or not a given alcoholic ever developed pseudo-Cushing syndrome. The researchers who conducted the study published in Alcoholism: Clinical & Experimental Research believe that the lingering stress-related effects of cortisol can seriously impact a person’s chances for avoiding an alcohol relapse; they also believe that large numbers of the people who temporarily or permanently drop out of alcohol treatment likely do so, at least in part, because of the residual effects of cortisol elevation. In a related finding reported in 2010, researchers from Texas Tech University and Penn State University identified unaddressed or untreated stress as one of the main factors in an individual’s inability to successfully cope with his or her cravings for alcohol or any other addictive substance. In turn, a reduced resistance to cravings increases the risks for an eventual relapse.

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