How does stress increase risk of drug abuse and relapse?
Abstract
Rationale The notion that stress leads to drug abuse in vulnerable individuals and relapse in addicts is not new. Most major theories of addiction postulate that stress plays an important role in increasing drug use and relapse. Several animal studies and some human laboratory studies have shown that stress exposure enhances drug self-administration. Although clinical observations suggest that exposure to stress increases drug use, and are associated with craving and relapse in addicts, human research in this area is largely correlational and at times contradictory.Objective Given the growing preclinical evidence that supports the key role of stress in substance abuse, careful examination of this research area in humans is warranted. This paper examines empirical evidence on how stress may increase the vulnerability to drug abuse, and explores whether chronic drug abuse alters the stress response and coping in addicts, thereby increasing the likelihood of drug seeking and relapse. Unanswered questions on the association between stress and substance abuse in humans are identified.Conclusion Preclinical research has shown that stress, in addition to drug itself, plays a key role in perpetuating drug abuse and relapse. However, the mechanisms underlying this association in humans remain unclear. A greater understanding of how stress may perpetuate drug abuse will likely have a significant impact on both prevention and treatment development in the field of addiction.
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Inability to handle everyday stress leads to exacerbated physiological responses and is associated with the development and course of adverse long-term health outcomes, including major depression, substance abuse, and anxiety disorders.
“Inability to handle everyday stress leads to exacerbated physiological responses and is associated with the development and course of adverse long-term health outcomes, including a wide range of psychological disorders such as major depression, substance abuse, and anxiety disorders (Duffing et al., 2014;McEwen, 2008;Sinha, 2001).”
From Cortisol Response to Stress: The Role of Expectancy and Anticipatory Stress Regulation (2020) · cites this paper as Sinha, 2001
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Self-citationStress-related factors in cannabis use and misuse: Implications for prevention and treatment
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Self-citationSocial stress, therapeutics and drug abuse: Preclinical models of escalated and depressed intake
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Induction of ΔFosB in Reward-Related Brain Structures after Chronic Stress
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The role of central dopamine D3 receptors in drug addiction: a review of pharmacological evidence
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Modeling stress and drug craving in the laboratory: implications for addiction treatment development
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Self-citationAnimal models of drug relapse and craving
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Stress‐Induced and Alcohol Cue‐Induced Craving in Recently Abstinent Alcohol‐Dependent Individuals
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Self-citationThe anxiogenic drug yohimbine reinstates methamphetamine seeking in a rat model of drug relapse
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Stress decreases the ability to resist smoking and potentiates smoking intensity and reward
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Analysis of opioid efficacy, tolerance, addiction and dependence from cell culture to human
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Neurobiology of relapse to heroin and cocaine seeking: An update and clinical implications
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Shared and unique mechanisms underlying binge eating disorder and addictive disorders
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Stress-induced modulation of instrumental behavior: From goal-directed to habitual control of action
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Alcohol, stress, and glucocorticoids: From risk to dependence and relapse in alcohol use disorders
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“…in larger-scale adaptations and wear and tear (allostatic overload) to the reward and neuroendocrine regulation circuits (Koob and Le Moal, 2005; Sinha, 2001); these adaptations may represent the pathophysiology underlying the transition from controlled to compulsive alcohol-seeking in humans…”
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Stress Enhancement of Craving During Sobriety: A Risk for Relapse
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kappa-Opioid receptor signaling and brain reward function
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Is Food Addictive? A Review of the Science
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Translational and reverse translational research on the role of stress in drug craving and relapse
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Inoculation stress hypothesis of environmental enrichment.
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REVIEW: Norepinephrine and stimulant addiction
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Self-citationPsychostimulant abuse and neuroinflammation: emerging evidence of their interconnection.
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A Gender Perspective of Addictive Disorders
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Severity of childhood trauma is predictive of cocaine relapse outcomes in women but not men
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- Authors
- Sinha, R.
- Affiliations
- Yale University (US)
- Corresponding author
- Sinha, Rajita
- ORCID
- Sinha, Rajita
- Venue
- Psychopharmacology
- Published
- 2001-12-01
- Volume
- 158
- Issue
- 4
- Pages
- 343-359
- ISSN
- 0033-3158 (ISSN-L)
- 1432-2072
- OpenAlex
- W1984346427
- Semantic Scholar
- 81996b4691a9c531758df882218ad0286494d73e
- Cited by
- 1,505
- References
- 259
- Citations by year
- 2026: 25 · 2025: 43 · 2024: 45 · 2023: 53 · 2022: 67 · 2021: 76 · 2020: 134 · 2019: 75 · 2018: 102 · 2017: 65 · 2016: 77 · 2015: 67 · 2014: 73 · 2013: 67 · 2012: 81
- FWCI
- 13.05
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Psychopharmacology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Institute on Drug Abuse (P50DA009241, K12DA014038, DA14038, R01DA011077)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Keywords
- stress, drug abuse, relapse, addiction, craving, self-administration, stress response, coping, chronic drug abuse, drug-seeking behavior, addiction prevention, addiction treatment
- MeSH terms
- Adaptation, Biological, Adaptation, Psychological, Animals, Humans, Models, Biological, Neural Pathways, Recurrence, Risk, Stress, Physiological, Stress, Psychological, Behavior, Addictive, Substance-Related Disorders
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