Substance Abuse: Stress and Alcohol Addiction

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Substance Abuse: Stress and Alcohol Addiction


Guest: Dr. Suzanne Thomas – Behavioral Sciences

Host: Dr. Linda Austin – Psychiatry

Dr. Linda Austin: I’m Dr. Linda Austin. I’m interviewing Dr. Suzanne Thomas, Associate Professor of Psychiatry at the Center for Drug and Alcohol Programs, at MUSC. Dr. Thomas, one of your major areas of research interest is in the relationship between stress and substance abuse and, in particular, alcohol use. Can you explain what that relationship is? What do researchers observe, or what do people observe even in their everyday life?

Dr. Suzanne Thomas: Thank you for having me, Dr. Austin. Research has really been very productive in this area. It’s sort of like understanding the solar system and looking at outer space. It’s one of those things that the more you see and the more you know, the more you realize how much there is yet to be known. The relationship between stress and alcohol consumption is like that. We’re just beginning to scratch the surface.

One of the things that we know, at least regarding the study of people who are addicted to alcohol, is that stress is a major contributor to relapse. People who have been abstinent for years and feel like they’ve got it under control, maybe those cravings have abated and they feel like their life is back on schedule, will experience a major stressor, or several small stressors in a row, and then relapse. And we ask them, when they’re back in treatment, for example, what was it? You know, you’ve been successful for four or five years, what was it?

So many of them will say, well, you know, my family member died, or I lost my job, or I had a move. Even good stressors, things that are just a change, like, I got married, or I had a new child. Those are stressors as well. Anything that disrupts the normal flow and your normal daily activities and expectations for your day can be perceived as a stressor. And they are particularly risky for people who are trying to overcome an addiction.

Dr. Linda Austin: Any idea why that would be? What is it about stress that makes people want to reach for a beer, or a glass of wine?

Dr. Suzanne Thomas: What happens when you become addicted to a substance is, essentially, you overlearn using that substance. Your brain has changed so that it becomes a very ingrained habit, essentially. Think of it like this, when you’re driving to work, you can sometimes just sort of turn off your brain, so to speak, you know, your car is just almost carrying itself. You’ve done it so many times that you always take a right on this street, and take a left here. And, sometimes, later, on the weekend, if you happen to be on that street and you find your car turning onto the same street, as if you were going to work, that’s an overlearned habit; that’s an overlearned behavior. And, if you’re not paying attention, to kind of override that automatic behavior, then you’ll find yourself on the wrong street, going to work when you really don’t need to be.

We think that it’s something like that when we talk about addiction. People who have used a substance over and over, and over, their brain has changed because that behavior is overlearned. And, often, you need to be very vigilant and kind of pay attention to not use that substance.

When you have a major stress in your life, it requires more of your brain power, essentially, more of your attention and coping skills to try to cope with that stress. And so often when people expend that mental energy to cope with that stress, they might have less mental energy and attention to focus on their continued recovery, so they go to that overlearned behavior, they go to grab that drink, stop at the bar, those kinds of things begin to take control again.

Dr. Linda Austin: I would think, also, that an explanation as simple as the fact that, for many people, alcohol makes their mood more elevated; it makes them happy. For other people, it makes them feel more relaxed. If you’re feeling stressed out, to feel either happy or more relaxed, feels pretty good. There are many things that we do constantly, throughout the day, shifting our position in our chair just to be more comfortable, we are constantly trying to make ourselves feel better and more comfortable. And, for many people, alcohol is just one more thing in that realm.

Dr. Suzanne Thomas: Yeah. I definitely agree. And there’s some evidence that people who find alcohol more of a mood regulator, more of a good feeling-type substance, those people are the ones who are more likely to go on to abuse alcohol.

Dr. Linda Austin: So then, what advice would you give someone who realizes that they are dealing with stress, maybe even the stress of a long day and coming home and having a drink at 5:00? Is that a bad thing, necessarily?

Dr. Suzanne Thomas: No. I wouldn’t say that should definitely be curbed. Certainly, you should pay attention to it. One drink at the end of the day, there’s even evidence that there could be health benefits, cardiovascular benefits. If you’re not a drinker, we wouldn’t say, oh, start drinking for those effects. However, there is strong evidence that suggests that if you’re the type of person who goes to alcohol for the purpose of regulating your moods, that is, if you are a stress-motivated drinker, or a coping-motivated drinker, if that kind of drives when you use alcohol, you are at greater risk for developing an alcohol problem than someone who drinks for, maybe, just enhancement motives, in other words, to make a good time a little bit better. If you drink to regulate your bad mood, there’s a better chance that you will escalate that drinking over time and potentially develop a problem with alcohol.

Dr. Linda Austin: What are some strategies, then, that one might think about pursuing in order to become more resilient in the face of stress?

Dr. Suzanne Thomas: That’s a great question. We know we can’t prevent stress from happening in our lives. The best we can do is to set ourselves up for success in the face of stress. That is, what can you do, as you said, to make yourself less susceptible to the ill effects of stress? Getting enough sleep at night, for example, actually does make you more stress-resilient. So, if you need seven to eight hours of sleep and you can get that four or five times a week, you are more resilient. Eating a regular diet is good. Exercise is one of the main things. In addition to reducing stress, it [exercise] actually does create a system in your body that allows you to better cope with stress when it occurs. Having someone that you can confide in, that you can talk to, that you can actually share your feelings with is a great strategy and something valuable for us to have more stress resilience. Having a spiritual life, being able to take quiet time and meditate, those things are also important for our stress resilience.

Dr. Linda Austin: I would think that, maybe, even structuring one’s day to decrease stress, to allow enough time so you don’t have to rush, for example, or to avoid driving during rush hour. I hear people say, gee, what should I do, whenever I watch the news, I just get so stressed out, and I’ll say, well, maybe you shouldn’t watch the news.

Dr. Suzanne Thomas: Say, take a walk.

Dr. Linda Austin: Yes. Those kinds of things, to be more mindful and really purposeful about reducing stress.

Dr. Suzanne Thomas: Right. And being able to feel, to kind of have a sense of when you can feel yourself starting to get stressed, or your blood pressure starts to rise, or your heart rate, or you feel mentally drained, if you could be mindful, as you said, to those inner feelings where you can catch it before it gets into this full blown complete disruption, you can start employing the strategies that we’ve talked about to sort of curb the escalation.

Dr. Linda Austin: Dr. Thomas, thanks so much for talking with us.

Dr. Suzanne Thomas: Thank you, Dr. Austin.

If you have any questions about the services or programs offered at the Medical University of South Carolina or if you would like to schedule an appointment with one of our physicians, please call MUSC Health Connection: (843) 792-1414.

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