The role of stress in alcohol use, alcoholism treatment, and relapse

Addiction to alcohol or other drugs (AODs) is a complex problem determined by multiple factors, including psychological and physiological components. Stress is considered a major contributor to the initiation and continuation of AOD use as well as to relapse. Many studies that have demonstrated an a ssociation between AOD use and stress have been unable to establish a causa l relationship between the two. However, stress and the body's response to it most likely play a role in the vulnerability to initial AOD use, initiat ion of AOD abuse treatment, and relapse in recovering AOD users. This relat ionship probably is mediated, at least in part, by common neurochemical sys tems, such as the serotonin, dopamine, and opiate peptide systems, as well as the hypothalamic-pituitary-adrenal (HPA) axis. Further exploration of th ese connections should lead to important pharmacological developments in th e prevention and treatment of AOD abuse. Studies indicate that treatment te chniques which foster coping skills, problem-solving skills, and social sup port play a pivotal role in successful treatment. In the future, individual ized treatment approaches that emphasize stress management strategies in th ose patients in whom a clear connection between stress and relapse exists w ill become particularly important.