National Institute on Alcohol Abuse and Alcoholism No. 32 PH 363 April 1996
Alcohol and Stress
The term "stress" often is used to describe the
subjective feeling of pressure or tension. However, when scientists refer to
stress, they mean the many objective physiological processes that are initiated
in response to a stressor. As this Alcohol Alert explains, the stress
response is a complex process; the association between drinking and stress is
more complicated still. Because both drinking behavior and an
individual's response to stress are determined by multiple genetic and
environmental factors (1-3), studying the link between alcohol consumption and
stress may further our understanding of drinking behavior.
The Stress Response
The maintenance of the body's relatively steady internal
state, or homeostasis, is essential for survival. The body's delicate
balance of biochemical and physiological function is constantly challenged by a
wide variety of stressors, including illness, injury, and exposure to extreme
temperatures; by psychological factors, such as depression and fear; and by
sexual activity and some forms of novelty-seeking. In response to stress, or
even perceived stress, the body mobilizes an extensive array of physiological
and behavioral changes in a process of continual adaptation, with the goal of
maintaining homeostasis and coping with the stress (4).
The stress response is a highly complex, integrated network
involving the central nervous system, the adrenal system, and the cardiovascular
system. When homeostasis is threatened, the hypothalamus gland, at the base of
the brain, initiates the stress response by secreting corticotropin releasing
factor (CRF). CRF coordinates the stress response by triggering an integrated
series of physiological and behavioral reactions. CRF is transported in blood
within the brain and in seconds triggers the pituitary gland to release
adrenocorticotropin hormone (ACTH), also referred to as corticotropin. ACTH then
triggers secretion of glucocorticoid hormones (i.e., "steroids") by the adrenal
glands, located at the top of the kidneys. Glucocorticoid hormones play a key
role in the stress response and its termination (4).
Activation of the stress response affects smooth muscle, fat,
the gastrointestinal tract, the kidneys, and many other organs and the body
functions that they control (4). The stress response affects the body's
regulation of temperature; appetite and satiety; arousal, vigilance, and
attention; mood; and more (4). Physical adaptation to stress allows the body to
redirect oxygen and nutrients to the stressed body site, where they are needed
most (4).
Both the perception of what is stressful and the physiological
response to stress vary considerably among individuals. These differences are
based on genetic factors and environmental influences that can be traced back to
infancy (5).
Stress is usually thought of as harmful; but when the stress
response is acute and transient, homeostasis is maintained and no adverse
effects result. Under chronic stress, however, when the body either fails to
compensate or when it overcompensates, damage can occur (4). Such damage may
include suppression of growth, immune system dysfunction, and cell damage
resulting in impaired learning and memory (4,6).
Does Stress Influence Drinking?
Human research to clarify the connection between alcohol and
stress usually has been conducted using either population surveys based on
subject self-reports or experimental studies. In many but not all of these
studies, individuals report that they drink in response to stress and do so for
a variety of reasons. Studies ind icate that people drink as a means of coping
with economic stress, job stress, and marital problems, often in the absence of
social support, and that the more severe and chronic the stressor, the greater
the alcohol consumption (7). However, whether an individual will drink in
response to stress appears to depend on many factors, including possible genetic
determinants of drinking in response to stress, an individual's usual drinking
behavior, one's expectations regarding the effect of alcohol on stress, the
intensity and type of stressor, the individual's sense of control over the
stressor, the range of one's responses to cope with the perceived stress, and
the availability of social support to buffer the effects of stress (1,2,7,8).
Some researchers have found that high levels of stress may influence drinking
when alternative resources are lacking, when alcohol is accessible, and when the
individual believes that alcohol will help to reduce the stress (1,8).
Numerous studies have found that stress increases alcohol
consumption in animals (9) and that individual animals may differ in the amount
of alcohol they consume in response to stress (10). Such differences may be
related in part to an animal's experiencing chronic stress early in life:
Prolonged stress in infancy may permanently alter the hormonal stress response
and subsequent reactions to new stressors, including alcohol consumption
(10,11). For example, monkeys who were reared by peers, a circumstance regarded
as a stressor compared to mother-rearing, consumed twice as much alcohol as
monkeys who were mother-reared (10). According to Viau and colleagues (11),
adult rats handled for the first 3 weeks of life demonstrate markedly reduced
hormonal responses to a variety of stressors compared with rats not handled
during this time (11). In humans, Cloninger reported an association between
certain types of alcoholism and adverse early childhood experiences (12).
Animal studies reporting a positive correlation between stress
and alcohol consumption suggest that drinking may take place in response to
chronic stress perceived as unavoidable (2,13). For instance, rats chronically
exposed to unavoidable shock learn to be helpless or passive when faced with any
new stressor--including shock that is avoidable--and to demonstrate increased
alcohol preference compared with rats that received only avoidable shock (2).
The rats exposed to unavoidable shock exhibit the hormonal changes indicative of
the stress response, including increased levels of corticosteroid hormones (2).
Whether humans drink in response to uncontrollable stress is
less clear, according to Pohorecky (7). In a review investigating the connection
between alcohol consumption and stress, Pohorecky notes several studies in which
researchers sampled individuals from areas affected by natural disaster. One
study found that alcohol consumption increased by 30 percent in the 2 years
following a flood at Buffalo Creek, West Virginia. Similarly, there was evidence
of increased drinking in the towns surrounding Mount St. Helens following
eruption of the volcano (7). Following the nuclear plant accident at Three Mile
Island, however, alcohol consumption was infrequently used by those sampled as a
means of coping with the resulting stress (14).
In both humans and animals, drinking appears to follow stress
(2,3,7,13). Some human research, however, shows that drinking may take place in
anticipation of or during times of stress (15).
Does Drinking Reduce or Induce Stress?
Some studies have reported that acute exposure to low doses of
alcohol may reduce the response to a stressor in animals and humans. For
example, low doses of alcohol reduced the stress response in rats subjected to
strenuous activity in a running wheel (3). In humans, a low dose of alcohol
improved performance of a complex mental problem-solving task under stressful
conditions (3). However , in some individuals, at certain doses, alcohol may
induce rather than reduce the body's stress response (16).
Much research demonstrates that alcohol actually induces the
stress response by stimulating hormone release by the hypothalamus, pituitary,
and adrenal glands (4,6,17,18). This finding has been demonstrated in animal
studies. In one study with rats, the administration of alcohol initiated the
physiological stress response, measured by increased levels of corticosterone
(19). In addition to stimulating the hormonal stress response, chronic exposure
to alcohol also results in an increase in adrenaline (20).
Stress, Alcoholism, and Relapse
Stress may be linked to social drinking, and the physiological
response to stress is different in actively drinking alcoholics compared with
nonalcoholics (17). Researchers have found that animals preferring alcohol over
water have a different physiological response to stress than animals that do not
prefer alcohol (21). Nonetheless, a clear association between stress, drinking
behavior, and the development of alcoholism in humans has yet to be
established.
There may, however, in the already established
alcoholic, be a clearer connection between stress and relapse: Among abstinent
alcoholics, personally threatening, severe, and chronic life stressors may lead
to alcohol relapse (15,22). Brown and colleagues (15) studied a group of men who
completed inpatient alcoholism treatment and later experienced severe and
prolonged psychosocial stress prior to and independent of any alcohol use. The
researchers found that subjects who relapsed experienced twice as much severe
and prolonged stress before their return to drinking as those who remained
abstinent. In this study, severe psychosocial stress was related to relapse in
alcoholic males who expected alcohol to reduce their stress. Those most
vulnerable to stress-related relapse scored low on measures of coping skills,
self-efficacy, and social support. Stress-related relapse was greatest among
those who had less confidence in their ability to resist drinking and among
those who relied on drinkers for social support. Although many factors can
influence a return to drinking, Brown and colleagues note that stress may exert
its greatest influence on the initial consumption of alcohol after a period of
abstinence (15).
Drinking and Stress--A Commentary by
NIAAA Director Enoch
Gordis, M.D.
Stress is commonly believed to be a factor in the
development of alcoholism (alcohol dependence). However, current science is more
informative about the relationship between drinking and stress than about the
relationship between stress and alcohol dependence.
Drinking alcohol produces physiological stress, that is, some
of the body's responses to alcohol are similar to its responses to other
stressors. Yet, individuals also drink to relieve stress. Why people
should engage in an activity that produces effects similar to those they are
trying to relieve is a paradox that we do not yet understand. One hypothesis is
that stress responses are not exclusively unpleasant; the arousal associated
with stress itself may be rewarding. This might explain, for example, compulsive
gambling or repeated participation in "thrill-seeking" activities. Current
studies may illuminate genetic variations in the physiological response to
stress that are important in drinking or other activities with the potential to
become addictive.
Training clinical staff to accurately appraise patients'
drink-provoking stressors may help staff to identify individuals at risk for
relapse. One route to relapse prevention is the teaching of coping skills where
patients learn how to deal with these stressors without drinking. How this
treatment approach compares with others remains of special interest.
References
(1) Sadava, S.W., & Pak A.W. Stress-related problem
drinking and alcohol problems: A longitudinal study and extension of Marlatt's
model. Canadian Journal of Behavioral Science 25(3):446-464, 1993. (2)
Volpicelli, J.R. Uncontrollable events and alcohol drinking. British
Journal of Addiction 82(4): 381-392, 1987. (3) Kalant, H.
Stress-related effects of ethanol in mammals. Critical Reviews in
Biotechnology 9(4):265-272, 1990. (4) Tsigos, C., &
Chrousos, G.P. The neuroendocrinology of the stress response. In: Hunt, W.,
& Zakhari, S., eds. Stress, Gender, and Alcohol-Seeking Behavior.
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Bethesda, MD: the Institute, 1995. (5) Meany, M.J.; Diorio, J.;
O'Donnell, D.; Smythe, J.W.; Parent, A.; & Sharma, S. Serotonin as a
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