In the aftermath of the terrorist attacks on New York City and Washington, D.C., people across the country and abroad are struggling with the emotional impact of large-scale damage and loss of life, as well as the uncertainty of what will happen next. These are stressful times for all and may be particularly difficult times for people who are more vulnerable to substance abuse or may be recovering from an addiction. For example, we know that stress is one of the most powerful triggers for relapse in addicted individuals, even after long periods of abstinence. NIDA-supported ethnographers are already reporting increases in street sales of various drugs. Given that individuals may turn to drugs to cope with life's stressors, it is more important than ever that NIDA supports a comprehensive research portfolio that better informs how we prevent and treat drug abuse and addiction.
Many clinicians and addiction medicine specialists suggest that stress is the number one cause of relapse to drug abuse, including smoking. Now, research is elucidating a scientific basis for these clinical observations. In both people and animals, stress leads to an increase in the brain levels of a peptide known as corticotropin releasing factor (CRF). The increased CRF levels in turn triggers a cascade of biological responses. Animal and human research has implicated this cascade in the pathophysiology of both substance use disorders and Posttraumatic Stress Disorder (PTSD) (Jacobsen, et al. Am J Psychiatry 2001). Research also has shown that administering CRF or a chemical that mimics the action of CRF in animals produces increases in stress-related behaviors (Koob, Heinrichs. Brain Research 1999; Jones, et al. Psychopharmacology 1998). And, mice that lack a receptor for CRF (CRF1) have impaired stress responses and express less anxiety-related behavior (Smith, et al. Neuron 1998; Timpl, et al. Nature Genetics 1998). Furthermore, people subjected to chronic stress or those who show symptoms of PTSD often have hormonal responses that are not properly regulated and do not return to normal when the stress is over. This may make these individuals more prone to stress-related illnesses and may prompt patients to relapse to drug use.
Kosten TR, Rounsaville BJ, Kleber HD: A 2.5 year follow-up of depressions, life crises, and treatment effects on abstinence among opioid addicts. Arch Gen Psychiatry 1986; 43:733-739. |
Dawes MA, Antelman SM, Vanyukov MM, Giancola P, Tarter RE, Susman EJ, Mezzich A, Clark DB: Developmental sources of variation in liability to adolescent substance use disorders. Drug and Alcohol Dependence 2000; 61(1): 3-14. |
Sinha R, Fuse T, Aubin LR, O'Malley SS: Psychological stress, drug-related cues, and cocaine craving. Psychopharmacology 2000; 152:140-148. |
Brewer DD, Catalano RF, Haggerty K, Gainey RR, Fleming CB: A meta-analysis of predictors of continued drug use during and after treatment for opiate addiction. Addiction 1998; 93:73-92. |
Piazza PV, Deminiere JM, Le Moal M, Simon H: Stress- and pharmacologically-induced behavioral sensitization increases vulnerability to acquisition of amphetamine self-administration. Brain Research 1990; 514:22-26. |
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Piazza PV, Le Moal M: Pathophysiological basis of vulnerability to drug abuse: role of an interaction between stress, glucocorticoids, and dopaminergic neurons. Annu Rev Pharmacol Toxicol 1996; 36:359-378. |
Kreek MJ, Koob G: Drug dependence: Stress and dysregulation of brain reward pathways. Drug Alcohol Depend 1998; 51:23-47. |
Piazza PV, Le Moal M: The role of stress in drug self-administration. Trends Pharmacol Sci 1998; 19(2):67-74. |
Sinha R, Catapano D, O'Malley S: Stress-induced craving and stress response in cocaine dependent individuals. Psychopharmacology 1999; 142:343-351. |
Sinha R, Fuse T, Aubin LR, O'Malley SS: Psychological stress, drug-related cues, and cocaine craving. Psychopharmacology 2000; 152:140-148. |
Matheny KB, Weatherman KE: Predictors of Smoking Cessation and Maintenance. Journal of Clinical Psychology 1998; 54(2):223-235. |
Shaham Y, Stewart J: Stress reinstates heroin-seeking in drug-free animals: an effect mimicking heroin, not withdrawal. Psychopharmacology 1995; 119:334-341. |
Erb S, Shaham Y, Stewart J: Stress reinstates cocaine-seeking behavior after prolonged extinction and a drug-free period. Psychopharmacology 1996; 128:408-412. |
Stewart J: Pathways to relapse: the neurobiology of drug- and stress-induced relapse to drug-taking. Journal of Psychiatry & Neuroscience 2000; 25:125-136 |
Ahmed SH, Koob GF: Cocaine- but not food-seeking behavior is reinstated by stress after extinction. Psychopharmacology 1997; 132:289-295. |
Lê AD, Quan B, Juzytch W, Fletcher PJ, Joharchi N, Shaham Y: Reinstatement of alcohol-seeking by priming injections of alcohol and exposure to stress in rats. Psychopharmacology 1998; 135:169-174. |
Y. Buczek, Lê AD, Wang A, Stewart J, Shaham Y: Stress reinstates nicotine seeking but not sucrose solution seeking in rats. Psychopharmacology 1999; 144:183-188. |
Research shows that Posttraumatic Stress Disorder (PTSD), a psychiatric disorder, may develop in people after they experience or witness life-threatening events such as terrorist incidents, military combat, natural disasters, serious accidents, or violent personal assaults like rape. Research also shows that PTSD is a risk factor for substance abuse and addiction. Because the events that occurred on September 11, 2001, were experienced by thousands of people, as well as rescue workers in and around the vicinity of the attacks, and were televised to millions across the world, it is likely that some individuals may develop behavioral and emotional re-adjustment problems. Symptoms of PTSD can include reexperiencing the trauma; avoidance of people, places, and thoughts connected to the event; and arousal, which may include trouble sleeping, exaggerated startle response, and hypervigilance. People who develop such symptoms may be more prone to escape from the realities of the day by self-medicating with drugs (Khantzian. Am J Psychiatry 1985). In fact, clinical observations suggest that PTSD patients may use psychoactive substances without a physicians directions to relieve traumatic memories and other symptoms associated with PTSD (Brown. Drug Alcohol Dependence 1994).
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Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB: Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry 1995; 52:1048-1060. |
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Deykin EY, Buka SL: Prevalence and risk factors for posttraumatic stress disorder among chemically dependent adolescents. Am J Psychiatry 1997; 154:752-757 |
Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB: Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry 1995; 52:1048-1060. |
Jacobsen LK, Southwick SM, Kosten TR: Substance Use Disorders in Patients with Posttraumatic Stress Disorder: A Review of the Literature. Am J Psychiatry 2001; 158(8):1184-1190. |
Saxon AJ, Davis TM, Sloan KL, McKnight KM, McFall ME, Kivlahan DR: Trauma, Symptoms of Posttraumatic Stress Disorder, and Associated Problems Among Incarcerated Veterans. Psychiatric Services 2001; 52(7):959-964. |
Chilcoat HD, Breslau N: Postraumatic Stress Disorder and Drug Disorders. Archives of General Psychiatry, 1998; 55:913-917. |
NIDA has a robust research portfolio that encompasses the overall role that stress can play in initiation of drug use and relapse to drug use, as well as the intensification of symptoms as a result of stress. For example, NIDA is pursuing research to develop better ways to teach drug addicts how to cope with stress, craving, and drug-associated stimuli. Also, NIDA supports research to help determine what makes some individuals more or less vulnerable to abuse and addiction, particularly after experiencing a traumatic event. More specifically, NIDA is supporting several projects studying PTSD and substance abuse. For example, NIDA-funded researchers are investigating the role of anxiety and anger in self-medication with benzodiazepines among people with PTSD; mapping the occurrence of PTSD and substance use symptoms and their impact across the life-span of Vietnam veterans; and determining the role of stress in relapse to drug use among cocaine dependent individuals with and without PTSD. NIDAs broad research portfolio regarding stress and PTSD will be particularly useful as we attempt to develop interventions to help people better cope with stress and trauma.
To respond to the demands of these changed times, NIDA is assigning very high priority to research on all aspects of the relationships between stress and substance abuse. We are seeking research proposals that can extend our knowledge of the impact of stress on vulnerability to drug use initiation, the transition from episodic to chronic drug abuse and addiction, and the complex phenomenon of relapse. In immediate response to the events of September 11, 2001, NIDA has awarded several grant supplements to researchers in the New York City region so that they can provide a rapid assessment of the impact on drug abuse and addiction prevalence rates and evaluate service delivery needs and opportunities. Grants awarded supplements include:
53371since 10/23/01
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The National Institute on Drug Abuse (NIDA) is part of the National Institutes of Health (NIH), a component of the U.S. Department of Health and Human Services. Questions? See our Contact Information. Last updated on Tuesday, February 26, 2002. |