How chronic stress impacts addiction + relapse

Living with chronic stress is challenging for everyone, and its relationship with opioid use disorder (OUD) adds another layer of complexity. Understanding how to treat chronic stress effectively is critical to avoid the potential of recurrent opioid use. Ophelia provides reliable support and expert guidance to help individuals navigate this journey successfully regardless of whether they live in close proximity to a healthcare provider. 

What is chronic stress?

We all know what stress feels like. The physical symptoms can range from headaches and muscle tension to shortness of breath and accelerated heartbeat. Fatigue, irritability, trouble sleeping, and mental fog are common psychological responses to stress.  

It can be challenging to deal with stress, but it usually lasts briefly. Chronic stress develops over a longer period, with people remaining in a state of tension caused by ongoing pressures or challenges that are beyond their ability to cope effectively. 

Chronic stress can come from social determinants of health, including housing instability, financial pressure, ongoing work stress, relationship conflicts, unreasonable expectations, and major life events like divorce. Persistent physical health challenges are stress triggers, too. Over time, chronic stress can take a significant toll on your overall well-being. 

When a person experiences chronic stress, they’re in a constant state of heightened alertness. The body reacts by continually releasing stress hormones like cortisol and adrenaline¹. This persistent activation of the body’s stress response can lead to significant health problems, including:

• Weakened immune system functioning
• Increased risk of cardiovascular diseases
• Digestive issues
• Sleep disruptions
• Anxiety and depression
• Reduced concentration and memory problems

Stress also contributes to unhealthy coping mechanisms like overeating, self-isolating, and OUD.

How can chronic stress impact opioid use disorder?

Self-medication

Chronic stress puts a person’s mind and body in a constant state of fight-or-flight. It disrupts the brain’s stress response system and alters its chemistry, increasing the individual’s vulnerability to addiction². Using opioids might become a coping mechanism for individuals to help relax. 

The relief from the emotional and psychological strain is temporary, but it allows people to suppress their feelings of being overwhelmed. In other situations, drugs or alcohol can help individuals reduce anxiety or help manage their sleep. Unfortunately, it easily becomes a pattern of self-medication.

While every case differs, the self-medication process often follows a specific pattern. Stress creates discomfort, leading to individuals seeking relief. Substances provide a temporary escape, which leads to repeated use and cravings. Continued substance use leads to neurochemical dependence³, becoming a substance dependency.

This is what makes the connection between chronic stress and OUD troubling: It happens so gradually it goes unnoticed by individuals and their loved ones until OUD has fully taken hold. 

Relapse potential

The impact of chronic stress doesn’t dissipate after seeking OUD treatment. Stress can still weigh heavily on a patient’s mind and can contribute to recurrent opioid use through biological and psychological means. For instance:

• Biological: Stress hormones like cortisol can reshape neural pathways, deeply imprinting drug-associated memories and behaviors into the brain. Prolonged stress exposure and lasting brain changes can also increase cravings.

For example, chronic stress can alter the brain’s reward circuits and stress response systems and impact the hypothalamic-pituitary-adrenal (HPA) axis⁴, reducing a patient’s ability to manage emotional and physiological challenges without substances. These factors make individuals more susceptible to opioid-seeking behavior, which can lead to recurrent opioid use.

• Psychological: Stress compromises a person’s emotional control and cognition. For those dealing with OUD, stress is much more acute. Chronic stress can further diminish a person’s ability to self-regulate, making it harder to resist substance-use triggers. Stress can also cause a person to experience the same emotional states that lead to dependency. They might perceive opioids as a familiar escape from discomfort.

How to treat chronic stress during OUD management

Seek professional support

Effective OUD treatment requires consistent professional support. Treatment professionals provide critical guidance in developing personalized stress-management strategies. Additionally, counseling can provide a structured environment to explore emotional challenges and build coping skills. Open communication about stressful experiences, situations, and triggers allows clinicians to customize treatment plans to a patient’s needs.

Redevelop emotional regulation

Deep breathing⁵, cognitive reframing, and emotional awareness practices help rewire the neural pathways disrupted by chronic stress and OUD. These techniques reduce cortisol levels, enhance emotional regulation, and improve neurological responses to stress triggers.

Change lifestyle patterns

Structured daily routines are fundamental to successful OUD treatment management. Consistent sleep patterns, balanced nutrition, and exercise regimens provide physical stability. It also helps to develop and maintain a supportive network of peers, friends, and loved ones who can have the individual’s back when things get tough. Prioritizing self-care is crucial, as it can be the foundation on which a person can build their long-term treatment and stress-management plan.

Develop practical coping mechanisms

Developing stress-management skills is vital to preventing recurrent opioid use. Some people get a lot out of journaling. It allows individuals to track emotional patterns and triggers. Others reach out to counselors or family members for support.   

Consider holistic recovery approaches

OUD treatment combines multiple therapeutic interventions. Medication-assisted treatments (MAT) address physiological dependencies. Counseling or talk therapy for stress management can provide insight into the root causes of stress, and care providers can offer strategies to handle negative stimulation in a healthy way. Meanwhile, some people in treatment find support in acupuncture and yoga. The goal is to develop a personalized strategy addressing stress and OUD.

Consider trauma-informed stress management

Many individuals with OUD have experienced significant trauma, which complicates the stress response. Trauma-informed approaches recognize how the past influences a patient’s current psychological state. It’s possible to develop healthier coping mechanisms by addressing underlying emotional needs.

Look at social + environmental surroundings

A person’s environment plays a critical role in their stress levels. Understanding family dynamics and workplace challenges is key to managing stress. To be in the best position to manage long-term treatment, it’s important for a person to develop a strong support network and create healthy boundaries.

Seek virtual support

Digital health platforms and telehealth services now offer additional stress-management resources. Virtual counseling provides flexibility for people navigating OUD management. Individuals have access to help, even if they’re geographically far from a doctor’s office.

Does Ophelia provide mental health support during OUD treatment?

Yes! Ophelia provides mental health support during OUD treatment. Our telehealth platform offers comprehensive mental health services for individuals managing OUD. Some of our key features include:

• Assistance from a dedicated care team of clinicians 
• Medication-assisted treatment (MAT) support
• Personalized care plans
• Substance dependency and mental health counseling
• Digital support resources

Our care team and clinicians are here to address co-occurring mental health conditions frequently associated with OUD, such as depression, anxiety, chronic stress, and trauma-related disorders.