How Stress Makes Us More Vulnerable to Addiction – Interview with Shahram Heshmat

Drugs act as a form of self-medication to dispel unwanted distress.

We see how at the moment addiction is one of the most discussed topics in the media. Looking at how drug overdose is currently the 9th leading cause of death in the US, it seems reasonable that people are so concerned. Some stereotypes about people who had been through some hard times or that work all day and use drugs/alcohol to get over the stress might seem stupid and irrelevant but studies tell us once again that there might be a connection between stress and addiction. I talked to Shahram Heshmat (Ph.D.), who specialized in the Health Economics of addiction and obesity, in order to understand how stress and addiction are linked and how we can help ourselves when we realize we may be in a position of vulnerability.

1. In your article ‘Stress and Addiction’ you talk about the link between emotional stress and the initiation and maintenance of an addiction. How do you think high levels of stress impact teenagers and young adults considering the already difficult period they go through?

Chronic stress often goes together with anxiety, depression, anger, and indifference. So drugs act as a form of self-medication to dispel unwanted distress.

2. You talk about how stress in combination with poor coping skills leads to this increased risk factor of initiating an addiction. Can you please describe what would be a healthy set of coping skills?

The key skill is to learn self-control. Self-control refers to the exertion of control over the self by the self, which involves altering the way an individual feels, thinks, or behaves (i.e., the self is seen as an active agent). For example, when people are experiencing negative emotions, they may distract themselves by shifting their attention to something else. The power to disengage our attention from one thing and move it to another is essential for well-being. The point is to reduce the power of transient feelings (see https://www.psychologytoday.com/blog/science-choice/201703/10-strategies-developing-self-control)

3. You said that trauma in early childhood alters our genetics, making us feel as if we live in a constant state of emergency. Can you explain a little bit more about this state, how it develops and how we can get better?

Excessive or chronic stress can distort our stress response system. Excessive stress on the body is termed allostatic load (the impact of lifelong experiences of “wear and tear”). High levels of uncontrollable stress and chronic stress promote sustained allostatic load resulting in unhealthy and inappropriate stress reactions. This person might be unable to terminate a stress response. Helping young adults with the ability for engaging in self-reflection, and identifying alternative ways to manage difficult emotions could be quite helpful.

4. Why do you think that drugs and other substances are the ‘self-medication’ people use when stressed?

Drugs of abuse (e.g., cocaine or amphetamines) are addictive because they directly enhance the effects of dopamine providing pleasurable experience Depressive feelings emerge when the dopamine system is underactive, for instance during withdrawal from addiction. In short, the reward center in the brain is where all drugs of abuse, directly or indirectly, have their effect.

5. Why aren’t people generally getting help when they are stressed? Do you consider there’s a stigma around this topic?

That is a very important question. Perhaps lack of education.

6. In this fast world, where stress has become a trait we all share, what advice would you give to a person that realizes they might have chronic stress?

This first step is understanding how the stress system influences their behavior.

Exercise and social connectedness and close, personal relationships are perhaps the world’s greatest stress reducers. It is also shown that physical activity is associated with the release of so-called “feel-good” endorphins.

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