NIDA Notes

Stressful Experiences Affect Likelihood of Remission of Drug Dependence, Continued Drug Use, and Relapse

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By Eric Sarlin, M.Ed., M.A., NIDA Notes Contributing Writer

This study:

  • Showed that stressful life events are associated with reductions in a person’s chances of becoming or remaining abstinent from drugs for at least 3 years.
  • Suggests that coping with stress and negative affect play an important role in relapse prevention for addictive behaviors.
Figure 1. Survey Data Used To Estimate the Influence of Stressful Life Events on Remission From Drug Dependence In their initial interviews for the 2001-2002 NESARC, participants disclosed: (1) Any history of drug dependence that occurred a year or more before the interview and (2) Any drug use or dependence during the year leading up to the interview, plus any stressful life events experienced during that year. In follow-up interviews in 2004-2005, participants who had reported prior-to-past-year dependence in their initial interviews again reported any drug use or dependence in the past year. See full text description at end of article.

Drs. Sean Esteban McCabe, James Cranford, and Carol Boyd at the University of Michigan’s Center for the Study of Drugs, Alcohol, Smoking, and Health examined associations between stressful life events and drug use in the responses of 921 adults to the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). All these respondents reported that at some time prior to the past year, they had symptoms that met the criteria for a diagnosis of drug dependence (see Figure 1). At the time of the interview, 560 (60.5 percent) were no longer dependent and had been abstinent for at least a full year. The remaining 361 had used drugs during the past year.

The researchers compared the respondents’ drug histories during the past year with their reports of stressful life events during that time. The stressful events considered included serious illness or death among one’s family members or friends, financial crises, job loss, and arrest (see the full list). The researchers found that, consistent with their hypothesis, the respondents who had reported stressful experiences had about 20 percent higher odds of being among those who had used drugs during that year.

Figure 2. Mean Number of Stressful Life Events Predicts Remission of Drug Dependence Of 921 participants who reported drug dependence prior to the year leading up to their initial NESARC interview, those who had experienced fewer stressful events during the past year were more likely to have been in full remission (abstinence or asymptomatic use) or partial remission during that year. At follow-up interviews 3 years later, participants who had reported fewer stressful events in their initial interviews were still more likely to be in remission, but that relationship was weaker. See full text description at end of article.

Moreover, the number of reported stressful life events correlated with the severity of drug use. Those who had remained abstinent all year reported an average of 2.7 stressful events, and those who were dependent on drugs reported an average of 4.7 stressful events. Those who used drugs but were not dependent and those in partial remission reported 3.9 and 4.0 stressful events, respectively (see Figure 2).

These relationships between stressful experiences and drug use were independent of demographic factors that increased the likelihood of past-year drug use: being a man, being 18 to 24 years old, being unmarried or divorced, and having low personal income.

Impact Persists but Weakens Over Time

Three years after their 2001-2002 interviews, 758 of the respondents responded to follow-ups. Their rate of past-year abstinence was 69 percent, with only 7 percent drug dependent. The stressful events reported in the earlier interview predicted the severity of drug involvement reported in the follow-up interview. Thus, respondents who reported a whole year of abstinence at the follow-up interview had reported an average of 3.0 stressful events before their first interview, compared with 4.4 among those who were dependent at the follow-up.

Dr. McCabe comments, “Our results suggest a strong association between stressful events and remission from drug use over a relatively long, 3-year time scale. Programs that target stress exposure as well as stress reactivity and resilience could be a helpful component of a comprehensive plan for chronic-care disease management and relapse prevention.”

The relationship between stress and drug remission is complex. Stressful life events can trigger relapse; at the same time, drug use also can create stressful life consequences for individuals and families. Dr. McCabe proposes that untangling the causal dynamics between the two will be challenging, but could benefit treatment still further.

“In future studies, ecological momentary assessments and intensive longitudinal methods could be used to study stress and relapse with greater temporal resolution,” Dr. McCabe says. “Emerging technological innovations involving tools like smartphones or wearable sensors could help us understand the temporal relationships between stress and remission and identify which interventions are most effective for which people under which circumstances.”

This study was supported by NIH grants DA036541 and DA031160.

Stressful Life Events Assessed

  • Death of a family member or close friend
  • Serious illness/injury of a family member or close friend
  • Move or new member of the household
  • Fired or laid off from a job
  • Unemployed and looking for a job for more than 1 month
  • Trouble with a boss or coworker
  • Change of job, job responsibilities, or work hours
  • Divorce, separation, or end of a steady relationship
  • Serious problem with a neighbor, friend, or relative
  • Major financial crisis, bankruptcy, or inability to pay bills on time more than once
  • Trouble with the police, arrest, or incarceration (respondent or a family member)
  • Victim of a crime (respondent or family member)
Text Description of Figure 1

The figure illustrates the experimental design of the study that determined remission from drug dependence over time and the influence of stressful life events. The bottom line indicates a timeline of the years included in the assessment, from 2000-2001 to 2004-2005. The two gray boxes at the top represent the two interviews to assess respondents’ drug use and dependence as well as stressful life events. The gray box at the left represents the initial interview conducted in 2001-2002. In this interview, respondents were queried about stressful life events in the past year, drug use in the past year, and drug dependence in the past year. They were also questioned about a history of drug dependence prior to the past year, indicated by the blue box on the left end of the timeline. The gray box on the right represents the follow-up interview conducted in 2004-2005. During this interview, respondents were queried about their drug use in the past year and drug dependence in the past year.

Text Description of Figure 2

This bar chart illustrates the relationship between the mean number of stressful life events and drug remission patterns determined at the two NESARC interviews. The vertical (y-) axis indicates the mean number of stressful life events in the year before the initial interview, ranging from 0 to 5.0. The horizontal (x-) axis indicates the four remission patterns, including, from left to right, abstinent, asymptomatic use, partial remission, and still drug dependent. Blue bars represent the values determined at the initial interview and red bars indicate the values determined at the follow-up interview. Respondents who were abstinent at the initial interview reported a mean of about 2.7 stressful life events in the year before the interview, whereas respondents who were abstinent at the follow-up interview reported a mean of about 3.0 stressful life events in the year before the initial interview. Respondents with asymptomatic drug use at the initial interview reported a mean of about 3.8 stressful life events in the year before the interview, whereas respondents with asymptomatic drug use at the follow-up interview reported a mean of about 3.7 stressful life events in the year before the initial interview. Respondents with partial remission at the initial interview reported a mean of about 4.0 stressful life events in the year before the interview, whereas respondents with partial remission at the follow-up interview reported a mean of about 4.2 stressful life events in the year before the initial interview. Respondents who were still drug dependent at the initial interview reported a mean of about 4.7 stressful life events in the year before the interview, whereas respondents who were still drug dependent at the follow-up interview reported a mean of about 4.5 stressful life events in the year before the initial interview.

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