Understanding Dual Diagnosis of Stress and Addiction

For many people, battling everyday stress is like walking on eggshells. They suffer in silence, feel emotionally overwhelmed, and hunt for quick fixes. At this point, they may turn to maladaptive behaviors such as drinking or substance use to escape from the stress. Over time, they become dependent on the substance to feel normal.

This is where addiction starts and when it co-occurs with stress, it becomes a dual diagnosis. Without treating both conditions simultaneously, stress continues to drive addictive behaviors, and addiction makes it more overwhelming and weighed down.

Table Of Contents

• What Is Unhealed Trauma?
• How Chronic Stress and Addiction are Related to One Another
• Signs of Dual Diagnosis – Stress and Addiction
• Why Stress Can Trigger Relapse
• Types of Mental Health Conditions Influencing Substance Use
• Components of Dual Diagnosis Treatment
• Benefits of Dual Diagnosis
• Ongoing Support for Recovery

What Is Stress?

Stress is a state of worry or emotional overwhelm in response to challenging life situations. It often shows up as nervousness, anxiety, or constant overthinking. Experiencing stress is a normal part of everyday life. It is the body’s natural reaction to perceived pressure or threats. Stress may originate from real challenges or be perceived or imagined as harmful by the individual experiencing it.

How Chronic Stress and Addiction are Related to One Another

An individual living with chronic stress often stays constantly on guard. They may feel tense and mentally trapped, leading to persistent worry and overthinking, which takes a steady toll on their mental well-being. Chronic stress can develop from job-related factors, relationship difficulties, financial insecurity, or unresolved emotional experiences from the past. Research references from NIH suggest that stress is a major risk factor that drives substance use and the likelihood of a relapse.

Stress leads to a state where the body remains in a constant state of ‘fight or flight’. This also places prolonged strain on the nervous system. Ongoing stress disrupts the proper functioning of the brain’s reward centers and makes it harder to feel calm or at ease. Stress keeps the individual on edge and makes it harder to feel calm or at ease. Due to elevated cortisol levels, emotional uneasiness builds up, and that’s hard to shake.

Over time, the person may begin to search for ways that can give them instant relief from the ongoing stress. They may use alcohol or any other substances to numb their feelings and feel relaxed. This brief sense of calm may lead to dependence and the person may fall back on using the substance more frequently. This sets the stage for substance dependence, leading to conditions like alcohol use disorder (AUD) or substance use disorder (SUD).

The connection between stress and addiction is bi-directional. It means the symptoms blend into one another and create a cyclical pattern where stress drives more substance use and substances intensify stress symptoms.

Signs of Dual Diagnosis – Stress and Addiction

When stress and addiction co-occur, individuals often feel constantly anxious and irritable. They may struggle to focus and find decision-making challenging. Frequent mood swings are common, and they can remain hypervigilant, perceiving real or imagined threats that only increase their stress. Some of the obvious signs are as follows:

• Always feels on the edge
• Unable to relax
• Overthinks various issues in life
• Regularly using alcohol or substances for relief
• Irritable mood
• Feeling emotionally numb
• Racing thoughts
• Trouble falling asleep
• Relying on the substance to reduce anxious feelings
• Feels anxious and stressed out when the substance is not available
• Social withdrawal
• Lack of interest in activities that they liked previously

Why Stress Can Trigger Relapse

Stress has long been known to increase the likelihood of alcohol relapse. During the recovery process, stress can reactivate old patterns of substance use. The person may return to drinking as they used substances previously to numb feelings and escape from mental pressure. According to NIH-backed research, there is a close association between a life stressor and the individual’s chance of experiencing a relapse.

When stress resurfaces, the brain craves a familiar comfort that can provide immediate relief from the negative feelings. Moreover, ongoing stress reduces self-control, and even highly motivated individuals may have strong cravings that are harder to resist.

Chronic stress impairs the functioning of the prefrontal cortex, which regulates emotions and controls impulsive decision-making. As a result, the risk of relapse increases notably in times of emotional strain.

Types of Mental Health Conditions Influencing Substance Use

Several mental health conditions increase vulnerability to substance use, especially those that involve anxiety, overthinking, and nervousness. These mental health disorders often overwhelm the person’s ability to cope with stress. It drives the person to seek relief by using drugs or alcohol. Here are the conditions

• Anxiety disorders and substance use
• Post-traumatic stress disorder (PTSD) and substance use
• Acute stress disorder and substance use

Components of Dual Diagnosis Treatment

Dual diagnosis treatment is a comprehensive plan that treats addiction and the underlying mental health condition that fuels addiction. This treatment approach treats both conditions simultaneously, so that the cyclical pattern of substance use and stress can be managed together. Some of the key components of this treatment are –

• Comprehensive evaluation: It uses a thorough approach to understand the stress triggers of the individual alongside substance use. The patient’s trauma history, emotional patterns, and history of drug use are recorded to determine personalized care.
• Integrated therapy: Use of therapy is vital in dual diagnosis treatment. Instead of addressing the two conditions separately, therapy targets the connection between stress-induced mental health conditions and addiction together.

It creates a safe space for the individual to express their negative emotions and understand how both conditions feed on one another. Some of the common therapies used to treat patients are trauma-informed care, cognitive behavior therapy, and family therapy that improve emotional regulation and help build appropriate coping skills to combat stress.

• Medication management: Medications are used to reduce intense cravings and mood swings during the recovery process. This helps detox the body safely under the supervision of a healthcare expert.
• Relapse prevention: One of the major focuses of dual diagnosis treatment is to ensure relapse prevention. This involves identifying the triggers that increase the chance of relapse. Individuals are prepared to face challenging life situations by altering how they think and feel about the situation, thereby helping them use appropriate coping skills to face stress, manage cravings, and respond to difficult emotions without turning to substances. Over time, this builds confidence, resilience, and a stronger sense of control in their recovery journey.
• Peer support: It offers individuals a supportive space to openly share their struggles and recovery journey with people having similar experiences. In group therapy sessions, shared experiences and insights foster encouragement. It also reduces feelings of isolation and helps participants feel supported as they move towards recovery.

Benefits of Dual Diagnosis

For individuals dealing with ongoing stress and addiction, dual diagnosis goes beyond symptom management. The goal of this treatment is to provide integrated support that not only handles stress-related factors but also how stress-related factors fuel addictive habits. Some of the benefits of dual diagnosis are as follows:

• It helps individuals learn ways to manage stress triggers and handle complicated life situations without depending on alcohol or any other substance
• Trauma-focused therapy provides a safe space to process negative feelings without any fear of being judged
• Addressing both conditions together leads to a lasting recovery by reducing the chances of relapse

Ongoing Support for Recovery

Someone living with a stress-related mental health condition and addiction feels uncertain about their recovery journey, unless they take the first step. However, with an integrated treatment approach, it is possible to break the cycle of stress and substance use. The treatment also focuses on addressing the underlying causes of both conditions, leading to healthier ways of coping during stressful circumstances.