New research shows high stress equals a greater likelihood of relapse. Here’s what you need to know to recognize and lower your stress levels.
By Tracey Dee Rauh
Six months had passed since Paul Tallo sat on a stool at his regular haunt, enjoying several beers before driving his truck off the road on a snowy night and being arrested for drunk driving.
He was abstinent, albeit without treatment or a program of recovery, sustaining sobriety fueled by a perfectionist’s struggle with guilt and embarrassment. By summer, however, with no one to talk to and a driver’s license back in hand, his resolve was waning, and he silently began to consider taking a drink.
“I wanted to justify having one beer around a Fourth of July bonfire but was unable to talk to even a very close sober friend about it,” says the 50-year-old computer technician who now has been sober for more than three years. “I believe I knew the answer, but the internal debate raged in my head.”
Just before the holiday, all that pressure burst when a driver made a sudden turn in front of him at an intersection.
“I cut her off and leapt out of my car,” he says. “It was an out-of-body experience. I was watching this guy I didn’t even know scream while her three terrified kids cried in the back seat. She called the police, and I could have been arrested. Luckily, I wasn’t, but it was a turning point.”
Although the details differ, it’s a rare person in recovery who cannot recall a time when stress—sobriety’s silent saboteur— put them in danger. Now, a Yale University study suggests that a person’s biological tendency toward stress can be measured as a tool to reduce relapse statistics that involve more than two-thirds of people who start treatment for substance use disorders.
“All over the world, we have outstanding treatment programs,” says Rajita Sinha, director of the Yale Stress Center in New Haven, Conn., and lead researcher in the study. “People achieve abstinence, sometimes for a considerable period of time. And yet relapse threatens them. Having validated biological markers to measure a person’s tendency toward stress could help doctors predict who is at highest risk.”
Although much is known about the link between stress and active addiction, mystery remains surrounding how stress relates to relapse.
“When the regions of the brain involved in regulating stress are not working well, it increases a person’s vulnerability to relapse,” says Sinha, who is also a professor of psychiatry, neurobiology and child study and previously directed an addiction treatment center at Yale. “We want to find those neural and biological measures that predict whether and how quickly this will occur.”
Sinha worked with patients who left treatment with great resolve and plentiful skills. Often, however, they would be back. When asked what happened, they rarely knew.
“Clearly, there’s a compulsive seeking or craving state that gets in motion and creates stress, maybe before they are even aware,” she says. “I wanted to understand what’s going on in the brain and body when this occurs.”
The Yale study involved 93 alcohol-dependent men and women, ranging from 18 to 50 years old. Participants received a free, extended inpatient stay in the Neuroscience Research Unit, where they first detoxed and then participated in therapy and educational sessions.
After four weeks, they met with researchers to talk about a recent stressful event— losing a job, fighting with a loved one, any time they felt very upset. They also discussed a time they had intense cravings and another situation when they felt relaxed but were not under the influence. From these conversations, researchers wrote little stories, which they read to patients in a lab while drawing the patients’ blood. Researchers tested the blood for levels of stress-related hormones, such as cortisol. Patients also had brain scans to evaluate function and atrophy. After discharge, participants returned to the facility 14, 30 and 90 days later to report on their recovery, cravings and if they had relapsed.
“What we found was that the odds went up two-and-a-half times for relapse in people who had elevated levels of stress hormones,” Sinha says. “What’s exciting here is that we can assess somebody’s biological tendency to stress and begin to think who may relapse more quickly and treat accordingly.”
Sherry Nykiel, director of the McLean Center at Fernside in Princeton, Mass., is intrigued by studies such as the one at Yale.
“Growing up in a chaotic house, which many people with addictions do, is traumatizing,” says Nykiel, whose self-pay facility treats dually diagnosed men and women for alcoholism and addiction and other disorders such as depression, anxiety and post-traumatic stress. “Trauma triggers the fight-or-flight response and elevated levels of cortisol. Combine that with not being exposed to the greatest coping skills in a dysfunctional family, and of course these folks are at higher risk of relapse.”
Any study that helps decipher the tendency for stress is invaluable to advancing treatment, she says. At the same time, she points out, anxiety and stress are inevitable parts of life. That means all people in recovery need to learn to recognize their triggers and weak spots.
“We always work with people on a relapse plan,” she says. “But it’s equally important to ask: What does your life look like outside treatment? What excites you? What provokes anxiety and fear? What do you love? It’s essential to envision life in recovery.”
Tallo learned this after his road rage incident, when he was introduced to the Big Book of Alcoholics Anonymous. “I guess stress is caused by what exposes our character defects or weaknesses,” he says. “I’ve learned to think of stress as a building up of pressure that requires a relief valve.mAlcohol used to be that relief for me, but it didn’t fix the problems. I only temporarily escaped them. After drinking, the issues still were there and maybe even worse.”
Today, he finds support by attending several Twelve Step meetings each week. He has a sponsor and sponsors others in the program. He cultivates close friendships with people in recovery and is in individual therapy to learn more about himself and the roots of his problems. He writes in a journal, exercises and practices meditation, working diligently to achieve personal growth and serenity.
That’s exactly the sort of enriching life in recovery that Nykiel at McLean’s Fernside Center hopes her patients will achieve.
“If we can find more resources to work with—be they biologically based like understanding cortisol levels, new psychosocial therapies, whatever—I’m willing to try it,” she says. “As a provider, it can be frustrating to watch relapse, to see someone self-destructing in front of you. It’s so easy to blame the individual. You have to step back and remember it’s so much more complicated than that. We have to move away from, ‘It’s just a choice.’ People’s lives depend on it.”