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Stress & Alcohol Use

Alcohol Research and Health
Alcohol and Stress
Volume 23, Number 4, 1999

Understanding Stress: Characteristics and Caveats
By Hymie Anisman and Zul Merali

Does Drinking Reduce Stress?
By Michael A. Sayette

The Role of Stress in Alcohol Use, Alcoholism Treatment, and Relapse By Kathleen T. Brady and Susan C. Sonne

Understanding Stress: Characteristics and Caveats
By Hymie Anisman and Zul Merali

NIAAA Alcohol Research and Health
Alcohol and Stress
Volume 23, Number 4, 1999

The Personal Notes of Terence T. Gorski
Written While Studying The Article
February 9, 2002

1.    Everyone Experiences Stress:  Everyone has to deal with stressful situations in their lives.  People in stressful situations often experience a biopsychosocial stress response that causes physical, psychological, and social symptoms that are capable of interfering with normal ways of thinking, managing feelings, behaving, and relating to others.  

2.    The Causes of Stress:  Stress is caused by internal experiences or external situations that activate a conditioned biopsychosocial stress response.  The biopsychosocial stress response, in turn, creates a state of physical or mental tension that starts draining physiological and psychological resources.

3.    Stressful Situations Cause Biopsychosocial Stress Responses:  When people experience stressful situations, a series of biopsychosocial changes occur that are designed to protect them from the adverse effects of stress and motivate them to use behaviors that will return stress levels to "normal levels."  

4.    People Develop Individualized Stress Responses:   Different people respond to the same type and intensity of stressful situations in remarkably different ways.  Some people are at low risk of experiencing stress-related problems.  These low risk people seem nearly immune from exhibiting stress-related biopsychosocial symptoms.  Other people are at high risk of developing stress related problems.  These high risk people seem to exhibit serious stress-related symptoms after experiencing relatively mild stressful events.  This is because the stress response is determined by a wide variety of biological, psychological, and social factors.  It is also influenced by significant life and learning experiences during the course of life.  These factors can be conceptualized as a complex interaction between the stressful situation and the person experiencing the stressful situation.  

5.    Types of Stress Responses:  There are two types of biopsychosocial stress responses:

 A.   Adaptive -- it reduces the damaging effects of the stress and restores biopsychosocial equilibrium.

B.    Maladaptive -- it increases the damaging effects of the stress and create progressive biopsychosocial instability.   

6.    Factors Related to the Type of Stress Response:  Whether the biopsychosocial response to a stressor is adaptive or maladaptive depends upon a complex interaction between two factors:  

A.    The characteristics of the stressor and 

B.    The characteristics of the person experiencing the stress.

7.    Characteristics of the stressor (Stressful Situation):

A.    The characteristics of situations that are related to the potential severity of the stress response include:

(1)   Intensity -- ranging from routine daily annoyances to unexpected disasters and traumatic experiences.

(2)   Duration -- ranging from very short isolated events to very long term events that invade and disrupt normal patterns of living.

(3)   Frequency -- ranging from single isolated stressful events to a series of closely related or ongoing stressful experiences. 

(4)   Predictability -- ranging from routine, expected and highly predictable stressful events to sudden, unexpected, and unpredictable events.

(5)  Controllability -- ranging from easily controlled by personal decisions and actions to totally out of the control of personal decisions and actions.

(6)  Social Context -- ranging from social recognition of the difficulty involved in managing the situation to social denial or minimization of the difficulty.  People who experience high stress in situations that are presented in the social context as typical low stress occurrences that should be easily managed tend to suffer low self-esteem and harsh social judgment when they reveal the stressful symptoms that they are experiencing.

B.   High Risk Stressful Situations:  The stressful situations that are most likely to create serious stress reactions tend to be high intensity, long duration, frequent, unpredictable, and uncontrollable situations.  

C.   Low Risk Stressful Situations:  The stressful situations that are least likely to create serious stress reactions tend to be low intensity, short duration, infrequent, highly predictable, and easily controlled situations.

8.   Characteristics of   

A.   The characteristics of the person experiencing the stressful situation that are related to the potential severity of the stress response include:

(1)  Temperament:  This includes the level of genetically influenced biopsychosocial resiliency.  Hot Responders have a genetic tendency to over react to relatively minor stressors.   Cold Responders have a genetic tendency to under react or block out even intense stressors.  Balanced Responders have the genetic tendency to respond in a proportional manner to the level of stressor that they experience.

(2)  Basic Belief Systems which provides us with the unspoken assumptions about self, others, and the world.  these assumptions are acquired in early childhood and the form "the truth as we know it" against which we judge all other truths. 

(3)  Survival-based Mandates & Injunctions which program us with a set of black and white instructions that tell us what we  "must do" and "can't do" in order to survive and thrive.  These are usually internalized in the form of deeply entrenched automatic responses that take control whenever excessive stress levels activate the Fight-Flight-Flee Response.  These survival-based mandates and injunctions are often driven by extreme, anger, fear, or hopelessness.

(4)   Learned Coping Style:   This includes the level of learned and integrated biopsychosocial resiliency skills, the previous exposures to specific stressors, and the previous success or failure at coping with similar stressors that's sets a pattern of positive or negative expectancy.  

B.    High Risk Individuals:  The individuals who are most likely to be adversely affected by a stressor are older people, in poor states of health, with low levels of both genetically inherited biopsychosocial resiliency and low levels of learned biopsychosocial stress coping skills, who have had previous exposures to similar stressors that they failed to cope with successfully.

C.   Low Risk Individuals:  The individuals who are least likely to be adversely affected by a stressor are younger people, in good states of health, with high levels of genetically inherited biopsychosocial resiliency and high levels of learned biopsychosocial stress coping skills, who have had previous exposures to similar stressors that they were able to cope with successfully.

9.    Stress Overload:  "Under certain circumstances the body's response to a stressor can actually make the adverse effects of stress worse."  If the stress is severe and prolonged or if the person has a low level of biopsychosocial resiliency in the face of stress, the biopsychosocial stress regulating mechanisms can become over-loaded.  This state of overload makes people more vulnerable to physical, psychological, and behavioral problems caused by future stressors. 

10.  An Integrated Model of Stress:  Stress is best conceptualized as a complex interaction between a stressor, an automatic conditioned stress reaction, and a consciously mediated stress response.

A.   Stressor: A stressor is a situation, event, or experience that is interpreted and responded to in a way that activates a conditioned stress reaction.

B.   Stress Reaction:  A stress reaction is an involuntary physical response to the stressor.  It is an automatic and unconscious biological response to a perceived threat that activates primitive psychological and social defense mechanisms.   

C.   Stress Response:  A conscious biopsychosocial response that is used to manage the stress reaction.  There are three types of stress responses:

(1)   Stress Cycling:  A stress response that intensifies the initial stress reaction.

(2)   Delayed Stress Response:  A stress response that temporarily reduces the severity of the stress reaction by distraction or self-medication resulting in a latter reactivation of the stress reaction.  

(3)  Stress Reduction Response:  A stress response that permanently resolves or reduces the intensity of the stress reaction by solving the problems that caused the stressor or changing the interpretations of the events causing the stress reaction. 

11.  Stress Reactions & The Onset of Illness:  Maladaptive Stress Reactions can be a powerful factor in causing and complicating physical illness, psychiatric disorders, and substance use disorders.  

12.  Stress Reactions & Relapse:  Maladaptive Stress Reactions can be a contributing factor to relapse for people who have been in recovery from addiction and mental disorders.

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