The relationship between stress and substance use: A review and integrative model

Introduction: Stress is a defining feature of life. The relationship between stress and alcohol and other drug (AOD) use is increasingly recognised. Policymakers, academics, and clinicians require a comprehensive understanding of this relationship in order to develop and implement effective prevention and treatment strategies. However, the evidence-base regarding stress and AOD use is disparate and inconsistent, hampering efforts to implement holistic initiatives.
Method: A comprehensive review of the peer-reviewed literature regarding the relationship between stress and AOD was conducted. Searches of online databases (Medline, PsycINFO, Scopus, Web of Science, PubMed) were undertaken, with 507 references included in the final review. A global organising schema was developed to capture dominant associations.
Key Findings: Stressors and AOD use interact in a complex and reciprocal manner. The relationship may be causal, bi-directional, or concurrent. Seven categories of stressors were identified for which there exists firm evidence of an association with AOD use. These are: common life stressors, work-related stressors, poor physical/mental health, insecure housing, discrimination (based on gender, race, or gender identification/sexual orientation), traumatic events, and childhood maltreatment. Examples will be provided, together with strategies to prevent or ameliorate related problems.
Discussions and Conclusions: Many individuals are likely to experience stressors that can exacerbate their risk of AOD use. Concomitantly, many people use AOD at levels that elevate their risk of experiencing stressful circumstances. Some marginalised populations are particularly susceptible. Effective prevention and treatment efforts which simultaneously target both stress(ors) and AOD use are identified together with their policy implications.