medically reviewed

Coping With Stress to Avoid Alcohol Relapse

An important part of recovery is learning ways of managing stress without alcohol so you’re better able to cope and avoid the temptation to drink. Read on to find out some of the common causes and signs of stress in order to effectively manage it.

Everyone experiences some degree of stress on a daily basis. Dealing with multiple responsibilities, health issues, family concerns, and money worries can be stressful enough, but when you’re in recovery, those issues can become compounded by the desire to drink. As you may know, stress can be one of the strongest triggers for relapse.

In fact, research has specifically shown that stress can increase cravings for alcohol, which could lead to a return to alcohol use and relapse.1,2 Learning healthier ways of managing stress is crucial for maintaining abstinence and helping you stay on track.

How to Manage Stress & Avoid Relapse

Managing stress isn’t always easy. Before you started the recovery process, you may have automatically grabbed a drink as a way of assuaging the unpleasant feelings, tension, and anxiety that precede or accompany stress. But an important part of recovery is learning ways of managing stress without alcohol so you’re better able to cope and avoid the temptation to drink.

stress and alcoholism

Everyone is different, so the stress management techniques that work best for one person might not be the best option for someone else. The most important factor is to find what works for you. Some tips and ideas for managing stress include developing healthy coping mechanisms and preventing stress before it gets out of hand. This could involve using one or a combination of the following tips:3,4

  • Be mindful. Be aware of the way you feel on a physical and emotional level when you start to experience stress. Notice if you’re having trouble sleeping or if your appetite changes. Developing awareness of the early signs of stress can help you take preemptive action.
  • Participate in physical activity. Studies show that exercise is one of the best ways of managing stress. It helps you release pent-up emotions and promotes the release of endorphins, your body’s natural feel-good chemicals.
  • Meditate or try a mind-body wellness method. Participating in yoga, breathing exercises, meditation, tai chi, or other types of wellness programs can help you release stress, calm down, and stay focused on what’s really important in your life.
  • Connect with others. Social support is crucial during recovery. Consider attending a 12-step meeting like Alcoholics Anonymous or another type of recovery group. Reach out to supportive friends or family, or look into joining a community organization or religious group, if that is aligned with your beliefs.
  • Maintain healthy boundaries. Learning how to say no to others helps you avoid taking on too many responsibilities.
  • Set realistic goals. Setting and achieving goals can give you a sense of accomplishment and help you stay on the path to recovery. Give yourself credit for achieving the goal of staying sober each day.
  • Talking to a therapist. Sometimes, you might not be able to handle stress on your own. There’s no shame in seeking help from a counselor or a rehab facility. It is actually a sign of strength that you’re willing to take control of your well-being and health before things get out of hand.

What Is Stress?

Stress isn’t all bad. It’s a term that basically refers to the physical, emotional, and mental way that you respond to pressure and perceived threats.10 The stress response evolved to help people stay alive in response to a threatening stimulus (e.g., when the caveman was being chased by a saber-toothed tiger, he needed to be able to take action in a split second to make sure he wouldn’t be eaten). The body’s response to stressful stimuli is known as the fight-flight-or-freeze response.5 This is when your body releases stress hormones to help you figure out whether to run away, stand and fight, or stay in place and hope the stimulus or stressor goes away.5,6

Everyone needs a certain amount of stress to stay motivated and achieve their goals. This is known as healthy stress.7 The problem occurs when stress becomes chronic or unmanageable; according to the American Psychological Association, unhealthy stress occurs when people are forced to operate beyond their limits, which leads to feelings of overwhelm.8 Not everyone is affected by stress in the same way, however; unhealthy stress can occur whenever you feel unable to cope with pressure and you get stuck in the stress response.5

Types of Stress

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) outlines four types of stress, which includes:5,9

  • General life stressors. This refers to things that most people deal with at some point in their lives, such as marriage, divorce, deaths in the family, problems at home, or illness (in yourself or someone you care about). People with alcohol use disorder (AUD) may have an increased risk of stress when faced with these issues. They can also experience more stress as a result of their drinking, such as having to deal with stress in relationships or at work caused by the effects of alcohol.
  • Catastrophic events. This includes manmade and natural disasters such as fires, floods, hurricanes, terror attacks, global pandemics and nuclear disasters. While research has shown that alcohol consumption tends to increase in the year following a disaster, other studies show an increase in alcohol consumption during catastrophic events such as pandemic.21,22
  • Childhood stress. This can involve exposure to physical, emotional, and sexual abuse or neglect. If you grew up in a chaotic, abusive, or neglectful environment, it’s possible that you’ll experience lasting effects of childhood stress for the rest of your life if you don’t address those issues. Research shows that being mistreated in childhood can increase the risk of both alcohol use in adolescence and adulthood and increase the risk of AUDs in general.
  • Minority stress. People who are members of racial or ethnic minorities, or those identify as LGBTQ+, can experience stress due to stigmatization, prejudice, and discrimination.

Considering Getting Help for Alcoholism?

Here are some links that can teach you more and help you get started.

Common Causes of Stress

Anything that feels overwhelming to you can be a source of stress. Stress and overwhelm can come from good events or bad ones. Not everyone experiences stress for the same reasons, but some common causes of stress can include:5,10,11

  • Money issues.
  • Relationship problems.
  • Getting married.
  • Getting divorced.
  • Having a baby.
  • Moving to a new home/location.
  • Starting a new job.
  • Losing your job.
  • Retirement.
  • Illness (in you or a loved one).
  • Death of a loved one.
  • Political situations.
  • Violence.
  • Crime.

Signs of Stress

The signs of stress can initially appear in subtle ways that build up over time until they cause serious physical discomfort and psychological distress. Stress can cause behavioral, physical, and emotional symptoms.5

Common emotional signs of stress include:5,10

  • Anxiety.
  • Fear.
  • Nervousness.
  • Sadness.
  • Irritability.
  • Depression.
  • Frustration.
  • Forgetfulness.

Physically, you could experience signs such as:5,10

  • Insomnia or sleep problems.
  • Diarrhea or constipation.
  • Headaches.
  • Bodily aches and pains.
  • Stomach upset or indigestion.
  • Fatigue.
  • Lack of energy and focus.
  • Heart palpitations.
  • Shallow breathing or hyperventilation.
  • Sweating.

Stress can cause behavioral symptoms, such as:5

  • Increased use of alcohol or drugs.
  • Withdrawing from social contact.
  • Experiencing sexual problems.
  • Snapping at others or having a short fuse.

Over time, stress can negatively impact all your bodily systems and lead to or exacerbate chronic health issues such as musculoskeletal disorders, cardiovascular problems, respiratory disorders, metabolic disorders, and problems with the reproductive system.12

The tension-reduction hypothesis is one of the most common hypotheses in studies on the link between alcohol use and stress.13 Supporting research has shown that this link seems to point to increased alcohol use as a result of the increased anxiety caused by stress.13 However, there isn’t always a predictable and direct link between alcohol use and stress, because not all forms of stress lead to alcohol use, not everyone drinks in response to stress, and not everyone who drinks in response to stress ends up with an alcohol use disorder.13 Other factors, such as genetics and life experiences, can influence alcohol use, the development of an alcohol use disorder as well as a person’s response to stress.13

stress insomnia and alcoholism

The results of a study published in Alcohol and Alcoholism can help clarify the link between alcohol abuse and stress. Researchers found that there appears to be a positive correlation between the number of past-year stressors and heavy drinking.14 They found that the frequency of heavy drinking days (for the study this meant a man having 5 or more drinks, and 4 or more drinks for woman) increased by 24% with the addition of each stressor in men, and by 13% with each additional stressor in women.14 Interestingly, the frequency of moderate drinking (less than 5 drinks for men or less than 4 for women) decreased with increasing levels of stress.14 The study concluded that stress doesn’t necessarily lead to more frequent alcohol use overall, but it can cause people who drink heavily to drink even more on the days they choose to drink.14

On the other hand, the results of a survey discussed in a study in Alcohol Research: Current Reviews, reports that the risk for overall alcohol use, abuse, and addiction increases as people experience increased stress up to a certain point.15 In men, the risk of alcohol use, abuse, and AUD increased steadily as they experienced an increase from 0 to 6 stressors in the past year, but the risk leveled off and actually appeared to decrease at 10 stressors or more.15 In women, the relationship was linear, with the risk of AUD increasing steadily with each additional stressor.15

Effects of Stress on Alcohol Consumption

People sometimes self-medicate and cope with stress by using alcohol. In the short term, drinking alcohol can indeed lower stress levels. However, if you experience ongoing stress and drinking increasingly becomes your usual way of coping, you are at a higher risk of developing alcohol dependence, and addiction (AUD).9,16

In addition, heavy drinking causes neuroadaptations in the brain that affect your brain chemistry, which leads to a change in the normal “set point” of your hormonal balance. Chronic alcohol use causes the release of higher amounts of stress hormones cortisol and adrenocorticotropic hormone.9 Your body starts to adapt to this increased level and that becomes your new norm; this means that you have higher overall levels of stress hormones in your body compared to someone who does not drink.9 Due to this shift, you can experience changes in the way you perceive and experience stress. If you are a heavy drinker, you might therefore experience increased anxiety in response to stress when compared to someone who abstains or who only drinks in moderation.9

According to the substance-induced model of anxiety, heavy and chronic alcohol use is seen as a key cause of anxiety.16 Heavy alcohol use and experiencing withdrawal periods can both cause changes in the nervous system that can both raise anxiety levels overall and exacerbate anxiety and heighten other negative feelings that a person experiences as a result of experiencing stress.

These biological adaptations may help to explain why a person with an alcohol use disorder, particularly in someone who relied on alcohol to ameliorate stress, is so vulnerable to relapse.9,16

What Happens If You Relapse Due to Stress?

Alcohol addiction is a chronic medical disease that has rates of relapse that are similar to other chronic, relapsing diseases.17 For example, addiction has a relapse rate of 40-60%, compared to rates of 50-70% for hypertension and asthma.17 Relapse is a common feature of recovery. If you relapse, it’s important to know that you’re not alone. Relapse does not mean treatment has failed or that you cannot become sober again, but it can indicate that you need to re-enter rehab or try a different form of treatment.17

alcoholics anonymous relapse prevention

If too much stress led you to return to alcohol use or relapse, you can take different steps to get back on track, such as:18,19

  • Acknowledging that relapse is a normal part of recovery. Try not to beat yourself up about it, because that can cause you to feel more stressed.
  • Maintaining your motivation. Identify (and perhaps write down) your reasons for entering recovery. Consider why you decided to stop drinking in the first place and think about the specific benefits of being sober.
  • Going to a support group meeting. Talking to others about your relapse can help release stress and help you get back on the path to recovery.
  • Practicing relaxation regularly. Make sure you have enough time each day that’s just for you.
  • Reaching out to supportive friends and family. Socialization with people you know and trust can help you feel loved and supported.
  • Developing positive self-talk. Try to combat negativity with realistic, positive facts. Tell yourself, “I’ve stopped drinking before, I can do it again.”
  • Ensuring that your basic needs are met. Remember the acronym “HALT” – Hungry, Angry, Lonely, T These emotions can be key triggers for relapse and stress.
  • Sticking with or adopting a positive, healthy lifestyle. Relapse doesn’t mean you have to stop exercising and eat unhealthy foods. Keep (or start) going to the gym or maintain your current exercise and healthy eating regimen, and make sure you get enough sleep.
  • Reaching out for help. Talking to an addiction counselor or entering rehab can be helpful for providing the structure and support you may need to get back (and stay) on track.

Lastly, if you do relapse, particularly if it is stress or anxiety as a response to stress that triggers the relapse, ask for help as quickly as you can and/or look into returning to treatment in order to help you get bath on track.20 It may also be beneficial to contact your main treatment provider (e.g., a counselor or doctor, and your support network) to discuss next steps or reexamine your aftercare plan. You may feel embarrassed or nervous to do so but that is what they are in your life for—to help you maintain your sobriety during the ups and the downs.

Sources
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[1]. Clay, J. M., & Parker, M. O. (2018). The role of stress-reactivity, stress-recovery and risky decision-making in psychosocial stress-induced alcohol consumption in social drinkers. Psychopharmacology, 235(11), 3243–3257.

[2]. Milivojevic, V., & Sinha, R. (2017). Targeting Stress Pathophysiology to Improve Alcoholism Relapse Outcomes. Neuropsychopharmacology, 42(5), 987–988.

[3]. Anxiety & Depression Association of America. (n.d.). Exercise for Stress and Anxiety.

[4]. National Alliance on Mental Illness. (n.d.). Managing Stress.

[5]. Mental Health Foundation. (2021). Stress.

[6]. Kozlowska, K., Walker, P., McLean, L., & Carrive, P. (2015). Fear and the Defense Cascade: Clinical Implications and Management. Harvard review of psychiatry, 23(4), 263–287.

[7]. Sanders, R. (2013). Researchers find out why some stress is good for you.

[8]. American Psychological Association. (2019). Why Stress and Anxiety Aren’t Always Bad.

[9]. National Institute on Alcohol Abuse and Alcoholism. (2014). The Link Between Stress and Alcohol. Alcohol Alert, 34 (4).

[10]. U.S. National Library of Health. (2020). MedlinePlus: Stress and your health.

[11]. American Psychological Association. (2017). Stress in America: The State of Our Nation. Stress in America Survey.

[12]. American Psychological Association. (2018). Stress effects on the body.

[13]. Anthenelli, R., & Grandison, L. (2012). Effects of stress on alcohol consumption. Alcohol research: current reviews, 34(4), 381–382.

[14]. Dawson, D. A., Grant, B. F., & Ruan, W. J. (2005). The association between stress and drinking: modifying effects of gender and vulnerability. Alcohol and alcoholism, 40(5), 453–460.

[15]. Keyes, K. M., Hatzenbuehler, M. L., Grant, B. F., & Hasin, D. S. (2012). Stress and alcohol: epidemiologic evidence. Alcohol research: current reviews, 34(4), 391–400.

[16]. Smith, J. P., & Randall, C. L. (2012). Anxiety and alcohol use disorders: comorbidity and treatment considerations. Alcohol research: current reviews, 34(4), 414–431.

[17]. National Institute on Drug Abuse. (2020). Drugs, Brains, and Behavior: The Science of Addiction: Treatment and Recovery.

[18]. Australian Government Department of Health. (2004). 8.1 Relapse prevention/management.

[19]. Friedmann, P. D., Saitz, R., & Samet, J. H. (1998). Management of adults recovering from alcohol or other drug problems: relapse prevention in primary care. JAMA, 279(15), 1227–1231.

[20]. Rajita Sinha, Ph.D. (2012). How Does Stress Lead to Risk of Alcohol Relapse? Alcohol Res. 34(4): 432–440.

[21]. Pollard MS, Tucker JS, Green HD. (2020). Changes in Adult Alcohol Use and Consequences During the COVID-19 Pandemic in the USJAMA Netw Open;3(9):e2022942.

[22]. Grossman, E. R., Benjamin-Neelon, S. E., & Sonnenschein, S. (2020). Alcohol Consumption during the COVID-19 Pandemic: A Cross-Sectional Survey of US AdultsInternational journal of environmental research and public health17(24), 9189.