Integrative Recovery Medicine

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Cortisol, Addiction, and Relapse

Stress has been shown to increase anxiety and cravings, which in turn, increases one’s risk for relapse.

This has been demonstrated in those that use opiates, alcohol, nicotine, cocaine, or marijuana. None of this is a surprise to those recovering from addiction.

What people in recovery may not know, is that research has discovered that when there are alterations in the stress hormones, it makes people more susceptible to relapse. 

It is common for people recovering from addiction to have changes in the hypothalamus/pituitary/adrenal (HPA) axis that are different from what is considered normal.

This is the hormone feedback loop that is involved in how our bodies respond to stress. 

In a balanced system, cortisol has a rhythm that cycles each day. It peaks in the morning and should go down throughout the day. It is also released in bursts by the adrenal glands in response to stress. It should peak and then return to normal baseline levels. 

Alterations in the stress hormones, including cortisol, can result in increased drug and/or alcohol craving.

Here are some of the findings from the research:

Increased drug cravings occur when people receive an injection of one of the stress-producing hormones (corticotropin-releasing factor).

In people recovering from opiate use, high cortisol levels are related to a higher risk of relapse. 

For those that had relapsed on cocaine, the release of high-stress hormones in response to a stressor resulted in increased cocaine consumption. 

In those recovering from alcohol, a blunted release of cortisol results in higher anxiety, more cravings and predicts a poorer recovery outcome. 

The stress hormones are connected to the nervous system. Dysregulation can have many symptoms. These can include; insomnia, anxiety, agitation, irritability, and fatigue. It’s important to assess (through testing) and to address any of the underlying abnormalities to ensure a more successful recovery.

As a functional medicine practitioner, it is routine to test adrenal function and to look at all areas of one’s life to ensure that there are adequate strategies and tools to be able to properly restore and regulate stress hormones. This, in turn, will result in better odds for successful addiction recovery.

References:

Sinha R. New Findings on Biological Factors Predicting Addiction Relapse Vulnerability. Curr Psychiatry Rep. 2011;13(5):398-405. doi:10.1007/s11920-011-0224-0

Sinha R, Fox HC, Hong KA, Hansen J, Tuit K, Kreek MJ. Effects of Adrenal Sensitivity, Stress- and Cue-Induced Craving, and Anxiety on Subsequent Alcohol Relapse and Treatment Outcomes. Arch Gen Psychiatry. 2011;68(9):942-952. doi:10.1001/archgenpsychiatry.2011.49