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Adjustment Disorder and the Risk of Drug Addiction

Stress is a normal part of life, and many different life events can result in high levels of stress. These events can be both positive or negative, such as marriage, divorce, buying a new house, death of a loved one, family strife, illness, or the experience of a traumatic event. Stress can be chronic and continual or the result of a one-time event.

When someone has an excessive and abnormal reaction to a stressor within three months of the event, and this stress is significant enough to impair a person’s ability to function normally in daily life, they may suffer from adjustment disorder, as defined by Psych Central. Work, social life, and schoolwork may all suffer as a result of an adjustment disorder.

Symptoms of adjustment disorder, as published by the National Library of Medicine (NLM) include:

  • Agitation
  • Impulsive, defiant, and reckless behaviors
  • Twitching or trembling
  • Feelings of tension and anxiousness
  • Excessive crying
  • Feelings of sadness and hopelessness
  • Social withdrawal
  • Irregular heart rate and additional physical complaints

Symptoms of an adjustment disorder do not persist beyond six months (upon the removal of the stressor) or meet the criteria required for a different mental health disorder. The journal CNS Drugs reports that adjustment disorder has a prevalence rate of 10-35 percent, making it a relatively common disorder.

Adjustment disorder commonly occurs along with depression, anxiety, disturbances of conduct, reactions that are maladaptive, suicidal behaviors and heightened risk of suicide, and substance abuse, Psychology Today publishes. The journal Clinical Practice & Epidemiology in Mental Health reports that as many as three-quarters of those diagnosed and admitted to treatment for adjustment disorder also suffered from substance abuse.

Stress is often a contributor to drug abuse and therefore to addiction as well. When two disorders, such as addiction and adjustment disorder, are present in the same person at the same time, these disorders are said to be co-occurring.

Stress, Drug Abuse, and Addiction

M_Matin-08735-650x433People abuse drugs for a multitude of reasons, including as a method to relieve stress, escape reality, feel good, calm tension, or self-medicate symptoms of medical or mental distress. When a person abuses drugs, changes are made to the brain’s chemistry. New chemical pathways for reward are formed, and drug dependence can develop with chronic drug abuse.

When a person is dependent on drugs, they may no longer be able to feel happiness, control impulses or emotions, or function normally without them. They may no longer be able to stop taking drugs, and this loss of control is a signifier for addiction. Stress is a well-known contributor to drug abuse, and high levels of stress increase the risk for developing an addiction to drugs, the Annals of the New York Academy of Sciences reports.

When a person feels stressed, the “fight-or-flight” response is activated. Heart rate, blood pressure, respiration, and body temperature all increase. A person becomes hyperalert, focused, tense, and awake. This can be helpful in times of danger; however, chronic, high, and unnecessary levels of stress can be harmful.

In the case of an adjustment disorder, elevated tension and stress may make drugs seem like an appealing method for alleviating problematic symptoms. Many drugs, such as central nervous system depressants like opioids (prescription painkillers and heroin) and benzodiazepines (sleep aids and anti-anxiety medications) work to slow down the stress response by depressing the central nervous system. Sedatives and tranquilizers, like benzodiazepines, act on levels of gamma-aminobutyric acid (GABA) in the brain. GABA is the brain’s chemical messenger, or neurotransmitter, that effectively curbs the stress response in the brain. Relaxation, pleasure, drowsiness, and short-term memory loss are some of the effects of abusing these drugs.

Someone who suffers from an adjustment disorder may choose to use these drugs in an effort to temporarily relieve their irrationally high stress levels. When these substances are used regularly, drug dependence forms. Dependence on central nervous system depressant drugs comes with significant withdrawal symptoms when the drug wears off and isn’t active in the bloodstream. Rebound anxiety, insomnia, and a spike in heart rate, blood pressure, body temperature, and respiration rates can occur as the central nervous system, which had become accustomed to being suppressed by the drugs, is no longer held back. Withdrawal symptoms and drug cravings can be intense and may result in a loss of control over drug use, leading to addiction.

Overlapping Contributors for Adjustment Disorder and Addiction

High stress and a significant life stressor can contribute to the onset of both an adjustment disorder and a drug addiction. Certain factors may make some people more vulnerable than others to developing both of these disorders simultaneously. For example, a person who may not have very effective coping mechanisms for stress may be at a higher risk for both of these disorders than someone who has strong coping tools. Environmental aspects, including the lack of a healthy support system at home, can contribute to these co-occurring disorders as well.

Genetics, as in a personal or family history of addiction and/or mental health disorders, can increase the risk for developing these disorders. Biology may play a role as well since certain regions of the brain involved in stress regulation, pleasure-seeking, impulse control, and emotional regulation are potentially related to a predisposition to both of these disorders.

Early exposure to stress may raise the risk for developing stress-related mental health disorders like an adjustment disorder. In a similar fashion, using drugs before the brain is fully developed (likely in a person’s mid-20s) can also increase the risk for addiction and problematic drug use later in life. For instance, the 2013 NSDUH reports on individuals who abused marijuana prior to age 14 and found a much higher incidence for subsequent addiction than in those who waited until after age 18 to initiate using the drug.

Co-occurring disorders, such as adjustment disorder and addiction, can serve to make the symptoms of each condition worse. Even though drug abuse may seem to temporarily lessen stress, in the long run, it can actually increase levels of stress and anxiety when drug withdrawal sets in after dependence has formed.

Medical detox is often necessary to help individuals safely process harmful drugs out of the body in an environment that can provide around-the-clock supervision to ensure stability both physically and emotionally. An increased risk for suicide is possible during drug withdrawal, especially when adjustment disorder is also present; therefore, professional monitoring and pharmacological tools are often needed during detox and treatment.

Integrated treatment models that work to manage the symptoms of both disorders are generally considered to be the optimal form of care for co-occurring disorders, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). A combination of behavioral therapies, pharmacological management, supportive care, life skills training, education, stress management techniques, 12-Step programs, and group, individual, and family counseling is ideal in treating adjustment disorder and drug addiction at the same time. Medical and mental health providers, along with substance abuse professionals, work together to devise and carry out a treatment plan to foster a sustained recovery from both disorders.

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