In recent articles here at AddictionNews, we have been exploring the relationship between stress and addiction. We have looked at the contribution of genetics to addiction and the contribution of trauma and chronic stress. 

Today, we’re going to dig deeper into the relationship between stress and addiction, starting with adolescents. It is very often the events of childhood that people cite as the wellsprings of their addictions, and it’s definitely a good place to start.

In a narrative review of stress-related substance use disorders (SUDs) in adolescents, four researchers from the United States published their results in the British publication, Medical Research Archives, the official journal of the European Society of Medicine. They found that:

[T]rauma- and stressor-related disorders and substance use disorders (SUDs) commonly co-occur in adolescents.

That’s just the start of it. Youth who have experienced “interpersonal violence” or multiple past traumas “are at the highest risk of developing these co-occurring disorders.” The authors cite a “strong bidirectional relationship between traumatic events and substance abuse.” The authors describe a familiar substance abuse pattern:

1. The self-medication hypothesis: “individuals use substances to temporarily alleviate trauma-related symptoms.”
2. “[T]his results in negative reinforcement,” including hyperarousal, dysphoria, and anxiety.
3. Withdrawal results in increased stress and anxiety, driving relapse.

Unlike so many American journals, which obfuscate the connection between adverse childhood experiences (ACEs, or child abuse), European journals are more blunt:

[E]xposure to traumatic events during childhood and adolescence is associated with a myriad of mental health concerns including posttraumatic stress symptoms (PTSS) and posttraumatic stress disorder (PTSD) and substance use disorders (SUD).

How strong does the correlation between child abuse and SUDs have to be before schools stop throwing money away on scare programs and invest in preventing child abuse? Is it possible that limiting head-injury-inducing sports might do more to curb SUDs than all the D.A.R.E. programs combined?

Children are remarkably resilient, the researchers show, with over 56% of Swiss youth experiencing a traumatic childhood experience, yet only 4.2% having been diagnosed with PTSD (post-traumatic stress disorder). Over 50% of English youth have experienced an ACE. However, the earlier and the more frequently children experience ACEs, the greater their likelihood of contracting SUDs.

The reverse of this statement must be true: That youth involvement with substance use is less addictive if it is not accompanied by trauma or chronic stress. This theory is tested in the research of Dr. Gary Wand, professor of psychiatry and endocrinology at the Johns Hopkins School of Medicine. In an article for the journal Alcohol Research & Health, Dr. Wand explains how the stress response influences the progression of alcohol use disorder (AUD) and other SUDs.

Dr. Wand shows that increased stress hormones in the brain increase self-administration of alcohol and other drugs. This drug usage does not turn into an addiction, however, without “excessive and/or prolonged stress.” Then, the drugs and the stress work together in a reinforcing manner to degrade the reward response.

Once the stage of addiction is reached, withdrawal results in “gross impairment of the normal stress response […] resulting in a state of anxiety and internal stress.” At this stage, Dr. Wand reports, people continue their substance abuse, not for hedonic pleasure, but to relieve the negative impacts of withdrawal.

It appears that stress works as a funnel to channel substance use into addiction. For example, nearly 80% of all European 16-year-olds have used alcohol, with half of all 16-year-olds using it within the past 30 days. Yet only 3.13% of European 15- to 19-year-olds have been diagnosed with an SUD. 

What are the major differences between those who use and those who abuse? “Approximately 24-30% of youth with PTSD also meet criteria for a comorbid SUD.” The researchers say the problem doesn’t get better with age:

Estimates of co-occurring disorders are even higher among adults (30-50%), with up to 85% of individuals seeking treatment for PTSD having a comorbid SUD.

We can see clearly through this research that stress is not only a major motivator for experimentation with substances of abuse, it is an accelerant. It reinforces a cycle of self-medication that gets worse the earlier the stress starts and the more frequently it happens. We refer readers to our articles on increasing resilience in children for suggestions on breaking the stress/substance abuse cycle.

Written by Steve O’Keefe. First published June 17, 2026.

Sources:

“Co-occurring trauma- and stressor-related and substance-related disorders in youth: A narrative review,” Medical Research Archives, November 27, 2024.

“The Influence of Stress on the Transition From Drug Use to Addiction,” Alcohol Research & Health, 2008.

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