The Stress-Vulnerability Model
of Co-occurring Disorders
- What causes psychiatric disorders?
- Why do some people develop a psychiatric disorder but others don’t?
- What affects the course of the disorder?
These are common questions raised by people with co-occurring disorders and their family members. The stress-vulnerability model provides answers to these questions. This model can help in understanding the causes of psychiatric disorders, how psychiatric disorders and addiction can influence each other, and how co-occurring disorders can be managed and treated together.
Handout available
This information is also available as a PDF, which is included in the Hazelden Co-occurring Disorders Program.
Download the Stress-Vulnerability Model handout
As the name suggests, two main factors are involved. “Vulnerability” refers to our basic susceptibility to mental health disorders. This is determined by our genetic makeup and our early life experiences. It is affected by our use of medications and our likelihood of using alcohol or drugs. “Stress” refers to the challenges faced in our lives. It is affected by our coping skills, social support, and involvement in meaningful activities.
Biological Vulnerability
If we are vulnerable to something, it means we’re more likely to be affected by it. For example, some people might be biologically vulnerable to certain physical illnesses-such as heart disease or asthma. Maybe the disease runs in the family, or maybe something in our early life “set us up” for it.
Some people are biologically vulnerable to certain psychiatric disorders: bipolar disorder, major depression, schizophrenia, or anxiety disorders (panic, post-traumatic stress), for example. This vulnerability is determined early in life by a combination of factors, including genetics, prenatal nutrition and stress, birth complications, and early experiences in childhood (such as abuse or the loss of a parent). This is why some families are more likely to have members with a particular psychiatric disorder. Although vulnerability to psychiatric disorders is primarily biological in nature, people can take steps to reduce their vulnerability, including taking medication and not using alcohol or drugs. It’s also worth noting that the greater a person’s vulnerability to a particular disorder, the earlier it is likely to develop, and the more severe it may become.
Similarly, some people also have a biological vulnerability to developing an addiction: they are more likely to develop alcohol or drug abuse or dependence. This is why addiction, similar to psychiatric disorders, sometimes “runs in families.”
What Are the Elements of the Stress-Vulnerability Model?
These two main areas — biological vulnerability and stress — are influenced by several other factors that people have some control over. These factors include
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alcohol and drug use
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medication use
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coping skills
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social support
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meaningful activities
This means that by addressing these factors, people can reduce symptoms and relapses and improve the course of their co-occurring disorders.
Alcohol and Drug Use
Using alcohol or drugs can increase a person’s pre-existing biological vulnerability to a psychiatric disorder. Thus, substance use can trigger a psychiatric disorder and lead to more severe symptoms and other impairments. Because most people with co-occurring mental and substance use disorders have a biological vulnerability to psychiatric disorders, they tend to be highly sensitive to even small amounts of alcohol and drugs.
Stress
Stress in the environment can worsen biological vulnerability, worsen symptoms, and cause relapses. Stress is anything that challenges a person, requiring some kind of adaptation. Serious stressful events include losing a loved one, getting fired from a job, being a victim of crime, or having conflicts with close people.
Stress is often associated with negative events, but positive events and experiences may be stressful as well. For example, performing well in school, getting a new job, starting a new relationship, having a baby, or being a parent all involve some degree of stress.
It is also possible for stress to be caused by not having enough to do. When people with co-occurring disorders have nothing purposeful or interesting to do, they tend to have worse symptoms and are more prone to using substances. So a lack of meaningful involvement in life-in areas such as work or parenting, for example-can be another source of stress.
Coping Skills
Developing coping strategies can help with handling stress and reducing its negative effects on vulnerability. Examples of coping skills include
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relaxation skills for dealing with stress and tension
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social skills for connecting with people, dealing with conflict, and getting support
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coping skills for managing persistent symptoms such as depression, anxiety, and sleeping problems
Stress is a normal part of life. Effective coping enables people to be engaged in interesting, rewarding activities that may involve stress, such as working or being a parent. Coping efforts can make it possible for someone with co-occurring disorders to live a normal life without suffering the negative effects of stress.
Involvement in Meaningful Activities
Having something meaningful to do with one’s time gives one a sense of purpose, and reduces the stress of having nothing to do. Meaningful activities can include:
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work
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school
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parenting or other caregiving responsibilities
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homemaking
Social Support
Another way to reduce the negative effects of stress on vulnerability is through social support, which comes from having close and meaningful relationships with other people. Supportive people can help in a variety of ways, such as
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helping people solve challenging Problems
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supporting people in using coping strategies to deal with symptoms and substance-use urges
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being open and willing to discussing and resolving personal disagreements, misunderstandings, and areas of conflict that could otherwise lead to stress
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letting people know that they are important and cared about
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supporting the person in pursuing personally meaningful goals
People who have good social support are less vulnerable to the effects of stress on their psychiatric disorder. Therefore, having strong social support enables people with co-occurring disorders to handle stress more effectively, and live a normal life.
Treatment Implications of the Stress-Vulnerability Model
Based on an understanding of the stress-vulnerability model, there are many ways to help people manage their psychiatric illness and co-occurring substance use disorder. In the broadest terms, the severity and course of a co-occurring mental health disorder can be improved by reducing biological vulnerability and increasing resiliency against stress.
Reducing Biological Vulnerability
Biological vulnerability can be reduced in two primary ways: taking medication and avoiding alcohol or drug use. Medication can be a powerful way of reducing biological vulnerability by helping to correct the imbalances in neurotransmitters (chemicals in the brain responsible for feelings, thinking, and behavior) believed to cause psychiatric disorders. By taking medication, the symptoms of a psychiatric disorder can be lowered and the chances of having a relapse can also be reduced.
Avoiding alcohol and drug use can reduce biological vulnerability in two ways. First, because substances affect the brain, using alcohol or drugs can directly worsen those vulnerable parts of the brain associated with psychiatric disorders. Second, using substances can interfere with the corrective effects of medication on vulnerability. This means that somebody who is using alcohol or drugs will not get the full benefit of any prescribed medications for his or her disorder, leading to worse symptoms and a greater chance of relapses.
Increasing Resiliency against Stress
It is impossible for anyone to live a life that is free of stress. However, there are many ways people can learn how to deal with stress more effectively, and to protect themselves from the effects of stress on worsening symptoms and causing relapses, including
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developing effective coping skills for managing stress and persistent symptoms
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getting involved in meaningful activities that structure one’s time and reduce the stress of having nothing to do
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building socially supportive relationships that help one manage the mental health disorder and maintain sobriety
CJ Peters
November 14, 2019
In today’s world, addiction is a disease that is impacting people of all ages, races, sexual orientations, and economic classes. It is a non-discriminatory disease.
Addiction has become so common that the American Psychiatric Association (APA) recently reported that one in three Americans know someone who is addicted to opioids. While opioids like OxyContin, fentanyl, and heroin are being abused at higher rates than ever before, they are certainly not the only addictive substances being abused by Americans.
According to the Centers for Disease Control and Prevention (CDC), more than 15 million Americans are addicted to alcohol. Another 15 million are addicted to prescription drugs, 1.5 million are dependent on cocaine, and 1.6 million addicted to meth. There is no shortage of addictions in the United States, which begs the question: Why are so many people addicted to drugs and alcohol?
There are countless reasons why people end up addicted to mind-altering substances. Some people start using drugs or alcohol to self-medicate symptoms of a mental illness, while others develop a dependence as a result of habitual recreational use (like college kids who drink alcohol weekly).
Addiction also sometimes develops after a person has experienced a physical injury and is prescribed a prescription painkiller like oxycodone. As previously mentioned, there are an innumerable amount of reasons for addiction development. Many people, however, can trace the development of their addictions to their life stressors.
Stressors Commonly Linked to Substance Use Disorder
Stress is something that nobody on this planet can escape. Of course, there are ways to minimize the possibility of stress, but no one is immune to it. Plus, not everyone is going to get stressed out by the same things. One person might find a certain situation extremely stressful while another is not affected by it at all.
When it comes to those who struggle with the disease of addiction, there is almost always some form of stress that has contributed to the development of their addiction. In fact, the National Institute on Drug Abuse (NIDA) reports that people who are exposed to stress are more likely to abuse drugs or alcohol at some point in their lives. Some of the most common stressors linked to substance abuse include the following:
- Pressure to perform at work, home, or school
- Poor time management
- A mental illness that is going untreated
- Experiencing a major life change (such as moving, having a baby, getting married, losing a loved one.)
- Childhood trauma
These stressors are complex to deal with, even for those who have the strongest psychological and emotional health. However, it is extremely important for someone to focus on the connection between their stress and addiction and what makes them vulnerable to continuing on with active addiction.
What is the Stress-Vulnerability Model?
The American Psychological Association Dictionary of Psychology defines the stress-vulnerability model as a theory that a “genetic or biological predisposition to certain mental disorders exists and psychological and social factors can increase the likelihood of symptomatic episodes.” While the APA only mentions mental illness in their official definition, the stress-vulnerability model is also applicable to the disease of addiction.
The stress-vulnerability model explores how biological factors and stress impacts a person’s likelihood of developing a substance use disorder or other mental disorder. It is well known that addiction has its biological elements, meaning many hereditary genes can increase one’s risk of developing an addiction, but science also supports stress as a risk factor when it comes to struggling with addiction.
As mentioned above, one of the most common stressors that people with substance use disorders tend to have a history of is childhood trauma. When people experience trauma, it creates a stress response in the body. That stress response can shape how that person perceives and processes the trauma. Common childhood traumas include:
- Sexual abuse
- Emotional abuse
- Physical abuse
- Poverty
- Neglect
- Being placed in foster care at an early age or put into the care of someone other than the biological parents
- Loss of a parent
- Bullying
- Witnessing/experiencing one or more violent acts
When traumatic experiences such as these occur at a young age, it affects a child’s resilience against future stress. And, if the proper coping skills are not applied when young, the child’s defense against future stress is diminished even further. But this does not just apply to children, as adults experience trauma as well.
Adults, however, are more likely to have the coping skills needed to manage a traumatic event without turning to the abuse of drugs or alcohol. If those skills are not present in an adult, they can be learned in a therapeutic setting.
There is no doubt that stress makes us more emotionally vulnerable. And when we are struggling with our feelings and do not know how to handle them, it is simply human nature to find a way to make ourselves feel better. For many people, drugs and alcohol provide that relief. Unfortunately, if issues related to stress are not identified and addressed, no amount of drugs or alcohol will make the pain go away.
Thankfully, there is treatment available that is effective and compassionate.
Do You Need Help for Your Substance Use Disorder?
Struggling with addiction to any type of substance can be traumatic and devastating, especially if you have been using to minimize stress. You may very well think that you are never going to be able to not use even if you do not want to. This is a common concern. However, there is nothing that can stand in your way of getting sober if you are determined to stop using—even stress.
Do not allow yourself to continue spiraling out of control. Addiction is a very painful disease to live with, but you do not have to live with it. At JourneyPure Clarksville, we can help you overcome the stressors that trigger your continued use, as well as provide you with the skills you need in order to maintain long-term recovery.
So call us now! We can help.
