stress as a risk factor for mental health and substance use...stress and substance use 0 10 20 30 40...
TRANSCRIPT
![Page 1: Stress as a Risk Factor for Mental Health and Substance Use...Stress and Substance Use 0 10 20 30 40 Days to relapse 0.0 0.2 0.4 0.6 0.8 1.0 ion Responders Non-responders Plasma Cortisol](https://reader033.vdocument.in/reader033/viewer/2022042314/5ee18f5dad6a402d666c65eb/html5/thumbnails/1.jpg)
Stress as a Risk Factor for
Mental Health and Substance
Use
Dr. Mustafa al’Absi, PhD
Sheena Potretzke, MS
Friday, February 10th 2017
![Page 2: Stress as a Risk Factor for Mental Health and Substance Use...Stress and Substance Use 0 10 20 30 40 Days to relapse 0.0 0.2 0.4 0.6 0.8 1.0 ion Responders Non-responders Plasma Cortisol](https://reader033.vdocument.in/reader033/viewer/2022042314/5ee18f5dad6a402d666c65eb/html5/thumbnails/2.jpg)
Introductions
Dr. Mustafa al’Absi
• University of Minnesota- Duluth
Medical School
– Dept. of Family Medicine and
Community Health
– Dept. of Biobehavioral Health
and Population Sciences
– Max E. and Mary LaDue
Pickworth Chair
– Founding Director of the
Duluth Medical Research
Institute (DMRI)
![Page 3: Stress as a Risk Factor for Mental Health and Substance Use...Stress and Substance Use 0 10 20 30 40 Days to relapse 0.0 0.2 0.4 0.6 0.8 1.0 ion Responders Non-responders Plasma Cortisol](https://reader033.vdocument.in/reader033/viewer/2022042314/5ee18f5dad6a402d666c65eb/html5/thumbnails/3.jpg)
Introductions
• Sheena Potretzke, MS
–BS Neuroscience
–MS Cognitive
Neuroscience
–Research Coordinator
at the Minnesota
Center for Chemical
and Mental Health
(MNCAMH)
![Page 4: Stress as a Risk Factor for Mental Health and Substance Use...Stress and Substance Use 0 10 20 30 40 Days to relapse 0.0 0.2 0.4 0.6 0.8 1.0 ion Responders Non-responders Plasma Cortisol](https://reader033.vdocument.in/reader033/viewer/2022042314/5ee18f5dad6a402d666c65eb/html5/thumbnails/4.jpg)
Overview
• Stress basics
• Brief review of current research surrounding:
– Stress and mental health
– Stress and substance use
• Suggestions/options for clinicians in treating stress
• QuestionsImage from: http://www.hoyespharmacy.com/wp-content/uploads/2015/04/Sl_StressBrain.png
![Page 5: Stress as a Risk Factor for Mental Health and Substance Use...Stress and Substance Use 0 10 20 30 40 Days to relapse 0.0 0.2 0.4 0.6 0.8 1.0 ion Responders Non-responders Plasma Cortisol](https://reader033.vdocument.in/reader033/viewer/2022042314/5ee18f5dad6a402d666c65eb/html5/thumbnails/5.jpg)
Stress Basics
• Stress is not a
disease.
• Stress can lead to both physical and
mental illness (Asberg et al, 2010;
Anderson, 2004).
![Page 6: Stress as a Risk Factor for Mental Health and Substance Use...Stress and Substance Use 0 10 20 30 40 Days to relapse 0.0 0.2 0.4 0.6 0.8 1.0 ion Responders Non-responders Plasma Cortisol](https://reader033.vdocument.in/reader033/viewer/2022042314/5ee18f5dad6a402d666c65eb/html5/thumbnails/6.jpg)
Stress basics
• Hypothalamic-pituitary-adrenal (HPA) axis
• Neuroendocrine system (Malenka, Nestler
& Hyman, 2009)
• 3 endocrine glands:
• Hypothalamus
• Pituitary
• Adrenal
• Stress hormones:
• Cortisol
• Adrenaline
• Corticotropin-releasing hormone (CRH)
• Adrenocorticotropic hormone (ACTH)
![Page 7: Stress as a Risk Factor for Mental Health and Substance Use...Stress and Substance Use 0 10 20 30 40 Days to relapse 0.0 0.2 0.4 0.6 0.8 1.0 ion Responders Non-responders Plasma Cortisol](https://reader033.vdocument.in/reader033/viewer/2022042314/5ee18f5dad6a402d666c65eb/html5/thumbnails/7.jpg)
Stress and Mental Health
• Stress functions as both an aggravator of
mental illness, and the main cause of the
disease (Asberg et al., 2010).
• Often intertwined.
![Page 8: Stress as a Risk Factor for Mental Health and Substance Use...Stress and Substance Use 0 10 20 30 40 Days to relapse 0.0 0.2 0.4 0.6 0.8 1.0 ion Responders Non-responders Plasma Cortisol](https://reader033.vdocument.in/reader033/viewer/2022042314/5ee18f5dad6a402d666c65eb/html5/thumbnails/8.jpg)
Stress and Mental Health
• Stress-related illness:
–Most common cause of long-term illness.
–Diverse etiology and clinical presentation(Asberg et al., 2010)
![Page 9: Stress as a Risk Factor for Mental Health and Substance Use...Stress and Substance Use 0 10 20 30 40 Days to relapse 0.0 0.2 0.4 0.6 0.8 1.0 ion Responders Non-responders Plasma Cortisol](https://reader033.vdocument.in/reader033/viewer/2022042314/5ee18f5dad6a402d666c65eb/html5/thumbnails/9.jpg)
Stress and Mental Health
• Stressful events
acute and post-
traumatic stress
disorder
• Chronis stress
variety of symptoms
(Anderson, 2004), and
cause illness (Asberg et
al., 2010)
![Page 10: Stress as a Risk Factor for Mental Health and Substance Use...Stress and Substance Use 0 10 20 30 40 Days to relapse 0.0 0.2 0.4 0.6 0.8 1.0 ion Responders Non-responders Plasma Cortisol](https://reader033.vdocument.in/reader033/viewer/2022042314/5ee18f5dad6a402d666c65eb/html5/thumbnails/10.jpg)
Stress and Mental Health
• Chronic fatigue syndrome (Asberget al., 2010)
• Prolonged stress without recovery
• 3 phases:
– Prodromal
– Acute
– Recovery
![Page 11: Stress as a Risk Factor for Mental Health and Substance Use...Stress and Substance Use 0 10 20 30 40 Days to relapse 0.0 0.2 0.4 0.6 0.8 1.0 ion Responders Non-responders Plasma Cortisol](https://reader033.vdocument.in/reader033/viewer/2022042314/5ee18f5dad6a402d666c65eb/html5/thumbnails/11.jpg)
Stress and Mental Health• HPA axis hyper/hyposensitivity found in:
– Schizophrenia (Goh & Agius, 2010)
– Major Depressive Disorder (MDD) (Nestler et
al., 2002; Asberg et al., 2010)
– PTSD (Rasmusson, Vythilingam, & Morgan,
2003)
– Psychosis (Pariante et al., 2004)
– Bipolar mania (Goh & Agius, 2010)
– Anxiety disorders (Goh & Agius, 2010)
– Other stress-induced conditions, e.g. chronic
fatigue syndrome (Asberg et al., 2010)
– Addiction (al’Absi et al., 2005; al’Absi et al.,
2004; al’Absi et al., 2014; al’Absi et al., 2003)
![Page 12: Stress as a Risk Factor for Mental Health and Substance Use...Stress and Substance Use 0 10 20 30 40 Days to relapse 0.0 0.2 0.4 0.6 0.8 1.0 ion Responders Non-responders Plasma Cortisol](https://reader033.vdocument.in/reader033/viewer/2022042314/5ee18f5dad6a402d666c65eb/html5/thumbnails/12.jpg)
Stress and Mental Health
• Diathesis-stress model (Salomon
& Jin, 2013):
– Diathesis = predisposition or
vulnerability for development
of pathological state
– Combination of predisposition and stressful event
= pathological states or diseases (Zuckerman,
1999)
– Stress defined by external events rather than
subjective experience and reactions to event(s)
(Monroe & Simons, 1991)
![Page 13: Stress as a Risk Factor for Mental Health and Substance Use...Stress and Substance Use 0 10 20 30 40 Days to relapse 0.0 0.2 0.4 0.6 0.8 1.0 ion Responders Non-responders Plasma Cortisol](https://reader033.vdocument.in/reader033/viewer/2022042314/5ee18f5dad6a402d666c65eb/html5/thumbnails/13.jpg)
Stress and Mental Health
• Diathesis-stress
model (continued):
–Resilience
•NOT the
opposite of
diathesis
![Page 14: Stress as a Risk Factor for Mental Health and Substance Use...Stress and Substance Use 0 10 20 30 40 Days to relapse 0.0 0.2 0.4 0.6 0.8 1.0 ion Responders Non-responders Plasma Cortisol](https://reader033.vdocument.in/reader033/viewer/2022042314/5ee18f5dad6a402d666c65eb/html5/thumbnails/14.jpg)
Stress and Mental Health
![Page 15: Stress as a Risk Factor for Mental Health and Substance Use...Stress and Substance Use 0 10 20 30 40 Days to relapse 0.0 0.2 0.4 0.6 0.8 1.0 ion Responders Non-responders Plasma Cortisol](https://reader033.vdocument.in/reader033/viewer/2022042314/5ee18f5dad6a402d666c65eb/html5/thumbnails/15.jpg)
Stress and Mental Health
• Stress vulnerability model (Zubin & Spring, 1977)
![Page 16: Stress as a Risk Factor for Mental Health and Substance Use...Stress and Substance Use 0 10 20 30 40 Days to relapse 0.0 0.2 0.4 0.6 0.8 1.0 ion Responders Non-responders Plasma Cortisol](https://reader033.vdocument.in/reader033/viewer/2022042314/5ee18f5dad6a402d666c65eb/html5/thumbnails/16.jpg)
Stress and Mental Health• Studies have demonstrated stress to
predispose development of mental
health problems in adulthood (Scott et
al., 2012; Varese et al., 2012; Benjet et
al., 2010; Kessler et al., 2010)
– Potential causes:
• Alterations in HPA axis
• Abnormal immunological
response
• Changes in plasticity:
– Cellular
– Molecular
– Epigenetic
![Page 17: Stress as a Risk Factor for Mental Health and Substance Use...Stress and Substance Use 0 10 20 30 40 Days to relapse 0.0 0.2 0.4 0.6 0.8 1.0 ion Responders Non-responders Plasma Cortisol](https://reader033.vdocument.in/reader033/viewer/2022042314/5ee18f5dad6a402d666c65eb/html5/thumbnails/17.jpg)
Stress and Mental Health• Intricate set of interactions involved in stress,
namely persistently elevated cortisol, or hypercortisolemia, leading to: (Agius & Goh, 2010):– Increased CRF
– Immune response
– Impaired negative feedback of HPA axis
– Neurodegenerative changes in hippocampus (Myint, 2009)• Hippocampal volume changes seen in:
– Schizophrenia (Sumich et al., 2002)
– Post-traumatic stress disorder (Felmingham et al., 2009)
– Borderline personality disorder ( Weniger et al., 2009)
– Depression (Sheline et al., 19999)
– Disruption of trophic/atrophic factors within neurons
• Polymorphisms in serotonin transporter (SERT)
![Page 18: Stress as a Risk Factor for Mental Health and Substance Use...Stress and Substance Use 0 10 20 30 40 Days to relapse 0.0 0.2 0.4 0.6 0.8 1.0 ion Responders Non-responders Plasma Cortisol](https://reader033.vdocument.in/reader033/viewer/2022042314/5ee18f5dad6a402d666c65eb/html5/thumbnails/18.jpg)
Stress and Mental Health
• Similarities in response support a common pathway
– Stress is mediated by HPA axis
– Hypercortisolemia
• Effect of hypercortisolemia:» Immune response (cytokines)
» Imbalance of a/trophic factors
• Differences (schizophrenia, bipolar disorder, PTSD,
depression):
– Different neurotransmitters
• E.g. Dopamine in schizophrenia vs. serotonin and noradrenaline in
depression
– Some neurotrophic factors specific
(Goh & Agius, 2010)
![Page 19: Stress as a Risk Factor for Mental Health and Substance Use...Stress and Substance Use 0 10 20 30 40 Days to relapse 0.0 0.2 0.4 0.6 0.8 1.0 ion Responders Non-responders Plasma Cortisol](https://reader033.vdocument.in/reader033/viewer/2022042314/5ee18f5dad6a402d666c65eb/html5/thumbnails/19.jpg)
Stress and Substance Use
• Stress is an
established, key risk
factor for both the
development of
addictive disorders
and relapse of
addictive behaviors
(Sinha and Jastreboff,
2013).
![Page 20: Stress as a Risk Factor for Mental Health and Substance Use...Stress and Substance Use 0 10 20 30 40 Days to relapse 0.0 0.2 0.4 0.6 0.8 1.0 ion Responders Non-responders Plasma Cortisol](https://reader033.vdocument.in/reader033/viewer/2022042314/5ee18f5dad6a402d666c65eb/html5/thumbnails/20.jpg)
Stress and Substance Use
![Page 21: Stress as a Risk Factor for Mental Health and Substance Use...Stress and Substance Use 0 10 20 30 40 Days to relapse 0.0 0.2 0.4 0.6 0.8 1.0 ion Responders Non-responders Plasma Cortisol](https://reader033.vdocument.in/reader033/viewer/2022042314/5ee18f5dad6a402d666c65eb/html5/thumbnails/21.jpg)
Stress and Substance Use
• Withdrawal stress
psychobiology:
– Define stress response
patterns and alterations
during smoking withdrawal in
smokers and those
attempting to quit.
– Use stress-related
biobehavioral measures to
develop a model to predict
smoking relapse
![Page 22: Stress as a Risk Factor for Mental Health and Substance Use...Stress and Substance Use 0 10 20 30 40 Days to relapse 0.0 0.2 0.4 0.6 0.8 1.0 ion Responders Non-responders Plasma Cortisol](https://reader033.vdocument.in/reader033/viewer/2022042314/5ee18f5dad6a402d666c65eb/html5/thumbnails/22.jpg)
Stress and Substance Use
• Stress-like effects of withdrawal from smoking
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
Rest Rest Tasks
Ra
tin
g
Period
Tension/Anxiety
--- Smoking
Abstinence
1
3
5
7
9
11
13
15
mm
Hg
Men Women
Group
Systolic BP Responses
Smoking Day
Abstinence Day
(al’Absi et al., 2002)
![Page 23: Stress as a Risk Factor for Mental Health and Substance Use...Stress and Substance Use 0 10 20 30 40 Days to relapse 0.0 0.2 0.4 0.6 0.8 1.0 ion Responders Non-responders Plasma Cortisol](https://reader033.vdocument.in/reader033/viewer/2022042314/5ee18f5dad6a402d666c65eb/html5/thumbnails/23.jpg)
Stress and Substance Use
0
2
4
6
8
10
12
14
16
18
20
8pm 9am 10am 11am 8pm 9am 10am 11am
Maintained Abstinence RelapsersTime
nm
ol/L
Day 1 (ad Lib) Day 2 (Quit Day)
Steeper decline
during the first
morning of
abstinence
Cortisol Concentrations
(al’Absi, Hatsukami, Davis, & Wittmers, 2004)
![Page 24: Stress as a Risk Factor for Mental Health and Substance Use...Stress and Substance Use 0 10 20 30 40 Days to relapse 0.0 0.2 0.4 0.6 0.8 1.0 ion Responders Non-responders Plasma Cortisol](https://reader033.vdocument.in/reader033/viewer/2022042314/5ee18f5dad6a402d666c65eb/html5/thumbnails/24.jpg)
Stress and Substance Use
• Association of blunted awakening response with early
relapse- also with intense craving and withdrawal symptoms
-12
-8
-4
0
4
8
12
Women Men
Maint ained Abst inence Relapsers
(al’Absi, Hatsukami, Davis, & Wittmers, 2004)
![Page 25: Stress as a Risk Factor for Mental Health and Substance Use...Stress and Substance Use 0 10 20 30 40 Days to relapse 0.0 0.2 0.4 0.6 0.8 1.0 ion Responders Non-responders Plasma Cortisol](https://reader033.vdocument.in/reader033/viewer/2022042314/5ee18f5dad6a402d666c65eb/html5/thumbnails/25.jpg)
Stress and Substance Use
0 10 20 30 40
Days to relapse
0.0
0.2
0.4
0.6
0.8
1.0
Su
rviv
or
Fu
nctio
nRespondersNon-responders
Plasma Cortisol Groups
• Blunted cortisol response to stress
associated with early relapse.
0 10 20 30 40
Days to relapse
0.0
0.2
0.4
0.6
0.8
1.0
Su
rviv
or
Fu
nctio
n
RespondersNon-responders
ACTH Groups
• Blunted ACTH response to stress
associated with early relapse.
• Disruption of the stress response is associated with increased risk for
relapse (al’Absi, Hatsukami, & Davis, 2005)
![Page 26: Stress as a Risk Factor for Mental Health and Substance Use...Stress and Substance Use 0 10 20 30 40 Days to relapse 0.0 0.2 0.4 0.6 0.8 1.0 ion Responders Non-responders Plasma Cortisol](https://reader033.vdocument.in/reader033/viewer/2022042314/5ee18f5dad6a402d666c65eb/html5/thumbnails/26.jpg)
Stress and Substance Use
0 10 20 30 40
Days to relapse
0.0
0.2
0.4
0.6
0.8
1.0
Surv
ivor
Function
RespondersNon-responders
ACTH Groups
(al’Absi, Hatsukami, & Davis, 2005)
• Blunted ACTH response to stress
associated with early relapse.
![Page 27: Stress as a Risk Factor for Mental Health and Substance Use...Stress and Substance Use 0 10 20 30 40 Days to relapse 0.0 0.2 0.4 0.6 0.8 1.0 ion Responders Non-responders Plasma Cortisol](https://reader033.vdocument.in/reader033/viewer/2022042314/5ee18f5dad6a402d666c65eb/html5/thumbnails/27.jpg)
Stress and Substance Use
• Stress and relapse: consideration of modifiers
– Individual differences
• Sex differences
• Emotional dispositions
– Situational factors
• Life adversity
• Use of multiple substances
![Page 28: Stress as a Risk Factor for Mental Health and Substance Use...Stress and Substance Use 0 10 20 30 40 Days to relapse 0.0 0.2 0.4 0.6 0.8 1.0 ion Responders Non-responders Plasma Cortisol](https://reader033.vdocument.in/reader033/viewer/2022042314/5ee18f5dad6a402d666c65eb/html5/thumbnails/28.jpg)
Stress and Substance Use
• Sex differences
![Page 29: Stress as a Risk Factor for Mental Health and Substance Use...Stress and Substance Use 0 10 20 30 40 Days to relapse 0.0 0.2 0.4 0.6 0.8 1.0 ion Responders Non-responders Plasma Cortisol](https://reader033.vdocument.in/reader033/viewer/2022042314/5ee18f5dad6a402d666c65eb/html5/thumbnails/29.jpg)
Stress and Substance Use
• Emotional dispositions
(al’Absi, Carr & Bongard, 2007)
![Page 30: Stress as a Risk Factor for Mental Health and Substance Use...Stress and Substance Use 0 10 20 30 40 Days to relapse 0.0 0.2 0.4 0.6 0.8 1.0 ion Responders Non-responders Plasma Cortisol](https://reader033.vdocument.in/reader033/viewer/2022042314/5ee18f5dad6a402d666c65eb/html5/thumbnails/30.jpg)
Stress and Substance Use
• Life adversity
Non-smokers Abstainers Relapsers
Lever of adverse experience
(Lemieux, Olson,
Nakajima, Schulberg,
& al’Absi, 2016)
![Page 31: Stress as a Risk Factor for Mental Health and Substance Use...Stress and Substance Use 0 10 20 30 40 Days to relapse 0.0 0.2 0.4 0.6 0.8 1.0 ion Responders Non-responders Plasma Cortisol](https://reader033.vdocument.in/reader033/viewer/2022042314/5ee18f5dad6a402d666c65eb/html5/thumbnails/31.jpg)
Stress and Substance Use
• Life adversity
Maltreated
(Ouellet-Morin
et al., 2011)
![Page 32: Stress as a Risk Factor for Mental Health and Substance Use...Stress and Substance Use 0 10 20 30 40 Days to relapse 0.0 0.2 0.4 0.6 0.8 1.0 ion Responders Non-responders Plasma Cortisol](https://reader033.vdocument.in/reader033/viewer/2022042314/5ee18f5dad6a402d666c65eb/html5/thumbnails/32.jpg)
Stress and Substance Use
• Psychosocial stressors increase smoking as well as the risk for smoking relapse (Cohen and Lichtenstein, 1990; Shiffman et al., 1996).
• A reduced HPA stress response following 24-48 hours of withdrawal predicts early relapse of cigarette smoking at one month (al’Absiet al., 2005; al’Absi et al., 2004; al’Absi et al., 2014; al’Absi et al., 2003).
![Page 33: Stress as a Risk Factor for Mental Health and Substance Use...Stress and Substance Use 0 10 20 30 40 Days to relapse 0.0 0.2 0.4 0.6 0.8 1.0 ion Responders Non-responders Plasma Cortisol](https://reader033.vdocument.in/reader033/viewer/2022042314/5ee18f5dad6a402d666c65eb/html5/thumbnails/33.jpg)
Stress and Substance Use
• Stress, smoking, and appetite regulation
– Does blunted response to stress predict changes in appetite,
dietary intake, weight, and smoking relapse?
![Page 34: Stress as a Risk Factor for Mental Health and Substance Use...Stress and Substance Use 0 10 20 30 40 Days to relapse 0.0 0.2 0.4 0.6 0.8 1.0 ion Responders Non-responders Plasma Cortisol](https://reader033.vdocument.in/reader033/viewer/2022042314/5ee18f5dad6a402d666c65eb/html5/thumbnails/34.jpg)
Stress and Substance Use
• Stress has been shown
to be related to both
subjective craving and
appetite hormones such
as leptin and ghrelin
associated with craving
for cigarettes (Potretzke
et al., 2014; Potretzke,
2017 unpublished
manuscript).
![Page 35: Stress as a Risk Factor for Mental Health and Substance Use...Stress and Substance Use 0 10 20 30 40 Days to relapse 0.0 0.2 0.4 0.6 0.8 1.0 ion Responders Non-responders Plasma Cortisol](https://reader033.vdocument.in/reader033/viewer/2022042314/5ee18f5dad6a402d666c65eb/html5/thumbnails/35.jpg)
Stress and Substance Use
• Leptin as a marker for stress and craving
0.5
1.0
1.5
2.0
2.5
Pre-baseline Post-baseline Speech task Rest Cognitive tasks Recovery
log
lep
tin
(n
g/m
L)
Period
Abstainers Relapsers
*
(Potretzke, Nakajima,
Cragin & al’Absi, 2014)
![Page 36: Stress as a Risk Factor for Mental Health and Substance Use...Stress and Substance Use 0 10 20 30 40 Days to relapse 0.0 0.2 0.4 0.6 0.8 1.0 ion Responders Non-responders Plasma Cortisol](https://reader033.vdocument.in/reader033/viewer/2022042314/5ee18f5dad6a402d666c65eb/html5/thumbnails/36.jpg)
Stress and Substance Use
• Leptin as a marker for stress and craving
(Potretzke, Nakajima,
Cragin & al’Absi, 2014)
![Page 37: Stress as a Risk Factor for Mental Health and Substance Use...Stress and Substance Use 0 10 20 30 40 Days to relapse 0.0 0.2 0.4 0.6 0.8 1.0 ion Responders Non-responders Plasma Cortisol](https://reader033.vdocument.in/reader033/viewer/2022042314/5ee18f5dad6a402d666c65eb/html5/thumbnails/37.jpg)
Stress and Substance Use
• Decline in leptin concentrations from ad libitum to abstinence
(Lemieux, Nakajima, Hatsukami,
Allen & al’Absi, 2015)
![Page 38: Stress as a Risk Factor for Mental Health and Substance Use...Stress and Substance Use 0 10 20 30 40 Days to relapse 0.0 0.2 0.4 0.6 0.8 1.0 ion Responders Non-responders Plasma Cortisol](https://reader033.vdocument.in/reader033/viewer/2022042314/5ee18f5dad6a402d666c65eb/html5/thumbnails/38.jpg)
Stress and Substance Use
• Models to orient research in the context of addiction:
– What does a blunted stress response mean?
– Is it a cause or an effect?
• Hypotheses:
– Long-term exposure to substances may produce changes in
multiple brain circuitries.
– Changes in key central nervous system (CNS) emotion and
cognitive substrates leading to dysregulated stress response.
– Psychosocial stress and early adversity may prime the brain to
be sensitive to substance exposure (vulnerability)
– Subsequent exposure to stress maintenance of substance
use and relapse
![Page 39: Stress as a Risk Factor for Mental Health and Substance Use...Stress and Substance Use 0 10 20 30 40 Days to relapse 0.0 0.2 0.4 0.6 0.8 1.0 ion Responders Non-responders Plasma Cortisol](https://reader033.vdocument.in/reader033/viewer/2022042314/5ee18f5dad6a402d666c65eb/html5/thumbnails/39.jpg)
Stress and Mental Health and Substance
Use
• New stress vulnerability model
Biological
Vulnerability
+
Stress
Mental Illness &
Substance Use
Disorders
Line, personal correspondence
![Page 40: Stress as a Risk Factor for Mental Health and Substance Use...Stress and Substance Use 0 10 20 30 40 Days to relapse 0.0 0.2 0.4 0.6 0.8 1.0 ion Responders Non-responders Plasma Cortisol](https://reader033.vdocument.in/reader033/viewer/2022042314/5ee18f5dad6a402d666c65eb/html5/thumbnails/40.jpg)
Implications for clinicians
• Evidence-based treatments
– Stress vulnerability model:
• Illness Management and
Recovery (IMR), Integrated
Illness Management and
Recovery (I-IMR) and soon to be
Enhanced Illness Management
and Recovery (E-IMR)
– Mindfulness-based stress
reduction/relapse prevention
• Integrated Coping Awareness
Therapy (I-CAT)
![Page 41: Stress as a Risk Factor for Mental Health and Substance Use...Stress and Substance Use 0 10 20 30 40 Days to relapse 0.0 0.2 0.4 0.6 0.8 1.0 ion Responders Non-responders Plasma Cortisol](https://reader033.vdocument.in/reader033/viewer/2022042314/5ee18f5dad6a402d666c65eb/html5/thumbnails/41.jpg)
Stress and Mental Health
Substance Abuse and Mental Health Services Administration. Illness Management and Recovery: Practitioner Guides
and Handouts. HHS Pub. No. SMA-09-4462, Rockville, MD: Center for Mental Health Services, Substance Abuse and
Mental Health Services Administration, U.S. Department of Health and Human Services, 2009.
![Page 42: Stress as a Risk Factor for Mental Health and Substance Use...Stress and Substance Use 0 10 20 30 40 Days to relapse 0.0 0.2 0.4 0.6 0.8 1.0 ion Responders Non-responders Plasma Cortisol](https://reader033.vdocument.in/reader033/viewer/2022042314/5ee18f5dad6a402d666c65eb/html5/thumbnails/42.jpg)
Questions
• Please feel free to
e-mail any
additional questions
to: Sheena
Potretzke