Academic journal article Alcohol Research: Current Reviews

Overview: Stress and Alcohol Use Disorders Revisited

Academic journal article Alcohol Research: Current Reviews

Overview: Stress and Alcohol Use Disorders Revisited

Article excerpt

In the 13 years since Alcohol Research & Health (now titled Alcohol Research: Current Reviews) first visited the topic of "Alcohol and Stress" (see Vol. 23, No. 4, 1999), there has been a sustained flow of new information in the field prompting us to publish this updated edition. Indeed, one could argue that this second look at the topic is long overdue. An entirely new lexicon of terms (1) has been developed to capture our evolving conceptualization of stress and its effects on health and disease risk. Many of these terms (e.g., allostasis and allostatic load), which were becoming popular around the turn of the 21st century, were hardly mentioned in that previous edition, so there is a fair amount of catching up to do. Unthinkable events (e.g., the 9/11 terrorist attack and its aftermath--Operation Enduring Freedom and Operation Iraqi Freedom) have occurred, spurring renewed interest in the role of uncontrollable acute and chronic stressors on drinking behaviors in civilians and military personnel alike. New fields have emerged (e.g., epigenetics), and their findings demonstrate that early-life trauma can leave an indelible stamp on an individual's genetic makeup (i.e., genome) and stress circuitry. Gene--environment interactions have been discovered that partly quell the artificial argument as to whether nature or nurture most influences disease risk. Finally, new integrated treatments have emerged (e.g., Najavits' Seeking Safety), and mechanisms of action partly defined (e.g., naltrexone's effects on stress axis function), that demonstrate how understanding the links between stress and alcohol drinking promotes improved treatment options for patients with alcohol use disorders (AUDs).

In their opening article to the 1999 Alcohol Health & Research edition on "Alcohol and Stress," Anisman and Merali (1999) summarized the literature to develop a working definition of stress and stressors (i.e., stressful situations) that we attempt to update in the present treatise. We also will embellish upon several themes that these authors chose to highlight, including the importance of sex differences and stressor specificity. By introducing these themes, we hope to set the stage for the articles that follow, which delve into several of these topics more deeply.

What Is Stress?

Webster's Third New International Dictionary (1981, p. 2260) defined stress as "a physical, chemical, or emotional factor (as trauma, histamine, or fear) to which an individual fails to make a satisfactory adaptation, and which causes physiologic tensions that may be a contributing cause of disease." Although this term now is widely used in the common vernacular, it is interesting to note that the scientific conceptualization of this phenomenon dates back only about 150 years.

Most stress research historians agree that the French physiologist, Claude Bernard (1865), was the first to recognize a key element in the stress response--the phenomenon now known as feedback regulation. Bernard noticed that the internal environment of cells ("milieu interieur") is tightly regulated and largely dependent on feedback it receives from the periphery or "external environment" (Goldstein and Kopin 2007). Some 65 years later, Sir Walter Cannon coined the term "homeostasis" to capture the "coordinated physiological processes that maintain most of the steady states of the organism" (Cannon 1929 as cited by Goldstein and McEwen 2002, p. 55). From Cannon's perspective, which derived from his study of the sympathetic nervous system (he also coined the phrase "fight-or-flight responses"), all organisms adjusted to challenges to their internal environments by making compensatory responses intended to restore homeostasis. By accomplishing such, the organism's chances for survival improved because the homeostatic or steady state was viewed as optimal and fixed at some preordained, stable level (Goldstein and Kopin 2007; Neylan 1998).

The Hungarian scientist, Hans Selye, who was influenced by Cannon's work, developed the concept of the General Adaptation Syndrome in 1936. …

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