A woman at a bar with a drink next to her.Research Shows Stress May Cause an Increase in Addiction Vulnerability


Carla Storr, ScD, MPH
Director, Center for Health Outcomes Research

Storr retired from UMSON in September 2021. The research described here was conducted during her tenure at UMSON.

Areas of Expertise:

Storr is a research scientist with a community and public health background. Her research is focused on the epidemiology of substance use and psychiatric disorders. She uses her expertise in measurement, methods, and advanced statistics to understand the influence of environmental factors on health, substance use and disorders, comorbidity, and care outcomes in nursing homes and assisted living facilities. Her research also focuses on the symptom burden of mental health conditions and disorders, specifically related to alcohol and drug use. She has been a University of Maryland, Baltimore Institutional Review Board member since 2015.

The BIG Idea:

Research has found evidence from preclinical, clinical, and population studies that highly stressful situations and chronic stress can cause an increase in addiction vulnerability – both the risk of developing addiction and the risk of relapse.

Storr is currently working as a subcontractor on a National Institute on Alcohol Abuse and Alcoholism grant, “Comorbid Patterns with Alcohol Use Disorders,” with a colleague at the Johns Hopkins Bloomberg School of Public Health.  

Why does the research matter?

Most people experience some form of stress – sometimes traumatic – in their lifetimes. Not everybody reacts the same way to the same experience, and the same person may respond differently to different types of stressors. The vast majority of individuals cope remarkably well, experiencing only temporary dysfunction, with recovery to normal functioning within a short time frame.

“However, some stress reactions can give rise to changes in behavior, physical and psychological well-being, and social interactions,” Storr says. “Many people self-medicate with drugs or alcohol in an effort to cope with upsetting events. While such behavior may appear to offer a quick solution, it can lead to more significant problems.”

For example, an increase in alcohol consumption following a stressful event may put one at risk for developing alcohol-related problems, such as continued drinking despite recurrent interpersonal problems caused or exacerbated by drinking. It could also cause additional problematic symptoms for those with pre-existing health issues related to alcohol consumption.

On the other hand, the experience of a stressful life event that might have resulted from alcohol involvement can serve as a wakeup call for the need to decrease or abstain from alcohol use. For example, alcohol problems could trigger getting fired from a job, leading the person to recognize the problem and seek help to stop drinking.

“It is important to explore the impact of stressful life events on transitions across stages of alcohol use, as stress may have differential effects on subsequent alcohol use depending upon a person’s history with alcohol use,” Storr explains.

Who does the research matter to?

“When working on mental health issues, it is hard to get large numbers of participants,” Storr says. “So we’ve been using databases that are population-representative samples, such as the National Epidemiologic Survey on Alcohol and Related Conditions from the National Institute of Alcohol Abuse on Alcoholism, which included two waves of data collection (2001 - 02 and 2004 - 05).” 

With this data, Storr and her colleagues have been exploring whether adverse childhood experiences (ACEs) and stressful life events (SLE) impact transition through increasingly progressive stages of problematic alcohol involvement over time in both men and women. Simultaneously, they can examine the probability of recovery/remission to a less symptomatic alcohol involvement stage among those who already exhibit problematic symptoms.

This research approach is different from other studies in which alcohol involvement is usually based on clinical diagnostic classifications. Instead, with the help of advanced statistics, Storr helps identify data-driven patterns of problematic symptoms to probe more deeply into the transitional aspects of symptom progression or remission.

Storr and her colleagues’ findings suggest that ACEs impact transitions in alcohol involvement, affecting both progression and remission. The association is magnified for those with multiple ACE exposures. These results highlight the need for prevention, early identification, and intervention to mitigate the risks associated with ACEs.  

What are the clinical applications of the research?

“As epidemiologists, we use our findings to provide data and support for clinicians who create needed interventions for substance use and psychiatric disorders, such as alcohol use disorder,” Storr says.

Health care providers can fail to recognize psychological distress and mental disorders because individuals more readily seek help for pain and physical ailments attributed to a stressor. “But by treating just the symptoms, you might never be getting at what the real problem is,” Storr explains.

She adds that clinicians should ask patients about life-changing events and how they are coping with those experiences, particularly relevant for clinicians working in health care settings treating patients with alcohol and other substance use disorders.