The Relationship of Social Stress, Economic Hardship, and Psychological Distress to Follow-up Addiction Severity Among Kentucky Substance Abuse Treatment Participants

Background and Purpose: Stress is associated with poor mental health, specifically anxiety and depression, and stress and mental health problems are predictors of substance dependence and addiction relapse.  Social characteristics, such as racial/ethnic minority status and low socioeconomic status, are often associated with increased psychological distress and substance use disorders.  Pearlin’s social stress theory postulates that the association between social characteristics and poor psychological wellbeing is due to increased exposure to stress related to social disadvantage.  This project used a conceptual model based on a social stress theoretical perspective to examine predictors of follow-up addiction severity in a sample of substance abuse treatment participants.  It was hypothesized that characteristics associated with social disadvantage, along with psychological distress, perceived stress, and economic hardship, would be predictors of addiction severity at follow-up.  In addition, since recovery support, efficacy, and self-control have been previously identified as mediators in the stress and relapse processes, these factors were included as mediators in the model tested. 

Methods: Secondary data from baseline and 12-month follow-up interviews with a broad, statewide sample of Kentucky substance abuse treatment participants (n=1123) was used for the analyses.  Univariate and bivariate analyses were conducted to examine variables and ensure data satisfactorily met assumptions of multivariate analysis.  Then, hierarchical ordinary least squares (OLS) regression was used to test the conceptual model’s ability to predict follow-up addiction severity, and comparisons were noted between the model’s ability to predict alcohol and drug addiction severity individually. 

Results:  The overall model significantly predicted both alcohol (F (17, 1096) = 20.97, p < .001) and drug (F (17, 1103) = 39.45, p < .001) follow-up addiction severity, although more variance in drug addiction severity (R² = .38) was explained by the model than alcohol addiction severity (R² = .25).  The only social characteristic significant when predicting alcohol addiction severity was gender, with women having lower addiction severity than men.  For drug addiction severity, gender, economic hardship, and perceived stress were significant predictors, and the relationship between perceived stress and drug addiction severity was significantly mediated by efficacy, self-control, and recovery support. The strongest predictors for both alcohol and drug addiction severity were efficacy, self-control, and recovery support. 

Conclusions and Implications: Findings demonstrate the importance of treatment providers attempting to increase participants’ efficacy, self-control, and recovery support in order to decrease future addiction severity.  Findings also suggest that stress may be more important for explaining the drug relapse process than the alcohol relapse process and these relationships should be studied further in future research.  Although lack of significant findings for many predictors associated with social disadvantage may be due to measurement error in the secondary dataset used, identifying a potential unique role of social stress in the relapse process should also be studied further in future research after adjustments to the current model or measurements are made.