Cortisol commonly known as the “stress hormone,” is produced by the adrenal glands and helps regulate many physiological functions such as metabolism, blood pressure, immune response, and energy levels. A rise in cortisol levels can result in several stress related disorders such as anxiety, depression and post-traumatic stress syndrome (1). When a person encounters stress, cortisol levels increase to prepare the body for a “fight-or-flight” response. Recovery is influenced by how long cortisol levels stay high.

Longer periods of elevated cortisol are linked to greater brain shrinkage and slower or incomplete healing (2).

Effects on Substance Use The responses to high levels of cortisol over long periods can increase vulnerability to substance use and addiction. Many individuals turn to alcohol or drugs as a way to cope with stress or to temporarily reduce the symptoms caused by elevated cortisol. Heavy substance use leads to damage to the HPA axis, which regulates the body’s response to stress thus making someone susceptible to constant and elevated stress (3). Substances may initially lower cortisol levels, but long-term use disrupts the body’s natural stress regulation system, leading to even higher baseline cortisol levels when the substance is not present (1.)

Additionally, cortisol interacts with the brain’s reward system, particularly in the release of dopamine, the neurotransmitter linked to pleasure and motivation (4). When stress and high cortisol persist, the brain becomes more sensitive to addictive behaviors as a means of relief (3). Overall, cortisol plays a significant role in both the human development and maintenance of substance use disorders, emphasizing the need for stress management and therapeutic interventions.

References

1. Gilani, A., et al. (2024). Aptamer-decorated graphene channel array with liquid-gating for sensing cortisol stress hormone. In 2024 IEEE Biosensors Conference (Biosensors) (pp.1–4). IEEE. https://doi.org/10.1109/BioSensors61405.2024.10712663

2. George, M., Abdel Mageed, S., Mansour, D., & Fawzi, S. F. (2025). The cortisol axis and psychiatric disorders: An updated review. Pharmacological Reports. Advance online publication. https://doi.org/10.1007/s43440-025-00782-x (SpringerLink)

3. Rahal, D., Shirtcliff, E. A., Fuligni, A., Kogut, K., Gonzales, N., Johnson, M., Eskenazi, B., & Deardorff, J. (2023). Dampened psychobiological responses to stress and substance use in adolescence. Development and Psychopathology, 35(3), 1497–1514. https://doi.org/10.1017/S0954579422000244

4. Wise, R. A., & Robble, M. A. (2020). Dopamine and addiction. Annual review of psychology, 71(1), 79-106.