In this article, we review the literature on interpersonal stress and rejection sensitivity and examine how these factors increase the risk of relapse in individuals with alcohol or drug dependence. We begin by considering the constructs of social pain and social threat, examining their evolutionary origins and their neuroanatomic, neuropsychological, and neurophysiological dimensions. Together, these perspectives provide insight into the role of interpersonal stress as a powerful and oftentimes destructive factor that affects individuals in recovery from substance dependence. We then review the empirical evidence showing that intrapersonal traits and interpersonal environments interact to increase an addict’s risk of relapse. We conclude by proposing that substance-dependent individuals with high-trait rejection sensitivity and a critical interpersonal environment are particularly vulnerable to relapse to substance use.
*Veterans Integrated Service Network (VISN) 4, Mental Illness Research, Education and Clinical Centers (MIRECC), Philadelphia Veterans Affairs Medical Center
†Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA.
Supported by the VA Advanced Fellowship Program in Mental Illness Research & Treatment (D.L.) of the VISN4 MIRECC, Philadelphia Veterans Affairs Medical Center (VAMC), and National Institute for Alcohol Abuse and Alcoholism (NIAAA) grant K24 AA013736 (H.R.K.).
H.R.K. has been a paid consultant for Alkermes, Lilly, Lundbeck, Pfizer, and Roche. He also reports associations with Eli Lilly, Janssen, Schering Plough, Lundbeck, Alkermes, GlaxoSmithKline, Abbott, and Johnson & Johnson, as these companies provide support to the ACNP Alcohol Clinical Trials Initiative (ACTIVE) and he has received honoraria from ACTIVE. D.L. declares no conflict of interest.
Reprints: David Leach, MD, Veterans Integrated Service Network (VISN) 4, Mental Illness Research, Education and Clinical Centers (MIRECC), Philadelphia Veterans Affairs Medical Center, University and Woodland Avenues, Philadelphia, PA 19104 (e-mail: firstname.lastname@example.org).