Fight, Flight, Fawn, Freeze: Rethinking Substance Use Through a Stress Response Lens

Abstract

Purpose of Review

This paper proposes a stress-response framework for understanding substance use in the context of adversity, integrating fight (resistance), flight (adaptive coping), freeze (maladaptive coping), and fawn (strategic assimilation/appeasement) responses, with resilience as a moderating factor.

Recent Findings

Evidence indicates that adaptive resistance and coping can protect against substance use, while maladaptive resistance, maladaptive coping, and fawning may increase long-term risk despite short-term relief. Resilience, both individual and collective, can buffer adversity’s effects and enhance positive stress responses, though measurement and conceptual inconsistencies limit cross-study synthesis.

Summary

Advancing research on adversity and substance use requires the use of validated measures, the simultaneous assessment of multiple stress responses to capture their interactions, and greater theorization of resistance and fawning/strategic assimilation, which remain underdeveloped and understudied in substance use research.

Introduction

Adversity, broadly defined as challenging or harmful life circumstances that threaten an individual’s well-being or development, is a near-universal experience [1]. Yet despite its ubiquity, people vary widely in how they respond to it. Recent reviews underscore substantial heterogeneity in how individuals respond behaviorally and emotionally to adversity—especially within marginalized groups [2]. In the context of substance use, adversity is frequently identified as a risk factor [3], with experiences such as trauma, poverty, stigma, and community violence associated with increased vulnerability to substance use and misuse [4, 5]. However, framing adversity and substance use solely in risk can overlook the complex strategies individuals use to navigate and buffer the effects of adversity [6]; strategies essential to understanding who develops substance use problems and who does not [7].

The complex strategies individuals employ to navigate adversity, including stress responses relevant to substance use, have been conceptualized through various theoretical lenses, with two frameworks proving especially influential. The Minority Stress Model has illuminated how marginalized populations experience structurally patterned, identity-linked stressors (e.g., discrimination, violence, internalized stigma) that compound general life stressors, offering critical insights into pathways linking social oppression to health disparities [8]. The 4Fs Model, grounded in neurobiological responses to threat, has provided clinicians with a taxonomy for understanding trauma responses, though its application to substance use research has been largely confined to clinical treatment settings [9].

In developing the Adversity Response Model, we draw on the Minority Stress Model to conceptualize adversity as arising from socially structured stressors that shape both exposure to stress and access to coping resources [8], while the 4Fs Model informs our specification of how individuals respond to these stressors at the level of threat appraisal and behavioral regulation, including response patterns such as avoidance, hyperarousal, or dissociation that may increase reliance on substances as coping strategies [9]. While both frameworks have advanced the field, their insights have not been synthesized to explain substantial within-group heterogeneity in substance use outcomes among individuals exposed to similar adversities [10], nor do they adequately incorporate resilience processes operating at individual, relational, and community levels that may moderate the relationship between stress responses and substance use behaviors [11].

Unlike the Minority Stress Model, which has often conceptualized stress responses as relatively uniform pathways from exposure to health outcomes [12], and the 4Fs Model, which emphasizes acute neurobiological responses without explicit attention to social context [13], the Adversity Response Model integrates these perspectives to conceptualize stress responses as socially embedded, dynamic processes. Stress responses are not fixed traits but evolve across time, contexts, and life stages, shaped by changing resources, relationships, and sociopolitical conditions [14].

Importantly, the present model is conceptualized as a general framework for understanding substance use responses to adversity across populations. However, it explicitly recognizes that social position, power, and exposure to structural marginalization shape which responses are available, socially reinforced, or penalized. As such, while all components of the model may be observed across groups, certain responses, such as strategic assimilation/appeasement, are more likely to arise in contexts characterized by stigma, discrimination, and unequal access to resources. Thus, the model is not population-specific but context-sensitive, offering a framework for understanding substance use responses to adversity across groups while accounting for how structural conditions shape response availability, consequences, and meaning.

This article proposes an Adversity Response Model in which adversity leads to stress, and individuals engage in behavioral and cognitive responses shaped by internal capacities and external context (Fig. 1). These responses are conceptualized as dynamic and context-dependent processes rather than fixed traits, such that individuals may engage in different responses across situations and over time. Temporal shifts in resources, threat exposure, and sociostructural conditions may alter how responses are expressed and how they relate to substance use risk. In this model:

Fig. 1.

Adversity Response Model as adapted from the Minority Stress Model [11] and the 4Fs Model [15]. Responses are dynamic and may shift over time and across contexts

• Resistance reflects a “fight” response: an active, oppositional pushback against conditions of adversity, often rooted in identity, agency, and sociocultural context, and expressed along a continuum from regulated, values-driven actions (e.g. adaptive) to reactive, dysregulated responses (e.g. anger, aggression, or violence; maladaptive).

• Adaptive coping represents a “flight” response: the attempt to manage or escape stress through strategies that may be adaptive (e.g., emotional regulation, help-seeking).

• Strategic Assimilation/Appeasement reflects a “fawn” response: a behavioral strategy that becomes particularly salient in contexts of structural marginalization, where individuals from marginalized groups may align with dominant norms or disavow their own group identities to gain acceptance, reduce perceived threat, or maintain safety. This response may manifest as internalized stigma, strategic silence, or the adoption of beliefs that reinforce existing hierarchies.

• Maladaptive coping represents a “freeze” response: a state of psychological or behavioral paralysis where individuals may disengage from decision-making or emotional processing. Often rooted in overwhelm or fear, this response can manifest as avoidance, denial, dissociation, or substance use, and may inhibit an individual’s ability to respond effectively to adversity.

• Resilience functions as both a buffer between adversity and stress and a potential modifier of the impact of the response on substance use, depending on the type of adversity, the context, and the substance involved.

A key barrier to integrating these responses into a coherent framework is how unevenly they have been conceptualized and measured across studies. While constructs such as adaptive/maladaptive coping, resilience, strategic assimilation/appeasement, and adaptive/maladaptive resistance are increasingly invoked in research on adversity and substance use, the conceptual and methodological treatment remains inconsistent. Resilience and adaptive/maladaptive coping are more established in the psychological literature [16], yet they are often measured inconsistently across studies. For example, in the systematic review of resilience measures by Windle et al. (2011), 19 different instruments were identified with widely varying item pools, numbers of dimensions, and theoretical bases (e.g., ego-resiliency scales grounded in personality traits; multi-dimensional measures emphasizing social and family resources; brief “bounce-back” indices with minimal items) with no current “gold standard” measure and substantial gaps in validation evidence across scales [17]. Table 3 from that review illustrates this variability: instruments purporting to measure the same construct differ markedly in target populations, intended purpose, number of dimensions/items, and underlying conceptual rationale (e.g., measures of adults’ coping resources versus youth developmental strengths versus culture-specific resilience profiles) [17]. These variations reflect deeper conceptual disagreements about what is being measured (whether resilience is a stable trait, a dynamic process, a set of protective resources, or an outcome of successful adaptation) and result in inconsistent factor structures and divergent construct definitions even among scales nominally assessing similar phenomena [17].

In parallel, coping research more broadly has generated a proliferation of instruments with different item pools and dimensional solutions (e.g., problem-focused vs. avoidance-focused vs. emotion-regulation strategies) that do not map cleanly onto one another or onto theorized stress response processes. This conceptual and operational heterogeneity complicates the aggregation of evidence about any one response type (e.g., flight vs. freeze) and obscures meaningful distinctions among them [23].

In contrast, resistance and strategic assimilation/appeasement, remain under-theorized, especially outside of stigma [18, 19] or identity-based frameworks [20, 21]. Moreover, researchers frequently conflate distinct stress responses or treat them as interchangeable, overlooking their distinct mechanisms and potential interactions. These patterns suggest that greater conceptual clarity is critical for identifying intervention targets and understanding how different stress responses shape substance use trajectories in the context of adversity.

For the Adversity Response Model proposed here, this means that existing empirical support for the 4Fs is fragmented and difficult to interpret. When constructs are measured inconsistently across studies, it becomes unclear whether observed associations reflect true differences in stress response processes or artifacts of measurement choice. These psychometric limitations substantially weaken the robustness of prior findings and likely contribute to the field’s persistent difficulty in generating coherent, cumulative conclusions about adversity-related substance use. By foregrounding these issues and advocating for clearer construct definitions and validated, response-specific measures, the current model aims to strengthen future research’s ability to test theorized pathways linking distinct stress responses to behavioral health outcomes, particularly in substance use.

Additionally, in this framework, we distinguish between adaptive and maladaptive expressions of fight, flight, and freeze responses in relation to substance use risk. Although trauma-focused models often conceptualize fight and flight responses as maladaptive when they involve dysregulated anger, panic, or hyperarousal [17], emerging substance use literature suggests that contextually directed fight (e.g. advocacy, boundary setting) and flight (e.g. mindfulness, positive reframing, support seeking), may function as adaptive coping strategies [22, 23]. In contrast, freeze responses, including denial and cognitive disengagement, are characterized by behavioral or psychological immobilization that may limit help-seeking and increase vulnerability to substance use. Accordingly, denial is conceptualized here as a freeze response due to its function in emotional and cognitive shutdown rather than active avoidance [24].

Below, we describe each stress response in turn, emphasizing both its relevance to substance use risk and the ways in which social context and marginalization shape its expression and consequences.

Fight: Resistance

Adaptive resistance involves the conscious rejection of harmful behaviors, norms, or systems [25]. In substance use contexts, adaptive resistance may be expressed by individuals who, despite exposure to high-risk environments, choose not to engage in substance use [7]. This can be seen as a form of agency that reflects a proactive stance shaped by identity, cultural values, and critical consciousness [26]. For example, among Black and Indigenous youth, resistance to substance use is often rooted in a broader rejection of oppressive systems and a reclaiming of cultural heritage [27]. One recent study by Gale et al. (2025) showed that youth who engaged in critical consciousness development (e.g., awareness of social injustice and participation in activism) were significantly more likely to resist substance use initiation [28]. This protective effect operates through resistance self-efficacy, with research demonstrating that both refusal efficacy and drug resistance self-efficacy predict lower adolescent substance use [29].

Emerging interventions have begun to formalize the process of building resistance. Community Wise, for instance, is a manualized, group-based intervention designed to reduce substance use and related harms by enhancing critical consciousness among individuals in economically disadvantaged, predominantly Black communities. Rooted in Paulo Freire’s liberation pedagogy, the program engages participants in identifying social determinants of health, analyzing structural oppression, and mobilizing collective action. Recent pilot findings demonstrate that Community Wise fosters both critical reflection and empowerment, offering early evidence that resistance-based interventions can play a meaningful role in substance use reduction and broader well-being [30]. A formative evaluation by Windsor et al. (2014) found significant post-intervention reductions in cigarettes smoked per day, days using illicit drugs, money spent on illegal drugs, and rearrests, providing empirical support for critical consciousness-based approaches to substance use prevention [31].

Unlike coping, which often centers the individual’s emotional response, resistance is more outward-facing and oppositional [32]. It may co-occur with coping strategies but is driven by a desire to counteract the forces of adversity, not just survive them [33].

While adaptive resistance can represent a productive response to adversity that mitigates substance use risk, resistance may also manifest in maladaptive forms. We conceptualize maladaptive resistance as reactive or dysregulated responses, such as impulsive anger, aggression, or violence, that may instead exacerbate substance use risk [34, 35]. For instance, Tomlinson et al. (2016) found bidirectional associations between aggression and drug use, while Boles and Miotto (2003) documented strong links between violence perpetration and increased substance use, particularly stimulants and alcohol. This distinction raises several important considerations for researchers interested in studying resistance. First, when interventions aim to increase critical consciousness of adversity, how can we ensure that the resulting fight response is channeled toward adaptive rather than maladaptive forms of resistance? Second, are there opportunities to support individuals in transitioning from maladaptive fight responses to more adaptive forms of resistance by leveraging their natural responses to adversity in ways that promote healthier and more constructive outcomes?

Flight: Adaptive Coping

Coping refers to the thoughts and behaviors individuals use to manage stress [36]. Adaptive coping strategies including mindfulness, cognitive reappraisal, and help-seeking, can serve as protective factors against negative health behaviors and outcomes [37]. Recent evidence strengthens this protective relationship: higher trait mindfulness is associated with lower prevalence of substance use disorders in adolescents [38], while formal help-seeking through screening and brief intervention programs shows sustained protective effects up to seven years post-intervention [39]. A study by Sullivan et al. (2006) found that adolescents who used problem-focused coping strategies in response to peer victimization had lower rates of cannabis use [40].

Importantly, coping strategies are not solely the result of individual choices, but are shaped by developmental, relational, and structural factors [41, 42]. Family cohesion, school connectedness, and community resources all influence which coping strategies are available and how effectively they protect against substance use [43]. This shaping occurs through concrete pathways: economically disadvantaged youth may turn to substance use as coping not due to personal deficit, but because therapeutic resources require insurance, transportation, and time flexibility their families lack [44]. Similarly, family-based interventions like the Strengthening Families Program reveal the intergenerational transmission of coping patterns. Parents experiencing economic stress model maladaptive coping behaviors, which youth subsequently adopt as normalized responses to similar stressors [45]. Thus, substance use may reflect a learned or constrained coping strategy within specific sociocultural and economic contexts [46].

Freeze: Maladaptive Coping

Maladaptive or avoidant coping including denial, emotional suppression, or substance use, is consistently linked to greater risk for substance misuse [47]. For example, a recent study by Solberg et al. (2023) found that avoidant coping mediated the relationship between adverse childhood experiences and substance use among college students [48]. Meta-analytic evidence confirms these associations: individuals with substance use disorders show significant impairments in emotion regulation compared to controls [49], while experiential avoidance, a core component of maladaptive coping, shows moderate positive correlations with substance abuse across populations [50]. Although denial is sometimes conceptualized as a form of avoidance [24], we situate it within the “freeze” response because it reflects cognitive and emotional disengagement that limits active coping or problem-solving [48]. Rather than facilitating escape or regulation, denial in this context functions as paralysis, constraining behavioral responses and increasing reliance on substances as a compensatory strategy.

Substance use can be a particularly accessible form of maladaptive coping for individuals facing chronic stress or trauma [51]. For example, people with limited access to mental health care, social support, or economic stability may turn to substances as a way to self-soothe or manage overwhelming feelings [52].

Fawn: Strategic Assimilation/Appeasement

The fawn response reflects a pattern of strategic assimilation or appeasement in response to stress or perceived threat, often driven by a desire to preserve safety, belonging, or approval within oppressive environments. Appeasement is typically a subconscious, emotionally driven reaction aimed at diffusing immediate conflict or harm, such as laughing at a racist joke to avoid tension [53]. In contrast, strategic assimilation is a more deliberate and long-term approach to navigating power structures, exemplified by racial code-switching where racial/ethnically employees adjust their self-presentation to mirror dominant group norms in professional settings [54]. Individuals adopt dominant cultural norms or beliefs to secure access, mobility, or safety (e.g., minimizing ethnic markers in professional settings to “fit in”) [55].

While racial and ethnic studies have significantly advanced our understanding of these processes [55–58], their impact on substance use behaviors remains underexplored. Within Latinx populations, for example, the concept of acculturation (a commonly used proxy for cultural assimilation) has yielded mixed findings regarding its relationship to alcohol and other substance use [59, 60], with meta-analytic evidence showing complex, moderated relationships that vary by demographic and how acculturation and substance use are measured [61]. This complexity may reflect the internal conflict inherent in assimilation processes.

Although fawning may offer short-term relief or access to resources, it can produce internal dissonance, eroded self-concept, and long-term stress. This is consistent with the “gap discrepancy model,” which suggests that psychological distress arises when out-group beliefs adopted for safety or acceptance conflict with internalized in-group values [62]. Research on Vietnamese and Cambodian adolescents demonstrates this pattern: intergenerational cultural dissonance was longitudinally associated with increased alcohol use, suggesting that the stress of navigating between cultures may manifest in substance use behaviors [63]. Unlike resistance, which pushes back against adversity, or coping, which seeks to manage it, fawning is a compliance-based survival strategy—one that may shield individuals in the short term but ultimately reinforces the systems and narratives that sustain harm.

Resilience: A Moderator and a Buffer

Resilience refers to the capacity to maintain or regain psychological well-being in the face of adversity [64]. Rather than being a static trait, resilience is a dynamic process that operates across time and contexts [65]. In this stress model, resilience can:

1. Buffer the link between adversity and stress, by helping individuals regulate emotional and physiological responses.

2. Modify the effectiveness of coping and resistance, by enhancing adaptive coping and reinforcing values-driven resistance.

A 2023 study by Heradstveit et al. found that adolescents with high resilience scores were significantly less likely to escalate substance use over time, even when exposed to high levels of family conflict [66]. A recent review by Schafer et al. (2024) emphasized that resilience emerges not only from internal traits but also from social and societal supports (e.g., institutional trust and community solidarity) which can reduce the risk of substance-related harm during adversity [67]. Resilience can be supported through strong social connections, cultural identity, and meaningful participation in community life.

In marginalized communities, collective resilience including family cohesion or spiritual practices, has been shown to reduce substance-related harms and foster recovery [68]. Family socialization processes play a particularly crucial role: among ethnic minority youth, family-based resilience strategies that combine emotional support with cultural socialization protect against substance use even in contexts of systemic adversity [69]. Burnette and Figley (2017) highlight how Indigenous communities draw on traditional healing practices, cultural continuity, and communal identity as powerful expressions of collective resilience, serving not only as protective factors against substance use but also as mechanisms of resistance to historical oppression and intergenerational trauma. Thus, resilience is both an individual capacity and a contextual condition that shapes how people respond to stress [67].

Conclusions and Future Directions

The proposed model reframes substance use risk not merely as a function of adversity but as the product of complex, contextually shaped stress responses. By grounding resistance, coping (adaptive and maladaptive), strategic assimilation/appeasement, and resilience within a behavioral stress framework, we gain a more nuanced understanding of how individuals, especially those in marginalized communities, navigate adversity. Rather than categorizing individuals into fixed stress response types, this model emphasizes stress responses as dynamic and context-dependent processes. These responses are not interchangeable; each reflects a distinct mode of survival, shaped by structural forces, cultural context, identity, and available resources.

Critically, this model underscores the importance of context-sensitive interventions. Substance use prevention and treatment efforts must move beyond individual-level pathology and account for the sociopolitical and cultural environments in which stress responses are formed and deployed. Recognizing when substance use is the result of constrained coping, when fawning reflects a need for safety, or when resistance is suppressed due to systemic barriers, is key to designing interventions that are empathetic, targeted, and just.

Future research should test this integrated model empirically, examining how these stress responses interact, co-occur, or shift over time in response to environmental change or intervention. This agenda requires validated instruments capable of distinguishing between the distinct stress responses and study designs that simultaneously assess multiple responses to capture their interactions. Longitudinal studies, culturally grounded measures, and intersectional approaches will be essential to advance this agenda. By shifting the lens from risk to response, and from trait-based to context-responsive models, we can move toward more effective, equity-oriented substance use prevention strategies.

Key References

• Vanyukov MM, Maes HHM, Iacono WG, Kirisci L, Samek DR, Silberg JL, et al. The Concept of Resistance to Substance Use and a Research Approach: The Resist! Project. Twin Res Hum Genet. 2023;26:31–9.

  • ◦ This article reframes substance use research by shifting the focus from identifying risk factors to exploring resistance traits.
• Frost DM, Meyer IH. Minority stress theory: Application, critique, and continued relevance. Curr Opin Psychol. 2023;51:101579. https://doi.org/10.1016/j.copsyc.2023.101579.

  • ◦ Theoretical underpinning of how adversity induces stress.
• Windsor LC, Benoit E, Lee C, Jemal A, Kugler K, Smith DC, et al. Critical dialogue and capacity-building projects reduced alcohol and substance use in a randomized clinical trial among formerly incarcerated men. Subst Use Misuse. 2024;59:1574–85. https://doi.org/10.1080/10826084.2024.2352611.

  • ◦ Describes an effective intervention that reduces substance use through resistance as a mechanism.
• Schlote S. History of the term ‘appeasement’: A response to bailey et al. (2023). Eur J Psychotraumatology. 2023;14:2183005. https://doi.org/10.1080/20008066.2023.2183005.

  • ◦Defines and provides a historical background on the concept of appeasement.
• Heradstveit O, Hysing M, Breivik K, Skogen JC, Askeland KG. Negative Life Events, Protective Factors, and Substance-Related Problems: A Study of Resilience in Adolescence. Subst Use Misuse. 2023;58:471–80. https://doi.org/10.1080/10826084.2022.2161319.

  • ◦ This study found that resilience factors can buffer the impact of negative life events on substance-related problems in adolescents.
• Schäfer SK, Supke M, Kausmann C, Schaubruch LM, Lieb K, Cohrdes C. A systematic review of individual, social, and societal resilience factors in response to societal challenges and crises. Commun Psychol. 2024;2:92. https://doi.org/10.1038/s44271-024-00138-w.

  • ◦ This review identifies multi-level factors that support mental health resilience during crises, while highlighting gaps in research.

Author Contributions

ABA: Conceptualization, Funding acquisition, Methodology, Project administration, Supervision, Visualization, Writing – original draft; JL: Writing – review & editing; XZ: Data curation, Writing – review & editing.

Funding

This study was funded by the National Institutes of Health (K01DA055521; PI: Algarin). The content is solely the responsibility of the author and does not necessarily represent the official views of the National Institutes of Health.

Data Availability

No datasets were generated or analysed during the current study.

Declarations

Human and Animal Rights and Informed Consent

No animal or human subjects by the authors were used in this study.

Conflict of interest

The authors have no conflicts of interest to disclose.