“One of the hallmarks of early addiction recovery is poor self-awareness of emotional states,” said corresponding author David Eddie, Ph.D., a Mass General Brigham psychologist at the Recovery Research Institute at Massachusetts General Hospital.

“People in recovery can experience a lot of stress, but they often don’t have great awareness of it or proactively manage it.”

For people in early recovery, stress often triggers cravings, and the struggle to resist those urges can create even more stress. Together, cravings and stress can lead to relapse. Stress and craving also tend to be associated with lower heart rate variability (HRV)—the natural variations in time between heartbeats, which reflects underlying health as well as how the body adapts to stress.