Individuals with Substance Abuse Disorder may also experience depression. When both conditions are present together, they are more difficult to treat. As a result, researchers have started reviewing different techniques to find a solution to this problem.

Co-occurrence of Depression and Substance-Abuse.

Substance Use disorder and substance dependence refer to the maladaptive pattern of use, leading to clinical distress.

      - Substance dependence is a more severe condition where the individual has trouble controlling the use and is dependent on substances.
       - Substance abuse refers to the residual effects of dependence.

Substance Use disorder and Personality disorder

In this study, researchers explored the implementation of the online platform VetChange as a way to decrease Iraq and Afghanistan veterans' alcohol use and PTSD symptoms . 

Impact of Web-Based Interventions on Veterans' Alcohol Use & PTSD Symptoms 

There are certain genes that can increase your vulnerability to developing addiction in life, combined with the right environmental circumstances. Genes cannot cause addiction completely by themselves, but there have been specific genes associated with substance use disorder. For example the genes GABRA2 and CHRM2 have been linked to alcohol use disorder, and HIST1H2BD has been linked with cocaine dependence. 

Genetic aspect of Addiction

- Drinking Motives Questionnaire
- Leeds Dependence Questionnaire
- Maudsley Addiction Profile (MAP)
- Readiness to Change Questionnaire (RTQ)
- Severity of Dependence Scale
- Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES)

Current Scales to measure addiction disorder symptoms

Negative Reinforcement: Pain avoidance

Positive Reinforcement: Pleasure seeking

Incentive Salience: Craving

Stimulus Response Learning: Habits

Inhibitory Control Dysfunction: Impulsivity 

Theories of Addiction

Individuals with psychotic disorders, such as schizophrenia, schizoaffective disorder, schizotypal disorder, and delusional disorder, have high rates of comorbid substance use disorders, with individuals with schizophrenia having a 5 times higher rate of substance use disorders than the general population. The abuse of substances in people with psychotic disorders is associated with worse symptomatic and functional outcomes including increased rates of hospitalization and relapses, more treatment non-adherence, increased violence, unstable housing/homelessness, brain volume loss, and higher rates of suicide.

Substance Use Disorder and Psychotic Disorders

- Sociocultural
- Dosing regimens are not representative 
- Effects of long-term administration of drug use are not conclusive                                     
- Positron Emission Tomography (PET)  is not enough evidence
- Experimental designs are limited to establishing cause and effect 
- Physiological evidence overlaps and is not necessarily clinically significant
- Imaging techniques and clinical assessment are not representative
 

Limitations of drug abuse as a brain disease 

The term "addiction" is not formally recognize in the DSM-5, and is instead labelled under the umbrella term "substance-use disorders." There is a stereotype surrounding addiction that those afflicted with the issue should simply learn to control it, or that they are to blame for engaging in the behavior in the first place. However, these stigmas clearly only worsen a person's condition, leading to the initial question: is the DSM-5's refusal to use the term "addiction" outright leading to additional stigma? Or does it not affect the matter at all? 

Does the DSM-5 not recognizing addiction formally affect the shame and stigma associated with people who struggle with addiction?

Although the traditional ideas of addiction focus more on substance and alcohol use, a growing consensus of information seems to point in the direction of social media addiction also being a form of addiction. Social media addiction refers to the obsessive need to log onto and use different social media platforms and websites. Social media addiction includes withdrawal symptoms, physiological indicators, and psychological impacts as well -- much like traditional addiction. 

Social Media Addiction

Those struggling with addiction often experience high levels of guilt and shame, leading to the initial usage of substances as a way to self medicate. Shame and addiction often end up in a vicious cycle, with people suffering from addiction being shamed for that addiction, and seeking out substances to manage the guilt and humiliation that comes with the shame they are being exposed to. Shame can also often be triggering enough to cause those in rehab and those recovering to relapse, which is why it is crucial that those suffering from addiction be treated with compassion. 

How Shame Impacts Addiction

The most commonly used substances by college students in the United States is reported to be alcohol, marijuana, psychedelic drugs, painkillers, and stimulants. Most of these substances become widely available to students upon entering college, and along with the independence creates an increase in use.

Substance Use in College

- Falls under the umbrella of substance use disorder. The word "addiction" is not formally recognized in the DSM-5.
- Strong, uncontrollable compulsion to administer a drug of abuse to yourself due to dependence.
- Acts on reward circuitry in the brain (dopamine) and changes the chemical composition of your brain over time.
- According to the DSM 5, only gambling addiction has been listed as a diagnosable disorder, the rest of the behavioral addictions are yet to find themselves a place on the DSM manual.

Alma College

Creighton University

Boston University

Rutgers University

State University of New York at Buffalo

The main differences between drug abuse and addiction are the level of use and the resulting change in the brain. That said, there is much overlap between the two.

Drug abuse and addiction

- Anxiety disorders
- Mood disorders 
- Psychotic disorders
- Personality disorders
- Eating disorders
- Sleep disorders
- Addiction
- Adjustment disorders

Categories of mental disorders/mental illnesses

The brain disease model of addiction (BDMA) purports that addiction is, fundamentally, a chronic and relapsing brain disease. The main argument is that drug use alters the brain's reward system and circuitry.

Brain Disease Model of Addiction (BDMA)

Breedlove, S. & Watson, N. (2017). Behavioral neuroscience, eighth edition. Oxford University Press.

Behavioral Neuroscience 8th Edition

Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5; American Psychiatric Association, 2013)

DSM V

- Pattern of substance use that lasts more than one month but does not meet the criteria for dependence 
- 21.6 million Americans suffer from substance-related disorder in 2013 

Drug/Substance Abuse 

Addiction

Alcohol Use Disorder is characterized by symptoms such as alcohol craving, recurrent use of alcohol that interferes with the fulfillment of one’s daily responsibilities, alcohol-seeking behavior, inability to control one’s drinking, drinking despite potential hazards (e.g., drinking while driving), the need for increased amounts of alcohol to achieve its effects (tolerance), and withdrawal symptoms when one stops or reduces alcohol intake (e.g., hand tremors, nausea, agitation, hallucinations). The disorder is distinguished as mild, moderate, or severe depending on the number of these symptoms that an individual may have: Mild cases present with two to three symptoms; moderate cases four to five symptoms; and severe cases six or more symptoms.

Alcohol Use Disorder (AUD)

Disorder Class: Disruptive, Impulse-Control, and Conduct Disorders

A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three (or more) of the following criteria in the past 12 months from any of the categories below, with at least one criterion present in the past 6 months:
1. Aggression to people and  animals
2. Destruction of property
3. Deceitfulness or theft
4. Serious violations of rules
 
The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.
 
If the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder
 
Specify age onset:  Individuals show at least one symptom characteristic of conduct disorder prior to age 10 years

[DSM-5] Conduct Disorder Criteria

Borderline Personality Disorder (BPD) is primarily defined by a pervasive pattern of instability across interpersonal relationships, self-image, and mood, combined with significant impulsivity. Individuals with this disorder often experience intense emotions and may engage in frantic behaviors to manage their profound fear of abandonment.

Borderline Personality Disorder

A personality disorder is defined by a pervasive and inflexible personality style that significantly deviates from cultural norms, causing problems for the individual and for others. This pattern typically emerges during adolescence or early adulthood and leads to significant distress or functional impairment.

Personality Disorders

Feeding and Eating Disorders are characterized by persistent changes to eating or eating-related behaviors that result in altered consumption or absorption of food, significantly impairing an individual’s physical health and/or psychosocial functioning. 

Feeding and Eating Disorders

Mood disorders are defined as severe disturbances in mood and emotions, which can include depression, mania, and elation. Unlike typical emotional fluctuations, the mood shifts experienced in these disorders are extreme, distort an individual's perspective on life, and significantly impair their ability to function in daily activities.

Mood Disorders

Sleep-Wake Disorders are defined using a multidimensional approach due to the expectations for co-existing or comorbid diagnosis in both mental and neurological health. They are largely characterized by individual’s interpretation of having dissatisfying sleep quality, timing, or amount of sleep. These complaints are often expressed alongside issues of distress or impairment during expected daytime activities. 

Sleep-Wake Disorders

Psychotic disorders are severe mental illnesses characterized by thoughts, perceptions, and behaviors that are so impaired the individual cannot function normally and becomes disconnected from reality. This state of being disconnected from the world is known as psychosis. People with these disorders often lose contact with reality and may experience extreme symptoms like hallucinations and delusions. Schizophrenia is a primary example of a psychotic disorder.

Psychotic Disorders

An adjustment disorder (AD) is a reaction to a stressful/significant life change. This reaction is marked by preoccupation with the responsible stressor shown by severe distress (more than what is typically expected) or constant thinking about the consequences of said stressor. This may alter one's mental health as a result. 

Adjustment Disorder

Anxiety disorders are characterized by features of excessive fear and anxiety, as well as related behavioral disturbances. These symptoms are often not temporary and linger beyond typical expectations. Excessiveness of these symptoms is clinician diagnosed with cultural contexts taken into consideration.

Anxiety Disorders

Neurodevelopmental disorders (NDDs) are a grouping of disorders that are characterized by onset during the developmental period and present as deficits in functioning. NDDs were first introduced as a category in the DSM-5 in 2013 

NDDs include 
-Intellectual disability (ID) 
-Communication disorders
-Autism Spectrum Disorder (ASD) 
-Attention-Deficit/Hyperactivity Disorder (ADHD)
-Neurodevelopmental Motor Disorders (including tic disorders) 
-Specific Learning Disorders

Neurodevelopmental Disorders (NDDs)

- The main supporting evidence is derived from animal models which have identified specific neural circuitry that addictive drugs act on including the mesolimbic brain reward system
- Neuroimaging studies on human brains of addicted individuals have also supported these animal models and the changes in reward circuitry and dopamine activation
- genetic research and twin studies have also found correlations between specific genetic markers addiction risk


Evidence for the BDMA

- One main critique is that the BDMA labels addiction as a chronic and relapsing brain disease, but many people with addiction recover without treatment
- Another critique is the presence of evidence that those addicted to recreational drugs can respond to small personal changes such as finances or mandatory drug tests

Critiques of the BDMA

Understanding and researching addiction through the brain disease model of addiction has provided numerous benefits including:

- Helping researchers understand specific neurobiological processes involved in loss of control, compulsive drug use, rigid behavior, and negative emotional states
- Revealing molecules and circuits of addiction has resulted in multiple effective medications (naloxone, buprenorphinenaloxone, and varenicline)
- The knowledge provided by the BDMA has also become. thebasis for using stimulation techniques to strengthen brain circuits with promising results
- The knowledge provided by the BDMA has also given clinicians a framework for specific and targeted interventions that strengthen the impaired brain circuits
- There have been positive effects on public policy surrounding addiction including the 2008 passing of the parity law, which requires insurance to cover costs associated with addiction treatment (the first time ever in the US)
- It also provides benefits for treatment because the model helps reduce the stigma attached to addiction as being a moral failing

Benefits of the BDMA

In a drug addiction context, brain disease suggests there is a significant brain dysfunction that is detectable and explained by discrepancies in drug use between addicts and non-addicts. 

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