Almost all research on CBT treatment for depression and Substance-Abuse show that CBT does improve mental health of patients. These treatments usually involved the development of behavioral or cognitive coping mechanisms. Most research indicates that this is an effective method. However, research on treating the comorbidity of these conditions is indecisive.

Traditional CBT Treatment for Depression and Substance-Abuse.

Third Wave is the name given to newer CBT treatment methods. They're varied in their methods, including acceptance, mindfulness, and positive reinforcement. Research is rare on these topics, but early findings indicate that acceptance and the introduction of new methods of positive reinforcement could be a potential treatment for these conditions.

"Third-Wave" Treatments for Depression and Substance-Abuse.

Transdiagnostic treatment techniques involve combining a variety of treatments to treat disorders with similar base processes. In this particular case, treatment involves setting goals to reduce substance dependency, development of cognitive awareness, and emotional regulation. In theory, this could help patients by targeting all of their underlying symptoms. However, this is still largely theoretical.

Transdiagnostic Treatment for Depression and Substance-Abuse

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.

Michigan State University

Syracuse University

Addictions counseling, also called substance abuse counseling, is a specialization in counseling that focuses on treating individuals with a dependency on drugs or alcohol.

Addictions Counseling

- 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.

Addiction

The relationship between substance abuse and mood disorders is bidirectional. Substance abuse can trigger or exacerbate mood disorders by altering neurobiological pathways, whereas pre-existing mood disorders can lead individuals to abuse substances as a form of self-medication to alleviate symptoms. This comorbidity is sustained by shared genetic vulnerabilities, environmental risk factors, and overlapping neurobiology.

Relationship Between Substance Abuse and Mood Disorders

Vujanovic, Anka A., Meyer, Thomas D., Heads, Angela M., Stotts, Angela L., Villarreal, Yolanda R., Schmitz, Joy M. (2017) Cognitive-behavioral therapies for depression and substance use disorders: An overview of traditional, third-wave, and transdiagnostic approaches. The American Journal of Drug and Alcohol Abuse, Vol 43, No. 4, 402-415. http://dx.doi.org/10.1080/00952990.2016.1199697

Cognitive-behavioral therapies for depression and substance use disorders: An
overview of traditional, third-wave, and transdiagnostic approaches

- Medical Model
- Alcoholics Anonymous/Narcotics Anonymous Model
- Therapeutic Model

Addictions Counseling Principles

When helping individuals overcome an addiction, it is important for the counselor to help the client develop a greater sense of self-efficacy, so they believe they can move past the addiction and resist the temptation to relapse.

Self-Efficacy in Addictions Counseling

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 

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

Drug withdrawal is usually an aversive experience.

Drug Withdrawal

Several clinical scales are used to measure the symptoms and severity of addiction disorders. These include:

- 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)

Measurement Scales for Addiction Disorder Symptoms

Certain genes, when combined with specific environmental circumstances, can increase an individual's vulnerability to developing an addiction. While genetics alone do not cause addiction, specific genes are associated with substance use disorders. For instance, the genes GABRA2 and CHRM2 have been linked to alcohol use disorder, and HIST1H2BD is associated with cocaine dependence.

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