A form of psychotherapy that integrates theories of cognition and learning with treatment techniques derived from cognitive therapy and behavior therapy. CBT assumes that cognitive, emotional, and behavioral variables are functionally interrelated. Treatment is aimed at identifying and modifying the client’s maladaptive thought processes and problematic behaviors through cognitive restructuring and behavioral techniques to achieve change. 

Cognitive Behavior Therapy (CBT)

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 . 

Saint Louis University

- 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

Post-traumatic Stress Disorder (PTSD) is a condition where an individual experiences a collection of persistent symptoms following a traumatic or profoundly stressful event, such as combat, sexual assault, or a natural disaster. For a diagnosis, these symptoms must last for at least one month. The traumatic event can be witnessed firsthand or secondhand. Historically, PTSD was referred to by terms like 'shell shock' and 'combat neurosis' due to its frequent association with war, but it is now recognized as affecting a wider population.

Post-traumatic Stress Disorder (PTSD)

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)

Livingston, N. A., Mahoney, C. T., Ameral, V., Brief, D., Rubin, A., Enggasser, J., Litwack, S., Helmuth, E., Roy, M., Solhan, M., Rosenbloom, D., & Keane, T. (2020). Changes in alcohol use, PTSD hyperarousal symptoms, and intervention dropout following veterans' use of VetChange. Addictive behaviors, 107, 106401. https://doi.org/10.1016/j.addbeh.2020.106401

Changes in Alcohol Use, PTSD Hyperarousal Symptoms & Intervention Dropout Following Veterans’ Use of VetChange

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

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

To many, the COVID-19 pandemic was a traumatic life event. As such, it is possible that individuals may experience PTSD symptoms after experiencing the COVID-19 pandemic.

Effect of COVID-19 Pandemic on the Development of PTSD

Complex PTSD is a disorder resulting from prolonged trauma such as childhood abuse or neglect, abusive relationships, or political imprisonment or torture. C-PTSD includes some or all of the criteria of PTSD, as well as additional symptoms that negatively affect ones quality of life and is typically more severe and treatment resistant than classical PTSD.

Complex Post-traumatic Stress Disorder (c-PTSD)

Acceptance and Commitment Therapy (ACT) has been used amongst individuals with diagnosed PTSD after Traumatic Brain Injury (TBI) with the intent to improve mood processes, PTSD specific outcomes and related symptoms, ACT outcomes, and overall quality of life

Acceptance and Commitment Therapy Used with Individuals with PTSD after Traumatic Brain Injury

- acute stress disorder
- Adjustment disorder
- Disinhibited social engagement disorder
- Reactive attachment disorder

Related Conditions to PTSD

There are mixed findings for the role of oxytocin in psychological disorders such as autism spectrum disorder, PTSD, and social anxiety disorder. Hoge et al (2008) found a positive correlation between anxiety and plasma oxytocin levels, while Schneider et al (2021) found that high basal oxytocin predicted less anxiety. Hoge et al hypothesize that oxytocin in individuals with anxiety may increase to compensate for dysfunctional oxytocin receptors.

Oxytocin and psychopathology

In 2021 the FDA approved the use of 3,4-methylenedioxymethamphetamine (MDMA) for the treatment of PTSD. The compound was studied as a treatment as studies suggest it acts by binding to the presynaptic serotonin transporters inducing a release of serotonin. The trials conducted administered three doses of MDMA paired with manualized therapy during an eighteen-week treatment plan. The results of the study showed significantly reduced symptoms of depression as well as regulated amygdalar serotonergic function in comparison to the control (placebo) group. Each study conducted showed similar results which led to the approval for the regulated use of MDMA to treat PTSD symptoms.

Treatment of PTSD using MDMA (Ecstasy)

Populations exposed to major natural disasters, a form of mass trauma, often show elevated rates of PTSD. For example, research conducted one year after Hurricane Katrina found that nearly 21% of residents in the affected areas suffered from the disorder.

PTSD Prevalence Following Natural Disasters

Throughout much of the 20th century, the condition now known as Post-traumatic Stress Disorder (PTSD) was referred to by other names, such as 'shell shock' and 'combat neurosis'. These terms originated from the belief that the symptoms were a direct result of the stress experienced during active combat.

Historical Terminology for PTSD

Experiencing a traumatic event does not automatically lead to the development of Post-traumatic Stress Disorder (PTSD). The likelihood of developing the disorder is influenced by a variety of identified risk factors, explaining why some individuals are more vulnerable than others after a similar experience.

Risk Factors for PTSD Development

The symptoms of PTSD form a constellation of responses to a traumatic event. Key symptoms include re-experiencing the trauma through intrusive and distressing memories or flashbacks. Individuals often engage in avoidance of stimuli or situations connected to the event. They may also experience persistently negative emotional states, feel detached from others, exhibit irritability and proneness to outbursts, and have a tendency to be easily startled.

Symptoms of Post-traumatic Stress Disorder (PTSD)

Several months after being involved in a serious car accident, an individual reports experiencing recurrent nightmares about the crash, actively avoids driving or even being a passenger in a car, and becomes intensely distressed and jumpy at the sound of screeching tires. Based on this pattern of symptoms, which of the following provides the most accurate psychological explanation for their condition?

Existing pharmacotherapies have limited efficacy and medication development is stagnant for many years now. That being said, the current research in psychedelics has  rekindled some optimism.

Alcohol Use Disorder (AUD) Treatment

AUDIT-C is a screener test for evaluating current alcohol consumption risk. 

Alcohol Use Disorder Identification Test (AUDIT-C)

Of veterans receiving outpatient care at Veterans’ Affairs hospitals, ICU admission within 1 year was 2% for abstinent patients versus 2.5% for severe alcohol misuse. Once discharged from the hospital probability of readmission within one year is 48% for abstinent patients versus 55% for patients with severe alcohol misuse. 

ICU Admissions and Alcohol Misuse

Current research has emphasized the significance of impulsivity in understanding alcohol use and associated issues such as AUD. Impulsivity is a complex concept comprising multiple dimensions, some of which are influenced by biology and genetics.

Behavioral and Biological Indicators of Impulsivity in the
Development of Alcohol Use, Problems, and Disorders

Mental Health issues include: Depression, Anxiety, Stress, Alexithymia, and Work Fatigue

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