This outlook is directly related to the implementation of expensive and unsuccessful drug policies as it focuses solely on neural mechanisms as opposed to behavioral and psychosocial factors.

Sociocultural limitations of BDMA


Since animal models are not necessarily representative of human tendencies with regard to drug consumption, conclusions about neurotoxicity can lack validity. For instance, it is hard to determine the neurotoxicity of a drug in an animal model as the regimens followed in dose increase are not the same as in human use. This dose increase leads then to tolerance, which can be neuroprotective.

Dosing regiment limitations of BDMA

There is an ethical limitation in how researchers can evaluate the long-term effects of a drug in a human sample. 

Long-term effects of drug use as a limitation of BDMA

Positron Emission Tomography (PET) is a technique used to create images of an active, living brain. The procedure involves administering a mildly radioactive substance, known as a tracer, to an individual either orally or via injection. This tracer enters the bloodstream, and its concentration in different brain regions is monitored. Since increased brain activity correlates with higher blood flow, a computer can track the tracer's movement to generate a map that distinguishes between active and inactive brain areas during a specific task.

Positron Emission Tomography (PET)

In studies that suggest that there are different cognitive results as well as physiological ones, it is not possible to determine that the differences between control and experimental drugs are the result of one drug and one drug only, or a result of the preexisting characteristics of the subjects. 

Experimental design of cross-sectional studies can be confounded in BDMA

Decreased activity of the striatum, resulting in less dopaminergic activity does not necessarily equate to a clinical implication. Physiological differences can be presented for a variety of reasons and do not necessarily correspond to illness. Furthermore, the overlap of results between control groups and experimental groups can suggest that despite the decreased activity of the striatum, the dopaminergic differences of drug users (such as methamphetamine users) are not clinically significant. 

Physiological evidence for BDMA is not necessarily valid

Techniques such as fMRI are not representative of BDMA as well as clinical studies. Both of these do not present significant functional changes between addicts and non-addicts.

Imaging techniques and  clinical studies are not representative of BDMA

PET scans can be inconclusive as it is hard to determine that the changes in dopamine transportation and the receptiveness of dopamine neurons are not only pathological but that the different results of control groups and the group that uses a drug are due to addiction. For instance, although one can state that the differences between groups are due to neuronal death, one cannot rule out them being a product of downregulation.   

PET scan limitations as an evidence source of BDMA

- 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
 

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- 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

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. 

Brain disease model of addiction in Health Psychology

Grifell , M., &amp; Hart, C. L. (2018). Is Drug Addiction a Brain Disease? https://doi.org/file:///C:/Users//OneDrive/Desktop/Research%20proposal/Drug%20addiction%20is%20not%20brain%20disease.pdf 

Is Drug addiction a Brain Disease? 

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

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.

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