Newton, T. F., De La Garza, R., Kalechstein, A. D., Tziortzis, D., & Jacobsen, C. A. (2009). Theories of Addiction: Methamphetamine Users’ Explanations for Continuing Drug Use and Relapse. The American Journal on Addictions, 18(4), 294–300. https://doi.org/10.1080/10550490902925920

Addiction theories in methamphetamine users

Negative reinforcement, defined as the removal of an unpleasant stimulus, was one of the earliest theories proposed to explain addictive behavior.

The basic idea is that drug/alcohol use reduces the negative symptoms of withdrawal, which prompts users in acute withdrawal to engage in drug use to lessen the effects of these negative symptoms. Withdrawal is associated with a negative emotional state and symptoms such as anxiety, chronic irritability, malaise, dysphoria, sleep disturbances, physical pain and fatigue, and decreased pain thresholds. Acute withdrawal is linked to decreased activity of the mesocorticolimbic dopamine system and neuroadaptive changes in the nucleus accumbens.

Negative Reinforcement in Addiction

Positive reinforcement, defined as the introduction of a desirable stimulus, can often be seen in the early stages of drug addiction and drug-seeking habit formation as the theory states users take the drug because they enjoy the drug and its effects. Positive reinforcement may also play a factor in quickly reintroducing drug habits after periods of abstinence.

Positive Reinforcement in Addiction

The stimulus response learning theory relates addictive behavior to habit formation and learning, where drug-related stimuli prompts a habitual response to take the drug. It has been hypothesized that repeated drug use elicits changes in dopamine receptors in the dorsal striatum that result in drug-seeking habits that are challenging to give up despite negative outcomes.
Other important elements of this theory include conditioned reinforcement and impulsivity.

Stimulus Response Learning in Addiction

The Incentive Salience theory of addiction attributes addictive behavior to sensitization of neural systems caused by repeated drug use that ultimately make the user “crave” the drug. Once a neural system has become sensitized to a drug, the drug becomes highly salient, or wanted and desired, by the user. Thus, increased exposure and repeated use results in the drug becoming increasingly desirable to the user. As the neural systems associated with wants and desires become continuously sensitized, drug-related stimuli has more control over behavior as wants/desires develop into cravings.

Incentive Salience in Addiction

The inhibitory control dysfunction theory attributes addictive behavior to impulsivity. Under this theory, the inhibitory system, which is involved in response inhibition and response selection, guides compulsive behavior that is associated with drug addiction. The loss of control over drug-associated behaviors suggests that addicted users are unable to efficiently regulate the reward system in their brain.

Inhibitory Control Dysfunction in Addiction

May, A. C., Aupperle, R. L., &amp; Stewart, J. L. (2020). Dark Times: The role of negative reinforcement in methamphetamine addiction. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.00114 

Dark Times: The role of negative reinforcement in methamphetamine addiction

People engage in drugs despite negative consequences because it alleviates negative, uncomfortable, unfavorable mental states and moods. Including withdrawal. 

Negative Reinforcement and Drugs

Cho, S. B., Su, J., Kuo, S. I.-C., Bucholz, K. K., Chan, G., Edenberg, H. J., McCutcheon, V. V., Schuckit, M. A., Kramer, J. R., &amp; Dick, D. M. (2019). Positive and negative reinforcement are differentially associated with alcohol consumption as a function of alcohol dependence. Psychology of Addictive Behaviors, 33(1), 58–68. https://doi.org/10.1037/adb0000436 

Positive and Negative Reinforcement are Differentially Associated with Alcohol Consumption as a Function of Alcohol Dependence

Positive reinforcement would be the positive, and or alleviating feelings that drugs provide the individual.

Positive Reinforcement 

Robinson, M. J. F., Robinson, T. E., &amp; Berridge, K. C. (2013). Incentive salience and the transition to addiction. Biological Research on Addiction, 391–399. https://doi.org/10.1016/b978-0-12-398335-0.00039-x 

 Incentive salience and the transition to addiction. 

Is the feeling of wanting, and this wanting is intense and present in conscious awareness. 

Incentive Salience: Wanting 

Habits is when you act on incentive salience, and it is it’s persistent quality that becomes dangerous. 

Stimulus-Response Learning: Habits 

Jentsch, J. D., &amp; Taylor, J. R. (1999). Impulsivity resulting from Frontostriatal dysfunction in drug abuse: Implications for the control of behavior by reward-related stimuli. Psychopharmacology, 146(4), 373–390. https://doi.org/10.1007/pl00005483 

 Impulsivity resulting from Frontostriatal dysfunction in drug abuse: Implications for the control of behavior by reward-related stimuli.

The inability to inhibit both unconditioned and conditioned responses. 

Inhibitory Control Dysfunction: Impulsivity

Impulsivity resulting from Frontostriatal dysfunction in drug abuse: Implications for the control of behavior by reward-related stimuli.

Drug Seeking Behavior has been tied to two phenomena
- "augmented incentive motivational qualities of the drug and associated stimuli"
- " impaired inhibitory control "

Drug Seeking Behavior - 2 phenomena 

Yaribeygi, H., Panahi, Y., Sahraei, H., Johnston, T. P., & Sahebkar, A. (2017). The impact of stress on body function: A review. EXCLI journal, 16, 1057–1072. https://doi.org/10.17179/excli2017-480

The impact of stress on body function: A review

Stress can cause structural changes in parts of the brain.

Stress and Nervous System

Chronic stress may result in atrophy of the brain mass as well as decrease its weight. These differences in cognition, memory and stress. 

Brain and Stress

Negative Reinforcement: Pain avoidance

Positive Reinforcement: Pleasure seeking

Incentive Salience: Craving

Stimulus Response Learning: Habits

Inhibitory Control Dysfunction: Impulsivity 

Arizona State 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

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 

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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