3.1. SUBSTANCE ADDICTION
Alcohol, tobacco, heroin and many other drugs can be found in our society. While illness, death, low productivity, and crime are associated with drug addiction, it has an overall immeasurable emotional and social cost. Psychologists and psychiatrists define addiction as a neuropsychiatric disorder characterized by a recurrent desire to continue taking the drug despite harmful consequences. (Goldstein and Volkow, 2002). Concrete diagnostic criteria for substance abuse (or drug addiction (Camí J, Farré M 2003)) are set in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) or the International Classification of Diseases and Related Health Problems (ICD-10) and are used to diagnose addiction and It is widely used to evaluate treatment.
Addiction can be defined as the loss of control over drug use or the behavior of seeking and taking drugs despite negative consequences (Nestler, 2001). Substance abuse (or drug addiction) is a neuropsychiatric disorder characterized by a recurrent urge to continue taking the drug despite harmful consequences. (Goldstein and Volkow, 2002). This drug-seeking behavior is associated with craving and loss of control. (Shaffer et al., 1999). Addiction results from acts of drug use and often requires repeated drug exposure. This process is strongly influenced by both a person’s genetic makeup and the psychological and social context in which drug use occurs.
DSM-V – 2013 In general, the diagnosis of a substance use disorder is based on a pathological pattern of behavior related to substance use.
Criterion A: Development of a substance-specific syndrome due to recent ingestion of a substance.
Criterion B: The changes can be attributed to the physiological effects of the substance on the central nervous system.
Criterion C: The substance-specific syndrome causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Criterion D: Symptoms are not attributable to another medical condition and are not better explained by another mental disorder.
3.2. DIAGNOSIS OF SUBSTANCE ADDICTION
In general, drug addiction or substance use disorder can be diagnosed after thorough evaluation by a clinical psychologist, psychiatrist, or licensed alcohol and drug counselor. Current diagnostic criteria are included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) (DSM V, 2013). These include:
Taken in larger quantities or for a longer period of time than intended;
A persistent desire or unsuccessful effort to reduce or control the use of the drug/substance;
Spending a lot of time on activities necessary to obtain and use drugs/substances or recover from their effects;
Craving or a strong desire or urge to use the drug/substance;
Repetitive use resulting in failure to fulfill important role obligations at work, school, or home;
Continuing to use despite persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of drugs;
Giving up or reducing significant social, occupational or recreational activities due to drug/substance use;
Repetitive use, even in situations where it is physically dangerous;
Continuing drug/substance use despite knowledge of a persistent or recurrent physical or psychological problem likely to be caused or exacerbated by the drug;
Tolerance defined by either: (a) intoxication or the need for a markedly increased amount of drug/substance to achieve the desired effect, (b) markedly diminished effect with continued use of the same amount of drug/substance;
Withdrawal as manifested by any of the following: (a) the characteristic withdrawal syndrome for the drug/substance, (b) the drug/substance taken to alleviate or prevent withdrawal symptoms.
These 11 criteria can be subdivided into impaired control over the substance (criterion 1-4), social impairment (criterion 5-7), risky use (criterion 8-9) and pharmacological criteria (criterion 10-11). It should be noted, however, that different types of drugs meet different sets of withdrawal criteria, and therefore specific diagnoses should refer to drug-specific sets of withdrawal criteria.
4.1. SUBSTANCE ADDICTION AND CHILDHOOD TRAUMA
There is ample evidence to support that exposure to early childhood and adolescence trauma is strongly associated with substance abuse in adulthood and may contribute as a risk factor for addiction later in life (Kendler et al., 2000; Molnar et al., , 2001; Nelson et al., 2006; Sinha, 2001, 2008). Exposure to stress during childhood and adolescence may alter the development of brain regions responsible for regulating emotional and behavioral stress responses, decision making, reward behaviors, and impulsivity, including the prefrontal cortex (Blanco et al., 2015; Heinrichs, 2005; McCrory et al. , 2012; Sinha, 2008). There may also be interactions between childhood trauma and lack of parental or social support, maladaptive coping skills, and daily stress levels that contribute to drug addiction later in life (Sinha, 2001). Trauma experienced in adulthood is also associated with the risk of substance abuse. For example, cocaine-dependent individuals report significantly more types of lifetime trauma compared to community-appropriate samples (Afful et al., 2010). In addition, studies (Miranda et al., 2002) have also revealed that 60-70% of women enrolled in substance abuse treatment report a history of partner violence in which substances can be used as a coping method (Lincoln et al., 2006). However, there is solid evidence of an association between war-related post-traumatic stress disorder (PTSD) and subsequent substance abuse (Bremner et al., 1996; Davis and Wood, 1999; McFall et al., 1991; Seal et al. , 2012). In addition, PTSD and substance use disorder comorbidity is extraordinarily high (Brady et al., 2004), especially opioid addiction (Fareed et al., 2013). Traumatic events can trigger chronic stress, as evidenced by PTSD (American Psychiatric Association, 2013; Reddy, 2013), for which medication is often used to escape distressing emotions and traumatic memories (Brady et al., 2004). This hypothesis can be extended to include trauma survivors who recover from trauma without a clinical diagnosis of PTSD and then start using drugs to cope with non-traumatic distress in daily life, leading to a cycle of addiction (Bremner et al., 1996; Charney et al., 1993). ).