Comorbidity and AddictionAmanda Flathmann

Advanced General PsychologyPsychology 492

Professor Mary Viventi

Running head: COMORBIDITY AND ADDICTION 1

COMORBIDITY AND ADDICTION 2

Abstract

Comorbidity levels among addicts have been recently discovered to be very common. Many addicts have an Axis I or Axis II psychological disorder, and as a result they self medicate with substances. Depression and anxiety are the most commonly diagnosed mental disorders and common among addicts. Successful substance treatment depends on the successful diagnosis of the mental disorder and a treatment plan to treat both disorder and addiction. The topic of addiction and comorbidity is important to study in an attempt to stop substance abuse. If people were presented with proper education and diagnosis about their psychological problem, addiction would naturally decline.

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Comorbidity and Addiction

Recent research has shown that college aged adults abuse substances in an attempt to self medicate a psychological disorder, thus creating the compound problem of comorbidity. Axis I and Axis II psychological disorders emerge in when the person reaches the age for college.

Anxiety disorder is the most commonly diagnosed psychological disorder and it has affected millions of people (Encyclopedia of Cognitive Science, 2010).

Addiction is commonly considered a chronic disease of the brain that impairs the social function of the individual and causes them to compulsively seek the substance (Dickinson, Schwabe, & Wolf, 2011).

Molander, Mar, Norbury, Steventon, Moreno, Caprioli, & Dalley (2011) studied anxiety and novelty seeking behavior in order to see how those behavior traits contributed to rationale impulsivity. Their study proved that rationale impulsivity was distinct from anxiety and novelty seeking behavior.

The outcome of the study proved that rationale impulsivity is extremely relevant in the etiology of addiction seeking (Molander, Mar, Norbury, Steventon, Moreno, Caprioli, & Dalley, 2011).

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As cognitive ability matures, gray matter thins as the person matures from adolescent age to college age. Myelin production increases to enhance the transmission of brain messages and function (Society for Neuroscience, 2011). If the cortical myelination process develops improperly, the person will lack inhibitory controls and become prone to addictive behavior (Bartzokis, 2005).

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Cortical Myelination

Cortical myelination involves the development of the insulation myelin sheathes that make up the connection pathways in the brain (Bartzokis, 2005). Proper development of the cortical myelin ensures a smooth flow of neural impulses throughout many separate areas of the brain (Bartzokis, 2005).

Inhibition of psychomotor response improves with age, and reaction time declines with age in the brain of a normally developed individual. Healthy social function requires appropriate responses which rely on the individual’s knowledge of the proper response and their ability to inhibit inappropriate responses in a perfectly timed manner (Bartzokis, 2005).

Proper myelination development in inhibitory circuits is how precise timing of inhibition is achieved in a normal individual (Bartzokis, 2005).

As the myelin cells reach a poorer condition in the brain of an addict, gene expression studies have shown that in alcohol and cocaine dependant individuals the myelin gene expression actually reduces (Bartzokis, 2005).

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Release of serotonin into synaptic space, and the binding to the protein receptors. (National Institute on Drug Abuse, 2011).

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5 Hydroxytryptophan Receptors Role in Addiction

5 Hydroxytryptophan receptor (5HT) is an amino acid that plays an important role in biosynthesis of the neurotransmitter serotonin and melatonin.

5HT is a neuromodulator of the emotional response, impulsiveness, anxiety, depression and aggression associated with addiction (Filip, Alenina, Bader, & Przegaliński, 2010).

Studies on cocaine addicts have shown that various manipulation to 5HT receptors in addicts play and important inhibitory action against cue-stimuli for cocaine abuse (Filip, Alenina, Bader, & Przegaliński, 2010).

5HT receptors have also been proven to play a role in psychiatric disorders such as schizophrenia and depression (Filip, Alenina, Bader, & Przegaliński, 2010).

5HT receptor manipulation can help with preventing cocaine abuse relapse, and help with withdrawal (Filip, Alenina, Bader, & Przegaliński, 2010).

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(National Institute on Drug Abuse, 2011).

• In a recent study, one hundred thirty nine young cocaine users were chosen as subjects selected for mental health evaluations completed psychiatric assessment (Herrero, Domingo-Salvany, Torrens, and Brugal, 2008).

• Fifty-five of the subjects were diagnosed with Axis I disorders, nineteen were diagnosed with Axis II disorders, and twenty-two were diagnosed with a disorder caused by the substance (Herrero, Domingo-Salvany, Torrens, and Brugal, 2008).

• Addiction often results from someone attempting to self medicate from a previously existing psychological disorder

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Adolescent and children’s brians are more sensitive to stress (Depression Forums, 2011).

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Stress, Depression, and Anxiety The central dopaminergic and the noradrenergic systems of the brain are activated by stress (Dickinson,

Schwabe, & Wolfe, 2011).

Stress activates the sympathetic nervous system which controls release of adrenaline and noradrenaline. Adrenaline and noradrenaline cause increased heart rate, release of noradrenaline, increased blood to the muscles, and dilation of the pupils (Dickinson, Schwabe, & Wolfe, 2011).

Stress is common among adolescents and college students. The transition from child to adult triggers stress, as do other stressors such as academic or athletic performance. The comobidity level is highest among adolescents and college students for these reasons.

Depression and anxiety are common as comorbid diagnosis along with substance abuse. Individuals suffering from comorbid depression have greater psychosocial problems that substance abuse alone because the clinical aspects of depression interfere with treatment (Leventhal, Mooney, DeLaune, & Schmitzn, 2006).

Anxiety is closely related to depression. Worry and fear involve a physiological hyperarousal which is the emotional “fight or flight” response (Encyclopedia of Cognitive Science, 2005).

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Deep Brain Stimulation, (Top News, 2011).

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Treatment of Addition

Deep brain stimulation has recently received attention as a new possibility for the treatment of addiction. The neural reward pathways are involved with addiction, which brings about the feeling of well being as a response to dopamine release after the substance abuse(Kuhn, Moller, Muller, Bogerts, Mann, & Grundler, 2011).

Cognitive behavioral therapy is essential in addiction treatment. Cognitive behavioral therapy helps address the habits and rituals associated with the substance abuse, and help the client develop a plan to counteract the relapse stimuli (Dickinson, Schwabe, & Wolf, 2011).

Teaching goal directed and decision making skills would help strengthen the client’s goal-directed system (Dickinson, Schwabe, & Wolf, 2011). Clients should be taught how to build up determination to abstain, identify high risk situations, manage stressful/ painful feelings, and develop social support and intrapersonal functioning (Dickinson, Schwabe, & Wolf, 2011).

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Treatment Completers and Dropouts

A recent study on completers and dropouts of treatment revealed that dropout showed a higher score higher in variables related to alcohol abuse, family problems, histrionic and antisocial scale, and histrionic personality disorder (Fernandes-Montalvo & Lopez-Goni, 2009).

Completers of the treatment program showed a higher score on the compulsivity scale (Fernandes-Montalvo & Lopez-Goni, 2009).

Dropouts consistently scored high on histrionic and antisocial personality disorder scale, while the completers tended toward compulsivity (Fernandes-Montalvo & Lopez-Goni, 2009).

Outpatient treatment proved to succeed more with individuals who scored high in compulsivity because of their tendency to set goals and establish better habits and rituals (Fernandes-Montalvo & Lopez-Goni, 2009).

Substance abuse causes damage to the individual’s motivational system in the brain. The individual’s interpretation and response to the environment are impaired therefore relapse is a common problem(Dezfouli, Piray, Keramati, Ekhtiari, Lucas, & Mokri, 2009).

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Herrero, M., Domingo-Salvany, A., Torrens, M., & Brugal, M. (2008). Psychiatric comorbidity in young cocaine users: induced versus independent disorders. Addiction, 103(2), 284-293. Retrieved from: http://web.ebscohost.com.libproxy.edmc.edu/ehost/pdfviewer/pdfviewer?sid=af0fb8a5-305e-4e6b-bdef-ea4a3e1ef788%40sessionmgr4&vid=2&hid=10

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