The Connection between Addiction and PTSD

Drug Addiction in Relation to PTSD, Relapse, Rehabilitation Services 

and the Effects of Drugs on the Human Body

The National Center for PTSD states that from those who have suffered from strenuous trauma, 10-20% of people will develop post-traumatic stress disorder, otherwise known as PTSD. PTSD is defined as a prolonged feeling of unease or recurring memories after experiencing an event that is viewed as life-threatening [1]. This disorder can vary in how it showcases itself and the extremities of the symptoms caused by the disorder. However, its symptoms are often categorized into four major categories: avoidance, reliving, negative thoughts, and hyperarousal [1]. Avoidance can be defined as the increased effort to avoid things that may remind a person of the traumatic event, is the first category. Second, reliving which is defined as when the brain chooses to replay memories of the trauma in a repetitive manner. An increased amount of negative thoughts, which typically arise in the form of feeling shame or guilt for the event, is the third symptomatic category of PTSD [1]. Hyperarousal, the fourth category, is known as an inability to allow oneself to relax or focus specifically in situations that would not be viewed that way without the presence of the disorder [1]. Its symptoms, even in the least extreme cases, can cause those suffering from the PTSD to find it difficult, oftentimes impossible, to complete everyday tasks, leaving victims feeling overwhelmed with everyday life and unable to connect with those around them [1]. This inability to relax, focus, and/or connect is one of the leading factors within those experiencing post-traumatic stress disorder to begin abusing substances [1]. 

Substance use disorder, or drug addiction, is defined as the lack of control with the usage of substances. Koob and Le Moal enhance the definition of what drug addiction is to be “a cycle of decreased function of brain reward systems and recruitment of anti-reward systems that progressively worsen, resulting in the compulsive use of drugs” [2]. Post-traumatic stress disorder is often seen to be tied with an imbalance of certain chemicals within the brain that are meant to help manage the stress levels of an individual. Without the correct presence of these stress-managing chemicals, individuals with PTSD can find themselves experiencing extreme levels of stress they have not experienced before, pushing them to find ways to balance the strain their conditions have placed on them [1]. Substance use can often stem from the belief that the euphoria experienced will bring relief to their symptoms. The authors of Drug and Alcohol Dependence state that the increased severity and number of symptoms spawning from the presence of PTSD often fall hand-in-hand with the likelihood of substance abuse [3]. 

A study done by Rikinkumar, et al., determined the ties between PTSD and opioid dependency. Through this study it is shown that the patients who face drug dependency often face the symptoms of PTSD when determined through the clinical criteria such as Maudsley Addiction Profile, the Severity of Dependence Scale, the Impact of Events Scale, and the ICD-10 [4]. Over 30% of those involved in the study met the criteria qualifying them for the diagnosis of post-traumatic stress disorder [4]. Within the four categories of the symptoms of PTSD, patients involved in the study had “clinically significant levels of intrusive (45.7%) and avoidant (65.7%) symptoms” [4]. As mentioned previously, substance abuse often stems from seeking a way to relieve intensified feelings of stress, especially those suffering from PTSD. Drug addiction can rewire the brain's perceptions of ‘rewards’, making it become more reliant on the usage of drugs due to the sense of euphoria experienced through the first couple of uses [2]. However, as the drug wears off and the body builds a tolerance to the drug of choice, the euphoric sensations received from usage begin to lose its initial effect. This leaves users unsatisfied and in “an opposing, aversive negative emotional state”, contrasting the ‘high’ they seeked initially [2]. Though the euphoria of the first few usages of substances seem to bring relief to the symptoms of PTSD, consistent use of opioids produces the opposite effect than what was originally seeked. Extended opioid usage in actuality increases stress levels and symptoms that could both lead to PTSD or enhance pre-existing symptoms if the disorder is already present [5]. 

Stress is known to be a high contributor to a person’s allostatic load, otherwise known as the negative effects of prolonged and chronic stress. An increased allostatic load “result[s] in progressive long-term changes in the brain” [6]. These chemical imbalances in the brain begin to weaken the strength of the parts that control emotions, thoughts, and actions while increasing the strength of the amygdala. The strengthening of this portion of the brain is what affects the individuals loss of control, cravings, and increased negative thoughts [6]. These changes create the opportunity for an individual to become more susceptible to drug cravings which can often lead to relapsing [6]. Relapsing is defined as “the return to drug-seeking and drug-taking behavior after a prolonged period of abstinence” [7]. 

A study was conducted using animal models to determine how the amygdala reacts to a drug relapse, specifically cocaine. The subjects were placed under different factors when the drug was being administered. Results from the study contain the evidence that one of the most noticeable characteristics to trigger a relapse is that of environmental factors [7]. This concept shows that particular things, such as locations, specific lighting, etc. that are very similar to that of the environment where the euphoria from the drug was being experienced, can elicit cravings that lead to a higher likelihood of a relapse [7]. 

Another study, completed in rehabilitation centers in Iran, also tested what factors an individual may face that increases the odds of a relapse. The results from this study were that current age, age when the individual began taking drugs, type of drug, and smoking habits all affect the chances of relapsing [6]. As the age of previous addicts increases, the chances of relapses increase respectively. However, the individuals that began using drugs later in their life are less likely to relapse after undergoing rehabilitation services [6]. The choice of drugs, in terms of modern versus traditional drugs, can affect the chances of relapsing, with modern drugs holding the higher odds [6]. 

Marijuana, a more traditional drug, is often abused for the psychedelic euphoria that is experienced through the presence of THC in the plant [8]. The withdrawal symptoms are range in a variety of physical and mental aspects [8]. These, however, are not placed to be nearly as detrimental as those of the harder drugs, as they are known to peak around day 4 of abstaining from drug use [8]. The primary symptoms of cannabis withdrawal are irritability, depression, a decrease in appetite, and an increase in saliva [8]. 

Opioids, which are classified as a modern drug, are majorly abused. When they are prescribed, they hold the purpose of getting rid of pain by attaching themselves to the receptors throughout the body that connect to the aspect of pleasure and pain. After connecting, they are able to block these receptors and dopamine is released throughout the body of the person taking them [9]. However, as mentioned previously, the prolonged usage of opioids can insight the feelings drowsiness, confusion, nausea, and euphoria, as well as the more projected symptom of slowed breathing [9]. The slowed breaths can limit the amount of oxygen that reaches the brain, which can cause extreme damage and even death [9]. The use of opioids can affect the central nervous system of an individual as well as induce sedation [10]. As a chemically similar drug, opioid users may progress to using heroin as it produces the same euphoric feeling and is oftentimes more easily accessed and cheaper [9]. 

A study was conducted on how heroin affected users' respiratory and body temperature. Different sized doses of diamorphine were given to those participating in the study, both dependent and independent users. The most noticeable changes in the participants was the falling of the heart rate and slowed breathing, which occurred in both groups [11]. However, those that were drug dependent recovered a normal paced breathing faster than those who were not. An interesting point to take notice of is the fact that though body temperature fell within both groups, however the temperature of the participants skin did not fluctuate [11]. Blood pressure changed within the group classified as dependent, yet not the independent group [11].Cocaine is often used for a similar sense of pleasure that both opioids and heroin are used for [12]. Depending on how the drug is taken in, different side effects may appear [12]. Smoking cocaine can worsen asthma whereas snorting cocaine can lead to a loss of smell and an inflamed runny nose. Despite the administration of the drug, cocaine usage as a whole can reduce blood flow, lead to strokes, or negatively impact an individual's cognitive functions [12]. 

Oftentimes, relapse takes place after an individual has visited a rehabilitation center [13]. Rehabilitation is portrayed as the fix all for drug abusers, especially as there has been a shift within the governments to focus less on justice and more on finding help through treatments. The biggest determining factor of the success for rehabilitation is the level of treatment provided and support [14]. The National Rehabilitation Implementation Committee states that “it is unlikely that any single agency can provide everything that is needed to address the issues contained within [the] cycle of addiction [14]. This concept of well rounded rehabilitation can feel overwhelming and stressful especially for those receiving the treatment. If this stress is added to pre-existing chemical imbalances such as those known to be present within both post-traumatic stress disorder and drug addiction, chances of relapse are higher if there are not enough pushing factors to justify the amount of effort needed to overcome substance abuse [14]. A study was held in rehabilitation centers in China to determine how anxiety affects the individual's chances to relapse [15]. It was determined that high levels of anxiety and stress often affects the ability of the individuals to maintain abstinence from drug usage [15]. The study concluded that by “understanding the relationship between anxiety and drug abstention motivation from the perspective of emotion [places] great significance for guiding individuals with substance use disorders in enhancing their drug abstention motivation by reducing negative emotion” [15]. The patients with a better ability to maintain their own sense of self success are more likely to be able to balance how their anxiety affects the motivation they hold towards relapsing [15].

Citations:

[1] National Center for PTSD, “Understanding PTSD and PTSD Treatment”, 2019. https://permanent.fdlp.gov/gpo123944/understandingptsd_booklet.pdf. [Accessed: January 13, 2023]. 

[2] G. Koob and M. Le Moal, “Addiction and the Brain Antireward System”, Annual Review of Psychology, vol. 59, January 2008. [Online Serial] Available: https://www.annualreviews.org/doi/10.1146/annurev.psych.59.103006.093548. [Accessed: January 14, 2023].

[3] C. Blancos, Y. Xu, K. Brady, G. Perez-Fuentes, M. Okuda, and S. Wang, “Comorbidity of posttraumatic stress disorder with alcohol dependence among US adults: Results from National Epidemiological Survey on Alcohol and Related Conditions”, Drug and Alcohol Dependence, vol. 132, no. 3, October 2013. [Abstract] Available: ScienceDirect, https://www-sciencedirect- com.liblink.uncw.edu/science/article/pii/S0376871613001452. [Accessed January 13, 2023].

[4] A. Fareed, et al. “Co-morbid Post-traumatic Stress Disorder and Opioid Dependence Syndrome”, Journal of Addictive Diseases, 2009. [Abstract]. Available: Taylor & Francis Online, https://www-tandfonline- com.liblink.uncw.edu/doi/abs/10.1080/15504260802620293? role=tab&scroll=top&needAccess=true&journalCode=wjdd20. [Accessed: January 13, 2023].

[5] I. Elman and D. Borsook, “The failing cascade: Comorbid post traumatic stress- and opioid use disorders”, Neuroscience & Biobehavioral Reviews, vol. 103, August 2019. [Online serial]. Available: https://www- sciencedirect-com.liblink.uncw.edu/science/article/pii/S0149763419300120. [Accessed January 14, 2023].

[6] R. See, R. Fuchs, C. Ledford, and J. McLaughlin, “Drug Addiction, Relapse, and the Amygdala”, Annals of the New York Academy of Sciences, vol. 985, no. 1, p. 294-307, January 2006. [Online Serial] Available: https://nyaspubs.onlinelibrary.wiley.com/doi/full/10.1111/j.1749-6632.2003.tb07089.x?sid=nlm%3Apubmed. [Accessed: January 17, 2023].

[7] R. See, R. Fuchs, C. Ledford, and J. McLaughlin, “Drug Addiction, Relapse, and the Amygdala”, Annals of the New York Academy of Sciences, vol. 985, no. 1, p. 294-307, January 2006. [Online Serial] Available: https://nyaspubs.onlinelibrary.wiley.com/doi/full/10.1111/j.1749-6632.2003.tb07089.x?sid=nlm%3Apubmed. [Accessed: January 17, 2023].

[8] N. Smith, “A review of the published literature into cannabis withdrawal symptoms in human users”, Addiction, vol. 97, no. 6, p. 621-632, May 2002. [Online Serial]. Available: https://onlinelibrary.wiley.com/doi/full/10.1046/j.1360-0443.2002.00026.x. [Accessed: January 19, 2023].

[9] “Prescription Opioids Drug Facts”, National Institute on Drug Abuse, June 2021. [Online Serial]. Available: National Institute on Drug Abuse, https://nida.nih.gov/publications/drugfacts/prescription-opioids. [Accessed January 18, 2023]. 

[10] D. Chau, V. Walker, L. Pai and L. Cho, “Opiates and elderly: Use and side effects”, Clinical Interventions in Aging, June 2008. [Online Serial]. Available: PubMed Central, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2546472/. [Accessed: January 18, 2023].

[11] K. Tress and A. El-Sobky, “Cardiovascular, respiratory and temperature responses to intravenous heroin (diamorphine) in dependent and non-dependent humans”, National Library of Medicine, November 1980. [Abstract]. Available: PubMed Central, https://www.ncbi.nlm.nih.gov. [Accessed: January 18, 2023].

[12] NIDA, “What are the long-term effects of cocaine use?”, Cocaine Research Report, July 2021. [Online Serial]. Available: National Institutes of Health. https://nida.nih.gov/publications/research- reports/cocaine/what-are-long-term-effects-cocaine-use.  [Accessed: January 18, 2023].

[13] E. Ezati, et al., “Evaluating drug use relapse event rate and its associated factors using Poisson model”, Journal of Substance Use, vol. 26, no. 1, June 2020. [Abstract]. Available: Taylor & Francis Online, https://www-tandfonline-com.liblink.uncw.edu/doi/abs/10.1080/14659891.2020.1779359journalCode=ijsu20. [Accessed: January 17, 2023].

[14] J. Doyle and J. Ivanovic, “National Drugs Rehabilitation Framework Document”, Health Executive Service, Dublin. Document. https://www.lenus.ie/bitstream/handle/10147/109460/National+Drugs+Rehabilitation+Framework+2010.pdf? sequence=1. July 2010. [Accessed January 18, 2023].

[15] Y. Li, X. Zeng, and H. Zhou, “Relationship between anxiety and drug abstention motivation in men with substance use disorders: a cross-sectional study of compulsory isolation rehabilitation in China”, Journal of Ethnicity in Substance Abuse, September 2021. [Abstract] Available: Taylor & Francis Online, https://www.tandfonline.com/doi/abs/10.1080/15332640.2021.1923103. [Accessed: January 19, 2023].