substance addiction

all right, so you might have read "the hobbit"or "the lord of the rings," you have probably seen them, you've definitely heard of them.but not everyone knows the story of their author, j.r.r. tolkien. tolkien was an englishworld war one veteran. a reluctant solider, he joined up with a sense of duty and he livedthrough the bloody battle of somme suffering tremendous shock, guilt, and loss during andafter the war. it took tolkien years to processes his experiences.to help him do it he turned to writing fiction and in time he constructed a world that helpedhim and all of us better understand war, human nature, loss, and growth. his novels werethe bi-product of trauma and they're among the more beautiful reminders of how it canaffect us.

most of us will experience some kind of traumaticevent in our lives and most of us will exhibit some kind of stress related behavior becauseof it, these symptoms usually fade but for some those reactions can linger and startof disrupt their lives or the lives of those around them. these reactions can develop intofull blown psychological disorders including post-traumatic stress disorder and, in an effortto cope, sometimes addiction, but it doesn't always have to be that way. ultimately, tolkien was able to harness theeffect of his trauma and shape them into something important and to reclaim is own life because thereis such a thing as post-traumatic growth, too. as it does with many other things psychologyapproaches trauma related disorders with different

perspectives, but they all tend to ask thesame questions. how do you identify and diagnose these disorders?and how do you treat them, so that the patients can recover? -- with the understanding thatthey might never be the same as they were before the trauma, but they can still be healthyand happy. in a way, psychology helps patients ask themselves,what tolkien asks his readers, and what frodo asks when he is finally safe back in the shire:"how do you pick up the threads of an old life? how to go on, when in your heart, youbegin to understand that there is no going back." it could be september 11 or a serious caraccident or a natural disaster or a violent crime that you survived but are still hauntedby. trauma comes in many different forms and

sometimes it can stick with you. when it manifests as nightmares, flashbacks,avoidance, fear, guilt, anxiety, rage, insomnia, and begins to interfere with your abilityto function it can come to be known as post-traumatic stress disorder or ptsd. it was once call "shell shock" a term usedto describe the condition of veterans, like tolkien in world war one but ptsd isn't limitedto veterans. it's defined as a psychological disorder generated by either witnessing orexperiencing a traumatic event. its symptoms are classified into four major clusters inthe dsm v. one of these clusters involves re-living theevent through intrusive memories, nightmares,

or flashbacks. the second involves avoidingsituations you associate with the event, while the third generally describes excessive physiologicalarousal like heart pounding, muscle tension, anxiety or irritability, and major problemssleeping or concentrating. and finally we have the fourth major symptom cluster: pervasivenegative changes in emotions and belief, like feelings in excessive guilt, fear, or shame -- or nolonger getting enjoyment out of what you used to. ptsd patients may also experience numbing,or periods of feeling emotionless or emotionally "flat" and dissociation, feeling as if situationsaren't real or are surreal, feeling like time has slowed down or sped up, or even blackingout. we have been discussing how anxiety or mooddisorders can affect a person's ability to

function and how that impairment itself leadsto more suffering and dysfunction. when any of these disorders is left untreatedsuffers may start to feel desperate to find some way to cope and one way may be substanceabuse. unfortunately, addiction and trauma can go hand in hand and it can be hard torecover from one without also dealing with the other. according to the us departmentof veteran's affairs more than 2 in 10 veterans with ptsd also struggle with substance abuseproblems and 1 in every 3 vets seeking treatment for substance abuse also have ptsd.and across many studies, between a third to a half of women in treatment for substanceabuse have experienced rape or sexual assault. for a long time most psychologists understoodptsd through the lens of fear conditioning

or the unshakable memory of being in mortaldanger and the learned responses that stem from that memory. but clinicians have alsobegun to recognize that for some the disorder can also be a kind of moral injury, wideningthe focus to include hauntings not just of violence done to a person but also what thatperson did or did not do to others. brandon was a combat drone operator in theair force he enlisted at 21 years old and spent 6 years sitting in a bunker in the americansouth-west watching iraq and afghanistan from surveillance drones. he watched soldiers die and people get executed.he also watched kids play, people get married, goats grazing -- and when the time came heordered hell fire missiles to strike military

targets or people who had no idea they whereeven being watched. although he was half a world away from combat,he ultimately suffered the psychological trauma felt by many on the ground soldiers. he wasdiagnosed with ptsd. brandon suffers no fears for his own safety, but still experiencesthe same intrusive memories, nightmares, depression, anxiety, and substance abuse of many emotionallytraumatized combat soldiers. so do a lot of other drone operators. but why do some victims or trauma suffer fromptsd while others seem able to move on? well, its psychology so the risk factors arecomplicated. some findings suggest that there may be genetic predispositions making somepeople more vulnerable than others. we also

know that context and environment matter,for instance, someone who has experienced childhood abuse might feel on the one handmore ready to deal with difficult and traumatic experiences. but on the other hand they mightbe more likely to default to the suppression and avoidance in which ptsd suffers frequentlyengage, which as we've discussed in previous episodes often makes psychiatric symptomsworsen over time. as far as whats going on in the brain, ptsdshares some similarities with anxiety disorders. for example the brains limbic system may floodthe body with waves of stress hormones like cortisol every time images of the traumaticevent bubble up uninvited into consciousness. and we've already talked a lot about how theamygdala and hippocampus are involved in those

classic fight or flight reactions, which whenprolonged can be really rough on the body. in fact, neuroimaging suggests that trauma-- or the chemical processes set into motion by trauma -- might actually damage and shrinkthe hippocampus. since this region is also associated with how we consolidate memories,this might explain how memories associated with trauma could fail to be filed away aslong-term memories and instead remain vivid and fresh through flashbacks and nightmares. if there's any silver lining to all of this,it's that some people may actually experience positive change after a trauma. treatmentand social support help some suffers achieve post-traumatic growth, positive psychologicalchanges resulting from the struggle with challenging

circumstances and life crises. that's in part what tolkien did. though hesuffered great trauma and loss on the battlefield, he was eventually able to use those experiencesto drive those powerful, allegorical stories. stories that helped not just himself, but many readersof all ages around the world. it seems that while whatever doesn't killyou might not necessarily make you stronger, sometimes it really does. but suffering can feed on itself. many victimsof trauma try to cope through whats colloquially called self-medicating and some can end upwith substance abuse or dependence issues. psychologists define addiction or dependenceas compulsive, excessive, and difficult-to-control

substance use, or other, initially pleasurablebehavior that beings to interfere with ordinary life, work, health, or relationships. this could mean over-consuming drugs or alcohol,or compulsively gambling, eating, shopping, exercising, or having sex. people with addictionsmay not even realize that they have lost control of their behavior for some time. addiction can refer to a physical dependence,a physiological need for a drug, that reveals itself through terrible withdrawal symptomsif the use stops or reduces. or psychological dependence, the need to use that drug, orcomplete that activity in order to relieve negative emotions.

people with addiction can sometimes be stigmatizedas pleasure-bound hedonists who have no self-control, but people often compulsively use substancesor do things in reaction to stress and other psychological problems. for various reasonsthey have been prevented from coping in other ways or maybe they just never learned how. so in this way addiction itself is often secondaryto the more complicated matter of how a person deals with stress and difficult emotions, or whatkinds of stressful situations they've survived. few will dispute that much of what makes addictionpossible is chemistry, but people are different -- from their life experiences to their biologicalsensitivities. so people respond in different way to different drugs and behaviors. manypeople can drink casually or gamble once in

a while without losing control. others simplycan't. people in recovery from addiction may alsohave different needs. some will need to be completely sober and never again touch thatdrug or do that thing. while others may in time be able to regain enough control to useagain in moderation. likewise, some folks can kick the habit ontheir own while others do better with or need support from professionals or support groups. researchers and groups like alcoholics anonymousdebate whether addiction is a mental illness -- like a "software problem" related to thoughts, andbehaviors, and feelings -- or a physical disease -- a "hard wire problem" related to biologyand genetics -- or both, and even whether

addiction and dependence are the same thing. either way it can be hard to recover froman addiction if you don't get the underlying problem treated. but some people believe thatyou can't treat the underlying problem without first getting the addiction out of the way. while this controversy too continues, manyare moving toward a model of treating both at at the same time. the so-called dual diagnosismodel of treatment. addiction that's rooted in deeper psychologicalissues -- especially in emotional trauma like ptsd -- often require some version of dualtreatment to untangle both issues. the good news is while ptsd and substancedependence may be distressing and complex,

people can begin to heal given the chanceand the resources. we're amazingly resilient creatures. when nurtured withthe proper support and practice, we can overcome a lot. today we talked about the causes and symptomsof ptsd and how trauma can affect the brain. we also looked at addiction, physical andpsychological dependence, the relationship between trauma and addiction, and why theycan require dual treatment, and we touched on post-traumatic growth with the wisdom of frodobaggins. thanks for watching, especially to all oursubscribers on subbable who make this show possible. to find out how you can become asupporter and help us do this thing just go to subbable.com/crashcourse.

this episode was written by kathleen yale,edited by blake de pastino and our consultant is dr. ranjit bhagwat. our director and editoris nicolas jenkins. the script supervisor and sound designer is michael aranda, andthe graphics team is thought cafe.