Learning objectives: What does it mean to be addicted?How have psychologists explained

addictive behaviour?Are certain people vulnerable to

addictions?How do we reduce/help those with

addictions?

A2 Psychology - Addictive Behaviour

The psychology of addictive behaviourModels of addictive behaviour • Biological,

cognitive and learning models of addiction, including

Explanations for initiation, maintenance and relapse

Explanations for specific addictions, including smoking and gambling

Factors affecting addictive behaviourVulnerability to addiction including self-esteem,

attributions for addiction and social context of addiction

The role of media in addictive behaviourReducing addictive behaviour • Models of

prevention, including theory of reasoned action and theory of

planned behaviourTypes of intervention, including biological,

psychological, public health interventions and legislation, and their effectiveness

What does it mean to be addicted?1.Write a basic definition

2.What kinds of things can people be addicted to?

3. What do you think causes a person to become addicted?

Defining addiction‘Addiction is a state of periodic or chronic

intoxication produced by repeated consumption of a drug’

(WHO, 1957)

Definitions now include other behaviours, not just drugs, e.g. sex, exercise, playing computer games, gambling, overeating

Defining addiction

‘a repetitive habit pattern that increases the risk of disease and/or associated personal and social problems. Addictive behaviours are often experienced subjectively as ‘loss of control’; behaviour still occurs despite efforts to stop it. Attempts to stop are often are marked with a high relapse rate’

Marlatt et al (88)

Shared attributes of addictions

All addictions seem to be characterised by self-indulgent behaviour with short term gratification at the cost of long term damage

Addictions lead to a powerful and rapid change of mood and sensation

Celebrity addictions –do you know what they suffer from?

Classifications of addictionsDSM-IV and ICD-10 include disabling

addictionsWHO- prefers the term ‘dependence’ to

addictionDependence = characterised by intermittent

craving for substance to avoid a dysphoric state (state of mind characterised by depression and guilt)

Dependence is differentiated- abuse and harmful abuse

Differences in classifications for addictions

Smoking- substance related disorder

Gambling- habit and impulse disorder

Explaining common addictions

In groups- explain your groups addictions using psychology theory/common sense

Chris and Farah – alcoholismEllie and Lucy- food addictionEmily, Naeemah and Andy- gambling addictions

http://www.youtube.com/watch?v=pHDYk15V6hE

Explaining addictions

Biological/medical/disease modelAddiction is a specific diagnosisAddiction is an illnessThe problem lies in the individualThe addiction is irreversibleThere is an emphasis on treatment

Genes and addictionsAddiction reflects an underlying

physiological abnormalityGenetics may play a roleIt is unlikely that a single gene is

responsible for addictive behaviourVery likely- multiple genes are involved

and different genes underlie different addictions

E.g. link between tobacco smoking and genes involved in dopamine regulation (Lerman et al, 99)

Genetic vulnerabilityMost research in this area focuses on alcohol

addictionFamily studies and twin studies are usedMerikangas et al (98) 36% of the relatives of

individuals with an alcohol disorder had also been diagnosed with an alcohol-use disorder

Difficult to separate genetics from the environment

Adoption studies do however show a linkTwin studies; 60-70% concordance for nicotine

dependence (Kendler et al, 99); 34-60% for alcohol abuse (Heath and Martin, 93)

Genetic predisposition for addictionsWhether this exists or not, you still need to

be exposed to a large amount of whatever to become addicted

Likely it is more complicated than genetics

BiochemistryHow the brain metabolises various addictive substances 2 key areas:-the dopamine reward system-the endogenous opioid system

Dopamine (neurotransmitter) has a vital role in the regulation of mood and emotion and in motivation and reward processes

Alcohol and nicotine affect the nervous system, increasing levels of dopamine (Altman et al, 96)

It is possible those that are susceptible to addictions might have inherited a more sensitive mesolimbic dopamine pathway (Liebman and Cooper, 89)

Controlling our behaviourPeople have the ability to exercise choice

over whether we engage in behaviours and we mostly maintain a balance so we don’t become addicted

Over indulgences are temporary for mostWe can do this because we have the ability to

balance 2 competing neurochemical systems- reward reinforcement system and control system

SerotoninSerotonin – plays an important role in controlSerotonin- lower levels found in impulsive

peopleOldham, Hallander and Skodal (90) –

patients who attempt compulsive suicides, impulsive homicidal behaviour, early onset alcoholism and bulimia –all have lower levels of serotonin

Obsessive –patients have high metabolic rates in the frontal areas of the brain and have high levels of serotonin

The brain’s Opioid systemBelieved to be linked to addictionOpioid neurotransmitters include

enkephalin and the endorphinsThe opioid systems are activated in

states of pleasure and can be directly stimulated by addictive drugs e.g. heroin, alcohol and nicotine

Naltrexone- used to treat alcohol addiction, blocks opioid receptors in the brain, preventing the rewarding effects of alcohol

Neuroadaptation

Drug dependence- based on the idea of neuroadaptation (Koob and LeMoal, 97)

Changes occur in the brain as result of the taking of psychoactive drugs

Tolerance quickly happens and so doses need to increase to have the same effect

Withdrawal symptoms- if drug taking stops

These symptoms will make people want to start taking the substance again

Summary- Biological modelsAlcohol, nicotine, opiate drugs- change brain

mechanisms (these act on the central nervous system)

Gambling and other addictions where no chemical substance is involved also change brain mechanisms

Evidence –correlational only

Sum up the biological model.

Provide 1 pro and 1 con

Learning (behavioural models)

1970s onwards Addictive behaviours – not seen as illnessesSeen as part of an individual’s repertoire of

behaviourAddictive behaviours- Acquired habits which are learned according

to the principles of SLTThings that can be unlearnedNot all or nothing categoriesNo different from any other behaviours

Classical conditioning Unconditional stimulus spontaneously produces an

unconditional response If the US is frequently associated with a conditional stimulus

this CS will come to produce the conditional response e.g. sitting with friends (US)= relaxed feeling (UR)Smoking with friends, leads to smoking alone becoming the

CS= relaxed feeling (CR)US-UR; CS-CR US- can be either internal/externalWikler (48) first applied this to people who were addicted to

opiate drugs. He noted withdrawal symptoms following the stopping of consumption of a drug. An addict deals with these feelings by hunting another dose, exposing them to a range of cues which become associated to the withdrawal.

Cue exposure theory (Heather and Greeley, 90) could explain why people suffer such intense cravings once they have been weaned off their addictive substance.

Operant conditioningDepends on the consequences of actions Behaviours are likely to be repeated if they

are rewarded in some wayPositive reinforcement – reward is a

desirable consequence, e.g. feeling relaxedNegative reinforcement- the reward is a

removal of an unpleasant consequence, e.g. the relief from withdrawal symptoms if smoking/drug taking continues

What is a reward varies- depending on the individual, their past/experiences/ their own needs etc

SLTThis is SLT developed, going beyond

simple observation to account for some of the more complex perceptual and reasoning skills of humans.

We learn through observing and hearing what others do/say

Significant people – make smoking etc attractive and rewarding

Also includes aspects of Cog Beh models – labelling and outcome expectancy model

Cog Beh modelsCognitive labelling models – an emotional

experience that is the result of an interaction between physiological arousal and its cognitive interpretation (the label). Cues to emotional arousal are very powerful, e.g. someone who is addicted to alcohol may smell it near a club and want alcohol more

Outcome expectancy model- cues set off expectations about an addictive substance, e.g. adverts of people drinking may trigger the thought ‘I really want/need a drink’

Sum up the behavioural model

Provide one pro and one con

Usefulness of Behavioural approachesLinks to cognitive make it more able to give

a solid explanationDoes stress the role of the media

(advertising for cigarettes/alcohol etc)However the theories of cognitive labelling

and outcome expectancy are simplistic (Tiffany, 99)

Avoids the idea that humans are creative thinkers

Cognitive models Emphasis on the processes that control mental functions

such as communication, learning, problem-solving, planning Self-regulation- weighing up the relative importance of

social and physical factors as well as one’s own personal goals when planning behaviour

Addictive behaviour- more common in people who place excessive reliance on external structures to maintain a balance between their physical and psychological needs

Impaired control over actions lead to addictive behaviour

Rational people can behave like this if they have faulty ways of thinking when exploring the consequences of their actions

Ainslie (92) all people can perfectly predict present and future consequences but they attach different weightings to them, mostly attaching greater weight to the present

Immediate reward over future benefit – called cognitive myopia (Hernstein and Prelec, 92)

Beck et al (93)Addictive beliefs play an important part in

the development of addictive behavioursAt first the individual thinks it would be

fun/exciting to drink/take drugs etc and then gradually they become reliant on the substance

These individuals often have very negative views of themselves and may suffer depression/anxiety

The cognitive processing model

Behaviours if repeated enough become automatic

Tiffany (90) argues that addictive behaviours are regulated by automatic processing

Drinking etc if repeated and repeated become automatic, thus it is difficult to stop automatic behaviour

We are continuously faced with situations that trigger automatic responses

This could be possible if everything else in an individual’s life is good, however if there are stresses etc it becomes more difficult

Sum up the cognitive model

Provide one pro and one con

Evaluations of cognitive theoriesUseful for explaining the thinking processes

of people who become addicted to certain behaviours

Provides helpful treatmentsAlso provides explanations for why relapses

occurDoes not explain why such addictions start

in the first place

Use one of the models to explain the following:

Russel Brand’s sex addictionPete Doherty’s drug addictionsMichael Jackson’s prescribed drugsDavid Hasselhoff’s alcohol addiction

Explaining specific addictionsSMOKING1.1 billion people are estimated to be

smokers across the world (WHO)4 million people are estimated to die from

smoke related illnesses (WHO)Evidence links smoking to:-high blood pressure; coronary heart

disease; lung disease; cancer and strokes-pregnant women who smoke are more

likely to have premature babies-smoke increases stress levels (Parrott, 00)

Why do people smoke cigarettes in the face of the side effects?.

SmokingThere are 3000 chemical components in

cigarette smoke- but nicotine is the active and addictive component

Hilts (94) compared nicotine to 5 other psychoactive drugs-heroin, cocaine, alcohol, caffeine and marijuana. He ranked nicotine lowest for intoxication but highest in terms of dependence

Relapse rates- 70% in the first 3 months of trying to give up. Individuals who give up experience quite nasty withdrawal effects

SmokingIt is classed as a psychoactive drug as it

directly affects the brain but it’s effects as more subtle than most drugs

Nicotine affects the central nervous system, its estimated that nicotine once smoked takes less than 25 secs to reach the brain

Nicotine has – stimulant and depressant effect on the brain- increases the amount of noradrenaline and adrenaline in the body

It activates the MESOLIMBIC PATHWAY- producing positive effects-smokers explain it has a relaxing yet arousing effect

Explaining smoking Biological factorsGenetic factors – Shields (42) looked at 42

twin pairs who had been reared apartOnly 9 pairs were discordant for smoking

behaviour

Explaining smokingSocial factorsMost people start smoking in childhoodTraditional learning theory is able to explain

smoking behaviour quite well- using the principles of operant conditioning

It is extremely common that the first experience is unpleasant, difficult to explain why children persist

SLTChildren continue to smoke to imitate role

modelsRole models are more influential if the are

the same sex, age or ethnic background as the observer

Those with a higher status have more influence (such as a celebrity) –Winnett et al, 89

The observation of others enjoying the experience leads to them persisting to expect future enjoyment

The role of parents in their children’s smoking behaviour

A key influence on smoking behaviour is parents’ attitudes to smoking

Children are twice as likely to smoke if their parents are smokers (Lader and Matheson, 91)

If parents’ attitudes are firmly against smoking, the child is 7 times less likely to smoke (Murray et al, 84)

Peer pressureBelieved to be very important, exerting

pressures on those that do not smoke to start .e.g. bullying

Michell and West (96) adolescents are considerably less susceptible to this kind of pressure. They explain that some here show a ‘readiness’ for smoking

Those not wanting to smoke, tend to adopt strategies to avoid situations where smoking is likely to be offered

What are the implications here are for health campaigns?

Individual differencesResearch in the US links smoking to certain

other traits such as poor performance at school, low self-esteem, evidence of risk taking behaviour (e.g drinking alcohol) –Mosbach and Lenethal, 88

Cognitive factorsTRA and TPBConner et al (06)- role of planned behaviour

in smoking initiation in 11-12 year olds.675 non-smoking adolescents were tested for

baseline measures including tpb9 months later they checked if any of these

adolescents had taken up smoking They used carbon monoxide poisoning instead of

subjective measuresResults- behavioural intentions were usually a good

predictor of smoking behaviourIn China childhood smoking is a big problem, Guo

et al (07) studied more than 14000 children with tra and tpb and found they were useful predictors of smoking behaviour

Problem gamblingExplain what is meant by the above

What causes such problems?

Problem gambling

Pathological gambling- term used to describe those at the most extreme end of the gambling behaviour spectrum

Problem gambling- gambling that is of a mild to moderate problem for the sufferer

Difficulties- no clear cut definition of what gambling is

General consensus- an activity where 2 / more people agree to take part – usually the operator and the person/persons who wish to gamble, the stake is paid by the winner

DSM-IV – to be a problem gambler you must have 5 or more:Preoccupation with gamblingNeed to gamble with increasing amountsRepeated unsuccessful efforts to control or cut

down gamblingRestlessness/irritability when trying to cut downReturn to gambling even after losing huge

amounts of moneyJeopardising or losing relationships due to the

gamblingCommitting illegal acts such as forgery to

conceal the gambling

Problem gambling Usually starts in adolescence for menLater in womenTypically gradual- starting with social to more

frequentGambling is common- millions report doing it

each year (National Centre for Social Research), however gambling does not always lead to addictions, e.g in Canada 0.6% of the population are addicted to gambling

Explanations of gambling behaviour

Biological accountsGenetic vulnerability (Eisen, Lin and Lyons, 99)Comings et al (01) argues the genetic vulnerability could be

explained in terms of genes controlling the activity of DOPAMINE, SEROTONIN AND NOREPINEPHRINE

Gamblers often report enjoying a high/buzz from the game/winning, problem gamblers have high levels of dopamine and norepinephrine in the anticipatory stage before non-problem gamblers

Meyers et al (04) compared 2 groups of problem gamblers- one playing cards not for money; the other gambling for money. Gamblers- raised heart rate and secreted more cortisol (both are linked to acute stress)

Rosenthal and Lesieur (92) problem gamblers who stop gambling, report withdrawal effects similar to drug addicts who stop taking drugs

There is evidence to link dysfunction of the prefrontal lobe to problem gambling (Cavendini et al, 02), high rates of EEG abnormalities have been found (Regard et al, 03)

Explanations of gambling behaviour

Meyers et al (04) compared 2 groups of problem gamblers- one playing cards not for money; the other gambling for money. Gamblers- raised heart rate and secreted more cortisol (both are linked to acute stress)

Rosenthal and Lesieur (92) problem gamblers who stop gambling, report withdrawal effects similar to drug addicts who stop taking drugs

There is evidence to link dysfunction of the prefrontal lobe to problem gambling (Cavendini et al, 02), high rates of EEG abnormalities have been found (Regard et al, 03)

Explanations of gambling behaviour

Sociocultural accountsGreater access to gambling opportunities are linked

to problem gamblingLadouceur et al (99) –found that problem

gambling rates increased with greater availabilityAn Australian study- found gambling rates

increased but not rates of problem gambling when access increased

National Lottery (UK, introduced in 94)-concern it would become addictive. GamCare survey in 98 found that 65% of people had played the national lottery compared to other countries where 90% in New Zealand and Sweden

Alcohol consumption- believed to increase gambling (evidence is inconsistent)

Explanations of gambling behaviour

Psychological factorsOne risk factor is impulsivity in

childhoodADHD is found in many problem-gamblers

(Carlson et al, 94)Operant conditioning- gambling is

reinforced when gambling is successful (money and the ‘buzz’)

Schedules of reinforcement show that variable successes are more powerful in making behaviour last and make them difficult to stop

Can’t explain the origin though

Explanations of gambling behaviour

Parental attitudes to gambling – are very influential particularly the father’s (Oei and Rayhi, 04)

Irrational self talk –common in gamblers, Winefield (99) found that 75% of game related thoughts were irrational, encouraging risk taking

Mood state- contributes to gambling, with people gambling to escape being depressed

Sharpe’s biopsychosocial model (02)

3 key contributing factors:1. Bioloigcal vulnerability (involving the

brain’s reward system)2. Family attitudes that support gambling3. High levels of impulsivity Nower et al (02) suggests a different

pathway-1. Behaviourally conditioned2. Emotionally vulnerable gamblers3. Anti-social, impulsive problem gamblers

(an underlying biological dysfunction, e.g. ADHD)

Vulnerability to addiction All addictive behaviours take place within a society- which has

norms, values etc E.g. France, considered odd not to drink alcoholSELF-ESTEEMLow self-esteem is linked to addictive behaviourATTRIBUTIONSCognitive biases –such as those found in young males who are

problem gamblers, unrealistic ideas about risk and their chances of influencing the outcome of their behaviour (Moore and Ohtsuka, 99)

PERSONALITYEysenck (97) ‘the addictive personality’ –addictive behaviour fulfils

a certain purpose related to the personality of the individual which are inherited: personality is divided up into 3 areas:

1. PSYCHOTICISM (P)2. NEUROTICISM (N)3. EXTRAVERSION (E)Evidence is mixed for high levels of P, but more convincing for N and

E for dependence to alcohol (Francis, 96)Correlational evidence onlyLink between alcohol addiction and personality disorder –

alcoholism is linked to anti-social personality/sociopathy

Vulnerability to addictionGender Smoking- increase in female smoking in the US

and UK, male smoking has remained stableWhy might this be the case?Ogden and Fox (94) Gambling- males are more regular gamblers

compared to females (Jacobs, 00)Social context of addictionDrinking, smoking and gambling to an extent-

are socially acceptableAlcohol –linked to transition from childhood to

adulthoodPeople with antisocial behaviour are more likely

to develop substance use problemsChildren with anxiety/depressive symptoms are

more likely to develop substance use problems and often it will be at an earlier age (Cicchetti and Rogosch, 99)

Vulnerability to addiction Family influenceSLT predicts children’s behaviour will reflect similarities in

their parents.Parents drugs use is linked to the onset of alcohol and

cannabis useParents with a permissive attitude to drug use are more likely

to have children who are more likely to start taking drugsRisk of substance abuse is higher where families have

problems

Sociocultural background is also significant- Hall et al found that people from lower social classes are more likely to develop substance use problems, same for those with a lack of educational experience

Problem gamblers show a wide range of school related difficulties- truancy etc (Fisher, 99)

Link between alcohol abuse and problem gambling in males (Vitaro et al, 01)

What role does the media have in causing addictions?Group 1- advertsGroup 2- tv showsGroup 3- role modelsGroup 4- filmGroup 5- computer games

Education How do schools address the potential

problem of addictions?

Does it work?

What else could they do?

The role of the media in addictive behaviour

TV shows such as Who Wants to be a Millionaire

Advertising e.g. the National Lottery ‘It could be you’

Other forms of addictive behaviour – Chapman and Fitzgerald (82) found that underage smokers preferred heavily advertised brands

Legislation has changed advertising Models are used widely within tv

shows/filmsSLT- we learn through observation and

vicarious reinforcement

How can addictive behaviour be reduced?.

Reducing addictive behaviour Models of prevention1. Education – to raise awareness of the

possible consequences of excessive smoking, drinking etc

2. Introduction to social change – raising prices of cigarettes etc, raising of age to buy products, controlling adverts

TRAInterested in how health beliefs lead to

health behaviourFishbein and Azjen (75, 80)Consists of 3 components:-attitude-behavioural intentions-subjective normsA person’s behaviour is influenced by an

interaction between their own views of their behaviour and how they think others will view it

TPBAzjen Later modelIncludes perceived behavioural control-subjective norm and attitude

Reducing gamblingThere is little research investigating the

effectiveness of reducing gamblingGadbury et al (93) conducted experiments

with high school students highlighting the difficulties with gambling, it did raise awareness but had little influence stopping such behaviours