Addiction

Specification: ADDICTION1. Models of addictive behaviour – (Biological,

Learning and Cognitive approaches) applied to smoking and gambling addictions.

2. Vulnerability to addiction - Risk factors and Media Influences.

3. Reducing addictive behaviour – TPB, interventions and their effectiveness.

A Definition of Addiction

‘Addiction is a persistent, compulsive dependence on a behaviour or substance…Even if it has negative consequences’.

Addictions can be varied e.g. sex, gambling, drugs, or even social media!

Specification: Models of addictive behaviour

1. Biological2. Learning 3. Cognitive

You need to know models for explaining addiction proposed by three approaches. These approaches are: -

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You need to be able to show how each model explains the stages of: -• Initiation (starting an addiction)• Maintenance (keeping an addiction going)• Relapse (returning to the habit)

Components of addiction – Griffiths (2005)

1. Salience – The importance of the behaviour to an individual, all they think about.

2. Mood modification – The experience reported by people whilst carrying out their addictive behaviour i.e. behaviour helps to ‘wake up in morning’ or ‘calm down at night’

3. Tolerance – Increased amount to achieve same effect

4. Withdrawal Symptoms – Unpleasant feelings/physical effects experienced when behaviour stops

5. Relapse – Reverting back to addiction after stopped (esp. when stressed)

Application 1: Smoking addiction

• Smoking dependency is the most prevalent. (Anthony et al,1994)

• Also recognised as a mental disorder in the DSM under ‘dependency on a substance’

Application 2: Gambling addiction

• Estimated that 5% of the adult population have a gambling addiction.

• Higher percentages are found in young adults, mentally ill individuals and the prison population. Shaffer et al (1999)

• Pathological gambling is recognised by the DSM as a mental disorder in 1980.

Principles: Genetics and biochemistry- Initiation, maintenance and relapse

– inc. case studies

The Biological Model

1. The Biological Model

a) Neurological influences b) Genetic

influences

1. The Biological Model

• This model covers brain function (in the form of neurotransmitters) and inherited predispositions (via our genes).

• There is a complex relationship between the two.

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Brain function is controlled by a network of neurons that are stimulated by biological and psychological triggers. Each neuron relays its activation to the apporpriate neighbouring neuron across a synapse (gap bridged by chemicals).

Neurological - What happens at a ‘synapse’ (gap between neurons)?

Electrical impulse triggers the release of a neurotransmitter. This crosses the synapse and triggers the electrical impulse in the next neuron.

Neurotransmitter level sensitivity• Natural thresholds are set for appropriate quantities of neurotransmitters

to be released. Certain drugs alter these thresholds and impact on the neurological pathways.

• Activities that stimulate high neurotransmitter release can have the same effect as taking drugs.

• These alterations have behavioural and mood consequences.

The link between types of neurotransmitter, behaviours and addictions...

(Neurotransmitters are next to the red arrows).

Neurotransmitter effects

Categories of Neurotransmitter

• EXCITATORY Transmitters: Glutamate, Aspartate.

• INHIBITORY Transmitters: GABA, Glycine.

• OTHERS: Noradrenaline, Adrenaline, Dopamine, Serotonin, Actylcholine, Histamine, Endocannobinoids - Endogenous Opoid Peptides - Enkaphalins, Endorphins, Dynorphins.

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These chemicals operate in a homeostatic way to keep brain function in balance. This means that compensation occurs if thresholds are artificially raised. This is very significant in addiction.

How transmitters work e.g. DOPAMINE

• Dopamine is the neurotransmitter most commonly associated with addiction.

• It is similar to adrenaline in that it affects brain processes that control: -– movement– emotional response – the ability to experience pleasure and pain. • Both the ‘highs’ and ‘lows’ of addiction can be explained at

the activity of neurotransmitters such as Dopamine.

Neurotransmitter level sensitivity• Natural thresholds are set for appropriate quantities of

neurotransmitters to be released. Certain drugs alter these thresholds and impact on the neurological pathways.

• Activities - such as gambling - that stimulate high neurotransmitter release can have the same effect as taking drugs.

• These alterations have both behavioural and mood consequences.

• Dopamine levels can be effected in two ways: - a) Increased release of dopamine.b) Prevention of its re-uptake at synapses, leaving more.

Once the dopamine has been removed from the synapses (re-uptake) this pleasant feeling disappears.

In order to regain it, one needs to take more of the substance. If the substance is used repeatedly, the body adapts to higher

levels of dopamine. Both the rate at which it is broken down and its re-uptake are increased.

This means more of the substance is required to produce the same effect.

This threshold adjustment is known as ‘tolerance’.

Neurological - DOPAMINE

DOPAMINE – The link in addiction

• Addictive drugs differ in the following ways: -– They activate different neurotransmitter systems.– They produce different psychoactive effects.– Heroin acts on the opiate system.– Whilst nicotine acts on the cholinergic system.– Cocaine acts on the dopaminergic and noradrenergic

systems.

• However, all either stimulate dopamine release (heroin, nicotine) or enhance dopamine action (cocaine) in the nucleus accumbens.

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b) Genetics• It has been suggested that

predispositions to some addictions are inherited. This can be investigated by examining concordance rates in identical (MZ) twins.

• Twins separated at birth and raised in different environments provide the best evidence for genetic predispositions.

• If addiction was totally genetically controlled, one would expect to find 100% concordance.

Genetics - Is addiction pre-determined?

Typically, concordance rates in genetically identical twins (MZ) are around 50 - 65%.

This suggests that addiction is not inevitable, though vulnerability to addiction may well be?

Genetics - ‘Pedigree’ research• A pedigree is a genome analysis. It can reveal whether or not a

trait has a genetic component. That is, whether or not addiction is passed down from parent to child by way of genes.

• Researchers can construct pedigrees of large families with addiction, as a first step to understanding the ‘disease’.

•They begin by comparing DNA sequences of individuals who have the disease with those who do not. They can then narrow down the possibilities to identify a small number of so-called "candidate genes" for addiction.

Source:http://learn.genetics.utah.edu/content/addiction/genetics/

• There are many ways that genes could cause one person to be more vulnerable to addiction than another: - 1. In initiating addictive behaviour.2. In continuing with additive behaviour.3. Easily activating the reward system.4. Intense or easily accessible feelings of pleasure.

• There could well be a specific gene/s for each!

• Remember: Susceptibility to addiction is the result of many interacting genes and is a very complex trait. Many factors determine the likelihood that someone will become an addict.

Genetics – Comings (1996)• 48.9% of smokers compared to

25.9% of general population carried A1 variant of DRD2 gene.

• supported by A1 variant of the DRD2 dopamine receptor linked to severe alcoholism (Noble et al, 1991)

• A1 variant means less dopamine receptors

I am a Nobleman

(NOBLE 1991)

1. InitiationBIOL

Initiation - neurotransmitters

Initiation introduces new levels of a neurotransmitter. This stimulates the ‘mesocorticolimbic dopamine pathway’ (MDP) – REWARD pathway - and a sensation of intense pleasure is experienced. Experience of pleasure provides motivation to further engage in the addictive activity.

SLC6A3-9 = Socks, locks, clocks, 6 Add 3 = 9

Genetics – Lerman et al (1999)

• Found that people with SLC6A3-9 gene are less likely to take up an addiction than someone without the gene

Im a LERRRMAAANN (1999)

Biological – Genetics and biochemistry

• Family and twin studies regarding alcohol dependency found heritability at 50-60% (McGue, 1999).

• An example of a gene that is linked to addiction is the A1 variant of the DRD2 gene…

Supporting research – Kendler et al (2004)

• Investigated genetic risk and family conflict re nicotine addiction.

• 1676 female twin participants.• No. of cigarettes smoked in lifetime

calculated.• Self report interviews on family and twins.• Found that increased family

conflict correlated with increased smoking levels.

• Also found high levels of heritability.

Supporting research - Blum et al (1991)

• Blum et al found that the A1 variant of the DRD2 gene had higher prevalence in families with history of alcoholism.

• Also fewer dopamine receptors seemed to be present in the ‘pleasure centres’ of their brains.

• Therefore, they suggested users are predisposed to seek behaviours that increase their dopamine levels, e.g. drinking.

2. MaintenanceBIOL

Maintenance – The role of Neurotransmitters

• Dependence develops when neurons adapt to changed levels and only function normally in the presence of chemicals from the new ‘addicted state’.

• The neural pathways in the brain have adjusted to need the substances generated from the addictive activity, in order to function.

• Without the substance/activity that generates the new levels of neurotransmitter, the user experiences withdrawal and intense cravings. This motivates the individual to engage in the addictive activity to reduce these negative sensations.

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Maintenance – The role of Desensitisation

• When the brain is activated excessively and repeatedly neurochemical homeostatic changes result in dopamine receptors becoming less sensitive. This means that more dopamine has to be generated to achieve the same effect.

• Not only is a greater amount needed, the desire for it is also heightened too – a double whammy!

• Addicts need larger and more frequent doses to achieve the desired effect.

Maintenance smoking – Fowler et al (2007)

• 1214 twin pairs• Investigated to see importance

of genetics with initiation of alcohol, nicotine and cannabis addiction

• Found environmental forces were more important

• However, genetics influenced EXTENT of the addiction

Maintenance – Smoking, Schachter (1977) – Nicotine regulation

• Smokers regulate their nicotine intake.• X11, 34-52 year olds, smoked ‘high’ or

‘low’ nicotine content in alternating weeks.

• Heavy smokers smoked more low-nicotine cigarettes.

• Light smokers did not appear to regulate consistently.

• Has applications to real life e.g. taxing cigarettes according to nicotine content.

Maintenance Gambling – Meyer et al (2004)

• During casino blackjack gambling, heart rate and noradrenaline/norepinephrine measured

• (which cause inc. heart rate/bp/pupil dilation – fight or flight response)

• …become elevated to a greater degree in men with gambling problems as compared to those without (Meyer et al. 2004).

Tolerance – As tolerance builds, you need more of behaviour to get same buzz.

Low dopamine – People with addictions may have either low levels of dopamine, or fewer receptors than most, causing them to need more of a substance to get the same feeling.

Maintenance:

3. RelapseBIOL

RelapseWithdrawal Symptoms – Unpleasant symptoms

In gamblers – Withdrawal symptoms can be physical (Rosenthal and Lesieur, 1992 found that extent of symptoms positively correlated with no. of hours spent gambling)

In smokers – Those with a sensitive mesolimbic pathway are more susceptible to relapsing

Also, Lerman 2007 found that smokers had increased CBF (cerebral blood flow) which could lead to relapse

=

CBF 2007

The story of John & James.• John Crawford has an identical

twin. His 16-year-old brother, James, is his clone.

• John has brown hair, brown eyes, and a cheeky smile. So does James.

• John weighs about 160 pounds. Ditto for James.

• The brothers walk the same, talk the same—their friends tease them because they even laugh the same.

The reason, of course, is that identical twins share exactly the same genes, those tiny units of hereditary material (DNA) that carry instructions for forming all the cells in the body, directing their activity... and for behaviour and emotions?

Can addiction run in families? Let us assume John & James have a parent who struggles with alcoholism…

Q: Are they destined by genetics to face the same fate?

A: Well the good news is that no single factor determines whether a person will become addicted to drugs. That’s because genetics, biology, and environment all influence a person’s risk for addiction (defined as a chronic yet treatable brain disease characterized by compulsive seeking and use).

• So… while the saying may be that substance abuse, in particular , “runs in the family,” as we will see later, a whole list of other risk factors, in addition to genes, determine whether a person actually gets hooked: -

– Age – Presence of other diseases – Diet– Stress– Peer pressure

Research evidence• Small et al. (2001) – used brain imaging to discover eating

chocolate was associated with increased blood flow in the MDP. Motivation to eat more chocolate activated the same parts of the pathway as did drug cravings.

• Comings et al. (1996) – concluded that neurotransmitters play a role in behaviours such as gambling.

• Koepp et al. (1998) – concluded neurotransmitters were implicated in addiction to video game playing.

The AAD Model• There has been a historical negative stereotypical view of addicts. This view

presupposes that addiction is a disease with biological and environmental origins (Hammersley 1999).

• It is known as the Addiction As Disease model (AAD).

• This view labels people, undermines the development of self-control and stigmatizes them.

It’s assumptions: -• Addiction is an illness• The problem lies in the individual• The addiction is irreversible• You cannot be ‘slightly addicted’

I’ve got a disease

Evaluation of neurological explanations

Friends• Helps to account for vulnerabilities and

susceptibilities and also provides information on why some may relapse more than others (individual differences).

Foes• Neurotransmitters have complex

effects which are not fully understood. Which neurotransmitters produce which rewards? Nicotine can negatively effect memory and learning and increase arousal but also positively reduce stress...thus it is difficult to assess.

• Social interaction is underrated. Social contexts as a motivator - e.g. Vietnam soldiers took drugs but stopped once back home (Robins et al 1975).Don't forget other

evaluative points too!(Methods, IAD, Keywords etc.)

More neurological model evaluation (AO2)

Reliability:+ Objective – empirical evidence, such as Lerman (2007) using brain scans to measure CBF. Repeatable and consistent methodology.

• + Application to everyday life – Can affect anybody, provides treatment of symptoms.

• + Treatments have a rapid effect.

• - Doesn’t combat the cause of the addiction. Symptoms treated with drugs.

Reductionist: – Simplified into genetics

and biochemistry. Ignores psychological or social dimensions

Deterministic: – the AAD model could cause passive patients, with no sense of responsibility.

The COGNITIVE model of addiction

Cognitive models of addiction• Cognition is thinking – information processing.

• The Cognitive model sees addiction as due to ‘distorted thinking’ relating to ‘dysfunctional beliefs’.

• These faulty processes relate to mood and impaired decision making abilities and can be self-fulfilling.

• A person may come to rely on drugs or even gambling as a way of coping with life’s problems.

• When these coping mechanisms are used excessively they may create more problems than they solve.

Outcome of faulty cognitions

• Faulty thinking leads addicts to: -

a) Focus on positive features of their habit.b) Minimise the negative consequences.c) Have impaired decision making abilities.

• There is a focus on the immediate benefits and ignoring of the long-term downside.

Cognitive explanations of gambling.

Faulty Thinking• “I will win, I can control the

odds, if I use my lucky numbers I'll be rich one day.”

Irrational biases• Overestimate the extent to

which they can predict or influence the outcomes. This also leads to a under estimation of how much has been lost/won.

• See Griffiths (1994) Gamblers irrational cognitive biases.

How do Heuristics apply to addictions e.g. Gambling?

• Rule of thumb :The usual rules apply.

• Hindsight Bias: ’I knew that would happen’

• Flexible attribution: ’I’m really good at Blackjack, I lost on the roulette because of the other bloke’

• Absolute frequency bias: ’I dont think about the losses...I won loadsa money.....’• Availability bias: Look how many people have won the lottery....loads!!

1. InitiationCOGNITIVE

Initiation of smoking and gambling – Gelkopf et al, 2002

• Individuals intentionally use drugs to treat psychological symptoms from which they suffer.

• It’s perceived as being helpful to the individual.

• They could smoke to relieve stress/anxiety, and gamble to relieve depression, for example.

Theories

1. The Relapse Prevention Model (RP)• Dependency starts with a perception that ‘discriminative stimuli’ can

identified that are associated with a positive outcome.

• This perception provides the motivation to start the behaviour and then maintain it..

• Relapse occurs when this perception has not been modified, so the addition is still relied upon to provide the positive experienced in the past.

• This model suggests that relapse will NOT occur if the beliefs/thinking about reward have been modified AND (most importantly) the belief/thinking that they do actually have the capacity to deal with the trigger.

Initiation:

Expectancy – Smokers may think they look cool.

Relieving boredom Positive feelings

2. MaintenanceCOGNITIVE

Theories

2. Cognitive Dissonance• This is the conflict between two opposing beliefs e.g….

“I am a drug addict”+

“I want to be drug-free”

• People are suggested to cope with this conflict by establishing some sort of justifying criteria (belief) for their failure to change . This belief is used to support why they have no choice but to maintain their addiction.

E.g. I don’t have the will power/I always fail.

3. Beck el al (2001) ‘The Vicious Circle’

• Low mood can be relieved by addictive behaviour.• Addiction can lead to problems.• These problems lead to low mood.• The circle begins again...

Low mood Using (smoking / gambling)

Financial, Medical, or social problems

Theories

Maintenance - Cohen and Lichtenstein (1990):

• Vicious circle – Smoking alleviated stress, causes illness, creates stress

4. COPING: The Self Medication Model

Initiation: • Individuals intentionally use the addictive behaviour to

cope with stress / psychological problems. • The particular addiction is not chosen at random but has

been selected as it is perceived to help a specific problem. • It fulfils 3 major functions: -

1. Mood regulation2. Performance management3. Distraction

Maintenance and Relapse: • Many smokers mention ‘stress relief’ as a major reason

why they persist with their habit.

Theories

5. Self Efficacy Theory - Bandura (1997)

• Self-efficacy refers to a belief in oneself to be able to organise and control any actions that are required to meet particular goals.

• Self-efficacy plays an important part in whether or not a person will start to engage in addictive behaviour (initiation)…and whether they believe they can do anything about it once established (maintenance and relapse)

Theories

Key Research

Cognitive bias in fruit machine gambling - Griffiths (1994)

• Compared 30 regular gamblers with 30 non regular gamblers and measured their verbalisations as they played a fruit machine.

• Regular gamblers believed they were more skilful than they actually were and were more likely to make irrational verbalisations during play (e.g. “putting only a quid in bluffs the machine”) they tended to treat the machine as if it were a person (e.g. “this fruity is not in a good mood”).

• They also explained away their loses by seeing ‘near misses’ as ‘near wins’. Something which justified their continuation = irrational thinking.

Maintenance of smoking – Tate et al, (1994)

• Showed withdrawal symptoms were based on expectancy i.e. they were mainly psychological

• as by telling a group of smokers they would expect no negative experiences during a period of abstinence

• It led to fewer somatic and psychological effects than a control group.

3. RelapseCOGNITIVE

Relapse – Self medication in smoking and gambling:

• Self medicate in times of…

• Stress (smoking)

• Crisis (gambling)

Relapse:Coping – Withdrawal symptoms may make it difficult to cope

with everday life without the emotional support of the substance.

Expectancy – especially with smoking, it may seem easier to quit 2nd time around?

Excitement – life without gambling may seem dull?!

Evaluation of the COGNITIVE Model

Strengths

Cognitive explanations help explain individual differences: e.g. millions of people have gambled but not all get addictive, as not all develop faulty cognitive biases (irrational thinking patterns)

Weaknesses

Griffiths (1994) – found that regular players seemed capable of gambling without attending to what they were doing (on auto pilot), -they weren’t thinking about it.

This suggests that cognitive process were not a major role in the maintenance of their addictive behaviour.

Evaluation of the COGNITIVE Model

Weaknesses contd.

• Publication Bias - Many studies have supported a link between positive expectations and drinking behaviour and other drug uses.

• However studies which have failed to show a link may not have been published, which means we gain an unrepresentative view of the research area

Cognitive explanations may be limited to particular addictions

Have less effect in chemical addictions (smoking), but more of a pronounced effect in gambling

Evaluation of the COGNITIVE Model

Cognitive model AO2• Free Will – Individuals may

feel they can change but also may feel they’re to blame.

• Ecological validity/Application to real life – Addictions affect lots of people in populations.

• Treatments – If it’s based on faulty thinking, it should be possible to be cured.

• Social desirability bias – people may lie about how often they smoke/gamble, could affect reliability.

• Subjectivity – Methods of diagnosis are not scientific.

• Self-report methods used to gather data, lowered reliability, increased subjectivity.

LEARNING THEORY

• According to this approach, addiction is a learnt behaviour.

• It is acquired via CLASSICAL, OPERANT or SOCIAL LEARNING.

Reinforcement and biology - a crossover!

• Classical and Operant conditioning involves stimulating pleasure centres in the brain.

• Research: Olds & Milner (1954) discovered rats would press a lever for the reward of mild electrical stimulation in specific areas of the brain (artificial). They also pressed the lever for stimulation of other rewards such as food or sexual activity (natural).

Role modelling?

Social Learning

Things that make you go hmmm!!!

• Pleasure is an important factor in healthy development. Would you eat McDonalds/bar of chocolate again if it were not pleasurable?

• These feelings act as reinforcers...therefore pleasure encourages essential behaviours... or in some cases unhealthy behaviours.

1. InitiationLT

Initiation (smoking) – Vicarious reinforcement

• Bandura said we learn through vicarious reinforcement, which is the observation of others.

• We learn from our peers and parents etc .

Initiation (gambling) – Glautieret al (1991)

• Classical conditioning – Good feeling from addictive behaviour, associate the two

Initiation (smoking/gambling) – White (1996)

• Positive feelings – act as positive reinforcement for the behaviour (operant conditioning) – due to dopamine in the mesolimbic system

• Takes a biological approach too! OOHH SYNOPTICITY?!

2. MaintenanceLT

Maintenance (smoking) – Classical Conditioning of a daily ritual

• When you do certain things at the same time of day, such as smoking in the mornings,

• You become classically conditioned to do it

• Association is hard to break• Like cue reactivity! Where

you see something associated with behaviour e.g. pub for alcoholics

Maintenance gambling – Cue reactivity

• Seeing something associated with behaviour, e.g. scratch card or ‘bookies’ for gamblers, brings back the initial ‘buzz’, making it hard to resist.

Maintenance of gambling – Operant conditioning

• Gambling is maintained through small wins, which provide operant conditioning via positive feelings. $ $

Maintenance (smoking/gambling) – West, 2006

• Approach-avoidance conflict where the addict wants to both use the drug/carry out addiction but also to avoid it because they know it is wrong

• And there may also be negative side effects

• Both positive and negative reinforcers for operant conditioning

3. RelapseLT

Relapse (smoking) – Cue reactivity, Glautier et al (1991)

• Alcohol-related stimuli (sight or sound of a pub) were shown to cause the same physiological responses as alcohol itself e.g. increased heart rate and arousal.

• Could be generalisable to other addictions?

• Can also apply to ‘maintenance’.

Relapse (smoking/gambling) Marlatt and George (1984)

• Marlatt and George found that multiple trigger cues increase the chance of relapse.

• If an addict comes into contact with a trigger cue of substance, after a period of abstinence…

• They gain classical conditioning – an association with the trigger, making them more likely to relapse.

Relapse – Negative reinforcement (operant?)

• To avoid the negative reinforcement of withdrawal symptoms.

• Could link to the fact that Rosenthal and Lesieur (1992) found a positive correlation between the number of hours spent gambling and the extent of their withdrawal symptoms.

Learning theory AO2• Nature/nurture? Based

on nurture, as it’s the idea that behaviour is learned from the environment. We are regarded as being born as a TABLEAU RAZA (blank slate)?

• Subjective – based on observational methods

• Reductionist – Doesn’t consider individual differences, or extraneous variables.

VULNERABILITY TO ADDICTION

Areas covered: -

a) Individual Differences- Personality- Stress- Peers- Ageb) - The influence of the Media

Personality factors – Self esteem

Refers to what an individual feels about themselves, for example their confidence, and feelings of self-worth.

Research suggests individuals with low self-esteem are more prone to addiction.

Found a negative correlation between self-esteem in boys and frequency of cannabis use – Valeskaet al (2009)

I hate myself

Self esteem – Kaufman and Augustson (2008)

To investigate factors influencing smoking behaviour...

• x7000 girls aged 13-18.• Assessed regarding self-esteem,

perceived weight, and whether they were trying to lose weight or not.

• Questionnaires were used.• After ONE YEAR, those with low self-

esteem were more likely to smoke.

son

Kaufman and Augustson (2008) AO2

• Large sample size.• Longitudinal study.

• All girls• Longitudinal study• No cause/effect can be

established.• Questionnaires were

used, which can be subjective.

• May also be influenced by social desirability bias?

Personality factors – Attribution theory

Proposes that behaviour is down to:

1. Situational attributes (external factors which cannot be controlled, such as peers/work).

2. Dispositional attributions (internal factors the individual can control, such as self-esteem).

However, we are more likely to use dispositionalattributes to blame others for their addictions, and usesituational attributes for ourselves = ACTOR-OBSERVEREFFECT.

Attribution theory – Hatgis et al (2008)

• Internal attributes (dispositional) about drug taking varied between a) those who had never taken drugs before and b) those who had experienced drugs or had friends that experienced drugs before.

• Internal attributes more common with cannabis use than alcohol or heroin.

Attribution bias – Seneviratne and Saunders (2000)

Investigated attributions by alcoholics.• 70 alcoholics were interviewed to find out

reasons why they themselves relapsed after abstinence. These were compared to their assessments of 4 relapse scenarios of other people:

• Situational attributions were used for alcoholic’s own relapse, such as party: everyone was drinking.

• Dispositional factors were given for the other scenarios, such as lack of will power.

• Shows actor-observer bias.

Vulnerabilities – Stress

Everyday stress:• People smoke, gamble, and

drink to deal with stress/daily-hassles.

• Stresses could lead to addiction, and add to both maintenance and relapse.

Traumatic stress:• PTSD (post-traumatic-stress-

disorder) linked to addiction

• Driessenet al (2008) found that 30% of drug addicts and 15% of alcoholics suffer from PTSD.

Vulnerabilities - Stress AO2

• Relates to real life as many people have addictions, therefore has ecological validity

• Arguably, has mundane realism.

• Quantitative data was collected on those with PTSD, which increases reliability etc.

• Individual differences (hardiness etc.).

• Extraneous variables.• Simplistic? Only looks at

stressors, not biology?

Vulnerabilities – Peers

Social Identity Theory:• States that the in-group will

discriminate against the out-group to enhance their self-image.

- Normative behaviour

Social Learning Theory:• States that social behavior

(any type of behavior that we display socially) is learned primarily by observing and imitating the actions of others

- Vicarious reinforcement

Splits into Social Identity Theory (SIT) and Social Learning Theory (SLT)

Vulnerabilities – Peers• Eiseret al (1989) – Positive rewards such as

popularity and social status (smoking), smokers befriend other smokers (Eiseret al, 1995) – SIT

• Duncan et al (1995) – Exposure to peers that carry out behaviour increase likelihood of smoking – SLT

• McAlister et al (1984) – Smoke due to increased popularity and peer approval - SLT

Vulnerabilities – Age

• Brown et al (1997) – Close friends and romantic partners are influential on attitudes and behaviours. Peers more likely to influence you in adolescence.

Botvin (2000) – More prone during adolescence.

Individual differences?

MEDIA INFLUENCES ON ADDICTIVE BEHAVIOUR

Promoting addictions – Sulkunen (2007)

• 140 scenes from 47 films were analysed.• All included scenes of either alcohol, drug, sex,

gambling or tobacco use.• Films such as ‘American Beauty’ and

‘Trainspotting’ depicted drug use in a positive light, compared to the ‘dullness’ of real life.

• Historical validity? Smoking rules are harsher today.

• Individual differences disregarded?• Lots of different films used.

Prevention - In film - Boyd (2008)

• Contrary to Sulkunen (2007) who said addictions were shown positively, Boyd found “films do represent the negative consequences of addiction” shown through…- Physical deterioration

- Sexual degradation

- Moral decline

Attempted prevention - Anti Drugs Campaign – (1998-2004)

• Aimed to educate US youths to reject illegal drugs, to prevent initiation of drug use, and to stop those already using drugs.

• Raised self-efficacy (self help) and showed the negative consequences of drug use

• Hornik et al (2008) examined results, which lead to an increase in marijuana use… (awkward!)

Promotion - Boyd contrasted by – Sargent and Hanewinkle (2009)

• 4384 adolescent participants (11-15).• All were surveyed to see whether or not they smoked.• All were exposed to watching smoking in movies over one

year.• Findings: Whether or not they had smoked previously was a

strong predictor that they would still be smoking at the end of the year.

Ethical issues (could cause smoking = harmful to participants)Social factors not considered (reductionist).Longitudinal study.

REDUCING ADDICTIVE

BEHAVIOUR

Theory of Planned Behaviour (TPB) (cognitive)

Attitude:Assessment and evaluation

of outcome of behavior

Subjective norm:Motivation to meet

perceived expectations of important others

Perceived behavioural control:

Perception of how easy/hard it would be to

carry out behaviour

Behaviour intention Behaviour

Actual behavioural control

Theory of planned behaviourTerm Definition

Attitude What the person believes the outcome of the behaviour will be – i.e. whether it’s going to give them a positive, or negative outcome.A smoker may think that they’ll gain popularity, or seem ‘cool’.

Subjective norm What ‘significant others ‘(friends/peers) think of the behaviour. This affects you because you want to comply with social expectations.If your friends smoke, you may do also.

Perceived behavioural control Whether behaviour is easy or hard to carry out.If you’re 18+, going and buying cigarettes is pretty easy.

• If you have a positive outlook regarding relevant attitudes, perceived behavioural control, and also want others to accept you, you are likely to carry out the behaviour.

Supporting TPB – Marcoux and Shope (1997)

• Large sample of 14 yr old participants.

• Using TPB to predict their alcohol use.

• Peer pressure/peers were significant variables.

• The model led to recommendations for prevention of alcohol abuse

• Reducing how readily available alcohol was (taking control away from individual)

Supporting TPB – Wall et al (1998):

• Used TPB for undergrad. students

• Useful in predicting excessive drinking

• Researchers believed it could be improved if it included gender-specific alcohol outcome expectancies.

Refuting TPB – Ogden (2003):

• Major fault of TPB is that it uses self-report methods

• Could be affected by social desirability, and make the reliability questionable

• However, there isn’t really another way to test opinions/beliefs.

• Subjectivity may therefore be OK?

Biological treatments - Agonist:

Agonist – maintenance/substitution treatment:- Maintain effects of substance using a safer drug- Manages withdrawal symptoms

e.g. Smoking – NRT (Nicotine replacement theory… Patches/gum, maintains nicotine in prefrontal cortex of mesolimbic system

Drugs – Methadone (can be used alongside counselling too!

Biological – Antagonist:

Antagonist – blocks the effects of substances on the brain, so no longer get the ‘buzz’

e.g. Smoking – Buproprion(SSRI – selective serotonin reuptake inhibitor)

Heroin (opiates) – Naltrexone

Antagonistic treatments are usually used as more of a last resort.

Biological treatments – AO2:

• Biological• Safer than the opiates

or tobacco• Cheap• Quick/fast• Deterministic –

removes blame from the patients

• Still reliant on a drug (agonist)• Drug can become addictive also• Side effects• Black market for methadone• Methadone can kill you• Reductionist, should be catered

to an individual’s needs• Individual differences doesn’t

look at social/psychological, treatments may not be appropriate

• Deterministic – patients may feel they can’t be cured

Psychological treatments:

Classical Conditioning:

Aversion therapy

• Owen (2001) – Assessed aversion therapy in alcoholics

• 82 hospitalised alcoholics• 5 treatments over 10 days• Given emetic (makes you sick)

after alcohol (of their choice)• Followed by behavioural &

cognitive questionnaire• Positive alcohol-related

behaviours were reduced• Found to be effective

‘Associating an addictive behaviour with something negative’

2001

Classical Conditioning:

Aversion therapy

• Kraft & Kraft (2005) – Used hypnosis to pair addictive behaviour with nausea

• Only 4 sessions (Cost effective)

• Long term success = questionable

‘Associating an addictive behaviour with something negative’

& 2005

• Siegel et al (1987) said once put back into a real environment, physical & mental changes led to relapse

Aversion therapy AO2:

• Fast, cheap treatment• Shown to work with

alcoholics (Owen 2001)- wasn’t so reductionist

due to both treatment & questionnaires

- However, was subjective

• Individual differences• Reductionist• May not be long-term• Siegel et al (1987) said

once put back into a real environment, physical & mental changes led to relapse

• Ethical – protection from harm

• Consent?

Cognitive Approach:

Cognitive behavioural therapy (CBT)

• Killen et al (2008) - found CBT + telephone counselling was more effective than phone counselling alone.

(who becomes a psychiatrist with the surname ‘killen’ ? I mean seriously)Talking about your

problems. According to Curran and Drummond (2005), CBT is main treatment for alcohol and cannabis dependency

2008

Cognitive Approach:

Cognitive behavioural therapy (CBT)

• Cavalloet al (2007) compared

- weekly CBT @ 45mins- to behavioural counselling

for 10-15mins 3x a week• CBT was more effective for

adolescents who wanted to stop smoking

Talking about your problems. According to Curran and Drummond (2005), CBT is main treatment for alcohol and cannabis dependancy

Cognitive Approach:

Cognitive behavioural therapy (CBT)

• Jiminez-Murcia et al (2007)• Treated 290 pathological

gamblers with CBT over 16 weeks

• After 6 months, success rate was at 80%, but noticed drop-outs & relapse towards the end

• (More so with obsessive compulsives)

Talking about your problems. According to Curran and Drummond (2005), CBT is main treatment for alcohol and cannabis dependancy

Spanish Jiminy = Jiminez

2007

Cognitive approach AO2:

• No ethical issues• Uninvasive• No side effects

• Relapse & attrition & individual differences – Jiminez-Murcia et al (2007)

• Time consuming• Gotta train to do CBT• Individual differences

Operant conditioning:

Contingency management (CM)

• Krishnan-Sarinet al (2006)• Looked at CBT and CM• 28 adolescent smokers who wanted to quit,

randomly allocated into:1. CBT group2. CBT + CM group• Programme lasted 1 month• Urine samples tested• CBT + CM group given money twice a day for

first 2 weeks. Frequency decreased for next 2 wks

• After 1 week, abstinence:CBT + CM = 77%CBT = 7%

• After the month, abstinence:CBT + CM = 53%CBT = 0%

Rewarded for sticking at something e.g. Getting money for not taking heroin

Operant conditioning:

Contingency management (CM)

• Higgins et al (1994)• USA• 28 cocaine addicts (all white males

from Vermont)• Urine tested• Clear urine = money reward• Money increased the more clean

samples in a row• Given advice on best ways to spend

their vouchers• Norm drug programme drop-out rates

= 70% within 6 weeks• This programme: 85% stayed 12 weeks

2/3 stayed 6 months!

Rewarded for sticking at something e.g. Getting money for not taking heroin

Contingency management AO2:

• Shown to work • Objective – Urine

samples in Krishnan-Sarin et al (2006)

• Small sample size• Reductionist• Ecological validity?

Would a voucher scheme work widespread? – political palatability

• Higgins (1994) – all white males, from Vermont = cultural bias + androcentric

Public health interventions and legislation:

Group counselling – Crits-Christophet al (2003):

• National Institute of Drug Abuse (NIDA) study• Trying to intervene with social and personal problems

associated with drug abuse• 487 American patients randomly assigned to one of four

groups of various sorts of counselling• They found:- All treatments led to decrease in drug abuse- Combination therapies were most successful- Worked best if they were told how to adopt more

positive behaviours, and healthy relationships

Doctors advice – Russell et al (1979):

• Looking at dr’s advise to help smokers quit• Carried out a study in five doctors’ surgeries

over 4 weeksTreatment offered:1. Follow up session – 0.3%2. Questionnaire about smoking habit + follow up – 1.6%3. Dr’s said to stop, questionnaire + follow up – 3.3%4. Leaflet, Dr said, questionnaire + follow up– 5.1%

• More help they get, better treatment

Helplines – Platt et al (1997):

• Assessing effectiveness of smoking helpline (Smokeline) in Scotland

• 848 of adult smokers, followed up 1 year after their initial call

• 143 of the 848 sample (nearly 24%) reported they’d stopped smoking

• 88% said they’d ‘made changes’• During the 2nd year, smoking prevalence was

6% lower than it was before the campaign• It reached a lot of people, and helped them.

Yay.

1997

Public Health AO2:

• Shown to work, especially Platt.

• Some addicts may not feel they can reach the support they need

• Individual differences• Issues in assessing the

impact• Reductionist – not

including biological