A2 Psychology Unit 4

Addiction

Biological Explanation – Initiation and Maintenance• Initiation (genetic)

– Dopamine (neurotransmitter) linked to pleasure and heavily linked to addictive behaviour– Individual has gene causing fewer dopamine receptors

• Could encourage addiction to compensate for natural deficiency of dopamine– Artificially increasing levels

– Evidence – studies on MZ and DZ twins• Han

– Major influence on decision to use addictive substances environmental not genetic• Jang

– Association between genetics and antisocial personality traits– Association between antisocial personality traits and alcohol addiction– Positive correlation between 2 = broken link/association

• Maintenance (neurochemical and bio reinforcement)– Changes in neurotransmitters have profound effect on mood, cognitions and behaviours

• Those experienced as pleasurable could reinforce performing activity hat caused it– Especially when it is dopamine being affected as more released = happier mood

• Explains maintenance of addictive behaviours– Biological positive reinforcement

• Addictive habits cause release of dopamine into limbic system, experienced as reward by brain– Down regulation

• Increasing amounts of stimulation needed the more the addictive habit is repeated to trigger brains reward system– Negative reinforcement

• Physiological and psychological discomfort when withdrawing from substance which are reduced through restarting the habit– Evidence

• Olds and Milner– Found rats would press lever for reward of mild electrical stimulation of brain in pleasure centres

» Choose this over other rewards (food, sex, etc.)– Rats found electrical stimulation more pleasurable than primary motivations– Supports biological reinforcement as shows feelings of pleasure can reinforce behaviour and encourage to continue

• Ashton and Golding– Nicotine stimulates many areas of brain– Has dramatic effect on neurotransmitter levels (reduce stress, increase arousal)– Could reinforce and maintain addiction

Biological Explanation – Relapse and Evaluation

• Relapse (neurological)– Negative reinforcement

• Return to addictive habit to remove uncomfortable withdrawal symptoms

– Impaired prefrontal cortex• Less self-control so may be unable to avoid addictive behaviour after stopping• Only correlational though so can’t infer cause and effect

• Evaluation– Ashton – the brain is very diverse and complicated

• Difficult to pin down a single response

– Orford – social context• Pleasures and escapes associated are highly varied and dependent on person, dose,

situation and society• Addiction varies between individuals but according to biological, everyone should

follow same pattern (deterministic)

– Comings – they don’t all have the gene• Strong emphasis on genetics, environment not taken into account• Some genes do appear frequently though not always there and can be found in

general public as well (individual differences)

Behavioural Explanation – Initiation and Maintenance• Initiation

– Develop addictive habits through environmental change– Operant conditioning (same as biological reinforcement)

• Addictive habits cause release of dopamine into limbic system• Experienced as reward by brain so reinforces behaviour

– Social learning theory• Observe people classed as role models so imitate and model their behaviours, including addictions• Requires operant conditioning after

– Must be conscious of it as we don’t take up addictions because life is rubbish– Explains smoking and alcohol– Evidence

• DiBlasio and Benda– Peer influence very important in development of adolescent smoking– Want to conform to friendship group and model behaviour– Social learning theory as imitating peers behaviours and addictions so want to be like them (peers positive reinforcement as also

accepted by them)

• Maintenance– Operant conditioning

• More behavioural change developed by irregular rather than regular schedule of reinforcement• Delfabbro – Variable-ratio schedule of positive reinforcement

– Rewards provided irregularly so person is aware of reward to be had but unsure when received– Uncertainty combined with desire for reward could easily explain why they spiral out of control

» Person repeats behaviour to give best chance of receiving reward– Addicted to biological esponse

– Negative reinforcement• Continue addictive habits to avoid negative withdrawal symptoms (gamblers going through physical ones)

– Classical conditioning• Object of addiction becomes unconsciously associated with excitement or physical arousal it produces• Become bored/under stimulated when no doing it so continue to repeat behaviour• Drummond – treatment through stimulus discrimination

– Smoker places cigarette in mouth without smoking it, eventually association is removed between object and conditioned response– If it removes the association, there must have been one there at the start

Behavioural Explanation – Relapse and Evaluation

• Relapse– Explanation states addictions learned over time by association/reinforcement– Treatment involves unlearning/replacing behaviours with something new– Means relapse should take as long as original learning did

• Happens very quickly with minimal effort

– Behavioural cannot explain relapse• Evaluation

– Griffiths – conditioning not enough• CC can explain motivation, doesn’t explain continuing• OC can explain ongoing behaviour, doesn’t explain why starting again after free

period without• Conditioning can explain separate parts but not all components together (must be

more to it)

– Delfabbro – where is the reward• Gamblers lose more money than gain so not receiving reward for continuing• Other factors involved (cognitive tricks allow you to ignore it)

Cognitive Explanation – Initiation and Maintenance

• Initiation– Attentional bias

• Look at outcome, ignore the process• Focus mainly on benefits of starting rather than negatives• Your perceived outcome of situation, notice what you want to notice, gamblers only see how much they can win

– Overestimation of personal qualities• Believe they have more control over outcome than they actually do• Overestimate extent they can predict the outcome

– Gamblers misjudge how much money lost

• Think they are strong enough to quit if they start

– Evidence• Griffiths

– Problem gamblers often overestimate amount of skill and control involved in gambling

• Wagenaar– Persistent gambling behaviour often result of over confidence in abilities to win

• Southwick– More positive outlook concerning effects of drugs = more likely to become users

• Maintenance– Griffiths states addicts developed number of heuristics to justify irrational behaviour and maintain in

control• Addicts are never in control

– Hindsight bias• Saying you knew something was going to happen to maintain in control

– Erroneous perception• Believe they are a 1 off/special case

– Personification• Personifying object of addiction• Passing responsibility to inanimate object

Cognitive Explanation – Relapse and Evaluation

• Relapse– Attentional bias

• See cues for addiction, keep thinking about addiction so causes them to relapse• Forget the bad and remember the good

– Overestimation of personal qualities• Believe they are strong enough for “just one more”

– Evidence• Nordgren

– Addicts with highest sense of confidence to control future impulses more likely to relapse 4 months later

• Evaluation– Dickerson and Baron – just trying to explain chance

• Irrational thinking more reflection of demand characteristics than rational underlying behaviour• Most of what people say is result of being unable to create rational and meaningful statements in chance

determined situations

– Griffiths – going through the motions• Cognitive processes don’t play major role in maintenance of behaviour whilst gambling (for regular players)

– Temporal factors are important

• Valid conclusions can’t be drawn between people with different levels of gambling experience

– Griffiths – estimation of control is not always overestimated• Some gambling activities do require some skill level, means player does have some control of outcome• Being aware of strategies/having the skills could be encouragement for player rather than irrational thinking

Vulnerability to Addiction – Risk Factors: Stress

• Everyday stress (more likely to cause addiction)– Addiction way to deal with everyday hassles– Start by having dink in the evening, spans to few drinks until gradually gets worse and becomes full

addiction– Starts as something small to relieve stress but builds over time– NIDA

• These stressors partially responsible for initiation, maintenance and relapse of many addictive habits

• Traumatic stress (not necessarily smoking)– People (especially children) especially vulnerable to forming addiction as coping mechanism for dealing with

severe stress– Severely stressed, could reach point of trying anything

• Drinking/smoking in large quantities causing addiction

– All about escapism and coping methods– Drissen

• 30% drug addicts, 15% alcoholics also suffer from post traumatic stress disorder• Mild trauma not enough to increase chance of addiction formation

• Evaluation– Hajek – do they reduce stress

• Smoking found to increase rather than reduce stress• Stress reduction could just be response to cigarette reducing cravings

– Makes smoking cause and solution to problems

– Cloniger – problems with individual differences• 2 types of alcoholics

– Drink to reduce tension (female prone to anxiety/depression)– Drink to reduce boredom (male risk taker)

• Undermines stress being sole cause because of individual differences between people and cause of it• If sole cause, no differences between people

Vulnerability to Addiction – Risk Factors: Peers

• Social learning theory– Picked up this way– Person learns through watching peers behaviours/actions

• Causes learning same addictions

• Social identity theory– Maintained this way– Wanting to identify with group could lead to formation

• Natural instinct to want to be liked, copy what others do so will be accepted into group• Because it is requirement of the group, reward is being part of it

– Reward not being accepted but being part of the group• Evaluation

– SLT• Duncan

– Exposure to peers who smoking increases chances of adopting this behaviour

• Eiser– Perceived rewards of social status and popularity continue to remain motivators after habit is taken up, can

become powerful motivators to maintain habits

– SIT• Mitchell

– Some teenagers develop addictions as feel it is expected, imitate them to be accepted as part of their social group

Vulnerability to Addiction – Risk Factors: Age

• Brown– Social crowd has greater impact on

smoking/gambling habits in young adolescence• Best friend/romantic partner take over this role later in

life

• Ogden and Fox– Common to use smoking as weight control

strategy in teenage girls• Very similar to peers/used alongside

Vulnerability to Addiction – Risk Factors: Personality• Eysenck – neuroticism and psychoticism

– 3 personality dimensions• Extraversion-introversion (boredom)

– Extroverts chronically under stimulated/bored, seek external stimuli to increase brain activity

• Neuroicism (coping strategy)– Neurotics commonly experience negative emotions like depression and anxiety

• Psychoticism (impulsive/immediately)– Psychotics can display hostile behaviour but also be impulsive and react with little consideration for

consequences

– Argues that any interaction of some/all traits could lead to person easily becoming addicted to wide range of physical/behavioural stimulus

• Evaluation– Belin

• Gave rats button that gave cocaine– One group were sensation seekers, immediately took large doses– Other group impulsive, took smaller doses but more likely to form addictions

• Suggests smaller regular doses = more likely to form addiction– Compared to large doses irregularly

• Done on animals, only looks like drug addiction so may not apply to others, how can you tell what a sensation seeking rat is

– Weintraub• Parkinson’s sufferers given L-dopa which increases dopamine levels

– Showed x3.5 increase in impulse control (impulsive) disorders like gambling and sex addiction

• Suggests dopamine can cause addiction/make addiction worse in people with impulsive disorders

Vulnerability to Addiction – Media Influences: TV and Film

• Another form of SLT• Addiction constantly shown in media

– Often accused of glamorising them– Reasoned because reflecting reality of world we live in

• Could encourage addiction• Dalton – smoking in films

– Found the more adolescents are exposed to smoking in films, more likely to start smoking

• Distefan – likeability of “smoking stars”– Likeability of smoking film stars relates to adolescents fans smoking

• Cape – favourite poison– Films tend to stigmatise drinking and smoking less than other forms of drug taking

• Will – active promotion– Media shows many positive messages about drug use/other potential addictions,

possible that favourable portrayals leads to more use of them by audience• Evaluation

– Does seem to be changes in trend• Alcohol still portrayed favourably, smoking become the “bad boy” of addictions, falling from

favour in media– Any research into the effect of media on addiction need to take into account that the

media responds to what people want to watch• As long as public wants to watch this type of behaviour, media will continue to portray it

Vulnerability to Addiction – Media Influences: Internet Advertising

• Online gambling is big business, websites likely to promote anything that says gambling is a good thing

• The Canadian Study– Popular study in gambling circles– Suggests gambling has beneficial effects

• Shows Cortisol levels drop 17% when players enjoy online gambling as forget stressors in everyday lives– Cortisol linked to number of disorders

– Only mentioned on gambling websites

• Wilde– Gambling companies pay for large amount of research

done into gambling addiction• Actual findings remain confidential

Reducing Addictive Behaviour – Theory of Planned Behaviour

• Attitudes, subject norms and control beliefs lead to intention which leads to behaviour– Attitudes = personal view, subject norms = social influence, control beliefs = feeling of

control• Behavioural attitude – product of personal views

– Persons attitude about addictive behaviour made by• Beliefs about consequences of behaviour (benefit)• Appraisal of the value of these consequences (cost/negative)

• Subjective norms – product of social influence– Persons subjective awareness of social norms relating to an addictive behaviour formed

by• Injunctive norm - what we believe our “significant others” feel about the behaviour• Descriptive norm - perception of what others are actually doing

– Rarely change, impacts many other things– More powerful than other 2

• Perceived behavioural control – over our intention to act/directly on behaviour itself– Greater feeling of control = stronger intention to perform behaviour becomes– Greater feeling of control = harder person will try/longer persevere at behaviour– Most important part but hardest to change

• Personal motivation is what makes a difference but is not mentioned in TPB

Reducing Addictive Behaviour – Theory of Planned Behaviour

• Method for addiction prevention– Intention and attitude have major influence on decision in addictive behaviours

• Manipulation of 2 could be powerful tool for prevention– Changing behavioural attitudes – Slater

• Previous campaigns to lower teenage marijuana use focused on risk avoidance had limited success– Teenagers not risk avoidant

• “Above the influence” focused on effect of drug reducing personal autonomy– Area they care more about

– Changing subjective norms – Wilson• Many anti-drug campaigns expose fact that most people don’t have addiction

– Undermines attitude of “everyone does it”, hopefully changes subjective norm– Changing perceived behavioural control – Godin

• Longitudinal 6 month study showed all 3 influenced intentions– Only perceived control could really predict eventual behaviour

• Many campaigns focus on increasing willpower– But doesn’t really work

• Evaluation– Arnitage – behaviour is not planned

• Theory and research make assumption that person will make rational decision based on perceived facts– Ignores emotions and other irrational fears

– Klag• Clearly explains intention formation, ignores vast array of other important factors• Study on 350 substance abusers, personal motivation major factor in successful outcomes

– Not included in TPB• Social factors are always ignored

– Overly simplistic• Ignores personal motivation• Intention rarely leads to behaviour

– Nomothetic• Trying to explain them all in the same way but doesn’t take individual differences into account

Reducing Addictive Behaviour – Biological Interventions• Antabuse/aversion therapy

– Aversive agent that produces nausea/possible vomiting when combined with alcohol– Very effective when used but need person to continue using them/they have to want to

quit• Agonist maintenance

– Act as less harmful replacement for dependent drug, results in fewer side effects• Allows for gradual and controlled withdrawal from substance/make withdrawal easier• Help addict with essential behavioural interventions that can prevent relapse

– Methadone is long acting synthetic opiate that• Blocks effects of illicit opium use

– Blocks receptors for chemicals• Prevent withdrawal symptoms• Decrease cravings

• Narcotic antagonist– Stop the drug from having an effect– Addict may not take it so have to be actively trying to get off it

• Requires will power• Evaluation

– Effectiveness is questionable• When used in designed way alongside behavioural/psychological treatments can make process

of removing biological addiction easier– If used alone, only effective as long as addict takes drug

• Some addiction so difficult to treat (Heroin), addicts moved onto “less dangerous” addiction (Methadone) to make withdrawal easier

• Only effective when used alongside psychological treatments– Overall effective

• Often see combination of biological and psychological interventions in more holistic way leads to most effective treatment

Reducing Addictive Behaviour - Behavioural Interventions• Aversion and desensitisation

– Aversion therapy• Pairing aversive stimulus (like electric shocks) with specific addiction response

– Could be randomly interspersed while engaging in addictive behaviour– Satiation therapy

• Presents addict with no other stimuli/activities but those associated with addiction– Effectiveness

• All therapies based on principles of cue exposure and relapse triggers– Can remove addictive behaviour but only short term as addiction still present

• If there is underlying cause, removing behaviour leaves chance for other addictions to form– Reduces overall effectiveness

• Griffiths– Case studies where gambling addicts have received aversion therapy have then become alcoholics– Most important factor in any addiction is their social situation– Addictions often caused by something else

• Reinforcement/token economy - Higgins– Subjects had urine tested several times a week for traces of cocaine

• Every time clean, given voucher worth £2.50, increased by £1.50 after each test– Showed traces went back to £2.50– Backed up with counselling so advised how to spend money

– General drug treatment has drop out rate of 70% for 6ws, this had 85% for 12ws and 2/3 for 6ms– Effective as helped to stay off drugs, not appropriate as being paid to stop– Doesn’t always work once reinforcement is stopped

• Evaluation – biological and behavioural therapies– Both treatments show very narrow view of addiction intervention

• Only focuses on addiction itself, ignores underlying causes– Reductionist research clearly identified both biological and behavioural aspects of addiction

• More holistic biopsychosocial approach needed, incorporating these factors with research into underlying causes for addiction formation

Reducing Addictive Behaviour – Cognitive Behavioural Interventions

• Motivational interviewing– Based on cognitive dissonance

• Unpleasant psychological state where person has 2 contradicting thoughts/cognitions

• People want to reduce dissonance so adopt new/change old cognitions– Instruct addicts about problems of dependency/advantages of

abstinence• Encourages contradictory arguments• Use dissonance to encourage them creating own reasons for quitting

– Miller and Rollnick – no addictive personality, everyone can have motivation to quit• Give advice, remove barriers, give choice, decrease desirability, practise

empathy, give feedback, clarify goals, active help– Never tell them that they need to quit

• Express empathy, develop discrepancy, avoid argumentation, roll with resistance, support self-efficacy

– Through positive interviewing techniques, therapist moves addict to point where uncomfortable with dissonance and change behaviour to reduce it

– Is individual to each person so can’t be repeated exactly/follow pattern

Reducing Addictive Behaviour – Cognitive Behavioural Interventions

• Relapse prevention– Marlett and Gordon – works on 2 levels

• Intrapersonal (inside issues)– Unpleasant emotions, physical discomfort, pleasant emotions, personal control,

urges/temptations• Interpersonal (outside issues)

– Conflicts, social pressures• Try to reach a point where these don’t matter

– Positive self-statements• Clients taught to rehearse positive self statements to help confidence in idea of

quitting– Decision review

• Look why you made choice as don’t normally think about it, self-evaluation– Distraction activities

• Simple way of coping with temptation/reducing impact of high risk situations– Not thinking about it = easier to get rid of

• Evaluation– Luty

• Lots of research supporting CBT, doesn’t suggest CBT more effective than any other single therapy– Doesn’t deal with background problem

• Very effective but ignore biological factors– Have to combine treatments for best success

Reducing Addictive Behaviour – Public Health Interventions

• Harm minimisation– Hierarchy of behaviours to reduce level of danger in

addictive behaviour• Don’t use drugs, if you must don’t inject, if you must inject don’t

share equipment, if you must share equipment sterilise injecting equipment before each

– Rather than encouraging to stop, encourage to perform in way that minimises risks

– Providing medically controlled drugs• Give medically controlled drugs as substitute

– Less harmful so helps to improve health, still doesn’t make them quit– Give heroine addicts methadone so we are in control

– Effectiveness• Very effective as addicts can carry on without as many dangers• More effective than other PHI, do have economic/moral

objections– Economic: people don’t want to pay for addicts to continue being

addicts– Moral: people don’t want others to do drugs

Reducing Addictive Behaviour – Public Health Interventions

• Peer-based programs– Bachman – cannabis reduction

• Health protection program asked students to talk about drugs to each other– State disapproval, say they didn’t take them

• Showed others were against drug taking, gave practise in saying no– Changed attitudes towards drugs, had reduction in cannabis use

– Sussman – active learning• Compared effectiveness of teacher lead lesson and ones where students participated (1000 US

students)• Suggested significant changes in attitudes to drugs/intentions to use in participation lessons

– Not teacher lead– Effectiveness

• Not based on sound theory/don’t provide much evidence in effectiveness• Mellanby

– Compared effectiveness of peer-led to adult-led delivering same material– Found peer-led as effective as adult-led if not more so

» Supports working well with peers» Possible because information more easily shared between similarly aged people

• Evaluation– Despite all interventions created, some still give up and relapse

• No right way of treating addiction, just lots of ways that need to be combined to have best chance of success

– Hard to underestimate importance of attempting combined approaches• No single treatment stands out• Medicine/science pursue nomothetic treatment but seems only effctive treatment is more

holistic, individual and ideographic– Orford

• Plenty of evidence that many addicts give up excessive appetites and addictions without help from experts