A level - Addiction


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  • Created on: 06-03-18 18:12
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  • Addiction
    • Risk factors
      • Family
        • Research shows that teens with substance abusing parents, are more likely to abuse drugs themselves
          • Parents may become a risk factor through their parenting style, in terms of the degree of 'parental control' and 'parental warmth'
            • Authoritative parenting, less chance to abuse of substance
        • Evaluation
          • Evidence  support for the importance of family influences on substance abuse and addictive behaviour
            • Bahr (2005) found that family characteristics that were mostly associated with an increased prevalence of binge drinking, smoking and drug use were tolerant parental attitudes and sibling substance use
              • Also found that teens with parents who were tolerant of substance use, were more likely to interact with peers who smoked, drank or used illicit drugs
                • Meaning the teen will be more likely to seek the company of peers that endorse substance abuse
          • It may be that alcohol and drug use may result in a withdrawal of parental involvement, rather than particular parent-teen interaction
            • Kerr (2000) suggested that a lack of parental monitoring may result from teen disclosing too much information about their substance abuse to their parents, parents inability with this information may cause them to stop monitoring children who they perceive as already beyond control
      • Genetics
        • Some born with genetic vulnerability to substance abuse
        • Slutske (2010) Gambling: interviewed 2889 twins pairs, investigating genetic factors in gambling addiction
          • Male MZ heribility estimate 49%
            • DZ 21%
          • Female MZ 55%
            • DZ 21%
        • Vink (2005) Nicotine: studied 1572 Dutch twin pairs to investigate genetic factors in nicotine addiction
          • Both genders, individual differences in initially starting smoking was by genetic 44%, and environmental 56% influence
            • Likelihood of becoming addicted, influenced mainly by 75% genetics
        • Those more vulnerable to addiction, have abnormally low levels of dopamine, and decreased ability to activate dopamine receptors in reward areas of the brain
          • Meaning, anything that increases the amount of dopamine, produces strong feeling of euphoria (feeling really good)
            • Blum (199) found particular variant of dopamine receptor gene associated with decreased dopamine availability, occurred more often in alcoholics than non-alcoholics
        • Evaluation
          • Explains why some people develop addiction, yet others who have the same environmental experiences do not, because of genetic vulnerability
            • A1 variant of dopamine-receptor gene found to be associated with cocaine dependence, nicotine dependence, and poly-drug abuse
              • Individuals who inherit this gene variant, more vulnerable to develop addiction
          • Research with women produced inconsistent findings, as only 2/4 adoption studies reported a significant correlation between alcoholism in female adoptees and their biological mothers
            • 2/5 twin studies found significant concordance for alcoholism among female MZ twins than among female DZ twins
              • Suggests genetic factor may be less important in development of alcoholism in women than in men
      • Personality
        • Certain personality characteristics can predict addictive behaviour
          • Krueger (1998) found traits: sensation seeking and impulsivity, thought to be contributor to gambling, alcohol and substance abuse
        • Research suggests relationship between addiction and personality disorders (antisocial personality disorder)
          • Alcoholics 44% have personality disorder, Cocaine addicts 70%, Opiate addicts 79%
        • Evaluation
          • Evidence for relationship between certain personality characteristics and addictive behaviours
            • Research shows personality is a key predictor in the initiation and development of substance abuse, and maintenance of substance dependence
              • Implications of findings, able to identify vulnerable individuals in advance, help can be given to stop their behaviour developing into an addiction, reducing costs of treatment
          • Longitudinal studies support the influence of impulsivity in predicting later substance use and addiction
            • Labouvie and MCGee (1986) found that teens who progressed to heavier levels of alcohol abuse tended to score higher on scores of impulsivity
              • Further research found higher impulsivity is associated with greater mortality risk, therefore impulsivity is linked to a range of health-risk behaviours beyond alcohol abuse (drug abuse)
      • Peers
        • Peers can exert their influence  by introducing individuals to risky behaviours, or pressuring them to take part
        • Mary O'Connell (2009) suggested 3 major elements to peer influence as a risk factor of alcohol addiction
          • Teens attitudes and norms about drinking develop by associating with peers who use alcohol
            • Peers provide more opportunities, for at-risk individuals to use alcohol
              • Individual ends up over-estimating how much their peers are drinking, which means they drink more to keep up with the perceived norm
        • Evaluation
          • Research support for the influence of peers on addictive behaviour
            • Moreno (2010) studied 400 MySpace profiles of 17-20yrs, found 56% profiles contained reference to alcohol
              • Stock (2001) found that teens who viewed peers Facebook profiles that contained reference to alcohol were more likely to drink themselves, concluded that exposure to social media alters teens perceptions and other alcohol-related risk cognition's
          • Teen alcohol abuse has become major health concern
            • Finnish longitudinal study of 155 women and 176 men collected data on alcohol consumption at regular intervals between ages 14 and 42
              • Found that early onset of drinking, was a significant risk factor for alcohol dependence in adulthood
                • Lead to social norm intervention, used to correct the teens misconceptions, which result in decrease of problem behaviour and lessen likelihood of later substance dependence
      • Stress
        • People deal with stress by engaging in pleasurable activities, that help them forget the stress
          • Self-medication, model says some individuals intentionally use different forms of unhealthy behaviour to 'treat' psychological symptoms they experience from stress in life
        • People who experience severe stress are more vulnerable to addiction
          • Robins (1974) interviewed soldiers within a year of their return from Vietnam war, almost half had used opium or heroin, 20% develop dependence
          • Kessler (1995) Interviewed men with history of PTSD, 34% reported using a drug at some point, 15% without PTSD
            • Women 27% with PTSD, 8% without PTSD
        • Evaluation
          • Those with better coping strategies for stress, should have less need for addictive behaviour
            • Matheny and Weatherman (1998) follow up study of 264 smokers, who completed a national cessation programme, found strong relationship between participants stress coping resources and their ability to maintain abstinence from smoking once they had given up
          • Limitation, relationship between stress and addiction appears to vary according to the type of addiction
            • Dawes (200) found stress was a significant predictor of drug relapse
              • Arevalo (2008) interviewed 393 women from substance abuse women in Massachusetts, found evidence for association between stress and illicit drug use, but no association between stress and alcohol addiction
    • Nicotine addiction explanation
      • Brain neurochemisty
        • Nicotine activates reward pathways
          • By binding to receptors on neurons, in the ventral tegmental area (VTA) of the brain, these neurons trigger the release of dopamine in the nucleus accumbens (NAc), nicotine also stimulates the release of glutamate, which then triggers additional release of dopamine
            • Role of glutamate, GABA, and MAO
              • Glutamate speeds up activity of neurons, and GABA slows down neuron activity
                • Zickler (2003) discovered that nicotine's effects on glutamate and GABA are responsible for the longer-lasting pleasurable effects
                  • Nicotine causes glutamate to speed up dopamine release, but nicotine also prevents GABA from slowing it down after dopamine levels have been raised, therefore increased reward and pleasure
                    • Cigarette smoke also contains an unknown substance which blocks the action of the enzyme 'MAO', responsible for breaking down dopamine after it had its effects, maintaining feeling of pleasure
        • Evaluation
          • Support for the link between nicotine and dopamine
            • Paterson and Markou (2002) found that an epilepsy drug (GVG) reduces dopamine in the NAc that occurs after taking nicotine, reducing the addictive tendencies of nicotine
              • BY counteracting pleasurable experiences gained by the increase in dopamine, this drug offers and alternative treatment for nicotine addiction
                • Researchers claim GVG works better than any other treatment, as it is not addictive or based of nicotine
          • Nicotine affects men and women differently
            • Cosgrove (2014) studied brains of men and women using PET scans, measuring the changing levels of dopamine when smoking, by observing dopamine levels in 16 long-term smokers
              • In women, there was a fast and strong dopamine effect in the dorsal putamen, whereas men only had moderate to low activation in this area, men had a fast and strong activation effect in the ventral striatum, whereas women only mildly affected
                • Concluding that they smoke for different reasons, men for the effect of nicotine itself, women to relieve stress and manage mood
          • Real life applications
            • Understanding the neuro-chemistry can lead to the development of new treatments for nicotine addiction, such as nicotine replacement therapy (NRT) in the form of patches or inhalers, research raising the possibility of nicotine immunisation (resistance)
              • Potential practical benefits of understanding go beyond nicotine addiction, as some diseases have co-morbidity (concordance) with nicotine use such as schizo., depression, and alcoholism, all of which are associated wit continued smoking
                • Therefore research offering more effective treatments for nicotine addiction, enables advances in treatments of these co-morbid disorders
          • Limited explanation
            • Any explanation that only considers the role of dopamine is limited as research increasingly shows that there are many other neuro-chemical mechanisms involved, it is a complex interaction of several neuro-chemical systems (neurotransmitter pathways,  GABA, serotonin and other systems
              • However Berrendero (2010) pointed out that the dopamine system is at the center of the neuro-chemistry of nicotine addiction, whilst other systems interact with it to have their effects
      • Learning theory
        • Initiation
          • Maintenance
            • Relapse - cue reactivity
              • Once smoking is stopped, the urge to continue (relapse) persist, long after withdrawal symptoms disappear
                • Person would associate specific moods, situations or environment with the rewarding effects of nicotine (cues can trigger relapse)
            • Smoking becomes an established behaviour, as it has positive consequences (positive reinforcement)
              • Smoking maintained to avoid negative symptoms (negative reinforcement)
                • As effects wear off, anxiety is experienced, craving increases (physical dependence)
          • SLT suggests young people observer and imitate role models (peers or parents) around them who smoke
            • Vicarious reinforcement leads them to expect positive consequences from smoking
          • According to OC, behaviour that is rewarded will increase in frequency
            • Addictive substances that are rewarded immediately, are learnt quickly
              • Nicotine smoke enters the brain within seconds, activating reward pathway, reinforcing the activity that produced it, resulting in quick learning
        • Evaluation
          • Limitation of the learning theory explanation for nicotine addiction, it fails to acknowledge different patterns in men and women
            • Lopez (1994) found women started smoking later than men, and that there are gender related differences in both the development and context of smoking behaviour
              • SLT fails to address these specific gender differences
          • Wiers (2013) Support for the importance of CC cues in nicotine cravings
            • Compared heavy smokers, ex-smokers and individuals who never smoked, asked them to respond to pictures of smoking related and natural cues, with either 'approach' or 'avoid' responses, craving scores were measured using a questionnaire of smoking urges
              • Heavy smokers bias toward smoking related cues, bias was positively correlated with their craving scores
                • Not the case for ex-smokers or non-smokers, confirming that smoking cues are present in heavy smokers, and play significant role in nicotine addiction
          • Evidence for claim that negative moods increase nicotine craving and risk of relapse amongst those trying to quit
            • Shiffman and Waters (2004) found that sudden increase in negative mood states, rather than slow changes in stress levels, were associated with relapse (even amongst those trying to quit)
          • Supported evidence for the claims of SLT on the development of addictive behaviour
            • Peer group influence found to be primary influence for teen, who experimented with smoking
              • DiBlasio and Benda (1993) concluded teens who smoked, more likely to hang out with other teens who smoke
                • Karcher and Finn (2005) youth whose parents smoked were 1.88x more likely to smoke, siblings smoked 2.64x , close friends 8x more likely than if parents, siblings and friends did not smoke
    • Symptoms
      • Withdrawal
        • Acute
          • Hrs after stopping, resolves in few weeks, body adjusts to loss of drug
        • Post acute
          • Lasts months/years, emotional/psychological problems, brain re-balances and reorganizes itself
        • Symptoms associated with discontinued use, opposite effects of drug (physical dependence)
      • Tolerance
        • Metabolic
          • Enzymes metabolizing the substance become more effective, (reduced concentration in blood at site of drug action) meaning the substance has a weaker effect
        • Learned
          • Learning through experience, to adjust behaviour to compensate for the effects of a drug (alcoholics walk more slowly)
        • Cross-tolerance
          • Developing tolerance to one drug, can cause reduced sensitivity to another drug (alcoholics need more anesthetic)
        • Require larger dose than before
      • Dependence
        • Physical
          • Occurs when withdrawal syndrome is produced by stopping drug use
        • Psychological
          • Becomes center of importance, thoughts, emotions and activities, experience cravings
          • Individual feels like they cannot cope with work without drug, absence of drug causes anxiety and cravings
    • Gambling addiction explanation
      • Learning theory
        • explains gambling as a behaviour that is subject to reinforcement, which in turn strengthen gambling tendencies
        • Vicarious reinforcement
          • Positive and negative reinforcement
            • Partial reinforcement
              • Variable reinforcement
                • Cue reactivity
                  • Cues associated with gambling
                • Occurs when a response is reinforced after an unpredictable number of responses
                  • takes longer for learning to be established
                    • They learn that they will not win every game, but will eventually win, if they persist
              • Only some behaviour (bets) are rewarded, also unpredictability about which bets will pay off
            • PR - winning money, 'buzz'
              • NR - distraction from aversive stimuli, such as anxieties of everyday life
          • See others being rewarded, may be through news
        • Evaluation
          • Limited explanation, it may be less to do with partial or variable reinforcement
            • Some forms of gambling have a short-time period between the behaviour and the consequence (scratchcard), whereas others (sport betting) have a much longer period between bet and outcome
              • This matters as some types of gambling have less to do with chance and more to do with the skill of the individual
          • Fails  to explain why some poeople become addiceted
            • It states that addiction is down to the consequences of gambling behaviour, however there are problems with seeing addiction solely as a product of its reinforcing properties
              • Although some people gamble at some point during their lives and experience the reinforcements associated with this behaviour, relatively few become addicts
                • Does not explain the underlying factors of why addiction occurs
          • Blaszczynski and Nower (2002) claim there are different pathways for gambling addiction
            • Gamblers who are 'behaviourally conditioned' may have begun gambling because of exposure to gambling through role models or peer groups, their addiction therefore may be largely explained through social learning and reinforcement
              • However., other gamblers have anxiety and/or depression, poor coping skills, and negative life events, these people may be 'emotionally vulnerable' which could be the cause of their gambling addiction
                • The LT does not account for explanations relating to psychological factors
          • Research support for the idea of excitement being associated with gambling
            • Mark Dickerson (1979) observed the behaviour of gamblers in real-life gambling environments, two betting shops in Birmingham
              • He found that high-frequency gamblers were consistently more likely than low-frequency gamblers to place their bets in the last two minutes before the start of a race
                • They may have delayed betting to prolong the rewarding excitement they felt (from the tension built by the radio commentary)
      • Cognitive
        • Based on assumption that irrational beliefs and distorted thinking patterns contribute to the development and maintenance of problem gambling
        • Types of Cognitive biases
          • The gamblers fallacy
            • Illusion of control
              • The 'near miss' bias
                • The recall bias
                  • Tendency to remember and overestimate wins, while forgetting about losses
                • When unsucessful outcome is close to a win, not constantly losing, but constantly near winning
                  • Have some rewarding value, despite lack of financial payout
              • Performance of superstitious behaviours, which the gambler believes help them to manipulate the event outcome in their favour
            • Belief that completely random effects are influenced by recent events
        • Griffiths (1994) investigated whether regular gamblers behaved differently to non-regular gamblers when laying fruit machines
          • Study took place in amusement arcade, he compared 30 regular gamblers (played more than once a week) to 30 non-regular gamblers (who played less than once a month), each individual was given $3 to spend on fruit machine
            • The regular gamblers believed they were more skillful than they actually were
              • They were more likely to make irrational statements, ;putting in only a quid in bluffs the machine' (illusion of control)
                • Majority of non-regular gamblers believed the game was 'mostly chance', non believed it was 'skill'
                  • 26/30 regular gamblers believed it as due to skill or equally chance and skill, and explained their losses as 'near misses'
                    • 1/3 regular gamblers continued to gamble, until lost all money, compared to 2 non-regular
        • Evaluation
          • Evidence for the role of cognitive biases
          • Applications, CBT may be helpful in reducing gambling addiction
          • Awareness does not decrease vulnerability to cognitive bias
          • Cognitive biases may have a biological basis
    • Reducing addiction
      • Drug therapy
        • Agonists
          • NRT
        • Antagonists
          • Varenicline  and Bupropion
        • Opioid antagonists
          • Naltrexone
        • Antidepresants
      • Behavioural interventions
        • Aversion therapy
        • Covert sensitisation
      • CBT
    • Theory of planned behaviour
    • Prochaska's stages
    • Disorder were an individual takes a substance or engages in behaviour that is pleasurable becoming compulsive with harmful consequences
  • Subjective norms
    • Perceived behavioural control
      • Behaviour
    • Attitudes towards behaviour
    • Intention
      • Behaviour

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