Addiction

Describing Addiction

Addiction is the compulsion to use a substance or engage in a behaviour, despite its harmful consequences. It is an inability to stop that behaviour, resulting in a failure to function adaquately.

Tolerance: occurs when there is a desensitisation at the synapse, and more is needed; metabolising enzymes become more effective over time; learned tolerance means the person learns to function normally.

Withdrawal syndome: when the body tries to cope with the cessation of the drug. Includes psychological effects like anxiety, irritability and poor concentration, and physical effects like tremors, nausea and sweating. There are two types of withdrawal, Acute withdrawal which begins hours after cessation of the drug where cravings are inense and persistent, or post acute withdrawal which occurs years after cessation, signs of emotional and psychological turmoil 

Dependence: there is physical dependence where the person takes the drug to feel normal, or psychological dependence where the substance is central to a persons thoughts, emotions and activities

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Risk Factors in Addiction 1

Peers: peers can exert influence on individuals using pressure and social conditioning. Social Learning Theory by Tajfel, refers to the idea that an individual's self concept is defined by the group they associate with. Eiser found that smokers tend to befriend smokers. 

Family: Family can exert influence through social leanring theory, schemas, parental style, and parental approval. Akers and Lee found social influcnes of family influcned a teenagers ability to try, continue or quit smoking. 

There is reasearch to support the influence of peers from Eiser, and family from Akers. However, Social learning theory cannot explain why some people do not copy behaviours

Personality: there are many personalities that are associated with addicitve behaviour, such as impulsivity, easily reward dependent, and psychoticism. There are issues with causes and effect, just becuase somone has these personality traits, it does mean it causes their addiction. Genetic explanations may be stronger as they may play a part in developing personality 

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Risk Factors in Addiction 2

Stress: Traumatic stress causes a vulnerability to addiction. Self mediciation also can occur, where people engage in these behaviours to treat their everyday stressors. Robins found that nearly 50% of soldiers back from a tour of Vietnam had engaged in opium or heroin addictions. There is research to support the link between stress and addiction from Robins. However, there are issues with causality as the stress may be a result of being additcted and not the other way around. There is also a paradox in terms of smoking, as smoking happens to relieve stress, but being addicted can cause stress. 

Genetic vulnerability: Some people are born genetically vulnerable to disorders. One example is the dopamine receptor gene, it is argued that addicts have different variants of genes to have different receptors. Caine found that mice engineered to lack the D1 receptor gene for dopamine will not self administer cocaine. Metabolising also occurs when some individuals are able to metabolise certain substances faster than others, meaning more is needed to feel the same effect. Slutske found that there was a 49% concordance rates between MZ twins in which one was a pathological gambler. This suggests there was a genetic impact on addiction. There is research to support a genetic and biological link for addiction from Slutske and Caine. However, there is a lack of cause and effect because the concordance rates are not 100%, so there must be another factor. Also just because someone has the gene, it does not mean they will have addictive behaviour

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Biological explanations for nicotine addiction

Initiation: nicotine enters the brain through the bloodstream and activates pleasure centres in the brain, in three ways: 1) Nicotine stimulates the production of glutamate, and this increases the amount of dopamine released. 2) The nicotine receptors in the ventral tegemental area are stimulated, which in turn stimulates the nucleus accumbens, to release dopamine. 3) Nicotine inhibits the actions of GABA, meaning the firing of neurons and the production of dopamine lasts longer. 

Maintenance: Dopamine creates a rush and a feeling of reward and pleasure, but the effects only last for a few moments, meaning there is need to prolong that rush by continuing to smoke. This leads to desensitisation at the synapse and therefore an increased amount is needed, leading to addiction. 

Relapse: The addiction is hard to quit because it has lots of withdrawal symptoms when the abstenance is attempted. The nicotine is taken again to relieve the symptoms. 

There is support from the idea of risk factors, especially genetic vulnerbaility, as it suggests people may be more susceptible to addiction. However, the approach is very reductionist as it fails to account for environmental factors. There is also a gender bias as men and women react differently to nicotine within the brain, women see a change in the dorsal putamen instead. 

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Learning theory of nicotine addiction

Initiation: The addiction is caused through vicarious reinforcement, as people smoke through watching others engage in that behaviour and be rewarded for it. 

Maintenance: Occurs through operant conditioning; as smoking relieves stress, an example of negative reinforcement, but also get rewarded through with initiation into a group, an example of postitive reinforcement. operant conditioning can also happen with the onset of dopamine and frm stopping the onset of withdrawl syndrome.

Relapse: Occurs through classical conditioning, when people smoke they often do it in the same environments each time, so when they engage with these environments, they will associate that stimuli with smoking and its positive effects.

There is research to support the idea of learning theory from Karcher and Finn, who found that close friends had the most significant impact on addiction. There is also coordination between the two explanations of biological and behaviourist approach, as they both agree with the idea of operant conditioning, this increases their validity. However, the learning theory ignores ideas of motivation, such as faulty thought processes as they believe it will help with their problems. The idea is also extremely deterministic, as it says that if you see the behaviour, you will copy it, without considering motivation

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Learning theory explanation of gambling

Inititation: begins by observing others being rewarded, through vicarious reinforcement. 

Maintenance: through operant conditioning, as we have a direct positive reward in the form of money, showing positive reinforcement. Also has properties of a negatives reinforcement as the gambling can provide relief from the stresses of everyday life. Partial reinforcement occurs when wins only follow some bets, not all. This makes quitting much harder as the reinforcement is so uncertain. Fixed interval is when there is a reward at a certain set time, fixed variable is when behaviour is rewarded a fixed number in a ratio of times, variable interval is a unpredictable reinforcement within a period of time, and variable ratio is completely random reward and time frame. Variable reinforcement is when people know that if they persist, they will win at somep point. 

Relapse: occurs through classical conditioning as they gamble in similar environments at similar times.

Dickerson investigated the role of positive reinforcement, finding that high frequency gamblers placved bets up to 2 minutes before a race to feel the buzz of engagement, whereas low frequency gamblers would wait until the next opportuntity. This is positive reinforcement as it shows a desire to experience a prolonged rush as well as getting the monetary reward.

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Evaluations of learning theory

There is research from Dickerson showing the role of positive reinforcement in learning.

This also explains why people fail to stop gambling, through partial and variable reinforcement. 

This idea is environmentally deterministic, as it suggests that environment causes behaviour, and that we do not have free will, therefore failing to explain why people dont get addicted when they see the behaviour.

This is also only the nurture side of the debate, as it does not factor in the genetic vulnerability or other biological influences

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Cognitive explanations of gambling addiction

Suggests that addiction occurs as a result of cognitive bias. It is based on four biases: Skills and judgement (belief in a element of control), ritual behaviours (greater chance due to superstitious behaviours), selective recall (only focusing on their wins not the losses), and faulty perceptions (a streak of losing will eventually end).

Initiation: caused by self medication, when gambling is used to treat other problems in life, almost like a coping mechanism. Also can be down to cognitive myopia, placing more excitement on current pleasure, rather than the future consequences. 

Maintenance: Gamblers fallacy is when they have an unrealistic belief about their ability to influence the outcome of their behaviour, such as an exaggerated self confidence. This encourages the continuation of the addiction.

Relapse: they overestimate the amount they have won, forgetting the amount they have lost. They also may have the just world hypothesis where they think the money will have to come back 

Griffiths investigated cognitive bias to find that regular gamblers thought they were more skillful and believed they could influence the outcome, claiming the game to be a combination of skill and chance. Irregular gamblers knew that the game was pure chance. 

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Evaluations of cognitive explanations

There is research to support from Griffiths showing that regular gamblers have a cognitve bias towards gambling. 

CBT also is an effective treatment and as this is based on cognitive challenging, it shows that there is at least in part cognitive

It is difficult to establish cause and effect, as the irrational thoughts may be a result of the gambling addiction, rather than a cause

Much of the research is self report, meaning the results are subject to social desirabilty bias as they want others to think better of them. This affects how reliable the results are and this means the claims of cognitve basis are at risk of being invalid

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Drug treatments

There are three types of drug treatment, Aversives, which produces unpleasant consequences when mixed with the substance, Agonists, which are substitues for the substance, and Antagonists, that block receptor sites to ensure the substance does not have its usual effects.

Smoking: The agonist used to treat smoking is nicotine replacement therapy. These release nicotine much slower than cigarettes and are free from the toxic chemicals, in the form of gum, inhalers and patches. Upon reaching the brain, the dopamine receptor sites are stiumulated in the same way as cigarettes, but cravings are controlled, helping to improve mood, and the dosage is lowered over time. Drug treatments are also used, such as Varenicline, are partial agonists that bind to nicotine receptors and stops the rewarding aspect of the nicotine.

Gambling: There is not drug proven to have a particular effect on gambling itself, but the SSRIs are used when in conjunction with cognitive therapy. They are used to reduce depression and anxiety as low levels of serotonin have been found in those with impaired impulse control. Increasing serotonin levels can stpop impulsive behaviours.

Heroin: Methodone is given to combat a heroin addiction which is prescribed. It allieviates the withdrawal symptoms

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Evaluations of drug treatments

There is research to support from Nakamura, who found that those on Varencline had a 65% abstinence rate, compared to a placebo group with a 30% rate. 

There is an economic benefit as drugs are cheap to produce, as well as easy to administer, meaning more patients can be treated in a short space of time. 

There are severe side effects associated with drugs, that may be similar to withdrawal symtoms which the drugs are trying to allieviate. This may mean that people will stop taking the drugs, and go back to the addictive behaviour, making the treatment ineffective

People can just as easily build a tolerance to their replacement drug, meaning a higher dosage is needed and this may lead to an addiction to that. This makes the treatment ineffective because they will just transfer from addiction to another.

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Cognitive treatments

CBT focuses on teaching patients to cope and avoid high risk situations. 1) They identify the their cognitive biases and work towards correcting them. For example, the therapist will ask the patient to describe their thought processes as they do the addictive behaviour. This is known as thought catching, before educating on issues with logic and rationalising their thought processes. 2) patients are also asked to practice these changes through cognitive reconstructing, which is educating patients about misconceptions they have, specfic skills are taught to cope in certain situations, and social skills are learnt to avoid addictive behaviour and how to cope with anxiety. 3) Relapse prevention also occurs where patients learn to identify triggers and situations of addictiion  so they can be avoided. 

There is research to support the effectiveness of treatment, from Ladouceur who showed 86% of patients were no longer classified as addictive after treatment like this. 

CBT also aknowledges risk factors as it also impacts peer influence and family influence, and this increases its validity as it may have additional benefits beyond the patient themselves.

However, the treatment is dependent on whether the patients wants to engage with the treatment, and if they are not interested, the treatment will not be effective

It is also normally given alongside drugs, so it is hard to distinguish what each treatment does by itself. This makes us question the results of the studies

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Behaviourist interventions

Aversion therapy:  is the physical form of classical conditioning where the addictive behaviour which is normally associated with pleasure is instead associated with disgust or pain. In terms of alcohol, a tablet will be given that makes the patient sick when mixed with alcohol, which then reduces the addiction over time. Similarly, gambling is detered with electric shocks. 

Covert sensitisation: This is the more imaginary form as the patient is encouraged to imagine the unpleasant experience after imagining their addictive behaviour, and they learn an association over time without actually experiencing nausea or sickness. In terms of nicotine, the client relaxes and imagines themselves smoking, which is then immeidately followed by images of nausea or illness- the more vivid it is the better. This encourages them to draw negative associations with smoking and thus extinguish the behaviour. 

There is research to support from Smith and Frawley found that after 12 months of treatment, alcoholics showed a 65% abstention rate, highlighting how behavioural treatments are successful in treatment of addiction. Covert sensitsation is also the more ethical treatment as there is no physical harm, wheras aversion has ethical questions raised and may not be approporate in all cases. These treatments are too reductionist as it only focuses on behavioural aspects when it is known that there is also psychological aspects of a disorder

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Theory of Planned Behaviour

The theory suggest we can change behaviour by reverse engineering the model. By reducing the cognitive factors that cause intention, we can reduce the chance of engaging with the behaviour. 

1.1) Behavioural attitude: individuals views on the behaviour and belief of its outcomes. If a persons views are more negative than positive, then they will be less likely to initiate the behaviour, e.g. potential smokers will not smoke if they see that the health risks and the cost outway the social aspect. Refer to Slater review of success of drug campaigns due to BA

1.2) Subjective Norms: refers to the views of the people around them, both society and personal. If the norm in society is no to engage in the behaviour, and they will be shunned for it, they will be less likely to do it. Wilson and Kolander studied public acceptance of substances

1.3) Perceived behavioural control: refers to how in control the individual feels they are of their behaviour. The more in control a person feels, the easier it will be for them to quit once the start, or easier to resist becoming addicted. Godin found PBC was a predictor in quitting behaviour

2) Intention: refers to a persons intention to perform an action

3) Behaviour: what the person actually ends up doing

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Evaluations of theory of planned behaviour

There is research to support from Norman. They examined smoking cessation intervention, looking at a persons intention to quit and whether they actually quit. They found that the theory was accurate in measuring a persons intention to quit smoking, but could not actually predict the actual quitting success. Instead, this was only predicted by the amount of times the participants had quit before. This research shows that the theory can predict temporary behaviour but not permanent behaviour.

There is also cross cultural validity, as it accounts for cultural difference, due to the inclusion of subjective norms. It makes sure to measure the norms within the given culture, rather than just western ideals, like most other measurements.

However, the Norman research can refute the use of it when prediciting permanent quitting behaviour. It suggests that the theory cannot be used to reduce addiction over a long period of time, and therefore alternative factors must play a role.

The model suggests it is a quick and instantaneous process, happening through a series of things changing swiftly, failing to account for the fact that change is actually a long and continous process. This means the theory is unrealistic in its application to real life addictions

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Prochaska's Six Stage Model of Behaviour Change to

Prochaska's model is a cyclical model, recognising that overcoming an addiction is not a quick, linear process, and that it requires gradual change over time that may include relapse in order to progress. If relapse occurs, the person returns to a previous stage of the model, before they can move on. Different stages of the model require different strategies. 

1. Behavioural Intention:

  • Precontemplation: there is no intention to change, due to lack of motivation or a denial or issues. Intervention- focusing on need to change
  • Contemplation: the person is now starting to weigh up pros and cons of the behaviour. Intervention- concinving that the pros outweign cons
  • Preparation: small changes are starting to be made such as booking a consultation appointment. Intervention- construct a plan to begin change e.g. GP appointment

2. Behaviour:

  • Action: big changes are being made including cessation and cutting down, for a period of up to 6 months. Intervention- Developing coping skills needed to quit
  • Maintenance: cessation has lasted more than 6 months. Avoiding relapse. Intervention- helping apply skills to situations to avoid relapse
  • Termination: no longer tempted to revert to addiction, the change is automatic and they are confident in coping
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Evaluation of Prochaska's model

The model can help improve Norman's research as even though they found that people relapsed after a certain period of time, and trying to quit before being a factor in success, the model can emphasise that relapsing is all part of the process of quitting, explaining the research further.

The model and its treatment is ideographic, meaning it is tailored to each person, accounting for relapse at any point, even the first and last stages. This can help with recovery as it means the patient can understand their addiction better and therefore the treatment involved will be more effective

However, the research from Baumann showed that compared to a control group, only 35% of problem drinkers were able to reduce their intake when refering to the model, suggesting specific interventions at each stage do not help

There is also a problem with overlap, as many of the stages are similar to others. This makes the stages quantifiable by the number of days, rather than the change in attitude, which arguably is the bigger factor in moving away from addiction

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