Addiction

• Genetics: there is strong evidence for a genetic component in smoking addiction, although no one gene has been identified. Fisher found that 33/51 adult male MZ twins were concordant whereas only 11/31 DZ were concordant which suggests a strong genetic component. (Initiation, maintenance, relapse)
• Reward Pathway: nicotine activates the mesolimbic pathway. Nicotine activates nicotinic acetylcholine receptors which releases dopamine in the nucleus accumbens. This produces pleasure. McGeehee found that the reward system keeps sending reward signals for 60 minutes after smoking a cigarette but within a few hours this pleasure is replaced by reduced concentration and grumpiness (maintenance). After quitting the brain still receives hard to resist signals of iminant reward that force the addict to take nicotine again. Addicts crave dopamine rush and their frontal cortex's resistance to these cravings has been worn down during their addiction period (relapse). 

• Slutske: it's hard to separate genetics from environmental factors with twin studies. + MZ twins are treated more similarly and spend more time together
• The concordance wasn't 100% so there must be environmental factors e.g. normative social influence. 
• Fowler examined over 1000 pairs of twins and found that social and environmental factors were more crucial in the initiation of addictive behaviour. Genetic and neurological factors were more closely linked to maintenance and behaviour becoming more extreme.
• Thorgeisson identified a gene that influenced the number of cigarettes smoked in a day. Those who smoked fewer than 10 a day were less likely to have the gene that those who smoker over 10 a day. This suggests that genetics may not determine initiation but they can make you more likely to become dependent. Genetics don't necessarily cause behaviour - not useful in explaining initiation. Furthermore subsequent research has found many addicts don't posses genes that were thought to be linked to addiction.
• Reductionist: reduces complex human behaviour down to a simple biological explanation. Ignores social, environmental and psychological factors. Contrast with cognitive/learning approach.

• Genetics: gambling seems to run in families. Having a genetic predisposition could make you more likely to start (initiation) and to relapse. Slutske studied over 5000 individuals and found concordance rates for MZ twins were almost twice as high as those for DZ twins. Research has found that individuals who inheret the D2 variant have fewer dopamine receptors in the pleasure centers of the brain meaning they need to engage in more pleasurable activity (e.g. gamble more often/ higher amounts) to get the same pleasure as a 'normal' brain. This can explain maintenance.
• Sensation seeking: Zuckerman says that sensation seekers look for novel experiences. They also have a lower appreciation of risk and view arousal as more positive than low sensation seekers. These traits mean an individual is more likely to maintain an addictive behaviour.
• Boredom avoidance: Blazscynski found that pathological gamblers had significantly higher boredome proneness that a control group of non-gamblers. This means that if they quit they are likely to get cravings to gamble in order to quench their boredom and relapse. 

• Slutske says it is difficult to separate environmental factors from genetic factors in twin studies. MZ treated more similarly than DZ. + only 64% concordance so must be environmental factors.
• Reductionist - contrast with SLT
• Contradictory research from Coventry + Brown who found that people who bet on horses had lower sensation seeking than non-gamblers. Contrasting research makes it hard to draw conclusions. 
• Determinism: if you are born with the D2 variant you are destined to become a gambler. Ignores free will - can make better life choices and choose not to become a PG. This weakens the bio approach. 

• Operant conditioning: learning through rewards and punishments. Initial rewards (pleasure + social rewards) can shape later behaviour. Continued rewards cause people to continue (maintenance) and the threat of withdrawal symptoms, punishments, make people continue but also relapse - attractiveness of iminant rewards. 
• Classical conditioning: Carter + Tiffany - cue-reactivity theory e.g. cigarette boxes conditioned stimulus and conditioned response is pleasure - triggers for cravings - maintenance and relapse. 
• Social learning theory: vicarious learning - we usually copy someone we admire or relate to e.g. peers or role model. Can explain initiaton, maintenance, and relapse. NIDA found 90% of US smokers started in adolescence due to peer imitation.

• RLA - Botvin implications for prevention: target adolescents and teach them how to refuse drugs (resistance skills) and equip them with anti-drug arguments to counteract pro-drug messages given off by smoking relatives/peers.
• RLA - Drummond et al implications for treatment: cue exposure. If the trigger is presented without the associated pleasure behaviour the association will be extinguished (stimulus discrimination) and cravings will be reduced upon seeing the stimulus. 
• Research support - Robins found Vietnam War veterans who became addicted to heroin in Vietnam were much much less likely to relapse compared to heroin addicts who became addicted in the same environment they lived in. (Cue-reactivity theory)
• Research support - Olds and Milner inserted electrodes into the limbic system of a mouse's brain so that when it pressed a button the area was stimulated and it gained pleasure. The mouse ignored food and drink to continue pressing the button. (Operant conditioning)
• Not all people have role models. Some people continue even when role models stop and some stop even when role models continue.

• Operant conditioning: initial rewards shape later behaviour. Griffiths says gamblers may become addicted due to psychological, social, physiological and financial rewards. Continued rewards + fear of withdrawal symptoms (punishment) = maintenance. Withdrawal symptoms + attractiveness of iminant pleasure (reward) = relapse.
• Classical conditioning: Carter + Tiffany - cue-reactivity theory. Maintenance + relapse.
• Social learning theory: vicarious reinforcement. Initation, maintenance + relapse. 

• RLA - Drummond et al - cue exposure
• Research support - Olds + Milner
• Research support - Robins
• Sharpe: consistent and significant losses do not stop gamblers, they often lose more than they win. This approach applies better to some addictions than others. However it can be explained with psychological, social and physiological rewards. Also the variable ratio: rewards aren't given every time but every nth time.
• Not all people have role models. People continue even if role models stop and stop even if role models continue. 

• Rational choice theory: Becker + Murphy - choose to engage in addictive behaviour as a result of weighing up the costs and benefits.
• Self medication model: people use their addiction to cope with life's demands e.g. social problems. A lot of smokers mention stress relief in their reasons for smoking. Absatining from nicotine, even briefly, leads to increased stress in the form of cravings. Smoking immediately relieves this anxiety and reduces the perception of stress. Beck et al - vicious circle.

• Research support - NIDA found people reported using smoking, alcohol, drugs etc as a way of coping with life's daily hassles e.g. money problems.
• Research support - Sanjuan found sexually abused women were more likely to use alcohol to remove sexual inhibitions.  
• Doesn't explain why people continue when the costs outweigh the benefits for example when you get lung cancer.
• RLA - West implications for intervention: make the costs of smoking higher/more evident by raising the price, making them illegal and harder to get, or using advertising to get people to realise the true costs of smoking e.g. dying early and leaving your children alone. 
• Assumes there is always an underlying problem when people start an addictive behaviour but often people start when they seemingly have no underlying problem.
• Cause or effect? Do the problems cause the addiction or does the addiction cause the problem. It could be that other factors cause the addiction e.g. peer pressure but the problems cause a cycle of maintenance. Therefore it doesn't explain initiation. 

• Rational choice theory: Becker + Murphy people choose to engage in addictive behaviour as a result of weighing up the costs and benefits. Griffiths says that gamblers have cognitive bias which leads to faulty thinking. This can explain why gamblers continue even when the costs outweigh the benefits. Griffiths studied 30 regular gamblers and 30 non-regular gamblers and found the regulars were more likely to treat the machine as if it were a person e.g. 'this fruity doesn't like me' and use other verbilisations such as describing their losses as 'near wins' to justify their continuation. 
• Self-medication model: gamble to relieve stress etc. Beck's vicious circle. 

• Assumes there is always an underlying problem but many people start when there seems to be no apparant problem. Cause or effect? Self medication can't explain inititaion. People may start for other factors e.g. sensation seeking, peer presure. 
• Research support - Li et al compared pathological gamblers who gambled for pleasure and those who gambled to escape the reality of their lives. Those who gambled for escapism were significantly more likely to have other substance dependencies. Support for the self-medication model. 
• Research support - Sanjuan
• Sharpe says that the benefits often don't outweigh the costs in gambling; consistent and significant losses do not stop gamblers from continuing. Many gamblers lose more than they win. However it could be the social, psychological, physiological benefits that counterbalance the costs of gambling.
• Can explain why some addicts are able to stop - when the costs outweigh the rewards.

AO1

• NIDA - people reported that they used smoking, alcohol and other addictive behaviours to cope with life's daily hassles such as money problems. 
• Stress induced rats are more likely to self administer drugs
• Increased stress levels are positively correlated with increased vulnerability to developing an addiction

AO2

• Non-human animals - issues with extrapolation
• Supports the cognitive approach's self-medication model by Becker et al
• Research support e.g. Li et al 
• Cloniger says there are two types of addicts: 1) those who use their addiction to reduce tension 2) those who use it to reduce boredom and have a tendency towards risk taking. Stress may explain addiction in some but not in all addicts. 

AO1

• SLT: vicarious learning, social identity theory, normative social influence.
• Mcalister found that transitions to increased smoking were linked with peer encouragement and the message that smoking is a behaviour that promotes popularity.

AO2

• Determinism vs free will - we can make our own decisions, we can act independently, we are not all easily influenced by others
• Specific to adolescents - doesn't apply that well to other age groups as they are less susceptible to peer pressure
• RLA - implications for treatment: group treatment + separation from bad influences

AO1

• The prime age for addiction is in adolescence and in retirement. 
• Shram found nicotine had a greater activating effect on the neural structures of adolescent rats but adult rats had worse withdrawal symptoms. 
• NIDA found that 90% of US smokers started in adolescence due to influence of peers.
• Hefler found that 47% of men over 75 drank daily - depression? boredom? money?

AO2

• Non-human animals - issues with extrapolation
• RLA - Botvin implications for prevention programmes targeting adolescents, teaching them drug refusal techniques and equipping them with anti-drug arguments to counteract pro-drug messages given off by smoking/gambling/drinking relatives/peers.
• Use an AO1 research as AO2 support if need be.

AO1

Eysenck:

• Psychoticism: hostile and impulsive
• Extaversion/Introversion: chronically under aroused and seeking external stimulation/lacking in self confidence using addiction to fit in.
• Neuroticism: often depressed or anxious

Cloniger:

• Novelty seeking
• Harm avoidance: tend to be a worrier and so use addiction to put mind at rest/pick them up
• Reward dependence

AO2

• Francis found a link between high scores on neuroticism and psychoticism and addiction
• Most research correlational
• Cause or effect? Would be hard to research, longitudinal

• They can glamourize addiction by not showing the true costs
• Waylen et al found that teens who watched films where the actors smoked were more likely to smoke. Even after controlling for social factors there was still a significant correlation between amount of films seen depicting smoking and smoking themselves
• Celebrities smoking - SLT vicarious reinforcement
• Boon + Lomore found that 59% of teens cited having their beliefs and attitudes influenced by a celebrity
• Research has found underage smokers prefer more advertised brands
• Griffiths says that the widespread way that the lottery and online poker are advertised makes them hard to avoid. These ads normalise gambling and make it seem more socially acceptable

• Waylen et al's study - only correlational, can't assume a causal relationship, cause or effect?
• RLA - thanks to research showing the negative effects of drug portrayal in media, the Office for Substance Abuse Protection (OSAP) has developed guideline materials about drugs for film and television writers. These recommend that the writers communicate the message that illegal drug use is 'unhealthy and harmful' and that addiction should be presented as a disease and that abstinance is the 'viable choice for everyone'. These guidelines also state that there should be no references to 'recreational drug use' as 'no drug use is recreational'.
• Byrne argues that films can have a positive influence in disuading people from taking drugs. For example the films 'Requiem for a Dream' and 'Trainspotting' are particularly important because of their widespread appeal but also because they provide enduring images and stereotypes of drug addicts. Byrne draws parallel with the fact that the dominant image of ECT comes not from public information leaflets but from the film 'One Flew over the Cuckoo's Nest'.
• Boyd supports this by saying that US film makers are offered a financial insentive to portray drugs in a negative way. Boyd thinks that generally they do.
• Research support - Sargent et al studied over 4000 adolescents and found that those who started smoking often cited the influence of smoking in films as a contributing factor.

• Behavioural attitudes: a campaign was released in 2005 to lower teen marijuana use. Most teen anti-drug campaigns focus on the risks involved but most teens are not risk-avoidant. The success of this campaign was due to how it focused on how marijuana use was inconsistent with bieng autonomous and acheiving aspirations: this was more successful in changing behavioural attitudes
• Subjective norm: Kolander et al say that most adolescents who smoke belong to a peer group that smokes. They may think that smoking is the norm when actually the majority of adolescents don't smoke. Exposure to statistics should form a part of an effective campaign and should correct their subjective norms. 
• Perceived behavioural control: research has found that the three factors all help to explain intentions but PBC was the most important predictor of behaviour. Researchers concluded that prevention programmes should help smokers focus on the willpower necessary to give up smoking and help increase their self efficacy - a person's belief in their ability to control their own actions and decide their own fate.

• Too rational: fails to take into account strong desires, emotions and compulsions and other irrational determinants of human behaviour. When completing a questionnaire about attitudes and intention people may find it hard to anticipate the strong emotions that compel their behaviour in real life. The presence of these strong emotions may help to explain why people sometimes act irrationally by failing to carry out an intended behaviour e.g. stop smoking even when it is in their best interest to do so. For example somebody carrying out a questionnaire at home may say they view smoking as negative and that they want to quit but when faced with the sights and smells associated with smoking plus peer pressure they may feel differently
• Armitage + Connor did a meta-analysis of studies using TPB and found that it was successful in predicting intention to change rather than actual behavioural change. In the context of changing risky behaviours we can make a distinction between a motivational phase where an intention is formed and a post-decisional phase which leads to behaviour initiation and maintenance.
• Self-report - research tends to rely on self-report for evidence despite evidence to suggest self presentational biases. People want to appear socially desirable and so would want to avoid presenting themselves as an addict unable to quit. We cannot rely on self-report due to biases from social desirability. 
• Topa + Moriano suggests that TPB ignores other factors such as identification with smoking peers which they say plays a mediating role in smoking addiction. Klag found motivation was a key factor in quitting success. Klag found individuals in Australia were significantly more likely to quit if they had decided to give up by themself rather than if they had been coerced by others e.g. a court sentence. Klag came up with the self determination model is preferable to TPB

• Methadone: a synthetic drug that acts in a similar way to heroin but is less addictive. Heroin addicts are given increasing amounts of methadone to increase their tolerance. Then the dosage is slowly decreased until they no longer need methadone or heroin.
• SSRIs: there is evidence to suggest serotonin dysfunction in pathological gamblers and SSRIs increase serotonin. Hollander et al found that PGs treated with SSRIs showed improvements compared to a control group.
• Naltrexone: a dopamine antagonist. Stops the reinforcing pleasure feelings that reward gamblers for gambling which in turn reduces their cravings to gamble. 
• Nicotine replacements: patches, gum, spray. These products reduce nicotine cravings and remove nicotine withdrawal symptoms when a person stops smoking tobacco. They may also desensitise the nicotinic acetylcholine receptors making cigarettes less rewarding to smoke. 

• Many addicts get addicted to methadone - just replacing one addiction with another. Furthermore methadone consumption is largely unsupervised and a methadone black market has occured where people sell their doses for as little as £2 meaning that usage can easily get out of hand. In 2007 methadone was responsible for over 300 deaths
• Hollander et al's study only uses 10 participants over 16 weeks meaning it has low population validity, may not be representative, can't generalise, don't know if they work as well in the long term. Blanco et al did a similar study with 32 participants for 6 months. They found little to no difference between the SSRI group and the control suggesting it may not be that effective. Contrasting evidence makes it hard to draw conclusions. 
• Research support - Kim + Grant found that gamblers on naltrexone reported fewer gambling thoughts and less gambling activity after 6 weeks on treatment compared to those not on naltrexone.
• A strength of patches is that you only need one per day and their effectiveness has been proved as real patches have been found to be more effective than fake patches.
• However 60% of addicts relapse immediately after stopping nicotine replacement treatment. This suggests nicotine replacement is not a long-term treatment or a cure. It may help them stop smoking by quenching their nicotine cravings but does nothing to stop them from being addicted to nicotine. Perhaps a psychological treatment would be more appropriate or else a combination.

• Reinforcement: based on operant conditioning, if addiction is a learnt behaviour then it can be unlearnt by giving addicts rewards for not engaging in addictive behaviour. Sindelar investigated the effects of monetal rewards on methadone addicts. Those in the reward group gained rewards for testing negative for drug use. They produced 60% more negative urine tests than the non-reward control group. 
• CBT: based on the idea that addiction is maintained by the person's thoughts about the addictive behaviour. CBT aims to change the way they think about the behaviour and teach them ways of coping with situations which lead to the behaviour in the past e.g. peer pressure from work colleagues. With pathological gamblers, cognitive errors such as the one that the individual can control and predict outcomes should be corrected. 
• Aversion therapy: based on classical conditioning. The addictive behaviour is paired with something negative e.g. emetic drugs so that the behaviour will become associated with the punishing stimuli. Over time the addict will no longer want to engage in the behaviour as they will associate it with being ill. 

• Research support - Ladoucer randomly allocated 66 pathological gamblers to a CBT group or a waiting list control. Of those who completed CBT, 86% no longer fulfilled the DSM criteria for pathological gambling. They also had a better perception of self-control and these imrpovements were maintained at a one year follow up. 
• Reinforcement and aversion therapy do not address the problem that lead to the addiction in the first place. The individual may have quit their original addiction but may quickly turn to another addiction. Furthermore what is to stop addicts engaging in the behaviour after the treatment stops and they know they won't receive the reward/punishment. This suggests these therapies may be more effective when combined with another therapies e.g. CBT which is more likely to address the underlying problem.
• Ethical issues with aversion therapy.
• Psychological therapies are not appropriate/effective in treating certain addictions e.g. heroin which has a strong biological effect on neurotransmitters on the brain. It would be best for them to be combined with biological treatments for example a smoker could have nicotine replacement and therapy - a combination which research has found is very effective. 

• Quitline: a free anonymous telephone counselling service where experts give advice and counselling to people trying to quit. Stead et al conducted a meta-analysis on over 18000 individuals and found that people receiving multiple calls from a quitline counsellor were 50% more likely to be successful in quitting compared to those with only self-help materials.
• Doctor's advice: available to everyone. They can assess the severity of addiction and advise possible ways to quit. Follow-up sessions have proved useful in preventing relapse. 70% of smokers visit their doctors every year. 
• Anti-smoking legislation: July 2007 it was made illegal to smoke in public buildings in the UK. Many smokers found that the ban lead to a more supportive environment for quitting. Statistics showed 1/4 million people stopped smoking with NHS stop smoking services that year.

• Research support - Beckham et al looked at 24 US military veterans who received a combination of quitline counselling and nicotine replacement as research has shown you are more likely to quit with a combination of counselling and medication. 11/24 had stopped by their agreed quit date and 9 were still abstaining 17 months later. 
• Quitline being over the phone means that people are more likely to open up as it is anonymous and there is a lack of face-to-face. Therefore this treatment is more appropriate for people unwilling to visit an expert either because they don't have the time or they feel embarassed or uncomfortable doing so. 
• West says there was a decline in smoking prior to the ban but this was followed by a rebound effect. Attempts to quit were greater in the 9 months before the ban than in the 17 months afterwards. 
• Research looked at 5 London GPs and found that those who received minimum advice were less likely to quit than those who received maximum advice (e.g. leaflets + tips + follow up). This has important implications for how government money is spent regarding addiction interventions - leaflets + doctor follow ups.