Addiction

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What is addiction?

  • Walters 1999 defines addiction as 'persistent and repetitious enactment of a behaviour pattern and includes the 4P's
  • Griffiths:
  • Progression - marked by an increase in severity i.e. moving from drinking wine to whiskey
  • Preoccupation - The activity becomes the most important thing for the person i.e. spending food money on gambling
  • Perceived loss of control - The addiction is in charge i.e. going to a casino instead of working
  • Persistence - despite the negative long term consequences the persoon maintains their addictive behaviour e.g. alcohol poisoning and stomach pumping doesnt deter user
  • Can be addicted to almost anything i.e. sex, caffeine, exercise, money, drugs, shopping
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Initiation

Biological approach: views addiction as more of a physical dependancy than psychological

  • Genetics can predispose or inhibit addiction i.e. significantly low smoking in those with SLC6A3-9 (Lerman et al)
  • Gambling created positive reward (adrenaline rush) both in anticipation of the event and during it
  • Reward system - addictive substance stimulates VTA (ventral tegmental area) to release dopamine (DA) --> transmitters lead to the dopamine passing into the Nucleus Accumbens (stimulates feelings of pleasure) --> pathway reaches the pre frontal cortex which is linked to memory
  • Comings (1997) - significantly high gambling in those with gene D2A1
  • New (2002) - found +ve correlation between low gambling control and low aggression control
  • Shields (1962) - MZ twins showed higher concordance for smoking than DZs
  • Jang et al (2000) - MZ twins more likely to share antisocial personality characteristics which may lead to various addictive behaviours that DZs

Social learning theory: incorporates cog. mediating variables such as self concept+monitoring and self efficacy

  • Suggests that young peopole begin smoking because of the social role models and learn to expect positive physical and social consequences from smoking (vicarious reinforcement
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Maintenance

  • Biological theory
  • Shachter (1977) - nicotine regulation model argues smokers continue to smoke to maintain nicotine in the body at level high enough to avoid withdrawal symptoms
  • Some participants given low nicotine cigarettes and others given high nicotine cigarettes
  • Heavy smokers smoked 25% more low nicotine cigarettes than high nicotine cigarettes
  • Sabol et al (1999) those without SLC6A3-9 gene were more likely to remain as smokers
  • Reward theory - nicotine increases dopamine release in reward system so gives positive feeling, smokers continue to smoke to keep experiencing this please
  • Corigall and Coen (1991) trained rats to self administer nicotine through implants in reward centres. Results found injecting rates with drug preventing dopamine release decreases nicotine self administration 
  • Wray and Dickerson (1981) report that gamblers prevented from gambling often report changes similar to withdrawal symptoms, so gamblers keep gabling to avoid withdrawals.
  • Potenza et al (2003) - when viewing gambling tapes, pathological gamblers showed different blood flow in brains compared to non-gamblers

Cognitive theory

  • Beck et al (2001) Vicious circle - Low mood --> engage in smoking/gambling behaviour to enhance mood --> medical/social/financial problems --> Low mood. Cycle continues.
  • Self efficacy - once smoking behaviour has initiated, feel unable to cope with withdrawal procedure so do not give up.
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Maintenance continued

Cognitive continued

  • Expectancies - If smokers expect withdreawal symptoms to be too unpleasant then they will carry on smoking
  • Becks vicious circle also applies to gamblers
  • Feelings of excitement and occasional win encourages gamblers to interpret their behaviours positively
  • Self efficacy - many gamblers do not see it as a problem, and withdrawal symptoms are not as serious as those of smoking. So some believe they 'can stop at any time' since physical effects are easy to cope with
  • Expectancies - such as big lottery wins gamblers see the possibilty that their actions will be like changing so carry on gambling

Learning

  • Smokers often mix with other smokers so makes it difficult to stop smoking around other smokers
  • Many smokers associate smoking with appetite reduction so craving for food is replaced by craving for nicotine
  • If smokers no longer provides positive feelings then the relationship dies and smoker may give up
  • Gambler continues because rewards are reliable and easy to come by
  • Gambling provides 'partial reinforcement'
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Relapse

Biological

  • Lerman et al (2007) - smokers deprived of nicotine show increased activity in certain parts of their brain during withdrawal
  • After night without smoking was increasing blood flow to the area of the brain concerned with attention, memory and reward
    • Suggestions that some people are more prone to cravings because of changes in brain chemistry
    • Abstinence from gambling has been found to produce mild withdrawal symptoms
    • Ciarrochi et al (1987) gamblers often have other addictions so if gambling. If gambling is given up then may switch to another addictive behaviour

Cognitive

  • Negative feelings (withdrawal) can be removed almost immediately by having a cigarette.
  • Self efficacy - if the person has given up once, may feel like they are able to do it again any time they want

Learning - smokers link materials associated with their addictive behaviour with the act of smoking itself i.e. seeing/handling a lighter or cigarettes could induce craving

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Risk Factors in developing addiction

APPS - Age, Peers, Personality and Stress

Age - Bennett (2006) found high levels of impulsivity in childhood may be a risk factor for pathological gambling and Carlton and Manowicz (1994) in a retrospective study (AO3) found adult pathological gamblers reported a higher rate of ADHD as children compared to the general population.

AO2 - Studies are correlational. Tested drug dependant individuals so there are reliability issue. Self report techniques also present problems with reliability. Chronic drug taking can directly produce the same behavioural characteristics measures by impulsivity scales which highlights the cause and effect issue.

Peers - SLT highlights the importance of modelling i.e. having friends who smoke preducts smoking and if individual sees friends enjoying drugs, increases curiosity which increases likelihood to smoke. Peer pressure is also a factor. Sussman and Ames (2001) found the deviant peer group tends to use drugs and is a role model for drug use. Exposure to peer modells increases the likelihood that teenagers will begin smoking (Duncan et al 1995). Also perceived rewards such as social status and popularity are vital in why adolescnets begin smoking and while they continue to smoke (Eiser et al 1989).

AO2 - Those with high self-efficacy are less influenced by peers. Also possible that people who are already abusers select friendship groups that fit their own drug use patterns (social selection). Morgan + Grude (1991) gave teenagers a questionnaire and followed up later, it found that the influence of a best friend was stronger than other friends and perceived use of drugs by friends was more important than their perceived approval. Best friends also most important in maintenance of drug use while friends generally influenced initiation through example and approval.

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Risk factors continued

Personality - (Belin et al 2008) placed rats in a device where they could self-administer doses of cocaine.One group of rats were sensation seekers and immediately started taking large doses and 2nd group were high in impulsiveness and started with lower doses but they were the ones that became addicted. (Weintraub ey al 2010) assessed individuals suffering from parkinsons who are trwated with drugs that increase dopamine levels. Side effects include a 3.5 fold increase in impulse control disorders including gambling and sex addiction. Therefore high levels of dopamine may increase impulsivity and therefore may cause addiction. (Buckholts et al 2010) study indicated that addictions may be simply more rewarding for people with certain personality types i.e. high impulsivity and sensation seeking because they have a more hypersensitive dopamine response system. The heightened response to an anticipated reward could make such individuals less fearful about the consequences of their behaviour.

AO2 - Research data is only correlational so it is difficult to determine cause and effect. Research on rats and other NHAs can be difficult to generalise to humans.

Stress - Addiction is generally associated with relieving anxiety. Research has shown that people exposed to severe stress are more vulnerable to addictions. Driessent et al 2008 found that 30% of drug addicts and 15% of alcoholics also suffered from post-traumatic stress disorder. Stress may be a risk factor for smoking addiction but the addiction doesnt have the desired effect (of reducing stress).

AO2 - Stress may create vulnerability in some but not all people. Cloniger 1987 found that there are 2 different kinds of alcoholics. Type 1 primarily drink to reduce tension and are more likely to be female. Type 2 individuals drink to relieve boredom, therefore stress may explain vulnerability for type 1 but not type 2

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Media Influences on addictive behaviour

Positive influences - inoculation (watching addictive behaviours could provide opportunity to discuss issues such as health and *** the behaviour comes to no good); priming (trigger of specific memories by a particular cue i.e. reminder of a friends ill health through smoking); positive role models (pro-social role models can provide basis for observational learning and imitation especially if behaviour produces reward). Negative influences - observational learning (smoking could be learned by observation + imitated if rewarding); disinhibition (media could reduce inhibitions about behaviour so it could be seen as a legitimate thing to do); priming (cues remind addict of pleasurable/rewarding aspects of addictive behaviour); arousal (emotional arousal and excitement from exposure to behaviour in media); desensitisation (exposure to behaviour in media may lead to increased acceptance).

Research - Waylen et al examined 360 top us box office films released between 2001 + 2005 incl. those that depicted smoking. Found that teenagers who watched films showing actors smoing were more likely to start smoking themselves even after controlling for social factors such as whether parents or peers smoked. Sargent and Hanewinkel surveyed 4390 adolescents then again a year later. Found that those individuals who had not smoked when first surveyed, exposure to movies with smoking over the intervening year was a significant predictor of whether they had begun to smoke a year later.

Practical implicationsTV ads and the internet have been identified as media that could be used to provide support for addicts and education about addiction. Kramer et al assessed the effectiveness of 5-week TV self help intervention designed to reduce problem drinking. Found the intervention group were more successful than control group in achieving low-risk problem drinking in a 3 month follow up. AO2 - most of the evidence is correlational so difficult to determine cause and effect. Kramer et al study intervention group received weekly visitd from researchers and therefore recieved extra attention.

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Reducing addictive behaviour

Theory of planned behaviour (TPB)

  • Proposed by Azjen (1989) and is cognitive theory about the factors that lead to a persons decision to engage in a particular behaviour.
  • According to TPB an individuals decision to engage in behaviour can be directly predicted by their intention to engage in that behaviour. 
  • Intention is a function of 3 factors: subjective norms (individuals subjective awareness of social norms relations to the behaviour e.g. not just simply social norms but the persons beliefs about that we thing sig. others (ie. parents) think is the right thing to do); behavioural attitude (the persons attitude to wards the behaviour formed on the basis of belifs of performing the behaviour); perceived behavioural control (aka self efficacy - the more control people believe they have over the behaviour the stronger their intention to engage in behaviour + an individual w/higher perceived control is likely to try harder to persevere for longer than someone with low PBC).
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Reducing AB continued

Research - Wilson and Kolander (2006) adolescents who smoke usually are part of a peer group who smoke and therefore may think smokin is the norm. Most adolescents dont smoke therefore exposure to stats (anti drug campaigns) should correct the subjective norm and therefore should form part of any effective campaign.

  • Godin et al (2006) surveyed participants at start of study and 6 months later, results found only perceived behavioural control was the most important predictor of ultimate human behaviour. Concluded that prevention programmes shouls focus on the will power required to give up smoking.
  • Majer et al (2004) investigated role of cognitive factors incl. self efficacy on abstinence. Found that encouraging an addicts belief in their ability to abstain was related to optimism and positive ooutcome. Therefore concluded that enhancing self efficacy should form primary goal of treatment.

Evaluation  

  • Has practical implications i.e. education and producing campains to change attitudes. Supported by research evidence. Problems with distinction between intention and expectations i.e. there are times when what a person intends to do and what they expect to do are different. Model implies free will is involved but with addictions such as smoking physical cravings and dependancy can make a considerable difference to a persons motivation and behaviour. Subjective norms are not always involved simply attitudes alone and attitudes are not always involved and subjective norms determine behaviour.
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Biological Interventions

Agonist substitution - eg. nicotine replacement therapies such as methadone for heroin addicts, prvoide the person with a safer drug that mimics the original with similar chemical properties but safer. Also nicotine patches mimic/replace effecs of nicotine, relieve withdrawal symptoms and stop cravings. Stead et al (2008) found smokers using NRT were 1.5-2x more likely to be abstinent from smoking compared to placebo or control.

Partial agonists - eg. varenicline which binds to acetylcholine receptors preventing nicotine binding, decreases cravings and reduced pleasurable effects of smoking. Jorenby et al (2006) compared placebo, bupropion and varenicline for helping smokers quit and after 1 yr the rate of continuous abstinence was 10% for placebo, 15% for bupropion and 23% for varenicline, however side effects include nausea, headaches and links to suicidal tendencies.

Antagonist treatments - eg. Bupriopron, block the effects of the substance/drug i.e. blocking nicotine receptors to remove the pleasurable effects of smoking, reduce the severity of cravings and withdrawal symptoms. However side effects include seizures, dry mouth, nausea and sweating. Also less effective than varenicline (jorenby study above). Tonnesen et al (2003) 27% of smokers on bupropion after 7-week treatment programme reported urge to smoke was a problem compared to 56% on placebo.

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Psychological Interventions

Counselling - can involve individual or group meetings, focuses on short term behavioural goals to develop coping skills and tools. McLellan (1985) found individual counselling to be more effective than medication along in treatment of herion addicts on methadone. However depends on motivation of the indiv. and the actual addiction. Hazel et al (2006) found that a telephone counselling service was good for helpin people to try to smoke but not with relapse.

Aversion therapy (bases on learning theory) - involves the individual learning an association between the drug and an emetic which discourages the person from continuing the behaviour. Mainly used for alcohol, involves the use of drug disulfiram which produces an acute sensitivitty to alcohol. 5-10 mins after alcohol consumed, person experiences an severe hangover for 30mins to several hours, so then associates alcohol with negative symptoms. Krampe et al (2006) in a follow up of 180 alcohol patients on a supervised disulfiram programme over 9 years found abstinence rate of 50%, however depends on willl-power and motiation etc

However such interventions do not tackle the cause only the symptoms.

CBT - uses cognitive restructuring to help client think differently about the problem, techniques include relapse prevention where indiv. learn to identify and correct problem behaviour. Hojek et al (2005)found useful for people to stay off cigarettes once stopped. Techniques involved teaching self-control, +ve/-ve consequences of behaviour and self monitoring to stop craving signs. Ladouceur et al randomly allocated 66 pathological gamblers to CBT or waiting list group. 86% of the treatment group were no longer classed as pathological gamblers and had increased self efficacy. 

Psychological interventions provide best support when used in conjunction with biological methods

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Public health interventions

  • Doctors advice - Russell et al (1979) carried out a study in 5 doctors surgeries over a 4 week period in 4 conditions and their success rates: follow up session a few weeks later (0.3%), questionnaire about smoking and follow up (1.6%), doctors advice to quit and follow up (3.3%), doctors advice to quit as well as leaflets and guidelines (5.1%)
  • Shows influence of doctors advice even though percentages were low
  • Workplace interventions - such as no smoking in enclosed spaces enforced by UK govt legislation 2007. However some may compensate by smoking at home to make up for lack of nicotine earlier in the day.
  • An Australian study that investigated attitudes immediately and six months after a similar ban in 44 government buildings suggested immediate resentment and inconvenience which diminished with time.   Despite this the ban only resulted in 2% quitting completely.  In the UK the ban was introduced in July 2007.  Between April and December of that year an estimated 250,000 people quit.  Most of these were in the nine months prior to the ban being introduced
  • Government initiatives - banning or restricting goods or advertising, increasing the price through taxation. They are often criticized for their apparent hypocrisy, for example in raising taxes on gambling to reduce behaviour whilst launching lotteries and reducing restrictions on Casinos. 
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