Addiction Chapter Summary

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Biological Models of Addiction

Genetics of Addiction:

  • Heritability estimates for alcohol addiction = 50% (McGue, 1999)
  • Illicit drug abuse heritability = 45-79%
  • Genetic inheritence = general predisposition to behavioural disorders
  • DRD2 gene linked to severe alcoholism, cocaine, heroin and nicotine addiction
  • Individuals become addicted to drugs that increase dopamine levels

Evaluation:

  • Explains individual differences in vulnerability to addiction and why some people resistant to treatment
  • Meta-analysis - large proportion of alcoholics had A1 variant of DRD2 gene
  • More recent studies have failed to find any relationship between A1 and alcoholism
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Biological Models of Addiction

The Disease Model:

  • Initiation: Addictive drugs stimulate reward circuit. Incentive sensitiation theory: increased exposure to drugs of abuse causes sensitisation to their desirability
  • Maintenance: Chronic exposure to drugs leads to downregulation. Drugs must then be taken to avoid withdrawal symptoms
  • Relapse: Drug becomes more important than other desires

Evaluation:

  • Some people particularly vulnerable to added rush of dopamine-enhancing drugs
  • Neurochemical explanations ignore other casual factors but offer hope for treatment
  • Stimulating environments protect against stimulation offered by addiction
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Biological Models of Addiction

IDA:

  • Banks et al (2008) - successfully tested cocaine replacement drug with monkeys
  • Reductionism - has advantages but ignores social context of addictive behaviour
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Cognitive Models of Addiction

Self-Medication Model:

  • Initiation: drugs taken to relieve psychological states
  • Maintenance and Relapse: Initial rush of nicotine provides stress relief, but chronic stress effect that prevents relapse

Evaluation:

  • Substance abuse disorders characterised by low ego control for impulses to self-medicate
  • Many cases of addiction where no problems to overcome
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Cognitive Models of Addiction

Expectancy Theories:

  • Expectations about outcomes of addictive behaviour contribute to excessive use
  • Initiation: Heavier drinkers have more positive expectations about effects of alcohol
  • Maintenance and Relapse: As addiction develops, more governed by unconsious expectations. Expectations manipulated to prevent relapse

Evaluation:

  • Subjective evaluation of anticipated effects are an important determinant of drinking behaviour
  • Research on alcohol focused on 'problem drinking' rather than 'addiction'
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Cognitive Models of Addiction

Rational Choice Theory:

  • Initiation: Becker and Murphy (1988) suggest that the concept of 'utility' determines consumption
  • Maintenance and Relapse: addicts are 'rational consumers' who act to maximise their preferences. Exception is gambling

Evaluation:

  • Explains why some addicts give up - utility of behaviour alters
  • Implications of treatment - change utility for consumer
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Cognitive Models of Addiction

Summary points:

  • Emphasis on positive findings exaggerates research findings in a particular area
  • Suggests idea that addiction is an uncontrollable behaviour which absolves addict from personal responsibility
  • Men hold stronger positive and weaker negative expectations about effects of alcohol
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Learning Models of Addiction

Operant Conditioning:

  • Initiation: Behaviours that produce rewards are likely to be reproducted (raise dopamine levels - positive reinforcement)
  • Maintenance and Relapse: withdrawal symptoms appear if drug discontinued. Relapse = negative reinforcement

Evaluation:

  • Explains why addiction does not require conscious awareness and why addictive drives take precedence over other drives
  • Does not explain why so many people do not become addicts despite taking drug
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Learning Models of Addiction

Classical Conditioning:

  • Initiation: stimuli that occur at same time as addictive stimulus become secondary reinforcers by association
  • Maintenance and relapse: associated stimuli (CS) + drug effect (UCS) = defensive response
  • Eventually CS, CR experienced as withdrawal symptoms
  • Motivated to take the drug again

Evaluation:

  • Individuals addicted to heroin in Vietnam less likely to relapse when back in the US because CS is absent
  • Treatment - cue exposure, based on stimulus discrimination
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Learning Models of Addiction

Social Learning Theory:

  • Initiation: learning takes place through observation and communication, arousing different outcome expectations and motivations
  • Maintenance and Relapse: individual experiences 'approach-avoidance' conflict concerning the drug
  • Prescence of multiple cues associated with drug makes relapse more likely 

Evaluation:

  • Peer influence is primary reason why adolescents smoking or take drugs
  • Low self-efficacy linked to likelihood of relapse
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Learning Models of Addiction

Links:

  • Evolutionary significance of occasional reinforcement - positive reinforcement likely 'on average'
  • Resistance training targeted at beginner adolescents
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Specific Addictions

Smoking Addiction:

  • Smoking is driven by psychosocial motives e.g rebelliousness
  • Desired image enough to tolerate unpleasantness after which addictive nature of nicotine takes over
  • Nicotine activates nicotine receptors in the brain, which leads to release of dopamine
  • Leads to temporary feeling of pleasure, which must be repeated to get the same effect
  • Greater nicotine intake in disadvantaged groups explains why harder to give up

Evaluation:

  • Smoking/peer popularity associated supported by Mayeux et al (2008)
  • Long-term smoking alters brain chemistry and may make depression more likely
  • French study supported link between socioeconomic status and smoking
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Specific Addiction

Gambling Addiction:

  • Shah et al (2005) - evidence of genetic factors in gambling in men
  • Black et al (2006) - first-degree relatives more likely to gamble
  • High sensation seekers - lower appreciation of risk and arousal evaluated more positively
  • Poor tolerance of boredom linked to pathological gambling

Evaluation:

  • Difficult to disentangle genetic and environmental contributions
  • Genetic predisposition for gambling through inherited trait for impulsivity
  • Gamblers as high sensation seekers not supported by evidence
  • Type of gambling makes a difference concerning sensation seeking
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Specific Addictions

Links:

  • Smoking addiction follows difference pattern in men and women
  • Biased assessment of gambling as 'pathological' in twin or family studies if genetic status known
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Vulnerability to Addiction

Self-Esteem:

  • Low self-esteem associated with self-defeating health behaviours
  • Lower self-esteem at age 16 associated with higher risk of addiction later on
  • Excessive mobile phone usage and pathological internet usage among individuals with low self-esteem

Evaluation:

  • Link between pathological internet use and low-self esteem supported by Niemz et al (2005)
  • Low self-esteem could be a cause or a consequence
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Vulnerability to Addiction

Attributions for Addiction:

  • Smokers attribute reasons for smoking to forces outside their control
  • Attribution for behaviour of others depends on substance type

Evaluation:

  • Attributions functional rather than accurate
  • Attribution of addiction - detrimental consequences for drug users as removes responsibility for change
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Vulnerability to Addiction

Social Context of Addiction:

  • Development of smoking explained by social learning theory and social identity theory
  • Motivation to take heroin includes pressure of belonging to a group that uses drugs

Evaluation:

  • Influence of peers wanes in later adolescence
  • Support for claims of SLT - exposure to peer models increases likelihood of smoking
  • Little is known about extent to which groups influence members to smoke
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Vulnerability to Addiction

Links:

  • Problems of determining casuality in studies of self-esteem - only possible in longitudinal studies
  • Male drug and alcohol abusers held more responsible for their problems than females
  • Drug abuse research socially sensitive, necessary to weigh up costs and benefits
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Media and Addictive Behaviour

Films Representations of Addiction:

  • Sulkenen (2007) - analysed 47 films with scenes of drug competence and enjoyment, contrasted with dullness of ordinary life
  • Use of drugs represented as way of solving particular problems
  • Gunasekera (2005) - analysed 87 films - most portrayed drug use positively without showing negative consequences
  • Only one in four films was free from portrayal of negative health behaviours

Evaluation:

  • Sargent and Hanewinkel (2009) - exposure to movie smoking was significant influence on adolescents taking up smoking
  • Boyd (2008) - movies frequently do portray negative consequences of drug and alcohol dependence
  • Films play important role in generating stereotypes of drug takers
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Media and Addictive Behaviour

Changing Addictive Behaviour:

  • TV support for problem drinking - Bennett et al (1991) found change in alcohol-related knowledge but not in attitudes or behaviour
  • TV self-help series (Kramer et al, 2009) - more in intervention group achieved low-risk drinking than in control group
  • Antidrug campaigns - US study included resistance skills and raising self-efficacy (Hornik et al, 2008) 

Evaluation:

  • Kramer et al - intervention group also received regular visits from researchers (extraneous variable was extra attention)
  • US study didn't work because messages not novel, and may contain message that drug-taking is commonplace encourage marijuana use
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Media and Addictive Behaviour

Links:

  • Ethical guidelines for representation of drugs in film developed in US
  • Creative media led Brian Wilson to use drugs to increase creative output
  • Most evidence about media effects on addictive behaviour is correlational, not casual
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Reducing Addictive Behaviour

Models of Prevention: Theory of Planned Behaviour

  • TPB include 'perceived behavioural control' - extent to which individual beliefs they will be able to carry out behaviour
  • Behavioural control acts on intention (more perceived control, strong intention) and behaviour (more perceived control, more effect)
  • Real-world application to change unhealthy behaviours - including stopping smoking and drug use

Evaluation:

  • Meta-analysis - TPB better predictor of intention
  • Too rational
  • TPB is an account of intention formation rather than actual behaviour
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Types of Intervention

Biological:

  • Methadone mimics effects of heroin but is less addictive
  • Drug treatments for gambling include SSRIs to increase serotonin levels and naltexone to reduce reinforcing properties of gambling

Evaluation:

  • Some addicts become as reliant on methadone as they were on heroin
  • Methadone use has resulted in a black market of drug
  • Support for use of SSRIs for gambling inconclusive, but effectiveness of naltrexone demonstrated by Kim and Grant (2001)
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Types of Intervention

Psychological:

  • Addictive behaviour reduce by reinforcement
  • CBT changes the way people think about their addiction

Evaluation:

  • Reinforcement interventions do not address the problem that led to addiction
  • CBT supported in studies of pathological gamblers
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Types of Intervention

Public Health and Legislation:

  • NIDA study - combination of individual and group drug counselling works best
  • Quitline services for smoking increased odds of stopping smoking by 50%
  • Legislation in 2007 led to creation of more supportive environment for stopping smoking

Evaluation:

  • NIDA study - reduction in cocaine use accompanied by reduction in HIV risk
  • Anti-smoking legislation led to rebound effect after ban
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Types of Intervention

Links:

  • Telephone Quitline services successful in returning military personnel
  • The clinician's illusion - many clinicians believe addiction is difficult to treat because they only come across advanced cases
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