Addiction Chapter Summary

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

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

IDA:

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

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

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'

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

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

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

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

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

Links:

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

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

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

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

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

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

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

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

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

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

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

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

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)

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

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

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