Addiction Chapter Summary

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Biological Models of Addiction

Genetics:

  • McGue (1999) - heritability estimates for alcohol around 50% 
  • Drug use heritability is 45-80%
  • Genetics = general predisposition to behavioural disorders
  • DRD2 gene linked to severe alcoholism, cocaine, heroin and nicotine addiction
  • 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 sensitisation theory: increased exposure to drugs of abuse causes sensitisations to their desirability 

Maintenance:

  • Chronic exposure to drugs leads to downregulation 
  • Drugs must then be taken to avoid withdrawal symptoms

Relapse:

  • Drugs become more important than other desires
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Biological Models of Addiction

Evaluation:

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

Synoptic Links:

  • 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 povides stress relief, but chronic stress effect that prevents relapse 

Evaluation:

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

Expectancy Theories:

  • Expectations aot 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 unconscious expectations. Expectations manipulated to prevent relapse

Evaluation:

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

Rational Choice:

  • 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 for treatment - change utility for consumer 
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Cognitive Models of Addiction

Synoptic Links:

  • 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 repeated
  • Maintenance and Relapse: Withdrawal symptoms appear if drug is discontinued. Relapse is known as negative reinforcement

Evaluation:

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

Classical Conditioning:

  • Initiation: Stimuli that occur at the same time as addictive stimulus become secondary reinforcers by association
  • Maintenance and Relapse: Withdrawal symptoms lead to take drugs again

Evaluation:

  • Individuals addicted to heroin in Vietnam less likely to relapse when they return back to the USA 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. Presence of multiple cues associated with drug makes relapse more likely

Evaluation:

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

Synoptic 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 driven by psychological motives such as rebelliousness
  • Desired image enough to tolerate unpleasantness after which addictive nature of nicotine takes over
  • Nicotine activates nicotine receptors in th brain, whcih leads to the release of dopamine
  • Leads to temporary feelings of pleasure, which must be repeated for the same effect
  • Greater nicotine intake in disadvantaged groups explains why harder to give up

Evaluation:

  • Smoking/peer popularity association supportd in study 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 (Peretti-Watel et al, 2009) 
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Specific Addictions

Gambling Addiction:

  • Shah et al (2005) - evidence of genetic factors in male gambling
  • 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 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

Synoptic Links:

  • Smoking addiction follows different pattern in men and women
  • Biased assessment of gambling as 'pathological in twin/family studies in genetic status known  
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Media and Addictive Behaviour

Film Representations of Addiction:

  • Sulkenen (2007) analysed 47 films with scenes of drug competence and enjoyment, contrated with dullness of ordinary life
  • Use of drugs presented as a way of solving a problem
  • Gunasekera (2005) analysed 87 films - most portraye drug use positively without showing negative consequences 
  • Only one if 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 an 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 by 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
  • Anti-drug campaigns - US study included resistance skills and raising self-efficacy (Hornik et al, 2008) 

Evaluation:

  • Kramer et al study - intervention group also received regular visits from researchers 
  • US stufy didn't work because messages not novel and drugs made commonplace 
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Media and Addictive Behaviour

Synoptic Links:

  • Ethical guidelines for representation of drugs in film developed in US
  • Creativemedia 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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Models of Prevention

Theory of Planned Behaviour:

  • Includes perceived behavioural control, - extent to why individual believes they will be able to carry out the behaviour
  • Behavioural control acts on intention and behaviour
  • Real World application to change unhealthy behaviours 

Evaluation:

  • Meta-analysis - TPB better predictor of intention
  • Too rational
  • Account of intention formation rather than actual behaviour 
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Models of Prevention

Synoptic Links:

  • White et al (2008) - TPB predicted intentions to engage in sun protection
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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 naltrexone to reduce reinforcing properties of gambling

Evaluation:

  • Some addicts become reliant on methadone
  • Used in black market
  • Support for SSRIs is inconclusive 
  • Effectiveness of naltrexone demonstrated by Kim and Grant (2001)
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Types of Intervention

Psychological:

  • Addictive behaviour reduced by reinforcment (Sindelar et al, 2007)
  • CBT changes the way people think about their addiction

 Evaluation:

  • Do not address the problem that led to the addiction in the first place
  • CBT support in studies of pathological gamblers (Labouceur et al, 2001)
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Types of Intervention

Public Health and Legislation:

  • The NIDA study - combination of individual and group drug counselling works best 
  • Quitline services for smoking increased odds of quitting by 50%
  • Legislation in 200 led to more supportive enviornment to quit smoking

Evaluation:

  • NIDA: reduction in cocaine use led to reduction in HIV risk
  • Anti-smoking legislation led to rebound effect (West, 2009)
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Types of Intervention

Synoptic Links:

  • Quitline services successful in returning military personnel (Beckham et al, 2008) 
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