Addiction PSYA4

This approach suggests that we become addicted to something because doing without the stimulus is very unpleasant. Tolerance is an important concept in biological explanations of addiction. The more we use a substance or carry out certain behaviours, the more tolerant we are to its effects, so addicts must continue the addictive behaviour more and more to maintain the subsequent positive feeling it creates. Withdrawal occurs when the addict stops engaging in the addictive behaviour, but a range of unpleasant physical symptoms arise, known as “withdrawal symptoms.”

Neurotransmitters play a role in both chemical and non-chemical addictions, as the addictive substance or behaviour causes changes in the brain chemistry following repeated use. Dopamine is the main subject of research. 

INITIATION

Lehrman et al. (1999) found people with the SCL6A3-9 gene are more likely to take up smoking than those without it, suggesting that it is because of genetic predisposition that we initiate the addictive behaviour of smoking. 

(-) reductionism

(-) some that smoked did not have the gene

(+) Noble referred to the DRD2 gene as the reward gene, claiming that those with alleles of DRD2 that lead to fewer dopamine receptors in the brain were more likely to become addicted, as certain drugs that increase dopamine levels compensate for the receptor deficiency. 

(+) Comings et al. (1996) found that the DRD2 variation was found in higher frequencies in smokers, pathological gamblers and alcoholics than the normal population. 

(-) Determinism: the fact that some people may be more likely than others to become addicted so substances/behaviours may allow us to ignore the element of free will in the initiation of addictive behaviour.

MAINTENANCE

According to the biological model, the reason for continued smoking is chemical addiction to the highly addictive substance, nicotine. There is clear evidence that nicotine is highly addictive and produces changes in how the brain works. 

(+) Schachter (1977) found that smokers who smoked low-nicotine cigarettes smoked 25% more cigarettes than those who smoked high-nicotine content cigarettes. 

(-) demand characteristics

(-) cause and effect (Ethics too)

Dopamine is a neurotransmitter that is important for communication in many parts of the brain, including the reward system. Nicotine increases dopamine release, providing a positive, rewarding feeling .

(+) Corigall and Coen (1991) found that mice would self-administer nicotine into the reward centres of their brain, unless their dopamine release system was inhibited.

(-) animal study

(-) dopamine affects many areas of the brain

RELAPSE

Long-term use of nicotine leads to a high tolerance to it. Stopping this use can lead to severe withdrawal symptoms, so to avoid this, the addict relapses. 

(+) Lehrman et al. (2007) found that when someone abstained from smoking for one night, they experienced increased blood flow to areas of the brain associated with memory, attention and reward.

Shah et al. (2005) found evidence of a genetic transmission of gambling behaviour in men, suggesting that there is a biological basis for gambling addiction. 

(-) only in men

(+) Black et al. (2006) found that first degree relatives of pathological gamblers were more likely to suffer from pathological gambling than more distant relatives. 

(-) other factors, i.e. SLT

INITIATION

This is closely linked to the physical experience caused by gambling, explained in terms of a positive reward theory. Gambling floods the body with adrenaline, which is thought to be highly addictive due to the “rush” it provides.

(-) Bergh et al. (1997) claims that there is a link between gambling, the reward system and impulsive behaviour. 

(-) Comings et al. (1996) showed that pathological gamblers are more likely to carry certain gene. (D2A1)

(-) cause and effect

MAINTENANCE

Wray and Dickinson (1981) found that gambling addicts who are stopped from gambling experience symptoms almost like withdrawal symptoms. To avoid the negative feelings associated with withdrawal, the addict continues to gamble. 

(+) Orford et al. (1996) found that gamblers and alcoholics both experience similar withdrawal symptoms and levels of perceived strength of addiction.

(-) self-report methods

(-) addicts are likely to lie

(-) Potenza et al. (2003) found, from MRI scans, differences in blood flow to the brains of non-gamblers and gamblers when watching a gambling tape compared to a happy or sad film.

(-) cause and effect

RELAPSE

Gamblers experience similar withdrawal symptoms to addicts with substance addictions, so a theory stands that gamblers relapse in order to stop the withdrawal symptoms. 

(-) Ciarrochi et al. (1987) found gamblers often have other addictions, such as alcoholism or shopping addictions. 

Cues associated with the behaviour, i.e. chips or dice, often cause a relapse of dopamine that the original gambling behaviour did. This causes prediction of a reward, which can cause a relapse. 

(-) Reductionism: biological approach reduces addiction, a complex phenomenon, to simple terms.

The cognitive model places emphasis on interpretation of events and habitual ways of thinking to explain the development of addictive behaviour. 
 

Beck (2001) developed the “vicious circle” to explain addiction from his cognitive triad: 
Coping – people engage in addictive behaviour as a means of coping with stress in their lives and for: 
Mood Regulation – addictive behaviours can be used to increase positive mood and reduce negative mood. 
Performance Enhancement – the addictive behaviour may make the person feel alert or more able to perform certain tasks.
Distraction – the behaviour may distract from less pleasant life experiences.

Expectancy      If the addict expects their behaviour to have negative consequences rather than positive ones, they are less likely to engage in the behaviour.Research has shown that expectancies about the effect of an addictive behaviour can sometimes have more of an influence on the addict’s experience than the actual changes produced. 

Self-Efficacy     Bandura (1977) claimed that self-efficacy beliefs are important factors in determining initiation or continuation of an addictive behaviour, as it determines whether we believe we can do something about our behaviour once it is established or not.

INITIATION

When someone begins smoking, it can be described in terms of expectancy. Smokers expect that nicotine will initiate social interactions or reduce stress due to faulty beliefs. In terms of coping, performance enhancement may explain why people start smoking. The self-efficacy belief that smokers can stop smoking at any time may contribute to the initiation of smoking behaviour.

(+) Heishman (1999) found that smoking can help someone concentrate with increased attentional focus and enhanced performance of well-learned behaviours. 

(+) Brandon and Baker (1991) suggested that people begin to smoke because they 

expect that it relieves boredom. 

(-) no evidence to support, just a statement

MAINTENANCE

Maintenance of smoking can be due to Beck’s cognitive triad and the continuation factor of the vicious circle. They engage in smoking, which leads to medical and financial problems, which then leads to a low, negative affect, which then leads to continuation of the smoking behaviour in order to cope with the depressed mood. 

(+) Cohen and Lichtenstein (1990) found that smoking actually increases stress levels, suggesting that it is an irrational belief that smoking decreases stress level. 

RELAPSE

Coping, self-efficacy, and expectancy can all explain relapse in smoking. 

(+) Tate et al. (1994) found that smokers who were told to expect no negative experiences during a period of abstinence experienced fewer physical and psychological effects compared to a control group who were not primed. 

INITIATION

Gambling behaviour at first provides the person with positive feelings, especially if they are winning money. Positive feelings generate positive thoughts, which can be hard to change once developed. The associations with gambling (i.e. the environment, the “rush”) can provide similar positive feelings, further strengthening existing conditions. 

MAINTENANCE 

Beck’s Cognitive Triad – through gambling, which initially provides reward through good feeling, many people get into financial trouble, which leads to a low mood, leading them to gamble again.
Coping – addicts may begin gambling to get a good feeling, encouraging them to interpret their behaviour in a positive way. 
Self-Efficacy – gamblers do not see their behaviour as such a problem, as the withdrawal symptoms are not as extreme as substance abuse so they continue, believing there are no consequences. 
Expectancy – stories of people winning large amounts of money through gambling are often in the media, so people believe their actions could be life-changing and this fuels their behaviour. 

Maintance

Griffiths (1994) compared 30 regular and 30 non-regular gamblers, finding that regular gamblers were more likely to believe they were skilled, and also more likely to believe they were skilled, and also more likely to make irrational verbalisations during play. They also expressed their losses as “near wins.”

(-) cause and effect   (-) personality traits and gamblers may be more skilled due to practise

Zuckerman (1979) claimed individual differences are important in determining the need for optimal amounts of stimulation. “Sensation seekers” have a lower appreciation of risk and look for varied and novel experiences. 
(-) correlation    (+) not nomothetic, but idiographic

Blazcyznski et al. (1990) found that poor tolerance to boredom leads to repetitive gambling behaviour.  
(-) Coventry and Brown (1993) found those who exclusively betted on horse racing in an off-course betting shop were lower on sensation seeking. Only applys to horse racing

RELAPSE

The withdrawal symptoms of gambling are not too serious, so the gambler returns to the possibility of winning money. Gamblers feel they can stop at any time, so a relapse is not perceived as much of a problem. 

INITIATION

Behaviour may begin because smoking is associated with desirable outcomes or rewards. The new smoker associates the cigarette with this positive feeling, reinforcing the link between smoking and feeling good. The desirable outcomes of rewards may be social acceptance due to peer pressure and normative influence. 

(+) Mayeux et al. (2008) found a correlation between smoking and popularity two years later. 

(-) correlation

(-) 16 year olds

(-) males

DiBlasio and Bersha (1993) found that peer group influences were the primary influence for adolescents who start to smoke.

MAINTENANCE

The pressures that caused smoking in the first place still exist when the addict smokes, so it is difficult to give up smoking. Smoking becomes highly ritualised behaviour, so the routines are hard to resist and so are maintained. 

RELAPSE

As smokers often link the materials associated with smoking with their addictive behaviour, seeing or handling a lighter/packet of cigarettes, for example, is enough to generate cravings for nicotine. 

(-) Robinson and Berridge (1993) pointed out that many people experimentally smoke during their lives, but relatively few become addicts.

INITIATION

According to the behaviourist model, gambling behaviour is initiated as the addict sees others winning on slot machines or the lottery. Their expectations of the win may drive them to place their first bet, being playing the lottery. Once they have started, the excitement is associated with gambling, causing addiction.

MAINTENANCE

Gamblers receive intermittent rewards, i.e. they do not win every time, which only serves to reinforce the addiction. If they were rewarded every single time they gambled, the one time that they stopped winning, they would stop gambling. 

However, if they are rewarded every now and again, they will continue to gamble on the basis that they could win the next time that they gamble. 

Griffiths (2009) found that gamblers playing slot machines may become addicted because of the physiological rewards, psychological rewards, social rewards as well as financial rewards if they win. 

RELAPSE

Returning to gambling after a period of abstinence can be explained in terms of cuereactivity. The material associated with gambling is all around, particularly with the easy way which people can now play the National Lottery, and the many scratch cards readily available. Gamblers are always surrounded by reminders of their addictive behaviour, causing them to relapse.

AGE

Levin et al. tested for a link between the age of initial nicotine use and addiction in female rats in the laboratory. The adolescent rats self-administered significantly more nicotine than the adults. Animals that used nicotine during adolescence continued to use more of the drug even after they became adults. 

(-) female rats and an animal study

(+) Shedler and Block (1990) found that those between the ages of 7 and 11 who had poor impulse control, social alienation and emotional distress were more likely to use marijuana once a week and one other drug experimentally at aged 18. 

(+) Monique Helfer claimed that 17% of women over 75 used painkillers and sleeping tablets every day, and in men over 75, 46% drank daily. 

(-) doctors are more likely to prescribe females medication

PEERS

Eiser et al. (1991) found that smokers tend to befriend smokers and non-smokers tend to befriend non-smokers. 

Two theories are important in smoking addiction: 

1) Social Learning Theory – Bandura, 1977

2) Social Identity Theory – Abrams and Hogg, 1990 

(+) Duncan et al. (1995) found that exposure to peer models increases the likelihood that teenagers will begin smoking.

(+) Brown et al. (1997) found that, with age, the roles of close friends and particularly romantic partners become increasingly important as influences on attitudes and behaviour.

STRESS

(+) NIDA (1999) found that people report that they smoke, drink, use drugs, gamble 

etc. as a means of coping with daily hassles. 

(+) Driessen et al. (2008) found that 30% of drug addicts and 15% of alcoholics suffered from post-traumatic stress disorder. 

(+) The metyrapone test found that, when given to addicts, abstainers and nonaddicts, they all reacted differently to a drug (metyrapone) that tests a person’s stress system:

In active heroin addicts, their ACTH levels in the blood hardly rose at all, as excess opioid molecules in the brain greatly inhibit the brain’s stress system.In people who were abstaining from heroin use and also not taking methadone, the ACTH levels in their blood rose almost twice as high as non-addicted people, as the constant on-off use of heroin made the stress system hypersensitive. 

In non-addicts, ACTH levels rose. 

PERSONALITY

Hans Eysenck (1997) propsed a psychological resource model, i.e. the individual develops an addictive habit because it fulfils a certain purpose related to the personality type of the individual:
Psychoticism: aggressive, cold, impulsive and egocentric characteristics
Neuroticism: moody, irritable and anxious characteristics
Extraversion: sociable, lively and optimistic characteristics

(-) Research evidence shows little support for a link between E and drug dependence.

(+) Francis (1996) found evidence of a link between dependence on alcohol, heroin, benzodiazepines and nicotine and “higher-than-normal” scores for N and P. 

(-) what is defined as a “normal” score?

(-) correlational evidence

(+) Stein et al. (1987) found people with certain behavioural traits may be more disposed to addiction, e.g. drug abusers have been found to be more rebellious, impulsive and sensation seeking than non-users. 

Sulkenen (2007) found that, in 140 scenes from 47 films, alcohol, drugs, tobacco, gambling and se were represented. Many films about drugs presented scenes of drug competence and enjoyment of the effects. 
(-) films may not be representative; they may have been chosen because of their content. 

Gunasekera et al. (2005) found that, in 87 of the most popular films of the last 20 years, only 1 in 4 was free from negative health behaviours such as unprotected sex, cannabis use, smoking and alcohol intoxication. 
(-) Simply because the film had it in does not mean that people will repeat the behaviour, as it is just a film.
(+) Sargent and Hanewinkel (2009) found that adolescents who watched films containing smoking behaviour were more likely to begin smoking in the next year. 
(+) longitudinal study
(-) not all addictions, as smoking is relatively accepted, as it is legal.
(-) Boyd (2008) claimed that not all films displayed addiction in a positive manner, and films do regularly represent the negative consequences of addiction.

Changing Addictive Behaviour

The fact that there are relatively few professionals in the field of addiction, and many addicts lack the motivation to attend support sessions has prompted a search for other means of support and education. The media has been identified as a useful tool for providing a form of intervention, especially TV documentaries and the internet. 

(-) Bennett et al. (1991) found that people who watched a series about alcohol addiction had more knowledge related to alcohol compared to a group of people who did not watch the series, but did not change their attitude towards alcohol consumption.

(-) content of the program may have led to this result

(+) Kramer et al. (2009) found that an intervention group was more successful than a control group in achieving low-risk drinking after watching a program about it. This difference was maintained at a 3 month follow-up. 

(-) extra attention from researchers may have caused improvement.

(-) control group were told they would receive treatment, so may have postponed trying to change their behaviour, perhaps artificially inflating the magnitude of the difference.

Attitude – positive or negative attitude towards the behaviour, combined with beliefs about the outcome, e.g. “if I stop smoking my health will improve.”

Subjective Norms – personal perception of how society would view the behaviour, and whether the individual is motivated to conform to these social norms, e.g. “my friends will approve of my attempt to stop smoking.”

Perceived Behavioural Control – an individual’s belief about their ability to carry out certain behaviours, taking into account internal and external control factors. These three factors interact to form a behaviour intention, which then leads to the actual behaviour. 

(+) It takes into account the fact that people, especially addicts, don’t often have control over their behaviour, as there may be certain obstacles that stand in their way. 

(+) Norman et al. (1998) found that perceived behavioural control was a strong predictor of binge drinking. 

(-) only one factor and only one type of addiction. Intention does not always lead to behaviour being carried out, especially in addiction behaviour. Addicts may intend to stop but may succeed to withdrawal, relapse, and continue with the addictive behaviour. The model does not take into account different types of intention. For example, a specific intention is more likely to be fulfilled than a vague intention. Behavioural Attitude

Subjective Norms
Perceived Behavioural       
Control

Intention Behaviour(-) Goodie (2005) found that there are individual differences between addicts and non-addicts in terms of their perceived control; for example, gamblers were less affects by their level of control in betting decision than non-problem gamblers. 
(-) reductionism: the TPB is criticised for being too rational, as it does not take into account emotions, compulsions or other irrational determinants. Culture differences: Hanson (2005) found that African-Americans were influenced by attitude, subjective norm and control to smoke, however, in Puerta Ricans and non-White Hispanic women, attitude and perceived control were the main predictors. 

Heroin Addiction and Methadone – methadone mimics the effects of heroin, but it is not as addictive. It produces feelings of intense euphoria like heroin, but its effects last for 24 hours and not 4 – 6 like heroin. The addict is slowly weaned off of methadone until they no longer need methadone or heroin, eliminating the addictive behaviour. 

(-) addicts can become just as reliant on methadone as they were heroin, so it can replace one addiction with the other.

(-) The UK Statistics Authority (2007) reported that methadone was responsible for 300 deaths in the UK in 2007, suggesting it is not a safe way to intervene in heroin addiction. 

Drug Treatments for Pathological Gambling – there is no drug currently approved for use in the UK to treat pathological gamblers. 

(+) George and Murali (2005) found evidence that links serotonin dysfunction to pathological gambling. 

(-) cause and effect

(+) Hollander et al. (2000) found that pathological gamblers treated with SSRIs improved significantly compared to a control group. 

(-) small smaple

(-) short-term

(-) Blanco et al. (2002) found no superiority of SSRI treatment compared to placebo treatment, suggesting that the drugs are not the cause of the improvement. 

Reinforcement – based on learning theory and the theory of classical conditioning, if addicts are given rewards for not engaging in addictive behaviour, then they will associate abstaining with rewards and thus continue with the behaviour. 

(+) Sindelar et al. (2007) found that if people on methadone treatment programs were given monetary rewards for being drug free, they were 60% more likely to test negative for drugs in comparison to a control group who received only methadone and no monetary reward. 

(-) giving former addicts extra money may not be wise, as they may spend it on drugs. 

(-) Reinforcement interventions do not address the underlying problems, so an addict could easily relapse or find another addiction to replace the former. This means that reinforcement interventions could be classed as ineffective.

Cognitive Behavioural Therapy – CBT changes the way people think about their addiction, encouraging rational belief and thought patterns rather than irrational beliefs such as “I have the ability to stop at any time,” for example. It also teaches addicts coping methods so that they can cope with situations that appear in the future that could lead to the addictive behaviour. 

(+) Landoceur et al. (2001) found that, when 33 pathological gamblers were given CBT, only 86% of them did not meet the DSM criteria for pathological gambling bythe end of the therapy. 

(-) may not be as effective on other addictions

(+) Critz-Christoph et al. (2003) carried out a study into the effectiveness of different interventions into cocaine addiction, finding that individual drug counselling and group counselling worked best in combination, with only 39% of patients reporting taking cocaine in the previous month. 

(+) Stead et al. (2006) found that people who received repeated telephone calls from a counsellor were 50% more likely to be able to abstain from smoking than smokers who received only self-help materials and/or brief counselling. 

(-) West (2009) found that, although the percentage of people who smoked in Britain decreased after the smoking ban, there were greater people who attempted to stop smoking before the ban was in place compared to after.

(-) people may have tried to stop smoking because of the ban.