The Psychology of Addictive Behaviour - 1. Models of Addictive Behaviour

“Addiction is the compulsive uncontrolled use of habit forming drugs.”
- Webster’s New International Dictionary

“Addiction is a state of periodic or chronic intoxication produced by repeated consumption of a drug, natural or synthetic.”
- World Health Organisation

“A repetitive habit pattern that increases the risk of disease and/or associated personal and social problems. Addictive behaviours are often experienced subjectively as ‘loss of control’ – the behaviour contrives to occur despite volitional attempts to abstain or moderate use. These habit patterns are typically characterized by immediate gratification (short term reward), often coupled with delayed deleterious effects (long term costs). Attempts to change an addictive behaviour (via treatment or self initiation) are typically marked with high relapse rates.”

• Gambling (Griffiths 2006)
   
• Overeating (Orford 2001)
   
• Sex (Carnes 1991)
   
• Exercise (Allegre et al. 2006)
   
• Videogame playing (Griffiths 2007)
   
• Love (Peele and Brodsky 1975)
   
• Internet use (Widyanto and Griffiths 2006)
   
• Work (Griffiths 2005)

The Disease Model

Suggest that addiction comes from disorder of the body.

• Eg. Neurochemical imbalance.
   
• The individual has limited control over their behaviour in the same way you have limited control over getting ill or not.

The Genetic Model

Suggests there is a genetic disposition towards addictive behaviour.

• The biggest risk factor for becoming a smoker is having parents who smoke. But is this genetic disposition or family influence?
   
• Evidence shows a higher incidence of certain genes in people with addictive behaviours.

The Experimental Model

Suggests that addictive behaviours are temporary and dependant on the situation we are in.

• People move on/grow out of  their addictive behaviours as their life circumstances change.
   
• Stanton Peele (1990). 

The Moral Model

Suggests that the key issue with addiction is lack of character.

• Addiction is a result of weakness/moral failure in the individual.
   
• Treatment gets people to repent and then develop moral strength.

All addictive behaviours have elements in common.
Some individuals engage in addictive behaviours without it being a full-blow addiction. Enthusiasms add to life whilst addictions take away from it.

• Salience
  Addiction is most important behaviour for the addict, even if they are not doing it they will be thinking about it (smoking and drinking can be engaged in with other activities so this tends not to be the case). If they do not engage in the behaviour for an extended period of time it will dominate their thoughts and behaviour -  reverse salience.
   
• Mood Modification
  Eg. a rush, buzz or high. The activity/drug can have different mood modifying effects depending on the time of day.

• Tolerance
  An increasing amount of drugs/betting/time is needed to achieve the same effect.

• Withdrawal Symptoms
  Unpleasant feelings/physical effects that occur when the addict behaviour is suddenly discontinued or reduced. Eg. the shakes, moodiness and irritability. A response to the absence of a chemical substance that the addict has developed a tolerance to. Can also be experienced by gamblers so effects may also be due to removal of behaviour as well (Orford 2001).
   
• Conflict
  People with addictive behaviours develop conflicts with those around them which can cause social misery and conflict within themselves.short-term pleasure and reliefs which leads to the disregard of adverse consequences and long-term damage. This only increases the apparent need for the addictive activity as a coping strategy.
  
  
• Relapse
   The tendency for repeated revisions to earlier patterns of the particular activity, even after years of abstinence and control. Relapses are common in all addictions (Griffiths 2002).

• Neurotransmitters
• Genetics
• Reinforcement

Easier to understand in relation to chemical addictions (nicotine, alcohol).

Harder to understand in relation to behavioural addictions (gambling).

Explanations focus on neurotransmitter substances in the brain and on genetic differences between those with/without addictions.

A person would be most susceptible to addiction during the initiation phase, because they have to have a predisposed vulnerability.

Biological predispositions are much less likely to have an effect during maintenance of the addiction.

Those with a biological predisposition are more susceptible to relapse.

Neurotransmitters

Neurotransmitter - a chemical that moves in the gaps between nerve cells to transmit messages. 

If the chemical is blocked or replaced then the message changes and there is an effect on the physiological systems, cognition, mood and behaviour. 

The neurotransmitter that is most commonly implicated is dopamine, but other chemicals have also been found to have an effect (Potenza 2001). 

Neurotransmitters have also been implicated in behaviours such a gambling (Comings et al. 1996) and videogame playing (Koepp et al. 1996). 

Genetics

Some family studies suggest there is a link between addictive behaviour and personality traits:

Jang et al. (2000) looked at the relationship between alcohol use and personality.

Over 3000 MZ twins and over 300 DZ twins.

Suggests: There is a connection between genetics and antisocial personality characteristics (attention seeking, not following social norms, violence) and between these personality characteristics and alcoholism.

Similar findings have also been claimed for behavioural addictions such as gambling (Comings et al. 1996).

More recently, genetic analysis has been carried out to look for differences in the genetic structure for people with/without addictive behaviours.

Reinforcement

Reinforcement is anything that increases the probability that the behaviour will recur in similar circumstances.

Commonly refers to learned associations acquired through operant or classical conditioning but may also be applied to other forms of leaning. 

The discovery of ‘pleasure centres’ in the brain helps with the question: what may be reinforcing?

Olds and Milner (1954) found that rats would push a lever for the reward of mild electrical stimulation in particular areas of the brain, even in preference to other possible rewards such as food, drink or sexual activity.

Reinforcement

The experience of pleasure is important for healthy development.

If food or sex was boring then the species would probably starve to death or fail to breed, but the feeling of pleasure associated with these activities act as reinforcement. 

If we associate these pleasure feelings with other activities then they will also be reinforced.

The pleasure that encourages essential behaviours is also the pleasure that can encourage damaging behaviour. Is addiction the price we pay for pleasure?

Genetics

Used to be investigated by studying family relationships which tend to emphasise the role of environmental factors in the development of addictive behaviours. 

Han et al. (1999) estimated the contribution of genetic factors and environmental factors to substance use in adolescence.

 Over 300 monozygotic (MZ) – identical – twins. and just under 200 same-sex dizygotic (DZ) – fraternal – twins.

 Concluded: The major influences on the decision to use substances were environmental rather than genetic.

:) Biological explanations can help explain susceptibility -

• Addiction is only present in some cases.
• Helps to account for inherent vulnerabilities and susceptibilities people are predisposed towards addictive behaviour during the initiation stage).
• Provides a reason as to why some people may be more resistant to addiction than others.

:( Neurotransmitters’ complex effects are not fully understood -

• The brain is remarkably complex and the effects of even one drug can be diverse, it is difficult to look at which neurotransmitter produces which reward.
• Ashton and Golding (1989) suggest that nicotine can simultaneously affect a number of systems, including: learning and memory, the control of pain and the relief of anxiety. It is generally believed that smoking nicotine can increase arousal whilst reducing stress – two seemingly incompatible responses.

:( Interaction with social context is neglected -

• The pleasures and escapes associated with taking a drug vary depending on the person, dose, social situation and the wider social context of the society they live in (Orford 2001). For example, the effects of ecstasy are likely to differ depending on the presence of ‘rave’ music (Larkin and Griffiths 2004). Drug taking in Vietnam was quite common, but most soldiers’ addictive drug use stopped spontaneously in their US home environment (Robins et al. 1975).
• Reductionist. 

:( Genotypes are not the whole story -

• Some genes appear more frequently in those with addictive behaviours than those without.The gene DRD2 has been found in 42% of people with alcoholism, 50% of pathological gamblers, 45% of people with Tourette’s syndrome and 55% of people with autism. It has also been found in 25% of the general population. Although it appears more frequently in those with behavioural syndromes, it cannot be the sole explanation for the behaviour (Comings 1998).
• Studies that analyse the genetic structure (genotype) of individuals tend to emphasise the role of genetics over the environment.

• Faulty thinking
• Irrational biases

Easier to understand in relation to behavioural addictions (gambling).

Harder to understand in relation to chemical addictions (nicotine, alcohol).

Explanations focus on faulty thinking processes and biases.

A person would be most susceptible to addiction during the maintenance phase. However, All individuals are equally susceptible to developing an addictive behaviour.

Faulty cognitions are less likely to have an effect during the initiation phase of the addiction.

Those with faulty cognitions would be more susceptible to relapse unless they undergo some form of cognitive correction treatment.

Faulty Thinking

The cognitive explanation focuses on the way we process information, faulty judgements might develop addictive behaviour.

But faulty thinking is what keeps us going. If you exist for just a few moments in the great expanse of time your impact the whole scheme of things is very little (at best) and yet we continue.

Faulty thinking around gambling: we will win/control the odds eg. ‘lucky numbers’on the lottery.

Irrational Biases

Despite the fact that the odds of almost all activities are weighted strongly in favour of the gambling operator, gamblers continue to believe that they can win.

Gambling may be maintained by irrational or erroneous beliefs (Griffiths 1994). 

People overestimate the extent to which they can predict or influence gambling outcomes and tend to misjudge how much money they have won or lost. Confirmed in numerous studies (Langer 1975, Langer and Roth 1983). 

People also overestimate the degree of skill/control that can be exerted in chance activities (Griffiths 1994).

:) Cognitive explanations help explain individual differences -

• Addiction is only present in some cases when people are engaged in exactly the same activity.
• During the development and maintenance stage, those who develop faulty cognitive biases may be more likely to develop problems).

:( Irrationality is an erratic predictor of addictive behaviour -

• Addictions like gambling do not appear to co-vary with other observable faucets of gambling, such as the level of risk taking or reinforcement frequency.
• Cause and effect of cognitive bias cannot be established.

:( Cognitive explanations may be limited to particular addictions – 

• Less of an effect in chemical addictions (eg. Heroin addict).
• More pronounced effect in gambling and videogame addictions.

:( Experimental factors may play a role -

• Griffiths (1994) found that regular gamblers had greater difficulty then occasional players in verbalizing their thoughts whilst they were gambling. Regular players seemed capable of gambling without attending to what they were doing (‘automatic pilot’).
• Suggests that cognitive processes did not play a major role in the maintenance of their behaviour.

:( Skill perception varies across individuals -

• Many cognitive processes through to underlie gambling behaviours are more likely to be observed when activities are perceived as having some skill component (Griffiths 1995).
• Beliefs about skill in gambling are neither completely irrational nor consistent amongst player.
• Cause and effect cannot be established.

Operant Conditioning

Addicts change their behaviour in response to change in the environments.

Eg. rewards/punishments  (an alcoholic drinking a bottle of whisky might relieve withdrawal symptoms).

Rewards (reinforces) and punishments can bring about changes in mood (pleasure), material changes (money – gambling).

Skinner (1953) during his work with animals was able to achieve greater behavioural change is he gave less reinforcement. 

This was furthered if he made the arrival of the reinforcements less predictable.

The schedule that produced the strongest behavioural change was the variable ratio which describes a situation where rewards are average every fifth time you perform a certain task.

Susceptibility

The person would be most susceptible to addiction during the initiation (initial rewards can shape future behaviour) and maintenance (continued rewards can maintain behaviour) phase. 

All individuals are equally susceptible to developing an addictive behaviour.

Relapse will be less likely if they have ‘unlearned’ the addictive behaviour.

:) Learning explanations help explain individual differences -

• Addiction is only present in some cases when individuals engage in the same activity (eg. drinking two or three pints of beer).
• Helps to account for individual difference during the development and maintenance stage (those who get constant rewards from their alcohol drinking will be more likely to develop a problem).

:( Neither conditioning explanation is sufficient on its own -

• Both theories are supported by evidence.
• Classical conditioning theory is useful in explaining people’s motivation in initiation of a gambling session.
• Classical conditioning theory is less useful in explaining the maintenance of gambling behaviour.

:( Findings contrary to operant theory -

• Researchers have raised questions about the extent to which behaviours like excessive gambling adhere to operant theory.
• Gamblers lose more than they win.
• Dalfabbro and Winefield (1999) reinforcement magnitudes are not independent of player responses (eg. stake sizes).

:( Operant explanations are not equally successful -

• It is difficult to develop general operant theories of very specific activities, such as gambling.
• Some activities are more suited to this explanation – slot machines, scratch cards where there is a short time-interval between stakes and outcome and where outcomes are entirely determined by chance.
• More difficult to apply these principles to skilled gambling games (black jack, poker, sports betting) where players decisions can significantly influence outcomes.