Addiction

Physical dependence

Results in withdrawal symptoms. Only establish for certain when they abstain or symptoms are apparent

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Psychological dependence

Compulsion to continue. Aims for increase in pleasure or reduction in discomfort

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Tolerance

Response to a drug is reduced so they need greater doses to produce the same effect

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Cross tolerance

When tolerance of one drug reduces sensitivity to another

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Withdrawal symptoms

Collection of symptoms associated with abstaining from a drug or reducing its use

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Walters 4P’s

Progression (increase in severity), preoccupation (with the activity), perceived (loss of control), persistence (despite negative consequences)

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Griffiths (salience)

The behaviour becomes the most important thing to the person and they have it on their mind much of the time

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Griffiths (mood modification)

The addict gets a rush or buzz when engaged in the behaviour. The addict is able to use their behaviour to bring mood change

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Griffiths (tolerance)

The addict needs a bigger dose than previously. Due to changes in metabolism, receptors and learning (down regulation)

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Griffiths (withdrawal symptoms)

Changes in mood, shakes, irritability etc as a result of cessation (stopping) applies to behaviours as well as chemical addiction

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Griffiths (conflict)

The pursuit of short term pleasure can cause conflict with others or internal conflict

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Griffiths (relapse)

A tendency to return to a behaviour, months or even years after an apparent cure. Just as common with behavioural addiction as it is chemical

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Risk factors - genetic vulnerability

Genetic predisposition, low numbers of D2 receptors inherited, less likely to smoke if CYP2A6 enzyme is not fully functioning

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Risk factors - stress (childhood trauma)

Epstein eat al found a strong correlation between incidence of childhood **** and adult alcohol addiction, but only for women with PTSD. Stress increases vulnerability

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Risk factors - stress (sensitive period)

Early experiences of distress in the sensitive period damage the brain creating a vulnerability to addiction in adolescence (Anderson and Teicher)

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Risk factors - stress (self medicate)

Gelkopf eat al - coping mechanism to treat the symptoms, perception of making things better

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Risk factors - stress (susceptibility)

Those who perceive stressful situations more negatively are more likely to be affected by stress

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Risk factors - personality (traits)

Some traits could be linked. Kruger eat al suggested high risk taking and impulsivity made addiction more likely

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Risk factors - personality (APD)

Antisocial personality disorder strongly correlates with addiction related behaviour and begins in early adolescence (Barnes et al)

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Risk factors - personality (impulsivity)

Ivanovo et al suggest impulsivity and addiction may share a genetic and neurological basis

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Risk factors - personality (social deviance proneness)

Personality seen as a predictor in marijuana use

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Risk factors - family influences (SLT)

Karcher and Finn - if parents smoke 1.88x more likely, siblings 2.64x more likely, peers 8x more likely

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Risk factors - family influences (parental style)

Degree of control and warmth may increase or decrease likelihood of addiction. Eg if they don’t care at all

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Risk factors - family influences (exposure)

More likely to have an addiction if it is part of everyday life or there is family history

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Risk factors - peers (attitudes and opportunity)

O’connell Et al suggested 3 elements to peer influence in alcohol addiction: attitudes influenced by peers, more opportunities with peers, overestimate how much peers are drinking and try to keep up

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Risk factors - peers (social networks)

Friends with similar interests may promote behaviours. Normalises behaviour online - show the best hide the rest

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Risk factors -peers (rule breaking)

Group norms of rule breaking may influence behaviour

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Risk factors - Barnes et al

473 biological, 128 adoptive families, Canadian youth sample. Results showed 12.6% of the sample used marijuana once a week or more. Associated with higher life problems. Results showed family, personality and peers predicted heavy marijuana use

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Risk factors - A03 SR Kendler et al

Used data from national Swedish adoption study. At least one biological parent had an addiction. Those with parents with addictive behaviours had greater risk of developing addiction (8.6%) Han those without (4.2%)

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Risk factors - A03 SR brain scans

MRI scans show the change in neurochemistry after drug use (genetics)

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Risk factors - A03 SR Karcher and Finn

Peers - 8x more likely to smoke if peers do

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Risk factors - A03 L testability

How can we effectively measure stress, subjective, hard to establish cause and effect

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Risk factors - A03 S Real life application

Tobler et al created a peer pressure resistance programme to help young people prevent taking up smoking. Can be used to benefit younger generation

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Dani and Heinemann's desensitisation hypothesis- dopamine

Dopamine is released from the ventral tegmental area(VTA) and transmitted along the mesolimbic pathway to the nucleus accumbens, which triggers the release into the prefrontal cortex, giving the sense of euphoria

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Dani and Heinemann's desensitisation hypothesis - acetylcholine

Nicotine binds to the nAChR receptors (subtype of ACh) which causes the neuron to be stimulated. within milliseconds, the receptor shuts down and cannot respond to neurotransmitters leading to down regulation

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What is down regulation?

chronic exposure to drugs results in a reduction in the activity of positive reward circuits in the brain.Drug molecules are present in addiction to the normal transmitters, the body adapts.Receptor sites reduced-drugs taken to avoid unpleasant state

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Role of glutamate

Nicotine increases the activity of glutamate, which decreases the activity of GABA. Nicotine stops MAO, which is the enzyme that breaks down dopamine in the synaptic cleft

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Up-regulation

going without nicotine for some time leads to re-sensitisation of neurons. This can lead to withdrawal symptoms.

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Chronic Desensitisation

leads to a permanent decrease in the number of active receptors, leading to increased tolerance

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Explanations of nicotine addiction - A03 Real Life Application

A greater understanding of neurochemistry had led to the development of treatments such as nicotine replacement therapy

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Explanations of nicotine addiction -A03 only considers dopamine

Neurochemical explanations only consider dopamine, which is a limitation as many other neuromechanisms are involved.

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Explanations of nicotine addiction - A03 reductionist

Choi et al found that most adolescents who became dependent had peers who smoked or felt they were under achieving at school. Therefore crucial psychological factors are overlooked when focusing solely on brain neurochemistry

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Explanations of nicotine addiction - A03 SR Fagerstrom et al

Treated 2 elderly parkinson's patients with nicotine gum & patches. Found significant changes in symptoms that were attributed to increased levels of dopamine, caused by nicotine administration

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Explanations of nicotine addiction - A03 implications

Khaled et al foudn long term smoking had an adverse effect as it altered brain chemistry, which could lead to depression

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Explanations of nicotine addiction - A03 gender differences

Cosgrove found gender differences in how smoking effected each gender. For women the dopamine effect was in the dorsal putamen, but for men it was in the ventral striatum. Implies more research is needed to fully understand

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Learning Theory Smoking - Classical conditioning primary reinforcer

smoking is the primary reinforcer as it is intrinsically rewarding (not learned) due to the biologically-determined effects of nicotine on the dopamine reward system

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Learning Theory Smoking -CC Secondary reinforcer

any other stimuli present at the same time as smoking becomes associated with the effects. e.g. pubs, friends, lighters etc

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Learning Theory Smoking -CC Cue reactivity

Secondary reinforcers also act as cues. can be identifies by self-reported desire to smoke, physiological signs of reactivity to cue and objective behavioural indicators when cue is present

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Learning Theory Smoking - Operant Conditioning Positive reinforcement

Feelings of mild euphoria, caused by physiological effects on the dopamine reward system in the mesolimbic pathway

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Learning Theory Smoking -OC Negative Reinforcement

Avoiding withdrawal symptoms

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Learning Theory Smoking - Brynner

suggested the media creates images of smoking as attractive and tough (SLT) but could be seen as outdated, due to assumption made in 1969 (temporal validity)

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Learning Theory Smoking - Goldberg

Researched monkeys. If pressed lever, they received nicotine, which had a reinforcing effect

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Learning Theory Smoking - A03 animal studies

Supporting research from animal studies presents a similar mechanism to humans however, there are issues with generalising research, example of extrapolation

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Learning Theory Smoking - A03 usefulness Drummound et al

proposed cue exposure therapy in which cues are presented with no way of engaging in behaviour. Aims to extinguish association

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Learning Theory Smoking - A03 Karcher and Finn

If parents smoke = 1.88x more likely. If sibling smoke = 2.64x more likely. If close friends smoke = 8x more likely

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Learning Theory Smoking- A03 Gunaskersera

Looked at top 200 films in 2000 and how addiction was portrayed. Sex 10% with one pregnancy, Smoking 67% with no side effects. Drugs all showed positive effects

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Learning Theory Gambling - vicarious reinforcement

Could see others being rewarded, starting the addiction

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Learning Theory Gambling - Direct reinforcement

Could be positive - winning money, or negative - offer a distraction from aversive stimuli

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Learning Theory Gambling - partial reinforcement

Leads to more persistent behaviour change. Only some bets rewarded, so more likely to maintain gambling

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Learning Theory Gambling - variable reinforcement

A variable (ratio) reinforcement schedule is partial reinforcement where the intervals between rewards vary. Highly unpredictable. Very resistant to extinction as they know they will win if persistent

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Learning Theory Gambling - cue reactivity

Helps to maintain gambling, but also can trigger it, especially after a long period of abstinence

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Learning Theory Gambling - Big win hypothesis

Aasved found many pathological gamblers report having a big win early on. They continue to gamble because of the desire to repeat the early 'peak experience'

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Learning Theory Gambling - Near Miss

Reid found this acted as a reinforcement as they provide excitement and thrill, which further encourage gambling

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Learning Theory Gambling - Gambling environment

acts as a reinforcer due to the exciting environment, which increases arousal, largely due to the appearance e.g. red, spacious, sounds etc

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Learning Theory Gambling - A03 SR Horsley et al

Tested assumption that partial reinforcement is fundamentally important in persistence of gambling, in absence of winning.Subjected low&high frequency gamblers to partial or continuous reinforcement.Partial reinforcement, high freq. = longer

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Learning Theory Gambling - A03 individual differences

Griffiths and Delfabbro argue people do not always respond in the same ways to conditioning, even with the same stimuli. Highlights individual differences and cognitive features of addiction

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Learning Theory Gambling - A03 Cannot explain all forms

Based on OC so difficult to apply to all types of gambling. For example, scratch cards have a short time period between behaviour and consequence, so suggests more complicated reasoning then chance and conditioning

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Cognitive Theory Gambling - expectancy theory

If people expect the benefits of gambling to outweigh the costs, then addiction is more likely. Memory and attention processes do not operate in a logical and rational manner

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Cognitive Theory Gambling - Beck's Viscious cycle

Low Mood -> Bia-> Gambling -> financial, medical and social problems -> low mood

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Cognitive Theory Gambling - cognitive biases gamblers fallacy

Belief in which a person thinks the probability of an outcome has changed

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Cognitive Theory Gambling - cognitive biases illusion of control

gamblers believe they have more control over an uncertain outcome

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Cognitive Theory Gambling - Cognitive biases flexible attribution

explains wins due to skill and loses due to others influence

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Cognitive Theory Gambling - cognitive biases recall bias

memory of wins recalled more easily than losses

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Cognitive Theory Gambling - Rickwood et al

suggested four different cognitive bias: skill and judgement, personal traits, selective recall and faulty perceptions

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Cognitive Theory Gambling - Griffiths procedure

60 participants, 30 reg, 30 non-reg. £3 to gamble with aim of staying on machine for 60 gambles. Asked them to verbalise thoughts, content analysis and interviews used

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Cognitive Theory Gambling - Griffiths Findings

Regular gamblers made almost 6x as many irrational verbalisations. Reg Gamblers also prone to illusion of control

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Cognitive Theory Gambling - A03 SR Michalczuk et al

comprared addictive gamblers with a non-addictive control group. Gambling group had significantly higher levels of gambling-related cognitive distortions

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Cognitive Theory Gambling - A03 Burger and Smith individual differences

Found people with high levels of control motivation were more likely to believe they could influence chance-determined situations. difference in personality suggests cognitive biases cannot explain all gambling

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Cognitive Theory Gambling - A03 methodological issues

Dickerson and O'Connor state that what people say in gambling situations may not be representative of deeply-held beliefs. undermines validity of research

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Cognitive Theory Gambling - A03 limitations of Griffiths research

subjective, unreliable measures, individual differences, personality differences

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Drug Therapy - Agonists

Agonists bind to neuron receptors and activates them, producing similar effect to the addictive drug and controls withdrawal effects. E.g. methadone

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Drug Therapy - Antagonists

Antagonists bind to the receptor sites and block them therefore the usual addictive effects cannot be produced. E.g. naltrexone

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Drug Therapy - NRT

Nicotine delivered in less harmful fashion, binds to the ACh receptors on mesolimbic pathway,stimulates the release of dopamine in the NA. dosage can be reduced over time, as cravings made less volatile

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Drug Therapy - Opioid antagonists

Enhance GABA in the mesolimbic pathway, which reduces the release of dopamine in the NA, which reduces the craving to gamble

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Drug Therapy - A03 warren et al

Warren et al found among 900 prisoners with a heroin addiction, inmates who received methadone used heroin a lot less (approx. 15 days a year) compared to those not receiving methadone

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Drug Therapy - A03 Stead et al

Reviewed controlled trial studies testing NRT products and found smokers using NRT were up to 70% more likely to have abstained from smoking after 6 months

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Drug Therapy - A03 Side Effects

Side effects of drug therapy such as headaches and weight gain provide a risk to the patient

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Drug Therapy - A03 individual differences

Drugs do not work in the same way for everyone. Chung et al suggested they need to become more tailored to individual genetic profiles if they are to be more effective

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Drug Therapy - A03 best in conjunction

Drug therapies work best in conjunction with behavioural/ learning therapies

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Behavioural interventions -aversion therapy

Based on CC and associates the drug with an unpleasant state, therefore counterconditioning the patient. e.g. Antabuse administered with alcohol

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Behavioural interventions - covert sensitisation

Type of aversion therapy that is in vitro because the unpleasant stimulus is imagined. Encouraged to relax, and then conjure up vivid image of themselves interacting in addictive behaviour&then imaging the unpleasant stimulus

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Behavioural interventions - A03 SR Smith and Frawley

studied 600 patients treated for alcoholism with aversion therapy. after 12 months, 65% totally abstinent

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Behavioural interventions - A03 SR McGonaghy et al

found that after one year gambling addicts who had received covert sensitisation were more likely (90%) to have deuced their gambling activity than those who received aversion therapy (30%)

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Behavioural interventions - A03 adherence issues

Have adherence issues due to the unpleasant nature of the treatment. Many may simply avoid the stimuli or drop out before completing the therapy

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Behavioural interventions - A03 only learning looked at

Only focuses on the learning aspect of behaviour and fails to address other psychological factors with could drive addictive behaviour

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CBT stages

initial assessment, goal setting, functional analysis, skills training, cognitive restructuring, teaching specific skills, HW

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CBT - functional analysis

identifies high risk situations and looks at the cognitive distortions of the patient.

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CBT skills training

replace poor coping behaviours with more constructive ones

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CBT cognitive restructuring

identifies cognitive biases and disputes them

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CBT specific skills

Coping mechanisms such as social skills training

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CBT - A03 Magil and Roy

used a meta-analysis of CBT trials and found it effective In reducing alcohol and illicit drug use

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CBT - A03 empowering

Can be seen as empowering because the patient is actively involved rather than a passive receiver

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CBT - A03 Cowlishaw et al

said it had beneficial effects for up to 3 months after treatment but after 9-12 months there was no significant difference between CBT and control groups

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CBT - A03 root cause

treats the root cause of the problem, which makes it more appropriate than drug therapy

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Ajzen's Theory of Planned Behaviour (TPB) - intentions

behavioural attitude, subjective norms, perceived behavioural control

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TPB - behavioural attitudes/ personal attitudes

weigh up the balance of favourable and unfavourable attitudes, e.g. smoking gives cancer and i don't want that

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TPB - subjective norms

ideas of normality based on what key people in the addicts life believes the behaviour to be normal, e.g. my mum doesn't want me to smoke so i will give up

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TPB - perceived behavioural control

How much control we think we have over a behaviour (self-efficacy) e.g. i only smoke with x friends, so i will not go out with them

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TPB - A03 SR Hagger et al

found TPB all three factors predicted an intention to limit drinking. they also influenced amount of alcohol consumed.

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TPB - A03 intention not change

Armitage and Conner completed a meta analysis and found although it was good at predicting intention, it did not predict actual change

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TPB - A03 methodological issues

three factors are subject to social desirability which can influence our attitudes. affects the validity of the theory

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TPB - A03 universality

TPB can be applied to any addiction

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Prochaska's 6 stage model of behaviour change - stages

Pre-contemplation, Contemplation, Preparation, Action, Maintenance, Termination

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Stage 1 - Pre contemplation

not thinking of changing their behaviour, could be due to denial or demotivation, intervention should focus on need for change, personalise the risk. 'ignorance is bliss'

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Stage 2 - Contemplation

thinking about making change, aware of costs and benefits of change, intervention should help them see pros outweigh costs. 'sitting on the fence'

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Stage 3 - Preparation

believes benefits are greater than the costs, will change within next month. intervention should help construct a plan to help identify social support.

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Stage 4 - Action

have done something to change the addictive behaviour in the last six months, intervention should focus on coping skills

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Stage 5 - Maintenance

the person has maintained some behavioural change for more than six months. intervention should focus on relapse prevention

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Stage 6 - termination

no longer returns to the addictive behaviour as a coping mechanism, intervention not required, abstinence is automatic

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TPB - A03 model is dynamic

recognises the nature of addictive behaviours and suggests the importance of time, recognises it is a changing process

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TPB - A03 Haslam and Draper

found women further along the model were more convinced of the dangers of smoking during pregnancy. women in first stage were more resistant to positive behavioural health, interventions need to be tailored to the individual

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TPB - A03 other explanations

changes in social norms could influence progression through the stages

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TPB - A03 lacks predictive validity

Different stages supposed to be associated with treatment seeking behaviours, however, this produced mixed findings, limits the usefulness of the model and questions underlying validity

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TPB - A03 CR Taylor et al

Reviewed available evidence and concluded that stage based approaches are no more effective than alternatives in treating nicotine addiction

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Addiction

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