Addiction!

What we have to cover:

1. Defining Addiction

2. Models of addictive behaviour (biological, social learning theory, cognitive)

3. Factors affecting addictive behaviour (Individual differences, vulnerabilities and social context)

4. Reducing addictive behaviour (Prevention and treatments)

So, we have to start from basics…

Define addiction…

‘Addiction is a persistent, compulsive dependence on a behavior or substance’

Addictions can be of ANYTHING, be it sex, gambling, drugs, or even your mobile phone!

Gambling addiction:

• Estimated that 5% of the adult population have a gambling addiction.

• Higher percentages are found in young adults, mentally ill individuals and the prison population. Shaffer et al (1999)

• Pathological gambling recognised by the DSM as a mental disorder in 1980.

Smoking addiction:• Smoking dependency is the

most prevalent. (Anthony et al, 1994)

• Also recognised as a mental disorder in the DSM under ‘dependency on a substance’

Components of addiction – Griffiths (2005)

1. Salience – The importance of the behaviour to an individual, all they think about.

2. Mood modification – The experience reported by people whilst carrying out their addictive behaviour i.e. behaviour helps to ‘wake up in morning’ or ‘calm down at night’

3. Tolerance – Increased amount to achieve same effect

4. Withdrawal Symptoms – Unpleasant feelings/physical effects experienced when behaviour stops

5. Relapse – Reverting back to addiction after stopped (esp. when stressed)

Biological Model

Principles: Genetics and biochemistryInitiation, maintenance and relapse –

inc. case studies

Initiation:

Genetics – Comings (1996):

• 48.9% of smokers compared to 25.9% of general population carried A1 variant of DRD2 gene.

• supported by A1 variant of the DRD2 dopamine receptor linked to severe alcoholism (Noble et al, 1991)

• A1 variant means less dopamine receptors

I am a Nobleman

(NOBLE 1991)

SLC6A3-9 = Socks, locks, clocks, 6 Add 3 = 9

Genetics – Lerman et al (1999):

• Found that people with SLC6A3-9 gene are less likely to take up an addiction than someone without the gene

Im a LERRRMAAANN (1999)

Biological – Genetics and biochemistry:

• Family and twin studies • Looking at alcohol

dependency• Found heritability at 50-60%

(McGue, 1999)

• An example of a gene that is linked to addiction is the A1 variant of the DRD2 gene…

Supporting genetics – Kendler et al (2004):

• Investigating genetic risk & family conflict in nicotine addiction

• 1676 female twins• No. of cigarettes smoked in lifetime

calculated• Self report interviews on fam, twins• Found that increased family conflict

caused increased smoking levels• Also found high levels of

heriditability

Supporting genetics - Blum et al, 1991:

• Blum et al, 1991 found that the A1 variant of the DRD2 gene had higher prevalence in families with history of alcoholism

• Also appeared to show fewer dopamine receptors in their ‘pleasure centres’ of their brains.

• Therefore they are more likely to seek behaviours that increase their dopamine levels

Maintenance:

Maintenance smoking – Fowler et al (2007):

• 1214 twin pairs• Investigated to see importance

of genetics with initiation of alcohol, nicotine and cannabis addiction

• Found environmental forces were more important

• However, genetics influenced EXTENT of the addiction

Maintenance – Smoking, Schachter (1977) – Nicotine regulation:

• Smokers regulate their nicotine intake• 11 34-52 year olds smoked high or low

nicotine content in alternating weeks• Heavy smokers smoked more low-

nicotine cigarettes• Light smokers did not appear to

regulate consistently• Has implications to real life e.g. taxing

cigarettes depending on nicotine content

Maintenance Gambling – Meyer et al (2004):

• During casino blackjack gambling, heart rate and noradrenaline/norepinephrine measured

• (which cause inc. heart rate/bp/pupil dilation – fight or flight response)

• …become elevated to a greater degree in men with gambling problems as compared to those without (Meyer et al. 2004).

Tolerance – As tolerance builds, you need more of behaviour to get same buzz

Low dopamine – People with addictions may have either low levels of dopamine, or fewer receptors than most, causing them to need more of a substance to get the

same feeling

Maintenance:

Relapse:

Relapse:

Withdrawal Symptoms – Unpleasant symptoms

In gamblers – Withdrawal symptoms can be physical (Rosenthal and Lesieur, 1992 found that extent of symptoms positively correlated with no. of hours spent gambling)

In smokers – Those with a sensitive mesolimbic pathway are more susceptible to relapsing

Also, Lerman 2007 found that smokers had increased CBF (cerebral blood flow) which could lead to relapse

=

CBF 2007

Biological model AO2:

• Objective – empirical evidence, such as Lerman (2007) using brain scans to measure CBF, reliable

• Application to everyday life – Can affect anybody, looks at treatment of symptoms, quick treatments. Doesn’t combat the cause of the addiction. Often treated with drugs.

• Reductionist – Simplified into genetics & biochem, not psychological or social

• Deterministic – Born with Genes & biochem, could cause passive patients, unwilling to change, ‘no blame’

• Individual differences – SLC6A3-9 gene, A1 of DRD2, doesn’t include gender, personality. Shows that genes do influence

Cognitive:

Initiation of smoking and gambling – Gelkopf et al, 2002:

• Individuals intentionally use drugs to treat psychological symptoms from which they suffer

• One that’s perceived as being helpful to the individual

• Could smoke to relieve stress/anxiety, and gamble to relieve depression

Initiation:

Expectancy – Smokers may think they look cool.

Relieving boredom Positive feelings

Maintenance of Gambling - Griffiths (1994):

• 30 gamblers & 30 non-gamblers• Got them to verbalise their thoughts

as they played• Found that gamblers personified

fruit machines, saying whether they were in a ‘good mood’ or a ‘bad mood’

• Regular gamblers also treated losses as ‘near wins’

• Cognitive bias of ‘skill level’ • Gambling is a rational choice

Maintenance of smoking – Tate et al, (1994):

• Showed withdrawal symptoms were based on expectancy i.e. they were mainly psychological

• as by telling a group of smokers they would expect no negative experiences during a period of abstinence

• It led to fewer somatic and psychological effects than a control group.

Maintenance - Cohen and Lichtenstein (1990):

• Vicious circle – Smoking alleviated stress, causes illness, creates stress

Relapse – Self efficacy, Bandura (1994):

• Self-efficacy is a person’s belief in his or her ability to succeed in a particular situation.

• Bandura described these beliefs as determinants of how people think, behave, and feel

• If people have a weaker self-efficacy, they’re more likely to engage in addictive behaviours, or take up previous ones.

Relapse – Self medication in smoking and gambling:

• Self medicate in times of…

• Stress (smoking)

• Crisis (gambling)

Relapse:Coping – Withdrawal symptoms may make it difficult to

cope without the substance.

Expectancy – especially with smoking, it may seem easier to quit 2nd time round

Excitement – life without gambling may seem dull

Cognitive model AO2:

• Free Will – Individuals may feel they can change but may feel they’re to blame

• Ecological validity/Application to real life – Addictions affect lots of people

• Treatments – If it’s based on faulty thinking, it should be able to be cured

• Social desirability bias – people may lie about how often they smoke/gamble, could affect reliability

• Subjectivity – Methods of diagnoses are not scientific

• Self-report methods used to gather data, lowered reliability, higher subjectivity

Social learning theory:

Initiation (smoking) – Vicarious reinforcement:

• Bandura said we learn through vicarious reinforcement, which is the observation of others

• We learn from our peers and parents etc

Initiation (gambling) – Glautier et al (1991):

• Classical conditioning – Good feeling from addictive behaviour, associate the two

Initiation (smoking/gambling) – White (1996):

• Positive feelings – act as positive reinforcement for the behaviour (operant conditioning) – due to dopamine in the mesolimbic system

• Takes a biological approach too! OOHH SYNOPTICITY?

Maintenance (smoking) – Classical Conditioning of a daily ritual:

• When you do certain things at the same time of day, such as smoking in the mornings,

• You become classically conditioned to do it

• Association is hard to break

• Like cue reactivity! Where you see something associated with behaviour e.g. pub for alcoholics

Maintenance gambling – Cue reactivity:

• Seeing something associated with behaviour e.g. Scratch card or bookies for gamblers

• Brings back the initial ‘buzz’ making it hard to resist

Maintenance of gambling – Operant conditioning:

• Gambling is maintained through small wins, which provide operant conditioning through positive feelings $ $

Maintenance (smoking/gambling) – West, 2006:

• Approach-avoidance conflict where the addict wants to both use the drug/carry out addiction but also to avoid it because they know it is wrong

• And there may also be negative side effects

• Both positive and negative reinforcers for operant conditioning

Relapse (smoking) – Cue reactivity, Glautier et al (1991):

• Note: In the book, this is under ‘initiation’ but it feels like it could easily link to relapse also!

• Alcohol-related stimuli (sight or sound of a pub) were shown to cause the same physiological responses as alcohol itself

• E.g. Increased heart rate and arousal

• Could be generalisable to other addictions

• Can also be maintenance

Relapse (smoking/gambling) Marlatt and George (1984):

• Marlatt and George found that multiple trigger cues increase the chance of relapse

• As if an addict comes into contact with a trigger cue of substance after a period of abstinence…

• They have that classical conditioning of association with that trigger, making them more likely to relapse

Relapse – Negative reinforcement (operant?):

• To avoid the negative reinforcement of withdrawal symptoms

• Could link to the fact that Rosenthal and Lesieur (1992) found the positive correlation between number of hours spent gambling and the extent of their withdrawal symptoms

Social learning theory AO2:

• Nature/nurture? Based on nurture, as it’s the idea that behaviour is learned from the env. Born as a TABLEAU RAZA (blank slate)

• Subjective – based on observational methods

• Reductionist – Doesn’t consider individual differences, or extraneous variables.

Individual differences, vulnerabilities and social contexts of addiction:

- Personality- Stress- Peers- Age

- Media

Personality factors – Self esteem:

Refers to what an individual feels about themselves, for example their confidence, and feelings of self-worth.

Research suggests individuals with low self-esteem are more prone to addiction.

Found a negative correlation between self-esteem in boys and frequency of cannabis use – Valeska et al (2009)

I hate myself

Self esteem – Kaufman and Augustson (2008):

• To investigate factors influencing smoking behaviour

• 7000 girls aged 13-18• Assessed on perceived weight, and

whether they were trying to lose weight or not

• Questionnaires were used• After ONE YEAR, those with low self-

esteem were more likely to smoke

son

Kaufman and Augustson (2008) AO2:

• Large sample size • All girls• Longitudinal study• No cause/effect can be

established• Questionnaires were

used, which are subjective

• May also be influenced by social desirability bias

Personality factors – Attribution theory:

Proposed that behaviour is down to:

1. Situational attributes (external factors which cannot be controlled, such as peers/work)

2. Dispositional attributions (internal factors the individual can control, such as self-esteem)

However, we are more likely to use dispositional attributes to blame others for their addictions, and use situational attributes on ourselves = ACTOR-OBSERVER EFFECT

Attribution theory – Hatgis et al (2008):

• Internal attributes (dispositional) about drug taking varied between - those who had never taken drugs before and- those who had experienced or had friends that experienced drugs before

• Internal attributes more common on cannabis use than alcohol or heroin

Attribution bias – Seneviratne and Saunders (2000):

• Investigate attributions by alcoholics• 70 alcoholics, interviewed to find out

reasons why they relapsed after abstinence, which were compared to 4 relapse scenarios of others

• Situational attributions used for alcoholic’s own relapse, such as party: everyone was drinking

• Dispositional factors for the other scenarios, such as lack of will power

• = Shows actor-observer bias

Vulnerabilities – Stress:

Everyday stress:• People smoke, gamble, and

drink to deal with stress/daily-hassles

• Stresses could lead to addiction, and add to both maintenance and relapse

Traumatic stress:• PTSD (post-traumatic-stress-

disorder) linked to addiction

• Driessen et al (2008), found that 30% of drug addicts and 15% of alcoholics suffer from PTSD

Vulnerabilities - Stress AO2:

• Relates to real life as many people have addictions, therefore has ecological validity

• Arguably, mundane realism

• Quantitative data collected on those with PTSD, increases reliability etc

• Individual differences (hardiness etc)

• Extraneous variables• Simplistic? Only looks at

stressors, not biology?

Vulnerabilities – Peers:

Social Identity Theory:• States that the in-group will

discriminate against the out-group to enhance their self-image.

- Normative behaviour

Social Learning Theory:• States that social behavior

(any type of behavior that we display socially) is learned primarily by observing and imitating the actions of others

- Vicarious reinforcement

Splits into SIT and SLT (Social Identity Theory) and (Social Learning Theory)

Vulnerabilities – Peers:

• Eiser et al (1989) – Positive rewards such as popularity and social status (smoking), smokers befriend other smokers (Eiser et al, 1995) – SIT

• Duncan et al (1995) – Exposure to peers that carry out behaviour increase likelihood of smoking - SLT

• McAlister et al (1984) – Smoke due to increased popularity and peer approval - SLT

Vulnerabilities – Age:

• Brown et al (1997) – Close friends and romantic partners are influential on attitudes and behaviours. Peers more likely to influence you in adolescence.

Botvin (2000) – More prone during adolescence

Individual differences

Role of the media in promotion/prevention of

addiction:Promotion/prevention

Promoting addictions – Sulkunen (2007):

• 140 scenes from 47 films• All included scenes of either alcohol, drug,

sex, gambling or tobacco use• Films such as American Beauty, and

Trainspotting depicted drug use in a positive light, compared to the ‘dullness’ of real life

• Historical validity? Smoking rules are harsher• Individual differences at how they would

affect• Lots of different films used

Prevention - In film - Boyd (2008):

• Contrary to Sulkunen (2007) who said addictions were shown positively

• Boyd found ‘films do represent the negative consequences of addiction’ shown through…- Physical deterioration

- Sexual degradation

- Moral decline

Attempted prevention - Anti Drugs Campaign – (1998-2004):

• Aimed to educate US youths to reject illegal drugs, to prevent initiation of drug use, and to stop those already using

• Raised self-efficacy (self beliefs?) & showed negative consequences of drug use

• Hornik et al (2008) examined results, and lead to an increase in marijuana use… (awkward!)

Promotion - Boyd contrasted by – Sargent and Hanewinkle (2009):

• 4384 adolescents, (11-15)• All were surveyed to see whether or not they smoked• Exposed to smoking in movies over a year• Whether or not they had smoked at the start was a

strong predictor that they would be smoking in the year later

Ethical issues (could cause smoking = harmful)Social factors not considered (reductionist)Longitudinal

Prevention and treatment of addiction:

Theory of planned behaviour (cog) – prevention:

Attitude:Assessment and evaluation

of outcome of behavior

Subjective norm:Motivation to meet

perceived expectations of important others

Perceived behavioural control:

Perception of how easy/hard it would be to

carry out behaviour

Behaviour intention Behaviour

Actual behavioural control

Theory of planned behaviour:Term Definition

Attitude What the person believes the outcome of the behaviour will be – i.e. whether it’s going to give them a positive, or negative outcome.A smoker may think that they’ll get popularity, or seem ‘cool’.

Subjective norm What significant others (friends/peers) think of the behaviour. This affects you because you want to comply with social expectations.If your friends smoke, you may also.

Perceived behavioural control Whether behaviour is easy or hard to carry out.If you’re 18+, going and buying cigarettes is pretty easy.

• If you have a positive outlook for the attitudes, perceived behavioural control, and also want others to be happy with you, you are likely to carry out the behaviour.

Supporting TPB – Marcoux and Shope (1997):

• Large sample of 14 yr olds• Using TPB to predict alcohol use• Peer pressure/peers were

important variables• Model led to recommendations

for prevention of alcohol abuse• Reducing how readily available

alcohol was (taking control away from individual)

Supporting TPB – Wall et al (1998):

• Used TPB for undergrad. students

• Useful in predicting excessive drinking

• Researchers believed it could be improved if it included gender-specific alcohol outcome expectancies.

Refuting TPB – Ogden (2003):

• Major fault of TPB is that it uses self-report methods

• Could be affected by social desirability, and make the reliability questionable

• However, there isn’t really another way to test opinions/beliefs.

• Subjectivity may therefore be OK?

Biological treatments - Agonist:

Agonist – maintenance/substitution treatment:- Maintain effects of substance using a safer drug- Manages withdrawal symptoms

e.g. Smoking – NRT (Nicotine replacement theory… Patches/gum, maintains nicotine in prefrontal cortex of mesolimbic system

Drugs – Methadone (can be used alongside counselling too!

Biological – Antagonist:

Antagonist – blocks the effects of substances on the brain, so no longer get the ‘buzz’

e.g. Smoking – Buproprion (SSRI – selective serotonin reuptake inhibitor)

Heroin (opiates) – Naltrexone

Antagonistic treatments are usually used as more of a last resort.

Biological treatments – AO2:

• Biological• Safer than the opiates

or tobacco• Cheap• Quick/fast• Deterministic –

removes blame from the patients

• Still reliant on a drug (agonist)• Drug can become addictive also• Side effects• Black market for methadone• Methadone can kill you• Reductionist, should be catered

to an individual’s needs• Individual differences doesn’t

look at social/psychological, treatments may not be appropriate

• Deterministic – patients may feel they can’t be cured

Psychological treatments:

Classical Conditioning:

Aversion therapy

• Owen (2001) – Assessed aversion therapy in alcoholics

• 82 hospitalised alcoholics• 5 treatments over 10 days• Given emetic (makes you

sick) after alcohol (of their choice)

• Followed by behavioural & cognitive questionnaire

• Positive alcohol-related behaviours were reduced

• Found to be effective

‘Associating an addictive behaviour with something negative’

2001

Classical Conditioning:

Aversion therapy

• Kraft & Kraft (2005) – Used hypnosis to pair addictive behaviour with nausea

• Only 4 sessions (Cost effective)

• Long term success = questionable

‘Associating an addictive behaviour with something negative’

& 2005

• Siegel et al (1987) said once put back into a real environment, physical & mental changes led to relapse

Aversion therapy AO2:

• Fast, cheap treatment• Shown to work with

alcoholics (Owen 2001)- wasn’t so reductionist

due to both treatment & questionnaires

- However, was subjective

• Individual differences• Reductionist• May not be long-term• Siegel et al (1987) said

once put back into a real environment, physical & mental changes led to relapse

• Ethical – protection from harm

• Consent?

Cognitive Approach:

Cognitive behavioural therapy (CBT)

• Killen et al (2008) - found CBT + telephone counselling was more effective than phone counselling alone.

(who becomes a psychiatrist with the surname ‘killen’ ? I mean seriously)Talking about your

problems. According to Curran and Drummond (2005), CBT is main treatment for alcohol and cannabis dependency

2008

Cognitive Approach:

Cognitive behavioural therapy (CBT)

• Cavallo et al (2007) compared

- weekly CBT @ 45mins- to behavioural counselling

for 10-15mins 3x a week• CBT was more effective for

adolescents who wanted to stop smoking

Talking about your problems. According to Curran and Drummond (2005), CBT is main treatment for alcohol and cannabis dependancy

Cognitive Approach:

Cognitive behavioural therapy (CBT)

• Jiminez-Murcia et al (2007)• Treated 290 pathological

gamblers with CBT over 16 weeks

• After 6 months, success rate was at 80%, but noticed drop-outs & relapse towards the end

• (More so with obsessive compulsives)

Talking about your problems. According to Curran and Drummond (2005), CBT is main treatment for alcohol and cannabis dependancy Spanish Jiminy

= Jiminez

2007

Cognitive approach AO2:

• No ethical issues• Uninvasive• No side effects

• Relapse & attrition & individual differences – Jiminez-Murcia et al (2007)

• Time consuming• Gotta train to do CBT• Individual differences

Operant conditioning:

Contingency management (CM)

• Krishnan-Sarin et al (2006)• Looked at CBT and CM• 28 adolescent smokers who wanted to quit,

randomly allocated into:1. CBT group2. CBT + CM group• Programme lasted 1 month• Urine samples tested• CBT + CM group given money twice a day for

first 2 weeks. Frequency decreased for next 2 wks

• After 1 week, abstinence:CBT + CM = 77%CBT = 7%

• After the month, abstinence:CBT + CM = 53%CBT = 0%

Rewarded for sticking at something e.g. Getting money for not taking heroin

Operant conditioning:

Contingency management (CM)

• Higgins et al (1994) • USA• 28 cocaine addicts (all white males

from Vermont)• Urine tested• Clear urine = money reward• Money increased the more clean

samples in a row• Given advice on best ways to spend

their vouchers• Norm drug programme drop-out

rates = 70% within 6 weeks• This programme: 85% stayed 12

weeks2/3 stayed 6 months!

Rewarded for sticking at something e.g. Getting money for not taking heroin

Contingency management AO2:

• Shown to work • Objective – Urine

samples in Krishnan-Sarin et al (2006)

• Small sample size• Reductionist• Ecological validity?

Would a voucher scheme work widespread? – political palatability

• Higgins (1994) – all white males, from Vermont = cultural bias + androcentric

Public health interventions and legislation:

Group counselling – Crits-Christoph et al (2003):

• National Institute of Drug Abuse (NIDA) study• Trying to intervene with social and personal problems

associated with drug abuse• 487 American patients randomly assigned to one of

four groups of various sorts of counselling• They found:- All treatments led to decrease in drug abuse- Combination therapies were most successful- Worked best if they were told how to adopt more

positive behaviours, and healthy relationships

Doctors advice – Russell et al (1979):

• Looking at dr’s advise to help smokers quit• Carried out a study in five doctors’ surgeries

over 4 weeksTreatment offered:1. Follow up session – 0.3%2. Questionnaire about smoking habit + follow up – 1.6%3. Dr’s said to stop, questionnaire + follow up – 3.3%4. Leaflet, Dr said, questionnaire + follow up– 5.1%

• More help they get, better treatment

Helplines – Platt et al (1997):

• Assessing effectiveness of smoking helpline (Smokeline) in Scotland

• 848 of adult smokers, followed up 1 year after their initial call

• 143 of the 848 sample (nearly 24%) reported they’d stopped smoking

• 88% said they’d ‘made changes’• During the 2nd year, smoking prevalence

was 6% lower than it was before the campaign

• It reached a lot of people, and helped them. Yay.

1997

Public Health AO2:

• Shown to work, especially Platt. Yay.

• Some addicts may not feel they can reach the support they need

• Individual differences• Issues in assessing the

impact• Reductionist – not

including biological