Psychology: Addiction

1. Initiation: all individuals have an equal chance at developing an addiction
   

2. Maintenance: faulty thinking occurs through maintaining a behaviour (the point where individuals are most susceptible to developing an addiction.)

3. Relapse: to prevent relapsing, you must change your faulty thinking (relapses occur when irrational thinking persists)

>Gelkopf's self-medication hypothesis:

- behaviour provides relief from emotional stress

> behaviour helps people cope by reducing negative moods (boredom/stress) + increase positive moods (excitement)

+ Blaszczynski: self-report evidence gambling used to improve moods (Gamblers More prone to boredom than non-Gamblers)

-C&E: more bored when not gambling?

+ real world applications: implications for treatment (e.g.boredom + stress can be treated with SIT/ hobbies)

-superficial: replaced with another activity

The role of expectancy

- Griffiths: Gambling is maintained by erroneous beliefs

1. Overestimate likelihood of winning

2. Overestimate skill + control

3. Misjudge how much money is won/lost

> (due to) Cognitive myopia

- Addicts place higher priority on present excitement (immediate gratification)

- limits an addict’s ability to consider future consequences of actions + control their reactive impulses

+ Delfabbro + Winefield: 75% of thoughts during gambling are irrational Gambler Tell themselves they are going to win

× Validity: Difficult to gather cognitive evidence- demand Characteristics

> 30 regular gamblers, 30 non regular gamblers

> regulars overestimated their skill

> Heuristics: Used by gamblers as a way of simplifying decisions or justifying their behaviour

1. Personification: objects given human characteristics so they can be blamed

2. Hindsight bias: using hindsight to justify action and outcomes

3. Availability bias: using information available to justify continuance in gambling

4. Flexible attribution:internal attributions for wins, external attributions for losses

× C&E difficult to establish: gamblers have faulty thinking to start with or it develops over time?

× reductionist: limited to certain addictive behaviors (gambling)

Relapse occurs as...

> distraction from any money or relationship problems

> Blanco- recall bias: overestimate/ remember wins but forget losses

> Just world hypothesis: rationalize losses & feel they deserve to win and eventually will be rewarded for efforts

>Beck: The Vicious cycle

low mood ----> addictive behaviour -----> financial, medical, social problems = low mood

-Initiation: Becker and Murphy

- people conduct a cost- benefits analysis on activities

- any activity is measured in terms of utility

maintenance:

- addictive behaviour is seen as a rational choice

- gambling an exception- minds affected by irrational bias

relapse: struggling with the balance between the costs outweighing the benefits

+ Holistic: help us better understand individual differences why not everyone relapses/ becomes addicted

1. expectancy theory: costs/benefits of smoking differs from non-addicts (choosing to smoke to alleviate stress, relax to feel confident, regardless if it reflects reality)

2. Bandura- self efficacy: belief that they won't become addicted. ( important component in determining whether people choose to engage in behaviour or not

1. Brandon et al: (less) expectancy theory, involves automatic processing

2. Beck: vicious cycle low mood ----> addictive behaviour -----> financial, medical, social problems = low mood

3. self efficacy: addicts hold negative expectancies about withdrawal symptoms believe they are unable to cope with them so don't quit

+ role of expectancy: Tate et al

• told p's not to expect any withdrawal symptoms
  
• this group experienced less effects than the control group that not told this
  

- smoking has other explanations: focuses on cognitive but includes biological components

- genetic stress diathesis = predisposed to irrational expectations

1. Cost benefit analysis: relapse occurs when the benefits are perceived to be higher than costs

2. Self efficacy: belief in no will power to stop/ starting again is only temporary

+ sylvain: CBT plus social skills and relapse prevention training effective in the long term

Maintenance/ relapse

> intermittent reinforcement: occasional payout to keep addicted & playing for longer until next win, regardless of losses.

> Skinner: rat study

- arrival of reinforcement less predictable = greater behavioural change

> positive reinforcement from physiological effect of dopamine release

> negative reinforcement from avoidance of withdrawals, prevents from quitting

> classical conditioning: cues from environment faced daily e.g. need to smoke after a meal can lead to relapse

- doesn’t explain individual differences: everyone is exposed to cues when trying to quit some relapse and others don’t

> genetic relatedness to addict

+ black et al: evidencethat 1st degree relatives are likely to suffer from pathological gambling thandistant relatives

×correlational: due toSLT, learning from family members

> specific genes: A1 variant of DRD2 gene: fewer dopamine receptors = need to compensate

+ Comings et al: pathological gamblers are more likely to carry DRD2 gene than regular gamblers

> Personality: Zuckerman “sensation seeking”

passed through genes, predisposed to seek out stimulating activities e.g. gambling

× reductionist: simplifieddown to genes, ignores cognitive process

> Kim Bio-chemical evidence: Mesolimbic dopamine reward system

-Gambling activates brains reward system & releases dopamine in mesolimbic pathway.

- Registers importance of pleasure and creates lasting memories linking gambling to pleasurable reward

- Attempt to recreate feeling by placing future bets

> Paris et al: underactive pituitary-adrenal response.

- pathological gamblers study: no cortisol increase (stress hormone) in saliva after being shown a video of preferred mode of gambling as well as a neutral video of a roller-coaster ride.

- Recreational gamblers had increase in stress hormone.

-The more stressful gambling is the harder it is to maintain.

- Attempts to avoid Withdrawals through negative reinforcement

- PG more prone to boredom and scored lower than non-gamblers on boredom tolerance = relapse and repetitive gambling.

× deterministic: assumes no control/free will over addiction, all pre-fixedo

+ kim and Grant: drug naltrexone increased dopamine production and reduced compulsions to gamble

- Specific genes: A1 variant of the DRD2 gene having fewer dopamine receptors in the pleasure centre of the brain.

- some individuals are more likely to become addicted to drugs such as nicotine that increase dopamine levels to compensate for this deficiency

- personality genes:less likely to engage in novelty seeking behaviour so are more resistant

× Deterministic: assumes addict has no free will

Family and twin studies: genetic influence/ heritability 50% to 60%

+ Agrawal and Lynskey: 45% and 79% for drug use and dependence

× Initiation stage: - Reductionists as genetics don’t account for 100% of dependence, more influenced through environmental factors

+ Fowler: 1214 twin study initiation of substance use influenced by environmental factors and maintenance through genetic factors

×Adoptions studies: rule out environmental factors

Shields:studied 42 MZ twins whose biological parents were smokers but raised by non-smokers and apart from the other

1.Smoking stimulates reward circuit,

2.Triggers the release of dopamine

3.Creates lasting memories that linksmoking to pleasurable reward

4. Chronicuse downregulates activity in

positive reward system

5. Withdrawalsymptoms

6. Negative reinforcement to remove them

7. Druglevels need to increase due to downregulation in order to stimulate RS

-Shachters Nicotine regulation model argues smokers continue to smoke to maintain nicotine in body at a level which avoids these feelings of withdrawal.

+ Application: nicotine regulation model helps tackle smoking (gum,inhalers, tablets help wean off addiction)

- Robinson and Berridge: incentive sensation theory explains why addicts continue behaviour even though they dislike it.

(Addicts develop strong motivation called incentive salience: a strong association between stimuli and reward)

> Eclectic approach: genetic stress diathesis: predisposition triggered by stressful life

Eysenck

> Biological based theory suggests that certain addictive personalities pre dispose addiction

1. Extroversion: extroverts are under aroused and need external stimulation i.e from addictive behaviour
   
2. Neuroticism: anxiety, irritability and depression- use drugs to negate these feelings
   
3. Psychoticism: aggression, impulsivity - leads to taking addictive substances
   

+ Francis: positive correlation between N+P and vulnerability to addictions

+Belin and impulsivity: Rats classed as sensation seekers took large doses and Impulsive rats took smaller but became addicted

× subjective: can't empirically test for personality types

× ethical issues: sensitivity of addicts, threat of sanction

× Cause or effect: trait results from addiction or pre-existing

× over simplified: multiple factors shape personality, not biological

× no application: no cure, gives individual an excuse

× Encourages learned dependency and SFP

× Deterministic: No personality guarantees addiction

1. Why acute stress leads to addiction:

- daily stressors: early adolescence coincides with transitional stressors (changing schools, new experiences) whilst being exposed to addictive substances
+ King and Chassin: found that experiencing stressful life events in adolescence was a factor in young people developing a dependence on drugs

+ Felsher: stress was a good predictor of gambling in male university students

2. Why chronic stress leads to addiction:

Stress influences biochemical pathways in the brain increasing sensitivity to neurotransmitters like D2 dopamine receptors

+ Research: korsten et al: new born rats subjected to isolation stress for 1 hour a day/9 had a greater tendency to self-administer cocaine when adults, than rats who did not suffer isolation stress when young
×Animal study and validity?

+ Humans research: traumatic experiences in childhood may shape biochemical pathways in children in similar ways, increases vulnerability to addiction

+ Hall et al: growing up in high crime rate areas, poor socio economic backgrounds, low standards of education (chronic stressor) = more likely to develop substance use problems.

1. Social learning theory:

Bandura: Behaviour learnt vicariously and imitated

- more likely to model those they have most contact with

- after initiation experience surrounding determine whether it continues

+ Eiser: social rewards such as popularity and social status are part of reason why adolescents take up smoking

+ Duncan: exposure to peer model increases the likelihood of smoking

2. Social identity theory:

Abrahams and Hogg: group members adopt social identity/ norms and values of group they belong to e.g. belonging to a smoker group makes it easier to start and belonging to a non-smoker group makes it harder

× Validity: self-report is highly subjective, especially among teens

× Unspecific: Doesn’t explain the extent to which these groups influence their members

1. Adolescents

- Teens exhibit unique Biological vulnerability to nicotine

+ Schram: age and nicotine- adolescent rats more sensitive to rewarding effects of nicotine & less sensitive to negative effects

+ Pre frontal cortex: still developing in teens (part of the brain that assess situations, make rational decisions, control emotions/desires) = decisions are not made well, teenagers are impulsive/irrational

2. Elderly

-1/3rd of alcoholics develop dependency after retirement

- Changes in old age e.g. status,changes in lifestyle or stressors (boredom, death of loved-one, sleep disorders) can lead to vulnerability

+ Helfer:17% of Swiss women over 75 use painkillers or sleeping tablets every day and 6% take tranquilizers

> uses SLT of observation and vicarious learning (provides models which teenagers copy)

1. Films and movies glamorize addictive behaviour making them more socially acceptable

2.Celebrities are role models for thousands

-endorse substance use which encourage addictive behaviours

3. Advertisements which encourage initiation into gambling, drinking, smoking

- uses heuristics e.g. availability bias in gambling ads by emphasizing wins and not losses

- Promotes addictive behaviors in positive light so low self-esteem teenagers adhere to this

+ Sargent and Hanewinkel (2009)

•Tested whether exposure to smoking in the movies influenced initiation into smoking

• surveyed 4384 adolescents aged 11-15, re-surveyed a year later

• Exposure was a significant factor to starting a year later

- Correlation only, subjective, ethical issues

+Sulkenen: found in 140 scenes from 47 films there was alcohol, drugs, tobacco, gambling and sex represented.

SLT: scenes presented drug competence and enjoyment from their use. (no taboo)

+ Charlton: children viewing cigarette ads associated smoking with appearing mature, grown-up and having confidence

+ Correlation between amounts of money spent on alcohol ads and the rise in consumption of alcohol by children 11-15

× Inconclusive research: what about media influence on different gender, age, personalities

× Few in-depth studies: not many follow up on the individuals interpretations on addictive substance portrayal in the media

× Subjective research: alcohol, cigarette and gambling advertisements are hard to measure objectively

× Ignores free will: assumes we are passive human beings soaking up information – self efficacy plays apart

> Danger that addicts can be demonised through media created moral panics

> Affects the chances of addicts seeking treatment or receiving adequate social support to help them abstain

+ However media advertisements and government campaigns may also be used to have a positive impact – support etc.

- Ajzen and Fishbein:

Attitude towards act or behaviour/ subjective norm --> Behavioural intention --> BEHAVIOUR

>Attitude:

- how person perceives behaviour/ expected outcome

- either positively/ negatively depending on beliefs on consequences of addictive behaviour

- consequences shape attitudes towards behaviour

> Subjective norm:

- expectations within individuals own social group

- injunctive norm: social influence + what is perceived to be right in the eyes of others

- descriptive norm: what others are doing

Ajzen:

Attitude/subjective norm/ perceived behavioral control --> intentions --> BEHAVIOUR

3. Perceived behavioural control:

- self efficacy: individuals belief around own ability to carry out behaviour (higher self efficacy = stronger intention/effort

• takes into account internal/external factors that help/hinder performance
• PBC + intention can predict behaviour itself
• PBC caneither act on the intention or directly on the behaviour itself

+ Holistic: build on TRA so more comprehensive, added PBC

+ Application: good predictor for assessing likelihood of developing addiction use - early action/ intervention

× Armitage: assumes all are rational thinkers and ignores impulsive, habitual, mindless behaviour

× Subjective research: based on self report, social desirability/ middle tendency an issue

× Armitage: metanalysis predicts intention only, not resulting behaviour (individuals differences = different factors at play)

× Reductionist- Klag's self determination theory, ignores self motivation where recovery more successful when not coerced to quit

+ Application: model for prevention/intervention- change attitudes/ understanding of how SN influences -intervention programmes

Encourages adaptive behaviours by associating addictive behaviours with unpleasant feeling

> Emetic drugs: Antabuse + alcohol induces nausea/vomiting to create conditioned response

+ effective with 50% of alcoholics: abstained for at least a year following treatment

× not effective long-term

× Griffiths + symptom substitution: treats symptoms only not cause so can addiction replaced with another (alcohol for gambling)

× ethical issues: reasoned conformed consent/ history of abuse

> ECT: used for smoking/alcohol in the past

+ effective for pathological gambling

× Impractical: not effective outside highly controlled lab settings

× ethical issues

> Rapid smoking: invokes nausea and develops avoidance of smoking

× not appropriate for all patients (cardio pulmonary problems)

Cues in addict's environment that are likely to trigger addiction are associated with a natural physiological state (relaxation)

> De-sensitisation: repeatedly exposed to cues (sights/smells of drug), then helped to control reaction through relaxation techniques until desire goes

+ practical: effective for everyday life, rather than avoiding cues

× costly, time consuming

1. Token economy: encourages adaptive behaviours by rewarding helpful, non addictive behaviours

> Tokens: exchanged for positive behaviour e.g. visiting/ internet time

- reinforces adaptive behaviours so more likely to occur

+ Sindelar: monetary rewards for methadone treatments

patients drew for rewards whenever they tested negative for drug use

60% higher than control group in testing negative

1. Cognitive therapy: assumes all behaviour is determined by our cognition. assumes all abnormal/addictive behaviour is due to irrational thinking

> CBT: helps identify/challenge irrational thinking using counselling/hw tasks

• challenges irrational thinking: gamblers challenge faulty thinking that they have the ability to control and predict outcomes

• Relapse prevention training: strategies that increase self control;

- challenge false beliefs systems through self talk/rational explanations

+ Ladoucer et al: 66 pathological gambler + cog therapy

-CBT: 86% no longer met the DSM criteria as PG

-reported control and self efficacy + maintained at 1 year follow up

+ Sylvain et al: combined CBT with social skills and relapse prevention.

- effective long-term: improvements in 1 year follow up

> Agonist treatments:

• less harmful replacement of the drug
• fewer side effects
• allows addict to be gradually withdrawn from substance
• given increasing amounts then withdrawn until able to ween off

> Drug therapy examples

• Methadone: synthetic, mimics effects of heroine, less addictive
• BZ's e.g. Valium: used to reduce alcohol intake and stop withdrawal shakes

> Evaluation

+ warren et al: assessed effectiveness of Methadone in treating 900 heroine addicted prisoners. On methadone: used heroine 15 times a year vs without: 99 times a year

× Substitution: Addicts can become addicted to replacement drug

× 2007: 300 deaths attributed to Methadone

+ Gelder: BZs effective for weening off, less likely to abuse it

+ cost effective: compared to rehab/councelling

> NRT:

• Nicotine given in less harmful form
• nicotine patches mimic/replace nicotine gained from smoking + desensitize nicotine sensors in brain
• relieves withdrawals and reduces cravings through negative reinforcement
• available as gum, inhalers and nasal sprays

> Evaluation

+ stead et al: meta-analysis shows that NRT patients 2x more likely to give up smoking on follow up compared to control cond.

× health risk: associated with CV disease, cancer, weakens immune system

+ cost benefits: solution for those finding it hard to give up

> Antagonist treatments:

• Blocks effect of drugs by eliminating effects of neurotransmitters by blocking cellular activity
• e.g. bupropion: block nicotine receptor so reduces withdrawals

> Over all Evaluation:

× Ethical issues: addicts not in sound mind to give fully reasoned consent for alterations of bodily chemicals

× inconclusive research: effectiveness of drug therapies on behavioural addictions

+ Naltrexone: drug therapy found for gambling addiction

× side effects: vomiting, suicide, depression, aggression- not appropriate for all

× only treats symptoms: underlying psychological problem probable > CBT better