Addiction Revision Guide

PSYA4

Specification

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Key terms

Chemical addiction: Physiological addiction to a mood altering substances, such as nicotine, drugs or alcohol.

Behavioural addiction: An addiction to an activity, such as gambling or shopping, which may alter mood, but only as a result of the body’s own chemicals, rather than an external substance.

Biochemical: ‘Natural’ chemicals such as neurotransmitters and hormones which control bodily responses, including mood.

Dopamine: Dopamine is a neurotransmitter that is important for communication in many parts of the brain, including the reward system.

Characteristics of addiction:

Griffiths identified the following characteristics of addictive behaviour:

1. Salience:The behaviour becomes the most important thing to the person and they have it on their minds for much of the time. Alcohol and nicotine addicts tend not to be so obvious in this regard, since they are able to combine their addiction with other behaviours in social settings. However, once deprived of their fix, salience becomes far more apparent.

2. Mood modificationThe addict gets a rush or buzz when engaged in the behaviour. The addict is also able to use their behaviour to bring about a mood change. Interestingly, the same chemical or behaviour can alter mood in different directions depending on time or setting. Nicotine can stimulate in the morning or relax before sleep.

3. ToleranceUsually associated with chemical addiction such as alcohol or heroin, this one can also be applied to behaviours. Basically the addict needs bigger and bigger hits to get the same effect as they did initially with smaller amounts. Risk-taking behaviour, for example, tends to get more extreme over time.

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Definition of addiction:

Addiction is a persistent, compulsive dependence on a behaviour or substance. 

Some researchers speak of two types of addictions: chemical addictions (for example, alcoholism, drug abuse, and smoking); and behavioural addictions

(for example, gambling and shopping).

4. Withdrawal symptomsChanges in mood, shakes, irritability etc. as a result of cessation. Applies to behavioural as well as chemical addiction.

5. ConflictThe pursuit of short term pleasure can cause conflict with other; parents, spouse, friends and can also result in conflict within the person.

6. RelapseA tendency to return to the behaviour, months or even years after an apparent ‘cure.’ Again this is just as common with behavioural addiction as it is with chemical.

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Griffiths believes that all six need to be present for a diagnosis of addiction. However, others disagree, believing that addiction doesn’t always result in undue disruption to a person’s lifestyle and occasionally no withdrawal symptoms are experienced on cessation.

Initiation Maintenance RelapseBiological

Genetic predisposition – various genes identified for different addictions. It is believed that some genes may make a person more or less sensitive to the effects of dopamine. Those who are less sensitive may seek out addictive substances/behaviours to compensate for low levels of dopamine (= pleasure), whereas those who are more sensitive do not seem to need the extra stimulation provided by addictions.

Biochemical effects – the body becomes used to the physiological effects produced by the addiction (increased dopamine, rush of adrenaline) and tolerance may occur (the person needs more and more of the substance or behaviour to produce the same effects). The addiction is maintained to continue receiving the pleasurable feelings originally produced and avoid the negative effects of withdrawal.

Biochemical effects - relapse occurs as a response to physiological withdrawal due to the loss of increased levels of pleasure producing biochemicals such as dopamine. The individual returns to the addictive behaviour to avoid the unpleasantness of physical withdrawal.

Learning Social learning theory – initiation occurs through observations of role models (peers, parents, media, celebrities, etc.) and imitation of their behaviour.

Classical conditioning (Cue Reactivity Theory) – stimuli related to the addiction (e.g. cigarette lighter, betting shop) become associated with the positive feelings produced. Operant conditioning – the addictive behaviour brings rewards such as peer acceptance, physiological ‘buzz’, etc. which makes the individual repeat the behaviour.

Classical conditioning (Cue Reactivity Theory) – when presented with stimuli related to their addiction, the addict anticipates the associated pleasure. This produces a physiological response which makes them relapse. Operant conditioning – the person relapses into their addictive behaviour to avoid the unpleasantness of withdrawal (negative reinforcement).

Cognitive

Coping (self medication) – initiation occurs because the individual believes that the substance/behaviour helps serves a specific purpose (e.g. mood regulation, performance enhancement, distraction). Often this might be to treat a psychological illness (such as depression) that has not been diagnosed or adequately treated. Expectancy – initiation occurs if the individual expects the behaviour to have positive outcomes. Self efficacy - It could be that addicts know that the habit is dangerous and addictive but they believe that they are able to control the behaviour and any problems that may arise from it.

Coping (self medication) – if the individual believes that the addiction does help relieve stress/boredom, etc., they are likely to continue.Expectancy – if the addict believes that giving up will be difficult, they are likely to maintain the behaviour to avoid the negative effects of withdrawal.Self efficacy – the individual must believe they are capable of giving up. If they do not, the addiction will be maintained.

Coping (self medication) – the addict may relapse because the withdrawal symptoms are so unpleasant that they feel they need the addictive substance/behaviour to cope with them. Expectancy – the addict must expect that abstaining from the addictive behaviour will be more beneficial than returning to it. If they do not, relapse will occur. Self efficacy – if the individual struggles with the withdrawal symptoms after giving up, they may feel unable to continue, and relapse into addiction.

General overview of each model in relation to the three stages of addiction:

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Can be used for questions such as ‘outline and evaluate the ...... model of addiction. If used to relate to a specific addiction or stage, you should make sure that you tailor it specifically to that question e.g. the biological explanation for the initiation of gambling addiction is reductionist because...

Biological

Reductionist-reduces complex addictions to too simple a level. Deterministic - says people have no free will over whether or not they

become addicted. Individual differences: explains why some people develop addictions and

others don’t in the same bad environments (those that do have a genetic pre-disposition).

Strong research support to suggest runs in families BUT this may be better explained by social learning theory-copying parents addictions

Lots or research done on animals- cannot generalise to humans. BUT, it would be unethical to carry out this type of research on humans.

Explains some addictions better than others. The biological approach offers a good explanation for chemical addictions (e.g. smoking) but is less effective for explaining behavioural addictions such as gambling.

Learning

Learning theories are reductionist. Stimulus response- humans seen as copying behaviours without thinking.

Deterministic. You are pre destined to become an addict. Learning theories explain addictive behaviour without involving any conscious evaluation of the costs or benefits of a particular activity.

Neither conditioning explanation is sufficient on its own: - Classical is useful to explain maintenance and relapse, but not initiation - Operant = useful to explain maintenance and relapse.

SLT-best learning theory as uses both operant and classical. But weak at relapse.

Likely that other models explain addiction better- e.g. cognitive as it sees humans as thinking about what they are doing

Cognitive

Helps explain individual differences: e.g. millions of people have gambled but not all get addictive, as not all develop faulty cognitive biases (irrational thinking patterns)

Logical and lots of supporting research Some research doesn’t support: Griffiths found gamblers gamble without

consciously thinking (auto-pilot) which goes against cognitive theory which says people think about what they are doing. So doesn’t explain maintenance.

It sees humans as being thinking beings so is not deterministic Doesn’t explain chemical addictions (smoking) as well as it explains

gambling.

GENETIC VULNERABILITY

AO1 AO2

SMOKING – BIOLOGICAL - INITIATION

General evaluation for each model of addiction

The heritability estimates for smoking in twin studies have ranged from 46 to 84%, indicating a substantial genetic component to smoking. Research has focused on the role of specific genes, including:

Those with the A1 variant of the DRD2 gene appear to have fewer dopamine receptors in the pleasure centres of the brain, meaning that they are more likely to become addicted to drugs (such as nicotine) that increase dopamine levels as this compensates for the deficiency by stimulating what few dopamine receptors they do possess. Comings et al (1996) found that 49% of smokers and ex smokers carried the A1 variant of DRD2, compared to 26% of the general population.

Lerman et al (1999) suggests those without the SLC6A3-9 gene are more likely to take up smoking (the gene seems to have a preventative effect). It is suggested that individuals carrying the SLC6A3-9 gene have altered dopamine transmission, which reduces their need for novelty and reward by external stimuli, including cigarettes.

(-) Concordance rates in twin studies may be better explained by social learning theory – twins share the same environment so may be influenced by the same family members.

(+) However, research shows higher concordance rates for smoking in MZ twins that in DZ, suggesting that genetics do play a role in explaining the initiation of smoking addictions.

(+) The genetic explanation helps to explain individual differences in initiation – not everyone who tries smoking becomes addicted because they do not have the gene that makes them vulnerable.

(-) Not everyone with the gene develops an addiction, and not all addicts have the gene. This means that genetics cannot be the only explanation for the initiation of smoking addiction. The diathesis stress explanation could help explain this – that some people have a genetic predisposition to develop a smoking addiction but it is only triggered by a stressful environment and/or events.

(-) This approach can be criticised as deterministic because it suggests that a person does not have free will over whether they develop an addiction – their genetic vulnerability will make it very difficult for them to resist.

BIOCHEMICAL EFFECTS – NICOTINE REGULATION AO1 AO2According to the biological model, the reason for continued smoking is chemical addiction to the highly addictive substance, nicotine.

Shachter (1977) argues that

(+) Schachter (1977) found that smokers who smoked low-nicotine cigarettes smoked 25% more cigarettes than those who smoked high-nicotine content cigarettes. This supports the theory that there is an

SMOKING – BIOLOGICAL - MAINTENANCE

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smokers continue to smoke to maintain nicotine in their body at a level high enough to avoid any negative withdrawal symptoms. This is known as the Nicotine Regulation Model.

optimum level of nicotine required to avoid withdrawal symptoms.

(-) Biological explanations of maintenance offer a reductionist view – it is unlikely that biochemicals offer a full explanation as there are likely to be environmental factors involved (e.g. life stresses).

BIOCHEMICAL EFFECTS AO1 AO2Nicotine increases dopamine release, providing a positive, rewarding feeling which leads to maintenance of the addictive behaviour.

(+) 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. This suggests that nicotine addiction is maintained because of the rewarding effects produced from increased dopamine levels.

(-) However, because this study was carried out on mice, we cannot be sure that the results would extrapolate to human beings, due to the differences in physiology between species.

(-) Biological explanations do not explain individual differences in the maintenance of smoking addiction. If nicotine is so addictive and rewarding, how is it that some people are able to give up?

BIOCHEMICAL EFFECTS AO1 AO2Long-term use of nicotine leads to a high tolerance to it (meaning that the amount of nicotine needed increases). Stopping this use can lead to severe withdrawal symptoms, so to avoid this, the addict relapses.

(-) Biological explanations for relapse ignore the role of environmental factors. For instance, it has been found that many people relapse due to life stress (NIDA, 1999).

(-) Biological explanations for do not explain individual differences in relapse. Presumably all smokers

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experience withdrawal symptoms, but not all smokers relapse.

(-) This explanation is deterministic because it suggests that smokers do not have any control over whether they are able to give up or not.

SOCIAL LEARNING THEORY AO1 AO2According to Social Learning Theory, initiation occurs through the process of vicarious reinforcement: reinforcement received indirectly, by observing another person being reinforced. In other words, the individual begins to smoke because they observe others receiving positive rewards (such as popularity) from the behaviour and they then begin to associate these rewards with the smoking behaviour.

As smoking is most likely to begin during adolescence, peers are likely to be the most influential role models, although media role models may also be influential.

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

(-) However, this study is a correlation, so cause and effect cannot be established; it may be that a third variable (such as confidence) is involved.

(-)Also, the sample was only 16 year old males, so we cannot be sure that the results will generalise to other populations.

(+) DiBlasio and Bersha (1993) found that peer group influences were the primary influence for adolescents

SMOKING – LEARNING - INITIATION

Remember that not all approaches will have an equal

amount of AO1 and AO2 for each addiction (smoking and gambling). Some approaches may explain certain stages or addictions more fully, or more

research may have been carried out in certain areas.

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who start to smoke.

(+) NIDA (2000) reported that 90% of US smokers took up the habit as teenagers and most of them attribute this to watching others, such as friends.

CLASSICAL CONDITIONG (CUE REACTIVITY THEORY) AO1 AO2Carter and Tiffany (1999) suggest that addicts start to associate certain stimuli with their addictive behaviour. This could be items such as cigarette lighters, or situations, such as when in the pub. These stimuli then act as ‘cues’, producing similar feelings to the addictive behaviour itself, thus encouraging the individual to continue with their addiction.

(+) Many studies (e.g. Carter and Tiffany, 1999) have supported the theory that exposure to smoking related cues increases the urge to smoke and produces a range of physiological effects (such as raised heart rate) which may contribute to the maintenance of smoking behaviour.

(+/-) Saladin et al (2012) report that women are more susceptible to smoking related cues than men, and other studies have shown that this may be particularly true at certain stages in the menstrual cycle, suggesting that response to cues may be at least partly determined by biological factors.

OPERANT CONDITIONING AO1 AO2

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The addiction is maintained because the pleasurable feelings produced by increased levels of dopamine act as positive reinforcement for the addictive behaviour, whilst the avoidance of withdrawal symptoms also negatively enforces the behaviour. The addict continues with the behaviour to maintain the pleasurable feelings and avoid the unpleasant symptoms of withdrawal.

(+) There is lots of animal research which demonstrates that rats will repeatedly self administering nicotine, due to the pleasurable effects it produces. For example, Levin and Rose (2010) gave rats an intravenous dose of nicotine and then offered them the opportunity to drink from a choice of two bottles; one laced with nicotine, the other with just water. They found that they licked the nicotine water significantly more times than the plain water, and that the number of licks they gave increased with every subsequent opportunity they were given. This supports the role of nicotine as a positive reinforcer being important in the maintenance of smoking addiction.

(+) However, this was an animal study, so we can’t be sure that results will generalise to humans.

CLASSICAL CONDITIONING (CUE REACTIVITY THEORY) AO1 AO2The likelihood of relapse is increased if the individual is confronted with ‘cues’ that remind them of their addiction. These cues produce similar physiological effects as the behaviour itself, causing the individual to relapse.

(+) Interventions for addiction based on cue avoidance do seem to be effective in presenting relapse.

(-) Does not explain individual differences. Some smoking addicts are able to give up, even though they are exposed to cues.

OPERANT CONDITIONING AO1 AO2Relapse can be explained via negative reinforcement. The individual relapses to avoid the unpleasant feelings produced by withdrawal. Common symptoms of withdrawal from nicotine are weight gain, constipation, anxiety and insomnia, which last for an average of three weeks.

(+) Parrott (1988) suggests that abstaining from nicotine, even for a brief period, causes increased stress and anxiety in the form of cravings.  Smoking immediately removes this anxiety and in the very short term reduces the perception of stress.  Note that longer term use actually increases stress but this isn’t noticed. 

(-) Neither learning explanation accounts for individual differences in the maintenance of smoking

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behaviour. Presumably all addicts are exposed to cues and experience withdrawal symptoms when they try to stop, but this approach does not explain why some relapse and others do not.

(-) The behaviourist approach is reductionist as it does not consider the role of biology, cognitions or social context in the maintenance of addiction. It suggests that relapse occurs through simple learning processes, which may not adequately account for the complexities of addictive behaviour.

COPING (SELF MEDICATION) AO1 AO2This explanation suggests that people purposely choose what they become addicted to. The individual chooses something that they believe will help them with a problem they have. E.g. someone may feel that smoking relieves stress so will initiate the behaviour as a form of stress relief.

Helps fulfil 3 major functions 1. Mood regulation 2. Performance management (they

may believe that smoking helps them concentrate)

3. Distraction (from problems or just boredom)

(+) Heishman (1999) found that smoking does help concentration, with increased attentional focus and enhanced performance of well-learned behaviours. This why explain why it may be used to self medicate.

(-) However, Cohen and Lichtenstein (1990) found that smoking actually increases stress levels. But it does not matter whether the choice e.g. smoking actually helps the person; it only matters that they believe that it does.

(+) This explanation is supported by the fact that smoking is more common in lower socio economic groups (Fidler et al, 2008) as they may have more stressful lives, increasing the need to self medicate.

EXPECTANCY AO1 AO2Whether smoking begins or not can be described in terms of expectancy. Smokers may expect that smoking reduces stress and negative feelings. They may believe that it makes them look ‘cool’ and attractive to the opposite sex. All of these expectancies may motivate smoking

(+) This is not a deterministic explanation – it sees the choice to partake in an addictive behaviour as an act of free will on the part of the individual.

SMOKING – COGNITIVE - INITIATION

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behaviour regardless of whether they reflect reality. It is enough that the smoker believes that they are true.

SELF EFFICACY AO1 AO2Self efficacy may help to explain the initiation of a smoking addiction because the individual may believe they are able to smoke without becoming addicted.

(-) Does consider individual differences in initiation of smoking, as some people may not start to smoke because they believe they will become addicted.

COPING (SELF MEDICATION)AO1 AO2The functions of coping may also explain why people maintain their addictive behaviour. It may be that people continue to smoke because the nicotine really does help them to concentrate for longer, or engage in repetitive tasks without getting unduly bored.

(+) Heishman (1999) found that smoking does help concentration, with increased attentional focus and enhanced performance of well-learned behaviours.

EXPECTANCYAO1 AO2Expectancies may influence whether someone continues to smoker or not. The smoker who expects the withdrawal symptoms to be unpleasant is more likely to maintain their addiction.

(+)This explanation for maintenance does take individual differences into account – those who expect withdrawal to be difficult are more likely to maintain the addiction.

(+) 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.

SELF EFFICACY AO1 AO2It could be that once smoking is initiated, the individual feels unable to cope with the withdrawal procedure associated with smoking, and so their addiction is maintained.

(+) Helps to explain individual differences – some people maintain their behaviour because they do not feel capable of quitting.

(-) Does not explain why some people

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have lower self efficacy. Therefore, does not offer a full explanation of why smoking addiction is maintained.

COPING (SELF MEDICATION)AO1 AO2In terms of coping, the negative feelings of withdrawal can be relieved almost immediately by smoking another cigarette. The symptoms of withdrawal include attention lapse, and smoking provides an immediate route to performance enhancement in this respect.

(+) Heishman (1999) found that smoking does help concentration, with increased attentional focus and enhanced performance of well-learned behaviours.

SELF EFFICACY AO1 AO2It may be that self efficacy can explain why smokers relapse. The may feel that they do not have the necessary ‘willpower’ or mental capabilities to abstain from their addiction long term.

Alternatively, if they have given up before, they may feel that they are able to do so again, so they do not feel that a return to smoking will be permanent.

(+) Treatment programs which aim to increase self efficacy have been found to be effective in preventing relapse. This supports the role of self efficacy in explaining why someone relapses.

(+) Does not explain why some people have higher self efficacy than others so therefore may not provide a full explanation for relapse.

SMOKING – COGNITIVE - RELAPSE

GAMBLING – BIOLOGICAL – INITIATION

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GENETICSAO1 AO2Zuckerman (1979) proposed the personality characteristic of ‘sensation seeking’ which may be passed on genetically. People with certain genes may be predisposed to seek out stimulating activities, such as gambling, and may therefore have a higher risk of developing an addiction.

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.

(-) Social learning theory could also explain why addiction to gambling may run in families – observation of gambling role models.

(-) Deterministic – suggests that some people may not have free will over the development of an addiction.

BIOCHEMICAL EFFECTS AO1 AO2Kim (1998) has found biochemical evidence which suggests that gambling may activate the brain’s reward system, causing the release of chemicals (such as endorphins) which create a rush of pleasure. Gamblers are likely to feel this sensation whenever they place a bet, due to the anticipation of winning (even if they do not eventually win). The occasional bet then becomes an addiction because they want to experience these feelings again.

(-) Does not explain individual differences in the initiation of gambling – most people have gambled occasionally (e.g. the National lottery, bingo, etc) but few become addicted.

BIOCHEMICAL EFFECTS AO1 AO2The individual continues with the addictive behaviour to maintain the positive effects (the feelings of pleasure) and avoid the negative

(+) Wray and Dickinson (1981) found that gambling addicts who are stopped from gambling experience symptoms almost like withdrawal

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consequences of withdrawal. symptoms from chemical addictions.

(+) Treatments using naltrexone (a drug which blocks the rush of endorphins) have been found to be effective in reducing thoughts about gambling and gambling behaviour itself. This suggests that at least part of the reason for the maintenance of the addiction is the pleasure received from gambling.

(+) Does not explain individual differences in gambling – if everyone experiences pleasure from gambling and withdrawal effects when they stop, why do some develop an addiction but others don’t? This is better explained by the genetic explanation for initiation.

BIOCHEMICAL EFFECTS AO1 AO2Gamblers experience similar withdrawal symptoms to addicts with substance addictions, so it is suggested that gamblers relapse in order to stop the withdrawal symptoms.

(+) Wray and Dickinson (1981) found that gambling addicts who are stopped from gambling experience symptoms almost like withdrawal symptoms from chemical addictions.

(+) This approach can be accused of being deterministic as it suggests that gamblers do not have free will over whether they relapse.

GAMBLING – BIOLOGICAL – RELAPSE

One of the main evaluation points for biological explanations for gambling (any stage) is that

biological approaches do not explain behavioural addictions, such as gambling as well as they

explain chemical addictions like smoking. This is why there is less material for biological gambling

explanations.

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(+) This explanation for relapse can also be said to be reductionist as it does not consider the complex social and cognitive factors that may contribute to relapse.

SOCIAL LEARNING THEORY AO1 AO2According to the behaviourist model, gambling behaviour is initiated through the process of Social Learning Theory – the addict sees others being rewarded for their addictive behaviour (winning).

(+) Gupta (1997) reports that 86% of children (aged 9-14) who gamble regularly reported gambling with family members. They also found that, as children's age increases they tend to gamble more at friend's homes and at school. This supports the role of SLT in initiation of gambling as parents and peers are likely to be the most important role models.

(-) However, this study is a correlation, so cause and effect cannot be established; it may be that a third variable is involved.

(-) The participants in Gupta’s study

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were not assessed for pathological gambling, so they may have only been occasional gamblers rather than addicts. Therefore, the study may lack validity.

OPERANT CONDITIONING AO1 AO2People are said to continue gambling in order to experience the biological buzz and reward. Although you do not win every time when gambling, intermittent or variable reinforcement has been shown to produce longer lasting acquisition of gambling and indeed other behaviours. Moreover, behaviours which are established this way (intermittent or variable reinforcement) are much more difficult to extinguish.

(+) Does explain why some people continue to gamble even when faced with regular losses (variable reinforcement).

(-) The behaviourist approach is reductionist as it does not consider the role of biology, cognitions or social context in the maintenance of addiction. It suggests that maintenance occurs as a result of simple learning processes, which may not adequately account for the complexities of addictive behaviour.

CUE REACTIVITY THEORY (CLASSICAL CONDITIONING) AO1 AO1The individual may condition to gamble because the material associated with their habit is presented to them on a day to day basis (e.g. walking past betting shops).

(+) Edelgard (2009) compared the heart rate of social and pathological gamblers (addicts) when presented with pictures of their preferred form of gambling (horse racing or scratchcards). They found that heart rate increased for

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both groups, but was significantly higher in the pathological group, particularly when exposed to cue for their preferred form of gambling. This may explain why gambling addicts continue their behaviour – because the increased physiological arousal (excitement/pleasure) experienced when they are exposed to cues reinforces their desire to continue gambling.

(-) Does not explain why some do manage to give up gambling, whilst others are not. Presumably all gamblers are faced with cues, but not all relapse.

CUE REACTIVITY THEORY (CLASSICAL CONDITIONING) AO1 AO2Returning to gambling after a period of abstinence can be explained in terms of cue-reactivity. 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.

(+) Wolfling et al (2011) found that pathological gamblers showed increased physiological arousal when presented with gambling cues, which also increased cravings to gamble, thus leading to an increased likelihood of relapse.

(+) Interventions for addiction based on cue avoidance do seem to be effective in presenting relapse. This supports the idea that cues are an important factor in explaining why relapse occurs.

(-) Does not explain why some people are eventually able to abstain long term, whilst others are not. Presumably all gamblers are faced with cues, as betting shops and National Lottery products are everywhere, but not all relapse.

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COPING (SELF MEDICATION) AO1 AO2Gambling may be seen as an exciting activity which relieves the boredom of everyday life.

The self medication hypothesis was first suggested by Duncan (1974). Drug addicts, in his view, have found a drug which provides them with temporary escape from an ongoing state of emotional distress which might be due to a mental disorder, to psychosocial stress, or to an aversive environment. Non-drug addictions, in his opinion, represent similar negatively reinforced behaviour (i.e. the behaviour provides relief from emotional distress).

(+) The self medication model can help to explain why people develop specific addictions. For example, those who are bored may be more likely to turn to gambling, whilst those with high levels of stress may become addicted to nicotine. (+) Blaszczynski (2006) found than gamblers are more prone to boredom vs. non-gamblers. This may explain why they are drawn to an ‘exciting’ addiction.

(+)This theory is compassionate to people with addictions. It presents them not as weak-willed, but as creative problem-solvers, who are attempting to fill the gap left by limited medical options.

(-) Also, it is difficult to establish cause and effect as it may be that gamblers are so used to the excitement that comes from gambling that they feel especially bored when they are not indulging in their habit (such as when taking part in psychological research!)

EXPECTANCY AO1 AO2If the individual expects that gambling will have positive outcomes they are more likely to develop an addiction. These expectancies may be increased

(+)Walters and Contri (1998) compared expectancies for gambling amongst a group of male American prisoners. They found that those

GAMBLING – COGNITIVE – INITIATION

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if they have a win early on. They may also expect few negatives of their behaviour, as gambling is seen as a relatively acceptable behaviour (unlike some other addictions such as heroin).

identified as probable pathological gamblers had significantly more positive (e.g. gambling makes me feel important/expert/in control) and arousing (e.g. exciting) expectancies than non gamblers.

(+) However, this was obviously not a representative sample, so results may not be generalisable.

COPING (SELF MEDICATION) AO1 AO2If gambling does help to relieve boredom, the individual is likely to continue with their addiction. They may also keep gambling to reduce the anxiety associated with losses from gambling.

(+) A study for the Australian government found that problem gamblers were more than 18 times more likely to experience severe psychological distress, and more than twice as likely to be depressed as people without a gambling problem. This would support that the maintenance of gambling is a form of self medication to distract from emotional problems.

(-) However, there is a clear cause and effect problem here, as it is not clear whether the distress/depression came before the gambling or after.

EXPECTANCY (IRRATIONAL COGNITIVE BIASES) AO1 AO2Regular gamblers seem to have irrational expectations of gambling which help to maintain their behaviour. They may overestimate the likelihood of winning and underestimate the potential for losses. They may also believe there is a skill to winning where there is no skill involved (e.g. slot machines).

(+) van Holst et al (2012) used MRI scans to measure the brain activities of problem gamblers and a control group when presented with various probabilities of winning or losing different amounts of money. They found that the ‘problem’ group had increased blood supply to the regions of the brain associated with reward expectancy, suggesting that problem gamblers may have over optimistic expectancies of gambling outcomes. They also found that the most severe problem gamblers were less likely to be risk aversive (to avoid risk).

(+) Using brain scans is an objective and scientific way to investigate gambling behaviour.

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(-) Other studies have found that expectancies only predict addiction in males, not females.

(COPING) SELF MEDICATION AO1 AO2If someone takes up gambling to relieve boredom, they may find that their boredom returns when they try to stop. They may even feel more bored because they have experienced the excitement of winning and so return to gambling to cope with these feelings.

In addition, they may now have anxieties associated with their gambling behaviour (money or relationship problems) which gambling can help distract them from.

(+) A qualitative study by Wood & Griffiths (2007) interviewed pathological gamblers on their reasons for relapse. They found that escape (from boredom/problems in every day life) was the main characteristic that facilitated a return to problem gambling. The authors suggest that those who are able to cope with unwanted emotions and environmental cues were less likely to relapse.

(+) Qualitative research offers rich data which may help us understand gambler’s thought processes more fully than quantitative research.

(-) But may not be objective/scientific.

SELF EFFICACY AO1 AO2The individual may begin to gamble again because they do not have confidence in their ability to give up permanently.

A 21-item measure of gambling abstinence self-efficacy (GASS) was developed by Hodgins et al (2004) to measure gambling addict’s beliefs about their ability to give up their habit.

(+) Using the GASS, Hodgins et al (2004) found that higher self-efficacy was related to fewer days of gambling over a 12-month period. This supports the role of self efficacy in explaining relapse.

(+) This has implications for the treatment of gambling addictions – increasing self efficacy may be a useful way of reducing relapse rates.

(-) However, this approach does not explain why some people have lower levels of self efficacy, so may not offer a full explanation for relapse in gambling addiction.

RISK FACTORS IN THE DEVELOPMENT OF ADDICTION

GAMBLING – COGNITIVE – RELAPSE

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Risk factors often appear as an applied question, where you will be

asked to identify risk factors in a given scenario. For this type of

questions, evaluation is not necessary as AO2 will be gained by

application.

AGEPoint: It is suggested that young people more prone to addiction because they have less mature brains. This means they are more sensitive to positive effects of drugs than older people. They also experience fewer negative effects from drugs that adults, which may help to maintain their addiction.

Evidence: A report commissioned by the NHS found that 67% of regular smokers

started before the age of 18 and 84% by age 19. Shram (2008) found that adolescent rats were more sensitive to the

rewarding effects of nicotine and less sensitive to its aversive effects compared to adult rats.

Evaluation: (+) This suggests that the younger someone tries smoking/gambling the more likely they are to develop an addiction.

(-) However, this research is based on animals so the findings may not be generalisable to humans.

PEERSPoint: There is lots of research to suggest young people are influenced by peers. It is thought that peer pressure is a major cause in starting to smoke. This links to Social Learning theory. Young people are more likely to imitate behaviour if they see it as rewarding e.g., smoking makes them seem cool.

Evidence: DiBlasio and Bersha (1993) found that peer group influences were the

primary influence for adolescents who start to smoke. Sussman & Ames (2001) found that friend and peer use of drugs is a

strong predictor of drug use among teenagers due to role modelling and being offered drugs by their peer group, demonstrating the influence of social networks in determining levels of individual vulnerability

Evaluation: (-) There is lots of research which supports the importance of SLT in explaining addiction.

(+) However, much of the research is correlational so cause and effect cannot be established. For example, the study by Sussman and Ames appears to show that peer groups cause smoking, but when it looked at other factors it found the family influence (poor supervision and conflict, parent’s drug taking behaviour) had an effect on addiction too. This shows that several factors may lead to a smoking addiction and that peer pressure is just one of these.

(-) It could also be that people are drawn towards people who enjoy the same things as them, e.g. smoking, gambling etc. Therefore, the same addictive behaviours may be similar in peer groups because they have joined the group because of these similarities, rather than that they changed their behaviour as a result of peer pressure after joining the group.

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PERSONALITY

Point: Eysenck (1967) proposed that there are certain personality types which are more prone to develop an addiction (the so called ‘addictive personality’). He suggested three components of personality, extroversion (vs introversion), neuroticism and psychoticism. Using questionnaires, Eysenck assessed personality types based on their ‘score’ on each of these three measures. He found that those who were scored highly on neuroticism and psychoticism were more at risk of developing an addiction.

Evidence: Francis (1996) found a link between addiction and high scores on both

neuroticism and psychoticism. Zuckerman (1983) suggested that individuals high in sensation seeking

(extraversion) are more likely to seek novel experiences, and this would make them more likely to develop an addiction.

Evaluation:(-) Most research is correlational. Certain traits may be present in people with addictions but this may just be coincidence or due to a third factor. For example, Teeson (2002) said it is difficult to see whether the addiction was caused by the person’s personality or the addiction caused a change in personality

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The media can influence addictive behaviour in two ways:

1. It can glamourise addictions (in films, TV, etc), making them seem ‘cool’ and playing down any negative effects, thus possibly leading more people to develop an addiction.

MEDIA INFLUENCES ON ADDICTIVE BEHAVIOUR

STRESS

Point: Addiction relieves anxiety (stress) e.g. smoking, drinking. Those who have suffered a very stressful situation or long term daily stress are more vulnerable to addiction, especially children and young people.Evidence:

Research has found that everyday stress could contribute to initiation and maintenance and explain why people relapse (because life is stressful again). (NIDA,1999).

Smokers say they smoke to relieve stress, but actually smoking increases stress levels! However, once in the maintenance stage of smoking, self medication is occurring to relieve the stress of not smoking! ( Hajek et al 2010)

Driesssen et al ( 2008) found that 30% of drug addicts and 15% of alcoholics also suffer from post traumatic stress disorder. Therefore this is some evidence for the fact that people that people exposed to severe stress are more vulnerable to addictions.

Evaluation:(+) Individual differences: stress can explain why some people are more vulnerable to addiction than others..(-) Correlational: cause and effect (between stress and addiction) cannot be established – it may be that a third variable is involved.(+) Lots of supporting research(+)Seems logical and fits in with cognitive self –medication model.

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2. It can be used to try and reduce addictive behaviour by means of advertising and public health campaigns.

NEGATIVE INFLUENCES

Point: Films such as Trainspotting and Human Traffic make addictions seem exciting and cool, which could lead to an increase in addictive behaviours. Television, especially soap operas, portrays potentially addictive behaviours such as smoking and alcohol consumption as a part of everyday life – this could also increase the likelihood of addiction. This can be explained by Social Learning Theory – if we see others being rewarded (or not punished) for a behaviour we are more likely to copy it.

Evidence: 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.

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.

Evaluation: (-) Boyd (2008) claimed that not all films displayed addiction in a positive manner, and films do regularly represent the negative consequences of addiction.(+) Sargent and Hanewinkel (2009) found that adolescents who watched films containing smoking behaviour were more likely to begin smoking in the next year. (-) The media may have more influence over children and adolescents (than adults) so findings may not be generalisable.(-) The media may only influence some addictions – smoking and drinking are legal so people may be more likely to be influenced to try them, whereas illegal drugs such as cocaine and heroin may carry more negative associations so will not be influenced by the media.

POSTIVE INFLUENCES

The media can be useful in educating a large section of society about the dangers of addiction, via advertising and public health campaigns.

Effectiveness:A government stop smoking campaign in 2004, using posters showing cigarettes dripping fat to demonstrate the effect of smoking on arteries, was found to be more effective than doctor’s advice in helping people give up smoking. The Tobacco Education Campaign Tracking study, commissioned by the government, shows that advertising campaigns prompted 32% of recent attempts to kick the habit while GPs were responsible for just 21%.

Evaluation:

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(-) Between 1998 and 2004 over $1billion was spend on US anti drugs campaigns, but research suggests that these campaigns may actually have increased cannabis use.  (Johnston et al 2002) says that this may be because the adverts gave the impression that cannabis use was commonplace.

• Proposed by Ajzen (1989)• It is a cognitive theory about the factors that lead to person’s decision to

engage in a particular behaviour. • According to TPB an individual’s decision to engage in behaviour can be

directly predicted by their intention to engage in that behaviour.

REDUCING ADDICTIVE BEHAVIOUR The Theory of Planned Behaviour (TPB)

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Evaluation of the TPB:

• Research support - Research into various areas of health psychology have shown that the TPB can be used to predict intention and behaviour. For example, White (2008) found that attitude, norms and perceived control were significant predictors of intentions to engage in sun protection, and these intentions were significant predictors of actual sun protection behaviour.

• Reductionism - the TPB is criticised for being too rational, as it does not take into account emotions, compulsions or other irrational determinants.

• Intention does not always predict behaviour - Miller and Howell (2005) found that although attitudes, norms and perceived control can predict intentions, they are not good predictors of actual gambling behaviour by underage teenagers.

• Methodological issues - Ogden (2004) highlights that behaviour in studies using the TPB is usually measured using self-report, and thus may suffer from lack of objectivity, lack of accuracy and bias.

Drugs used to treat addiction fall into one of two basic categories:

Agonist These act as a less harmful replacement for the dependent drug,

resulting in fewer side effects and allowing gradual and controlled withdrawal from the substance. Ideally they should be accompanied by counselling and rehabilitation.

Antagonist These block the effects of the target drug and prevent them from having

the desired effect.

Biological treatments

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NICOTINE REPLACEMENT THERAPY

NRT is an agonist substitute. Nicotine itself, whilst addictive, is much less damaging to the body than the other components of cigarettes (such as carcinogenic tars).

One strategy for reducing smoking is therefore to replace the nicotine obtained through smoking with a safer nicotine source.

Nicotine replacement therapy is available in a number of forms including patches, gum, nasal spray and inhalers.

Effectiveness of NRT:

(+) Selby (2012) found that a 21.4% who called a helpline to receive a free 5 week course of NRT were still non smokers after six months, compared to 11.6% of the control group.

(+) large sample – 1400(-) high drop out rate – only 2600 completed all follow up materials(-) Canadian study so may not be generalisable(+) but studies in other countries have found similar success rates with NRT(-) only follows up for 6 months so doesn’t monitor long term effectiveness

Evaluation of NRT:

(-) Side effects – common side effects of NRT include disturbed sleep, upset stomach, dizziness and headaches.(+) Availability – can be bought freely over the counter or may be available on prescription from the smoker’s GP. (-) May not be effective long term – a recent study found that about a third of smokers relapse after a period of abstinence. Researchers found no difference in relapse rates amongst those who used NRT. (-) The individual may become dependent on the NRT(+) However, the risk of dependence on NRT is small, and only a small minority of patients (about 5%) who quit successfully continue to use medicinal nicotine regularly in the longer term (Molyneux 2004).

(-) Doesn’t address the cause of addiction – research suggests that people may smoke to relieve life stresses. This treatment does not treat the underlying causes of addiction, so relapse may be more likely than with psychological therapies.(+) Can be combined with psychological therapies – biological therapies can be combined with psychological treatments such as Motivational Interviewing to improve long term effectiveness.

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GENERAL EVALUATION OF BIOLOGICAL TREATMENTS

(-) Behavioural or chemical – research suggests that biological treatments may be more useful for treating chemical addictions (such as smoking) than for behavioural addictions (e.g. gambling).

(+) However, this may be because the recognition and treatment of behavioural addictions is a more recent development, so there is less research evidence available.

(-) Ethical issues – there may be ethical issues involved in using treatments which interfere with bodily chemicals, particularly for non chemical addictions.

(+) However, the individual does give consent for the treatment to be carried out.

(-) Although it could be argued that their addictions make them unable to give fully informed and reasoned consent.

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NALTREXONE

Naltrexone is an opium antagonist – meaning that it blocks the action of opoids and endorphins in the brain, this reducing the rush of pleasure felt by the addict when they indulge in the additive behaviour.

The drug has been used for some time to treat chemical addictions such as alcoholism, but is now also being used to treat behavioural addictions such as gambling, sex and internet porn. Grant and Kim (2006) suggest that gamblers experience a rush of excitement akin to that of heroin users.

Effectiveness of naltrexone:

(+) Kim and Grant (2001) found that naltrexone reduced thoughts about gambling, the urge to gamble and – at relatively high does – gambling behaviour itself. In a further study, Kim et al (2001) found that, over a 12 week period, naltrexone was effective than a placebo in controlling the frequency and intensity of urges to gamble, as well as the behaviour.

(+) used a double blind procedure to eliminate demand characteristics and investigator effects(+) only measures over 12 weeks, so doesn’t monitor long term effectiveness

Evaluation of naltrexone:

(-) Side effects – possible side effects include nausea, headaches, constipation and insomnia. (-) Doesn’t address the cause of addiction – treatment does not treat the underlying causes of addiction, so relapse may be more likely than with psychological therapies.(+) Can be combined with psychological therapies – biological therapies can be combined with psychological treatments such as Motivational Interviewing to improve long term effectiveness.

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Psychological treatments

MOTIVATIONAL INTERVIEWING

Motivational interviewing is a form of cognitive behavioural therapy (CBT) which aims to change the way the addict thinks, so giving them the motivation to change their behaviour.

It draws on the theory of cognitive dissonance – the belief that we experience uncomfortable psychological tension when we hold two conflicting thoughts in our mind at the same time. The therapist aims to make the addict aware of the problems of dependency (e.g. health, cost) and the benefits of abstinence, thus creating cognitive dissonance between this information and their desire to engage in the addictive behaviour.

The therapist then guides the individual towards channelling this dissonance into change by building the addict’s sense of self esteem and self efficacy.

Effectiveness of MI

Dunn et al (2001) carried out a review of 29 studies which investigated the success of MI in reducing a range of negative behaviours, including substance abuse and smoking. They found that 60% of studies yielded a significant behaviour change.

(-) found to be most effective for substance abuse, so may not be suitable for all addictions(-) methodological differences between studies (e.g. procedure and sample used) make it difficult to establish a clear conclusion on effectiveness

Evaluation of MI (-) Training - therapists must be fully trained in MI procedures, so time and cost of training may be an issue. (-) Relies on the addict’s commitment to attending regular sessions, which may be a problem if the individual is still in the midst of their addiction. (+) Can be combined with biological treatments to increase effectiveness and reduce relapse. For example, NTR may help the addict abstain long enough to commit to MI. (-) May be effective long term – because this treatment aims to change the way the patient thinks about the addictive behaviour, it may be more effective than biological interventions in preventing relapse.

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AVERSION THERAPY

Aversion therapy is based on the principles of classical conditioning. It aims to create a negative association with the addictive behaviour. This may be achieved by administering drugs which cause nausea when the substance (e.g. alcohol) is consumed or by means of painful (but relatively mild) electric shocks when the behaviour is carried out.

Effectiveness of aversion therapy

Smith (1988) gave 327 smokers a five day course of treatment involving aversion therapy and therapy sessions. The participants self administered shocks though a wristband when taking part in smoking behaviour, such as opening a pack of cigarettes or placing one in the mouth. They were asked not to inhale any of the smoke so that there were no positive associations with the behaviour.

Participants were given a telephone interview to check on progress 13 months after the treatment ended. It was found that 52% had abstained from smoking for 12 months. (-) self report method – prone to social desirability bias(+) although this may have been reduced because it was a telephone interview rather than face to face(-) difficult to separate the effects of the therapy and the aversion therapy – may have been that the combination of the two was most effective

Evaluation of aversion therapy

(-) Ethical issues – the patient is being subjected to a very unpleasant substance or shock – this raises issues of psychological harm.(+) Consent - However, patients do consent to the treatment and drop out rates are low. Many addicts report that they find aversion therapy less unpleasant than psychological ‘talking’ therapies. (-) Informed consent – it could be counter argued that addicts are not psychologically healthy, so are unable to give fully informed consent because they may be so desperate to give up their addiction. (-) Relapse rates are high – aversive therapy weakens with time, meaning that the patient may return to their addictive behaviour. (+) Reinforcement sessions – Smith and Frawley (1993) found that two reinforcement sessions (involving further shock treatments) significantly reduced relapse rates. (-) Other factors – Smith (1988) found that relapse was much more likely when reformed smokers returned to a household where others smoked. This suggests that learning and environmental factors are also important considerations in the success of interventions for addiction.

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VOUCHER THERAPY

Voucher therapy is a behavioural (learning) theory based on the principles of operant conditioning. The basic premise is that the addict is given vouchers when they abstain from their addictive behaviour. These vouchers can them be exchanged for cash or a reward of their choice.

Effectiveness of voucher therapy:

Higgins et al (1994) gave 28 white male American cocaine addicts a voucher every time their urine test was clear from cocaine. The reward increased for each consecutive test that was clear, but returned to a lower level if they had a positive result. The participants also received counselling on how to spend their rewards.

The researchers reported a low drop out rate, with around 65% of addicts staying on the programme for 6 months. In a follow up study using a control group who were on a ‘standard’ drug treatment plan, 11 out of 13 patients receiving voucher therapy stayed on the programme for 12 weeks, compared to 5 out of 15 in the control group. (-) only cocaine addiction amongst white male Americans so may not be generalisable to other addictions/cultures(-) small sample, so again it is hard to generalise findings (-) the scheme also involved counselling and skills and employment training, so it is difficult to separate the effects of these techniques from the effectiveness of the voucher therapy

Evaluation of voucher therapy:

(-) Controversial – many people would be opposed to rewarding addicts for good behaviour, when the majority of the population is able to abstain without rewards. This may be a particular problem in the UK because, if the treatment was offered on the NHS, it would be the taxpayer who would foot the bill for the rewards. (-) Relapse – voucher therapy does not teach the individual how to deal with their addiction when the treatment ends, so they may relapse. (+) Can be combined with other therapies – the rewards offered may convince addicts to abstain long enough to commit to other therapies, such as motivational interviewing. These may increase effectiveness and reduce the likelihood of relapse.

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Public health interventions are aimed at changing the behaviour of a large

section of people.

Public health interventions

Doctor’s advice

This intervention simply consists of offering smoking cessation advice from doctors and/or nurses at local surgeries. Doctors are seen by many as an authority figure and knowledgeable. They have a clear role in advising about the dangers of addictions.

Effectiveness of doctor’s advice:

Ogden (2007) Looked at 5 London GP’S practices. They looked at whether the amount of support given by GPS increased the number of people who beat smoking addiction

They had 4 different conditions:1) Follow up only – were a smoker at the start of the study and then 12

months later they recorded whether they were smoking or not (so received no doctor’s advice). Less than 1% had given up

2) Filled in questionnaires about smoking habits and follow up = 1.6% had given up smoking..

3) Advised by doctor to give up smoking, filled in the questionnaire and follow up = 3.3% had given up smoking.

4) Advised by doctor to give up smoking, given a leaflet with tips for giving up and follow up at 12 months = 5.1% had given up smoking.

Shows that successful cessation increases with a higher level of advice from the doctor.

(-) London only – may not be generalisable.(+) studies in different areas have found similar results. (-) only followed participants for 12 months, so does not give a clear picture of long term effectiveness.

Evaluation of doctor’s advice • Effective: The above % for group 4 looks small, but if all GP’s did this

(leaflet and advice), it would lead to half a million people giving up in a year.

• Cause and effect: Difficult to day that the doctor’s advice given directly led to giving up smoking as correlational research method.

• May not work with all addictions e.g., could be used with food addiction and even gambling but may not be suitable for others e.g., severe alcoholism.

The smoking banSmoking in public places was banned in the UK in July 2007. Although the primary objective of this legislation was to protect workers and the general public from the harmful effects of second-hand smoke, evidence suggests that smokers have also found that the law has created a more supportive environment for them to quit smoking.

Effectiveness (+) Statistics show that nearly a quarter of million people quit smoking with the help of local NHS Stop Smoking Services between April and December 2007.

Evaluation(-) However, West (2009) found that although there was a decline in the percentage of people smoking in the UK who smoked prior to the ban on smoking, this was followed by a rebound effect. Attempts to stop smoking were actually greater in the nine months before the ban than in the 17 months after.

(+) But, this may have been because people tried to give up before the ban came into place.

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