Cognitive Theories of Addiction Dr Tony Moss London South Bank University

Cognitive Theories of Addiction

Dr Tony MossLondon South Bank University

Session Outline

• Tiffany’s Cognitive Model of Drug Urge• Franken’s Neurobiological Model of Craving• Moss & Albery’s Dual-Process Model of the

Alcohol-Behaviour Link• Dyer, Moss & Albery’s Dual Systems Theory of

Addiction

Tiffany’s (1990) CognitiveModel of Drug Urge and Use

• Argued that dependence is a form of automatic behaviour

• Repeated use of drugs leads to the automatisation of drug urges, which in turn increase the future frequency of actual use

• Therefore, craving is a non-automatic process that does NOT always have to precede drug use


• Tiffany argued that ‘craving’ has two components– Automatic: linked to

withdrawal etc.; activates schemata linked to use, so possibly nonconscious

– Controlled: when use is not possible, conscious evaluation of the ‘craving state’ lead to subjective ‘wanting’ experience

Tiffany, 1999, Alc. Res. Health


• Importantly, Tiffany sees subjective craving as being the result of interrupting an automatic drug-seeking schemata

• This may be due to either individual or environmental influences:

• E.g. having no alcohol available will ‘interrupt’ an automatic ‘drink alcohol’ schema, and induce craving, or;• Consciously trying to stop oneself from accepting a

drink offered at a party may lead to increased subjective craving


• This model is supported by studies of Attentional Bias in problem drinkers, e.g.– Sharma, Albery, & Cook ; Townshend & Duka (2001)

• These studies show that dependent drinkers are massively distracted by drug-related stimuli, to the extent that performance on an unrelated task becomes impaired– E.g. responding to the colour of a word in a stroop,

identifying the location of a dot in the dot-probe


• In addition, Sayette et al. (1994), amongst others, have shown that attentional biases are positively related to craving– E.g. attentional bias for smoking related words is

associated with factors such as subjective craving and time since last cigarette


• Presaging Tiffany’s work, Ludwig (1988), commenting on the automaticity of alcoholism, said:– “Others essentially think instinctively, short

circuiting both imagery and cognitions, and are inclined to act without knowing why. When alcohol becomes readily available, they drink before they think.”

Franken’s Neuropsychopharmacological Model of Craving and Relapse

• Franken attempted to integrate evidence from attentional bias research into a wide range of other evidence to explain craving and relapse

• Essentially a cognitive model:– Stimulus – Evaluation/Processing – Response

• Provided convincing neurological and pharmacological evidence to explain the mechanism of attentional bias


• Conditioning of drug stimuli increases dopamine levels

• This serves to increase AB for drug stimuli (cf. I-S theory)

• ‘Hypervigilance’ then occurs, increasing craving and decreasing attentional resources for other mental activities


• A useful model in that it demonstrates, quite convincingly, that attentional biases have a neuroanatomical underpinning

• Helps us understand the role of craving in relapse and drug use

• Perhaps not so clear if the model is ‘new’, or just reinforcing previous theories (esp. I-S and Tiffany) with solid neuropsychopharmacological evidence

Moss & Albery’s (2009) Dual-Process Model of the Alcohol-Behaviour Link

• A theory of the effects of alcohol on behaviour and cognition

• Based on dual-process models of cognitive processing

• The model distinguishes between pre-and post-consumption drinking phases– Argues that different effects of alcohol before and

after consumption starts are important to understand behavioural change


• Based on a theoretical dichotomy between types of cognitive processingAutomatic○ AKA: System 1, Implicit, Associative…○ Features: Fast, (often) Unconscious, Parallel, High

Capacity, Contextualised, Independent of IntelligenceControlled○ AKA: System 2, Explicit, Propositional…○ Features: Slow, Conscious, Serial, Low Capacity, Abstract,

Linked to Intelligence


• Pre-consumption Phase– Involves the activation of mental representations in

long term memory relating to alcohol• E.g. expectancies, beliefs, action schemata

– This can lead to changes in behaviour prior to the commencement of drinking

– These changes in behaviour could manifest in terms of subtle social behaviours (becoming more outgoing, chatty, relaxed), or even serve to moderate drinking behaviour once it begins (ordering high-alcohol content drinks, drinking the first few drinks more quickly)


• Consumption Phase– Once alcohol enters the bloodstream, it begins to

impair cognitive processing– Specifically, alcohol reduces the capacity and influence

of controlled processing– As yet, no evidence has shown impairments in

automatic processing• Therefore, active mental representations may still influence

behaviour via the automatic system as they normally would• Goals and actions that are derived in the controlled system

will be less ‘effective’


Dyer, Moss & Albery’sDual Systems Theory of Addiction

• An attempt at unifying the diverse evidence and theory in addictions

• Aims to demonstrate both theoretical coherence and practical utility

• Based on a Dual-Process model of cognitive processing, and an extension of the previous model in to the field of addiction– …And still a work in progress!


From Moss & Dyer, 2010









Documents

Cognitive Theories of Addiction Dr Tony Moss London South Bank University