Addiction Chapter Summary

Genetics:

• McGue (1999) - heritability estimates for alcohol around 50% 
• Drug use heritability is 45-80%
• Genetics = general predisposition to behavioural disorders
• DRD2 gene linked to severe alcoholism, cocaine, heroin and nicotine addiction
• Become addicted to drugs that increase dopamine levels

Evaluation:

• Explains individual differences in vulnerability to addiction and why some people resistant to treatment
• Meta-analysis - large proportion of alcoholics had A1 variant of DRD2 gene
• More recent studies have failed to find any relationship between A1 and alcoholism

The Disease Model:

Initiation: 

• Addictive drugs stimulate reward circuit
• Incentive sensitisation theory: increased exposure to drugs of abuse causes sensitisations to their desirability 

Maintenance:

• Chronic exposure to drugs leads to downregulation 
• Drugs must then be taken to avoid withdrawal symptoms

Relapse:

• Drugs become more important than other desires

Evaluation:

• Some people particularly vulnerable to added rush of dopamine-enhancing drugs
• Neurochemical explanations ignore other factors but offer treatment hope
• Stimulating environments protect against stimulation offered by addiction

Synoptic Links:

• Banks et al (2008) successfully tested cocaine replacement drug with monkeys
• Reductionism - has advantages but ignores social context of addictive behaviour  

Self-Medication Model:

• Initiation: Drugs taken to relieve psychological states
• Maintenance and Relapse: Initial rush of nicotine povides stress relief, but chronic stress effect that prevents relapse 

Evaluation:

• Substance abuse disorders characterised by low ego control for impulses to self-medicate
• Man cases of addiction where no problems to overcome 

Expectancy Theories:

• Expectations aot outcomes of addictive behaviour contribute to excessive use
• Initiation: Heavier drinkers have more positive expectations about effects of alcohol
• Maintenance and Relapse: As addiction develops, more governed by unconscious expectations. Expectations manipulated to prevent relapse

Evaluation:

• Subjective evaluation of anticipated effects are important determinant of drinking behaviour
• Research on alcohol has focused on 'problem drinking' rather than 'addiction' 

Rational Choice:

• Initiation: Becker and Murphy (1988) suggest that the concept of 'utility' determines consumption
• Maintenance and Relapse: Addicts are 'rational consumers' who act to maximise their preferences - exception is gambling

Evaluation:

• Explains why some addicts give up - utility of behaviour alters
• Implications for treatment - change utility for consumer 

Synoptic Links:

• Emphasis on positive findings exaggerates research findings in a particular area
• Suggests idea that addiction is an uncontrollable behaviour which absolves addict from personal responsibility
• Men hold stronger positive and weaker negative expectations about effects of alcohol 

Operant Conditioning:

• Initiation: Behaviours that produce rewards are likely to be repeated
• Maintenance and Relapse: Withdrawal symptoms appear if drug is discontinued. Relapse is known as negative reinforcement

Evaluation:

• Explains why addiction does not require conscious awareness and why addictive drives take precedence over other drives 
• Does not explain why many people do not become addicts despite taking drugs 

Classical Conditioning:

• Initiation: Stimuli that occur at the same time as addictive stimulus become secondary reinforcers by association
• Maintenance and Relapse: Withdrawal symptoms lead to take drugs again

Evaluation:

• Individuals addicted to heroin in Vietnam less likely to relapse when they return back to the USA because CS is absent
• Treatment - cue exposure, based on stimulus discrimination 

Social Learning Theory:

• Initiation: Learning takes place through observation and communication, arousing different outcome expectations and motivations
• Maintenance and Relapse: Individual experiences 'approach avoidance' conflict concerning the drug. Presence of multiple cues associated with drug makes relapse more likely

Evaluation:

• Peer influence is primary reason why adolescents smoke/take drugs
• Low self-efficacy linked to likelihood of relapse

Synoptic Links:

• Evolutionary significance of occasional reinforcement - positive reinforcement likely 'on average'
• Resistance training targeted at beginner adolescents 

Smoking Addiction:

• Smoking driven by psychological motives such as rebelliousness
• Desired image enough to tolerate unpleasantness after which addictive nature of nicotine takes over
• Nicotine activates nicotine receptors in th brain, whcih leads to the release of dopamine
• Leads to temporary feelings of pleasure, which must be repeated for the same effect
• Greater nicotine intake in disadvantaged groups explains why harder to give up

Evaluation:

• Smoking/peer popularity association supportd in study by Mayeux et al (2008)
• Long-term smoking alters brain chemistry and may make depression more likely
• French study supported link between socioeconomic status and smoking (Peretti-Watel et al, 2009) 

Gambling Addiction:

• Shah et al (2005) - evidence of genetic factors in male gambling
• Black et al (2006) - first-degree relatives more likely to gamble 
• High sensation seekers - lower appreciation of risk and arousal evaluated more positively 
• Poor tolerance of boredom linked to gambling

Evaluation:

• Difficult to disentangle genetic and environmental contributions 
• Genetic predisposition for gambling through inherited trait for impulsivity
• Gamblers as high sensation seekers not supported by evidence
• Type of gambling makes a difference concerning sensation seeking 

Synoptic Links:

• Smoking addiction follows different pattern in men and women
• Biased assessment of gambling as 'pathological in twin/family studies in genetic status known  

Film Representations of Addiction:

• Sulkenen (2007) analysed 47 films with scenes of drug competence and enjoyment, contrated with dullness of ordinary life
• Use of drugs presented as a way of solving a problem
• Gunasekera (2005) analysed 87 films - most portraye drug use positively without showing negative consequences 
• Only one if four films was free from portrayal of negative health behaviours

Evaluation:

• Sargent and Hanewinkel (2009) - exposure to movie smoking was significant influence on adolescents taking up smoking
• Boyd (2008) - movies frequently do portray negative consequences of drug and alcohol dependence 
• Films play an important role in generating stereotypes of drug takers

Changing Addictive Behaviour:

• TV support for problem drinking - Bennett et al (1991) found change in alcohol-related knowledge by not in attitudes or behaviour
• TV self-help series (Kramer et al, 2009) - more in intervention group achieved low-risk drinking than in control group
• Anti-drug campaigns - US study included resistance skills and raising self-efficacy (Hornik et al, 2008) 

Evaluation:

• Kramer et al study - intervention group also received regular visits from researchers 
• US stufy didn't work because messages not novel and drugs made commonplace 

Synoptic Links:

• Ethical guidelines for representation of drugs in film developed in US
• Creativemedia led Brian Wilson to use drugs to increase creative output
• Most evidence about media effects on addictive behaviour is correlational, not casual 

Theory of Planned Behaviour:

• Includes perceived behavioural control, - extent to why individual believes they will be able to carry out the behaviour
• Behavioural control acts on intention and behaviour
• Real World application to change unhealthy behaviours 

Evaluation:

• Meta-analysis - TPB better predictor of intention
• Too rational
• Account of intention formation rather than actual behaviour 

Synoptic Links:

• White et al (2008) - TPB predicted intentions to engage in sun protection

Biological:

• Methadone mimics effects of heroin but is less addictive
• Drug treatments for gambling include SSRIs to increase serotonin levels and naltrexone to reduce reinforcing properties of gambling

Evaluation:

• Some addicts become reliant on methadone
• Used in black market
• Support for SSRIs is inconclusive 
• Effectiveness of naltrexone demonstrated by Kim and Grant (2001)

Psychological:

• Addictive behaviour reduced by reinforcment (Sindelar et al, 2007)
• CBT changes the way people think about their addiction

 Evaluation:

• Do not address the problem that led to the addiction in the first place
• CBT support in studies of pathological gamblers (Labouceur et al, 2001)

Public Health and Legislation:

• The NIDA study - combination of individual and group drug counselling works best 
• Quitline services for smoking increased odds of quitting by 50%
• Legislation in 200 led to more supportive enviornment to quit smoking

Evaluation:

• NIDA: reduction in cocaine use led to reduction in HIV risk
• Anti-smoking legislation led to rebound effect (West, 2009)

Synoptic Links:

• Quitline services successful in returning military personnel (Beckham et al, 2008)