Psychology of addiction

Addiction before:

Addiction is a state of periodic (intermittent) or chronic (constant) intoxication produced by repeated consumption of a drug.

Addiction now:

Addiction is a compulsive physiological and psychological need to be occupied with or involved in something

Initiation:

Process where individual starts to become addicted

Maintenance:

Process where individual continues to behave in an addictive way, even in presence of negative consequences

Relapse:

An individual has managed to abstain form their addictive behaviour, but it has started to show signs and symptoms of the behaviour again

Genetics:

Genetic predisposition: Not certain if having a genetic predisposition will cause addiction, must be exposed to behaviour in order to trigger gene, at a higher risk.

Merikanagas et al (1998): 36% cases where individual had been diagnosed with an alcohol use disorder, also had genetic relatives diagnosed with alcohol use disorder.

Twins: Twin studies and adoption studies provided strong evidence to suggest that genetics do play a vital role in developement of addictive behaviours

Heath and Martin (1993): 39-60% heritability for alcohol dependence

Biochemical factors:

Dopamine reward system: Mesolimbic-dopamine system releases small amounts of dopamine, explains why most of us maintain a relatively stable mood. Alcohol and nicotine increase amount of dopamine released. Addicted person has fewer dopamine receptors so they smoke more to increase dopamine.

Altman et al (1996): Increased level of dopamine motivates individual to want more nicotine resulting in addictive behaviour

Opioid system: Opioid neurotransmitters include; enkephalin (associated with feelings of pleasure and euphoria) and endorphins (associated with pleasure and pain relief). System is directly activated by drugs and alcohol.

Neuroadaptation:

When individuals take psychoactive drugs it can result in changes in brain chemistry. When an individual stops taking the drugs, biochemical changes no longer occur. This explains withdrawal symptoms and wh some people develop a drug tolerance where they need to take more drugs in order to gain the same effects.

1. Brain becomes used to the drug

2. Taking drug no longer has same effect

3. Need a greater quantity to get 'rush' or 'high'

4. When stop taking the drug, body is not used to reduced levels of dopamine

5. Experience withdrawal symptoms

Initiation:

Biochemical: Start smoking to increase levels of dopamine

Genetics: Will begin smoking if they have a predisposition

Maintenance:

Biochemical: Maintain levels of dopamine and feelings of euphoria

Relapse:

Neuroadaptation: When they stop smoking, body not used to low levels of dopamine, withdrawal symptoms begin

Initiation:

Biochemical: Start gambling to heighten levels of serotonin

Genetics: Wills tart if have a genetic predisposition

Maintenance:

Biochemical: Maintain levels of serotonin

Relapse:

Neuroadaptation: When they stop gambling, body is not used to low levels of serotonin, withdrawal symptoms begin

Evaluation:

Shields (1962): 42 twin pairs who lived  apart, all but 9 cases were concordant

Lie et al (2003): Heritability for nicotine addiction is high 39-80%

Kendler et al (1999): Nicotine dependnece shows 60-70% heritability

Pergadia et al (2006): Genetic link to experience of withdrawal from nicotine

Volkow et al (2001): Ritalin administered to adult volunteers, those with fewer dopamine receptors loved it

Not 100% environmental factors must play part, lived apart so reduces enviornmental factors, 9 cases may have gene but not triggered, all suggest some kind of genetic link

Evaluation:

Eisen, Lin and Lyons (1999): evidence for genetic vulnerability to gambling

Eisen et al (2001): Twins have a similar incidence and severity of gmabling problems

Black et al (2006): Gambling more prevalent in close relatives

Comings et al (2001): Some genes control activity of neurotransmitters, dopamine and serotonin

Shinohara, Yanagisawa and Kagota (1999): Certain neurotransmitters rise in gamblers after winning streak

Dysfunctional Beliefs:

Beck et al (1993):

• Negative beliefs can lead to addictive behaviours
• May be fun/daring to drink/take drugs, gradually individual grows more reliant on behaviour, thought processes turn more negative
• Negative thought/try smoking/more negative thoughts/addicted

Cognitive Processing Model:

Behaviours often become automatic over a period of time.

E.g. Have a cup of tea and a cigarette

When behaviours become automatic, difficult to stop doing them when  everyday situations present us with cues that trigger the automatic behaviour.

Cognitive Myopia:

Hernstein and prelec (1992):

The individual has an impaired ability to control their actions, they have faulty processes when weighing up the consequences of their behaviour.

Ainslie (1992):

People with an addictive behaviour attach too much weight to immediate gratification for engaging in the behaviour and far too little weight to the long term benefits of avoiding partaking.

Don't think about the consequences, only the rewards

Initiation:

Dysfunctional Beliefs: Negative thought 'No one will like me if I don't smoke'

Maintenance:

Dysfunctional Beliefs: Carry on smoking as they believe they need it to get throught the day

Cogntive Processing Model: Smoking is an automatic response

Relapse:

Dysfunctional Beliefs: Cues make it hard to stop due to external stressors

Cognitive Myopia: Smoke as they only want the gratification

Initiation:

Dysfunctional Beliefs: Dysfunctional thought 'I have no money'

Maintenance:

Dysfunctional Beliefs: Carry on gambling as they believe they need to

Cognitive Processing Model: Automatic response to gamble when they are triggered by cues

Relapse:

Dysfunctional Beliefs: Cues and external stressors make it hard to stop gambling

Cognitive Myopia: Gamble as they only want to feel the gratification of winning

Evaluation:

Beck: Dysfunctional thinking can explain addiction, logical and makes sense

Tiffany (1990): Believes smoking behaviour can be automatic

:( Cause and effect with dysfunctional beliefs, beliefs initiate addiction or are they a consequence?

Giarelli et al (2004): Smokers have dysfunctional beliefs about the benefits of smoking

Evaluation:

Toneatto (1999): Typical cognitive distortions of problem gamblers; magnify gambling skills, minimise others gambling skills, superstitious beliefs, selective memory, illusion of control over luck

:) Strongly supports the assumption that dysfunctional beliefs are linked with problem gambling

:( Do these cognitive distortions contribute to maintenance of the addiction or are they a consequence?

Oei and Raylu (2004): Children's attitudes to gambling are influenced by attitudes of their parents, expecially their fathers

Delfabbro and Winefield (1999): 75% of game-related thoughts during gambling were irrational and encouraged further risk taking

Operant Conditioning:

Behaviour is repeated as it has been rewarded in some way

• Positive Reinforcement: Recieve reward
• Negative Reinforcement: Remove something unpleasant

E.g. Some may find it rewarding to take drugs whilst others may take it when they feel unhappy

Social Learning Theory:

Learn a behaviour through observing others, our role models such as parents, siblings, celebrities

We learn that these are all acceptable, attractive and rewarding behaviours

Initiation:

Social Learning Theory: Imitate when our parents or friends smoke and get a reward

Positive Reinforcement: Social

Maintenance:

Positive Reinforcement: More likely to repeat smoking because of reward e.g. smoke and pass test

Relapse:

Negative Reinforcement: Remove feeling of stress when doing an exam and removal of withdrawal symptoms

Initiation:

Social Leanring Theory: Observe people close to us gambling and want to try it for the reward

Maintenance:

Positive Reinforcement: May bring in more money

Relapse:

Negative Reinforcement: Relieves person of debts

Evaluation:

Winett et al (1989): People with higher status, exert stronger influence than low-status individuals :)

Lader and Matheson (1991): Children twice as likely to smoke if parents do :)

Murray et al (1984): If parental attitudes agaisnt smoking, child 7x less likely :)

Akers and Lee (1996): Five year study of secondary school students, found a significant positive correlation between smoking and 'social learning variables' :)

:( Self report technique, social desirability bias and correlational

:) Longitudinal, fewer participant variables

Evaluation:

Parke and Griffiths (2004) Individuals may find 'buzz' of gambling reinforcing and being in the company of like-minded people :)

Grant et al (2004): 40% cases where individuals relapsed, missed thrill of gambling :)

Adams et al (2004): Students with strict parents more likely to become problem gamblers :(

Learning Model - Assumes by losing, gambling would be discouraged :(

Self Esteem:

Based on how we see ourselves (self image) and how we would like to be (ideal self), if our self image and ideal self match then likely to have high self esteem, if they do not match, likely to have low self esteem and more likely to be more susceptible to addictive behaviours

Taylor et al (2006): Found those with a low self esteem in childhood were 1.6x more likely to be drug dependent in adulthood :)

Greenberg et al (1999): Looked at multiple addictions but only found a link to self-esteem for exercise 

Attributions:

Judgements individuals make to explain their own or others behaviour

• Situational (external) - Our own behaviour - 'Alcoholic because I grew up in a rough area' - more likely to become addicted
• Dispositional (internal) - Others behaviour - 'Alcoholic because he is weak' - Less likely to become addicted

Senevirante ans Saunders (2000): found that alcoholics who had a relapseexplained their own behaviour in terms of external attributions so are more likely to succumb to addiciton as they feel less personally responsible for their behaviour

Addictive Personality:

Eysenck: Proposed individual will develop addiction because it fulfills certain purpose related to personality type

P (Psychoticism): Angry, mood swings - Act on impulse and don't think about consequences

N (Neuroticism): Anxious, worrying, nervous, irritable and more easily stressed

E (Extraversion): Outgoing, sociable, don't like to be alone. attention seeking

People with high traits of N and P more likely to become addicted

Francis (1996): Found people with personality types high in P and N more likely to have problems with substance abuse

Stress:

Claridge and Davis (2003): Well established link between anxiety disorders and substance abuse. Individuals high on traits such as anxiety and more reactive to stressful life events motivates individual to seek quick and psychological relief from distress - form of drugs

Claridge and Davis: Addicts don't select drugs randomly but as a result of pharmacological action of drug. E.g. Person with high anxiety and aggression more likely to take heroin as opiates have a muting action that subdues rage

Peer Influences:

Simons-Morton et al (2001): Found when parents more involved and had high expectations, children at far lower risk of using drugs

Simons-Morton et al (2005): Found when peers spent more time with deviant peers more likely to dink alcohol

Wagner and Anthony (2002): Smoking tobacco and drinking alcohol increases possiblity of taking cannabis due to the availability

Age:

Dickson et al (2004): Problem gambling amongst adolescents shown to be 2 to 4x thatof adults. 10 to 15% of adolescents gamble excessively and makes them more vulnerable to developing a severe gambling problem

Messerlian: Ample evidence to show gambling amongst adolescents has increased over last two decades

Role of the Media:

Research suggests that media can influence addictive behaviours

Dalton et al (2003): Found that more adolescents exposed to smoking in films, more likely to start

Distefan et al (1999): Likeability of actors relates to adolescents fans' decision to start smoking

Boon and Lomore (2001): Found 75% of young adults admitted they had a strong attachement to celebrity, 59% stated they had a strong influence on beliefs

Gunsekera et al (2005): Study looking at 200 films showing drug use in a positve light without any negative consequences

Role of Media on Smoking:

:( Strasburger (1995): Despite advertising ban, tobacco still heavily advertised using passive inadvertent advertising - Sponsers and product placements

:( Sargent et al (2007): Demonstrated that exposure to smoking in movies predicted risk of becoming a smoker themselves, suggesting we need to be careful with material shown in films

:) Signorelli (1990): US TV characgters were 9x more likely to smoke than 1982, followed pattern of smoking in society

:) Klein (2005): For adolsecents, anti-smoking campaign and telephone help services can inform people so the media can have a positive influence

Role of Media on Gambling:

:( Korn and Reynolds (2008): Been an increase in advertising 'normalised' gambling. 'At risk' gamblers extremely sensitive to advertising

:( Hyung-Soek et al (2007): Nature of advertising encourages gambling, if an advertising campaign simply says 'Don't gamble' will have little impact

:) Meserlian and Derevensky (2007): Emotional real life stories suggested by participants to show the dangers can provide effective advertising campaigns to reduce addiction

:) Hyung-Soek (2007): If media representations are negative then people will view it negatively, so we should see a reduction in addictive behaviour

Role of the Media Evaluation:

:) Banning of cigarette advertising and smoking in public places have been successful

:( The 2005 Gambling Act allows all forms of gambling to be advertised in the mass media

:) Glamorization versus reality is complicated

:( Research on role of media effects is inconclusive, more research needed

:( Relationships between advertising and addictive behaviour is correlational

:) There could be different media effects for different addictions

:( Research conducted may not be suitable for policy decisions

Theory of Planned Behaviour:

Explains the relationship between attitudes and behaviours towards particular behaviours, explained in five steps. The amount of control they have determines whether or not they choose to carry out behaviours

Attitude: Develop beliefs that can influence our attitudes about behaviours

Subjective Norms: What owe think others attitudes are about the behaviour

Intention: How likely the individual will carry out behaviour, high intention = will carry out

Control: Whether the person feels they have control over themselves

Behaviour: Intention becomes an action

Evaluation of Theory of Planned Behaviour:

Armitage and Connor (2001): Found the extra 'preceived behavioural control' was important factor in determining intention compared to 'attitude' and 'subjective norm' alone :)

Armitage and Connor (2001): Predicts intention rather than behaviour change :(

Abraham et al (1998): Distinction between motivational stage (form of intention) and post intentional stage, diagram may need more input following intention :(

TPB too rational: Fails to take into account emotions that also influence human behaviour therefore it is reductionist as simplifying complex behaviour to three factors :(

Biological Interventions:

Nicotine Replacement Therapy:Include nicotine gums, patches, inhalers, lozenges and nasal sprays. Work by blocking nicotine recptors in brain so individual relapse, finds it less rewarding. Help to relieve withdrawal symptoms

Bupropion: Anti depressent acts by increasing dopamine and norepinephrine levels in brain. Has the same effect as smoking, also works by blocking nicotine receptors so could also reduce satisfying effects of smoking if individual relapses

Varenicline: Increases levels of dopamine in brain and blocks effects nicotine has on brain. Varenicline shown to be more effective in reducing relapse than bupropion

Evaluation of Biological Interventions:

:) These therapies help people avoid smoking as it suggests that biological interventions do work and are useful

:( Individual is still subject to harmful effects of nicotine as intervention isn't solving the problem, one drug replaced by another

:( Determinist - Takes responsibility of individual away, don't know how to cope without drugs

:( NRT isn't as satisfying as smoking, releases nicotine much slower into bloodstream so individual may smoke to get nicotine faster

Cognitive Interventions:

Cognitive Behavioural Therapy: Aim is to change way in which individuals think about their addictive behaviours and enable them to develop self control so more able to deal more effectively with urges. Therapist works to identify dysfunctional beliefs; discuss ways to challenge dysfunctional beliefs, sets homework tasks; individual feeds back any slip ups and discuss thought processes

Evaluation: Ladouceur et al (2001): After CBT no longer fulfilled DSM criteria and better perception of control - supports that cognitive interventions are helpful :)

Motivational Interviewing: Encourages individuals to be motivated to change their behaviours, weighs up positive and negativesof behaviour from individual

Evaluation: Dunn, Deroo and Rivara (2001): Found motivational interviewing effective in treating substance addictions - congitive interventions successful :)

Burke et al (2003): Found 56% reduction in alcohol consumption after MI :)

Behavioural Interventions:

Aversion Therapy: Drug called 'Antabuse' taken by alcoholics, when they drink alcohol it makes them vomit, then make a link between alcohol and vomiting preventing them from drinking alcohol. Rapid smoking used to treat smoking addictions, individual required to puff every six seconds causing feelings of nausea

Evaluation: Some studies shown that this is successful for smoking :) Aversion therapy not as successful for alcohol as individual may stop taking drug :( Does not focus on reasons for developing addiction :(

The Voucher Therapy - Individuals recieved a voucher that went up by $1.50 every time an individual gave a urine test that was clear of any trace of cocaine and counselling

Evaluation: Does seem to be effective :) Not sure % that relapsed after :( not applicable to real life :( drug users rewarded with money not well with tax payers :( Involves counselling, not sure what success is based on :( Gender/culture bias :(

Public Health Interventions:

Reducing Harmful Components: Reduce amount of nicotine in cigarettes, less nicotine = less satisfaction, may decide to smoke more

The Smoking Ban: Banning of smoking public places, however worried this will only encourage individuals to smoke in their own home and could also lead to a sense of solidarity between smokers

Restricting/Banning Advertising: In 2003, cigarrette advertising was banned in the UK. Gambling adverts in the UK must follow a set of guidelines e.g. must not appeal to under 18s or suggest that gambling can be a solution to financial concerns

Evaluation of Public Health Interventions 

Reducing Harmful Components: Benowitz et al (2007): After a gradual reduction in nicotine, 25% of p's in trial immediately stopped smoking :)
Tengs et al (2005): 18% decline in smoking in US over six year period

The Smoking Ban: Elton and Campbell (2008): Questionnaire showed that smoking band did not reduce people smoking :( did reduce number of heavy smokers :)
West (2009): Stop smoking attempts greater 9 months leading up to smoking ban :) than in 17 months after introduced :(
Mezies et al (2006) Found improvements in bar staff health after ban :)
Pell et al (2008): 17% year on year drop in hospital admissions of heart attack after ban :)

Banning Advertising: Pekurinen (1989): Research in Finland found significant reduction in cigarette consumption after total ban on cigarette advertising