What we have to cover:1. Defining Addiction2. Models of addictive behaviour (biological,social learning theory, cognitive)3. Factors affecting addictive behaviour (Individualdifferences, vulnerabilities and social context)4. Reducing addictive behaviour (Prevention andtreatments)
So, we have to start from basics…Define addiction…‘Addiction is a persistent, compulsive dependenceon a behavior or substance’Addictions can be of ANYTHING, be it sex,gambling, drugs, or even your mobile phone!
Gambling addiction:• Estimated that 5% of the adultpopulation have a gambling addiction.• Higher percentages are found in youngadults, mentally ill individuals and theprison population.Shaffer et al (1999)• Pathological gambling recognised bythe DSM as a mental disorder in 1980.
Smoking addiction:• Smoking dependency is themost prevalent. (Anthony etal,1994)• Also recognised as a mentaldisorder in the DSM under‘dependency on a substance’
Components of addiction – Griffiths(2005)1. Salience – The importance of the behaviour toan individual, all they think about.2. Mood modification – The experience reportedby people whilst carrying out their addictivebehaviour i.e. behaviour helps to ‘wake up inmorning’ or ‘calm down at night’3. Tolerance – Increased amount to achieve sameeffect4. Withdrawal Symptoms – Unpleasantfeelings/physical effects experienced whenbehaviour stops5. Relapse – Reverting back to addiction afterstopped (esp. when stressed)
Biological ModelPrinciples: Genetics and biochemistryInitiation, maintenance and relapse –inc. case studies
Genetics – Comings (1996):• 48.9% of smokers compared to25.9% of general populationcarried A1 variant of DRD2 gene.• supported by A1 variant of theDRD2 dopamine receptor linkedto severe alcoholism (Noble etal, 1991)• A1 variant means lessdopamine receptorsI am aNobleman(NOBLE 1991)
Genetics – Lermanet al (1999):• Found that people with SLC6A3-9 gene areless likely to take up an addiction thansomeone without the geneIm a LERRRMAAANN(1999)
Biological – Genetics andbiochemistry:• Family and twin studies• Looking at alcoholdependency• Found heritability at 50-60% (McGue, 1999)• An example of a gene thatis linked to addiction is theA1 variant of the DRD2gene…
Supporting genetics – Kendler et al(2004):• Investigating genetic risk & familyconflict in nicotine addiction• 1676 female twins• No. of cigarettes smoked inlifetime calculated• Self report interviews on fam,twins• Found that increased familyconflict caused increased smokinglevels• Also found high levels ofheriditability
Supporting genetics - Blum et al, 1991:• Blum et al, 1991 found that theA1 variant of the DRD2 gene hadhigher prevalence in families withhistory of alcoholism• Also appeared to show fewerdopamine receptors in their‘pleasure centres’ of their brains.• Therefore they are more likely toseek behaviours that increasetheir dopamine levels
Maintenance smoking – Fowler et al(2007):• 1214 twin pairs• Investigated to seeimportance of genetics withinitiation of alcohol, nicotineand cannabis addiction• Found environmental forceswere more important• However, genetics influencedEXTENT of the addiction
Maintenance – Smoking, Schachter(1977) – Nicotine regulation:• Smokers regulate their nicotine intake• 11 34-52 year olds smoked high or lownicotine content in alternating weeks• Heavy smokers smoked more low-nicotine cigarettes• Light smokers did not appear toregulate consistently• Has implications to real life e.g. taxingcigarettes depending on nicotinecontent
Maintenance Gambling – Meyer et al(2004):• During casino blackjack gambling,heart rate andnoradrenaline/norepinephrinemeasured• (which cause inc. heartrate/bp/pupil dilation – fight orflight response)• …become elevated to a greaterdegree in men with gamblingproblems as compared to thosewithout (Meyer et al. 2004).
Tolerance – As tolerance builds, you needmore of behaviour to get same buzzLow dopamine – People with addictions may have eitherlow levels of dopamine, or fewer receptors than most,causing them to need more of a substance to get thesame feelingMaintenance:
Relapse:Withdrawal Symptoms – Unpleasant symptomsIn gamblers – Withdrawal symptoms can be physical (Rosenthal and Lesieur, 1992found that extent of symptoms positively correlated with no. of hours spent gambling)In smokers – Those with a sensitive mesolimbic pathway are more susceptible torelapsingAlso, Lerman 2007 found that smokers had increased CBF (cerebral blood flow) whichcould lead to relapse
Biological model AO2:• Objective – empiricalevidence, such as Lerman(2007) using brain scans tomeasure CBF, reliable• Application to everyday life –Can affect anybody, looks attreatment of symptoms, quicktreatments. Doesn’t combatthe cause of the addiction.Often treated with drugs.• Reductionist – Simplified intogenetics &biochem, notpsychological or social• Deterministic – Born withGenes &biochem, could causepassive patients, unwilling tochange, ‘no blame’• Individual differences –SLC6A3-9 gene, A1 of DRD2,doesn’t include gender,personality. Shows that genesdo influence
Initiation of smoking and gambling –Gelkopfet al, 2002:• Individuals intentionally usedrugs to treat psychologicalsymptoms from which theysuffer• One that’s perceived asbeing helpful to theindividual• Could smoke to relievestress/anxiety, and gambleto relieve depression
Maintenance of Gambling - Griffiths(1994):• 30 gamblers & 30 non-gamblers• Got them to verbalise theirthoughts as they played• Found that gamblers personifiedfruit machines, saying whetherthey were in a ‘good mood’ or a‘bad mood’• Regular gamblers also treatedlosses as ‘near wins’• Cognitive bias of ‘skill level’• Gambling is a rational choice
Maintenance of smoking – Tate et al,(1994):• Showed withdrawal symptomswere based on expectancy i.e.they were mainly psychological• as by telling a group of smokersthey would expect no negativeexperiences during a period ofabstinence• It led to fewer somatic andpsychological effects than acontrol group.
Maintenance - Cohen and Lichtenstein(1990):• Vicious circle – Smoking alleviated stress,causes illness, creates stress
Relapse – Self efficacy, Bandura (1994):• Self-efficacy is a person’s belief in his or herability to succeed in a particular situation.• Bandura described these beliefs asdeterminants of how people think, behave,and feel• If people have a weaker self-efficacy, they’remore likely to engage in addictive behaviours,or take up previous ones.
Relapse – Self medication in smokingand gambling:• Self medicate in times of…• Stress (smoking)• Crisis (gambling)
Relapse:Coping – Withdrawal symptoms may make it difficult tocope without the substance.Expectancy – especially with smoking, it may seemeasier to quit 2nd time roundExcitement – life without gambling may seem dull
Cognitive model AO2:• Free Will – Individuals mayfeel they can change butmay feel they’re to blame• Ecologicalvalidity/Application to reallife – Addictions affect lotsof people• Treatments – If it’s based onfaulty thinking, it should beable to be cured• Social desirability bias –people may lie about howoften they smoke/gamble,could affect reliability• Subjectivity – Methods ofdiagnoses are not scientific• Self-report methods used togather data, loweredreliability, highersubjectivity
Initiation (smoking) – Vicariousreinforcement:• Bandura said we learn through vicariousreinforcement, which is the observation ofothers• We learn from our peers and parents etc
Initiation (gambling) – Glautieret al(1991):• Classical conditioning – Good feeling fromaddictive behaviour, associate the two
Initiation (smoking/gambling) – White(1996):• Positive feelings – actas positivereinforcement for thebehaviour (operantconditioning) – due todopamine in themesolimbic system• Takes a biologicalapproach too! OOHHSYNOPTICITY?
Maintenance (smoking) – ClassicalConditioning of a daily ritual:• When you do certainthings at the same timeof day, such as smoking inthe mornings,• You become classicallyconditioned to do it• Association is hard tobreak• Like cue reactivity!Where you seesomething associatedwith behaviour e.g. pubfor alcoholics
Maintenance gambling – Cuereactivity:• Seeing somethingassociated withbehaviour e.g. Scratchcard or bookies forgamblers• Brings back the initial‘buzz’ making it hard toresist
Maintenance (smoking/gambling) –West, 2006:• Approach-avoidanceconflict where the addictwants to both use thedrug/carry out addictionbut also to avoid it becausethey know it is wrong• And there may also benegative side effects• Both positive and negativereinforcers for operantconditioning
Relapse (smoking) – Cue reactivity,Glautieret al (1991):• Note: In the book, this is under ‘initiation’ but itfeels like it could easily link to relapse also!• Alcohol-related stimuli (sight orsound of a pub) were shown tocause the same physiologicalresponses as alcohol itself• E.g. Increased heart rate andarousal• Could be generalisable to otheraddictions• Can also be maintenance
Relapse (smoking/gambling) Marlattand George (1984):• Marlatt and George found thatmultiple trigger cues increasethe chance of relapse• As if an addict comes intocontact with a trigger cue ofsubstance after a period ofabstinence…• They have that classicalconditioning of associationwith that trigger, making themmore likely to relapse
Relapse – Negative reinforcement(operant?):• To avoid the negative reinforcement ofwithdrawal symptoms• Could link to the fact that Rosenthal andLesieur (1992) found the positive correlationbetween number of hours spent gambling andthe extent of their withdrawal symptoms
Social learning theory AO2:• Nature/nurture? Basedon nurture, as it’s theidea that behaviour islearned from the env.Born as a TABLEAURAZA (blank slate)• Subjective – based onobservational methods• Reductionist – Doesn’tconsider individualdifferences, orextraneous variables.
Individual differences, vulnerabilitiesand social contexts of addiction:-Personality- Stress- Peers- Age- Media
Personality factors – Self esteem:Refers to what an individual feels aboutthemselves, for example theirconfidence, and feelings of self-worth.Research suggests individuals with lowself-esteem are more prone toaddiction.Found a negative correlation betweenself-esteem in boys and frequency ofcannabis use – Valeskaet al (2009)I hate myself
Self esteem – Kaufman and Augustson(2008):• To investigate factors influencingsmoking behaviour• 7000 girls aged 13-18• Assessed on perceived weight, andwhether they were trying to loseweight or not• Questionnaires were used• After ONE YEAR, those with lowself-esteem were more likely tosmoke
Kaufman and Augustson (2008) AO2:• Large sample size • All girls• Longitudinal study• No cause/effect can beestablished• Questionnaires wereused, which aresubjective• May also be influencedby social desirabilitybias
Personality factors – Attributiontheory:Proposed that behaviour is down to:1. Situational attributes (external factors whichcannot be controlled, such as peers/work)2. Dispositional attributions (internal factors theindividual can control, such as self-esteem)However, we are more likely to use dispositionalattributes to blame others for their addictions,and use situational attributes on ourselves =ACTOR-OBSERVER EFFECT
Attribution theory – Hatgiset al (2008):• Internal attributes (dispositional)about drug taking varied between- those who had never taken drugsbefore and- those who had experienced or hadfriends that experienced drugs before• Internal attributes more common oncannabis use than alcohol or heroin
Attribution bias – Seneviratne andSaunders (2000):• Investigate attributions by alcoholics• 70 alcoholics, interviewed to find outreasons why they relapsed afterabstinence, which were compared to 4relapse scenarios of others• Situational attributions used foralcoholic’s own relapse, such as party:everyone was drinking• Dispositional factors for the otherscenarios, such as lack of will power• = Shows actor-observer bias
Vulnerabilities – Stress:Everyday stress:• People smoke, gamble, anddrink to deal withstress/daily-hassles• Stresses could lead toaddiction, and add to bothmaintenance and relapseTraumatic stress:• PTSD (post-traumatic-stress-disorder) linked to addiction• Driessenet al (2008), foundthat 30% of drug addictsand 15% of alcoholics sufferfrom PTSD
Vulnerabilities - Stress AO2:• Relates to real life asmany people haveaddictions, thereforehas ecological validity• Arguably, mundanerealism• Quantitative datacollected on those withPTSD, increasesreliability etc• Individual differences(hardiness etc)• Extraneous variables• Simplistic? Only looks atstressors, not biology?
Vulnerabilities – Peers:Social Identity Theory:• States that the in-group willdiscriminate against theout-group to enhance theirself-image.- Normative behaviourSocial Learning Theory:• States that social behavior(any type of behavior thatwe display socially) islearned primarily byobserving and imitating theactions of others- Vicarious reinforcementSplits into SIT and SLT (Social Identity Theory) and (Social Learning Theory)
Vulnerabilities – Peers:• Eiseret al (1989) – Positive rewardssuch as popularity and social status(smoking), smokers befriend othersmokers (Eiseret al, 1995) – SIT• Duncan et al (1995) – Exposure topeers that carry out behaviour increaselikelihood of smoking - SLT• McAlister et al (1984) – Smoke due toincreased popularity and peer approval- SLT
Vulnerabilities – Age:• Brown et al (1997) – Close friendsand romantic partners are influentialon attitudes and behaviours. Peersmore likely to influence you inadolescence.Botvin (2000) – More prone duringadolescenceIndividual differences
Role of the media inpromotion/prevention ofaddiction:Promotion/prevention
Promoting addictions – Sulkunen(2007):• 140 scenes from 47 films• All included scenes of either alcohol, drug,sex, gambling or tobacco use• Films such as American Beauty, andTrainspotting depicted drug use in a positivelight, compared to the ‘dullness’ of real life• Historical validity? Smoking rules are harsher• Individual differences at how they wouldaffect• Lots of different films used
Prevention - In film - Boyd (2008):• Contrary to Sulkunen (2007) who saidaddictions were shown positively• Boyd found ‘films do represent the negativeconsequences of addiction’ shown through…- Physical deterioration- Sexual degradation- Moral decline
Attempted prevention - Anti DrugsCampaign – (1998-2004):• Aimed to educate US youths toreject illegal drugs, to preventinitiation of drug use, and tostop those already using• Raised self-efficacy (selfbeliefs?) & showed negativeconsequences of drug use• Horniket al (2008) examinedresults, and lead to an increasein marijuana use… (awkward!)
Promotion - Boyd contrasted by –Sargent and Hanewinkle (2009):• 4384 adolescents, (11-15)• All were surveyed to see whether or not theysmoked• Exposed to smoking in movies over a year• Whether or not they had smoked at the start wasa strong predictor that they would be smoking inthe year laterEthical issues (could cause smoking = harmful)Social factors not considered (reductionist)Longitudinal
Theory of planned behaviour (cog) –prevention:Attitude:Assessment and evaluationof outcome of behaviorSubjective norm:Motivation to meetperceived expectations ofimportant othersPerceived behaviouralcontrol:Perception of howeasy/hard it would be tocarry out behaviourBehaviourintentionBehaviourActual behaviouralcontrol
Theory of planned behaviour:Term DefinitionAttitude What the person believes the outcome ofthe behaviour will be – i.e. whether it’sgoing to give them a positive, or negativeoutcome.A smoker may think that they’ll getpopularity, or seem ‘cool’.Subjective norm What significant others (friends/peers)think of the behaviour. This affects youbecause you want to comply with socialexpectations.If your friends smoke, you may also.Perceived behavioural control Whether behaviour is easy or hard tocarry out.If you’re 18+, going and buying cigarettesis pretty easy.
• If you have a positive outlook for theattitudes, perceived behavioural control, andalso want others to be happy with you, youare likely to carry out the behaviour.
Supporting TPB – Marcoux and Shope(1997):• Large sample of 14 yr olds• Using TPB to predict alcoholuse• Peer pressure/peers wereimportant variables• Model led torecommendations forprevention of alcohol abuse• Reducing how readilyavailable alcohol was (takingcontrol away from individual)
Supporting TPB – Wall et al (1998):• Used TPB for undergrad.students• Useful in predictingexcessive drinking• Researchers believed itcould be improved if itincluded gender-specificalcohol outcomeexpectancies.
Refuting TPB – Ogden (2003):• Major fault of TPB is that it usesself-report methods• Could be affected by socialdesirability, and make thereliability questionable• However, there isn’t really anotherway to test opinions/beliefs.• Subjectivity may therefore be OK?
Biological treatments - Agonist:Agonist – maintenance/substitution treatment:- Maintain effects of substance using a safer drug- Manages withdrawal symptomse.g. Smoking – NRT (Nicotine replacement theory…Patches/gum, maintains nicotine in prefrontalcortex of mesolimbic systemDrugs – Methadone (can be used alongsidecounselling too!
Biological – Antagonist:Antagonist – blocks the effects of substanceson the brain, so no longer get the ‘buzz’e.g. Smoking – Buproprion(SSRI – selectiveserotonin reuptake inhibitor)Heroin (opiates) – NaltrexoneAntagonistic treatments are usually used asmore of a last resort.
Biological treatments – AO2:• Biological• Safer than the opiates ortobacco• Cheap• Quick/fast• Deterministic – removesblame from the patients• Still reliant on a drug (agonist)• Drug can become addictivealso• Side effects• Black market for methadone• Methadone can kill you• Reductionist, should becatered to an individual’sneeds• Individual differences doesn’tlook at social/psychological,treatments may not beappropriate• Deterministic – patients mayfeel they can’t be cured
ClassicalConditioning:Aversion therapy• Owen (2001) – Assessedaversion therapy in alcoholics• 82 hospitalised alcoholics• 5 treatments over 10 days• Given emetic (makes yousick) after alcohol (of theirchoice)• Followed by behavioural &cognitive questionnaire• Positive alcohol-relatedbehaviours were reduced• Found to be effective‘Associating anaddictive behaviourwith somethingnegative’
ClassicalConditioning:Aversion therapy• Kraft & Kraft (2005) – Usedhypnosis to pair addictivebehaviour with nausea• Only 4 sessions (Costeffective)• Long term success =questionable‘Associating anaddictive behaviourwith somethingnegative’
• Siegel et al (1987) saidonce put back into a realenvironment, physical &mental changes led torelapse
Aversion therapy AO2:• Fast, cheap treatment• Shown to work withalcoholics (Owen 2001)- wasn’t so reductionistdue to both treatment &questionnaires- However, was subjective• Individual differences• Reductionist• May not be long-term• Siegel et al (1987) saidonce put back into a realenvironment, physical &mental changes led torelapse• Ethical – protection fromharm• Consent?
CognitiveApproach:Cognitivebehaviouraltherapy (CBT)• Killen et al (2008) - foundCBT + telephonecounselling was moreeffective than phonecounselling alone.(who becomes a psychiatrist with the surname ‘killen’ ?I mean seriously)Talking about yourproblems. Accordingto Curran andDrummond (2005),CBT is maintreatment foralcohol and cannabisdependency
CognitiveApproach:Cognitivebehaviouraltherapy (CBT)• Cavalloet al (2007)compared- weekly CBT @ 45mins- to behavioural counsellingfor 10-15mins 3x a week• CBT was more effective foradolescents who wanted tostop smokingTalking about yourproblems. Accordingto Curran andDrummond (2005),CBT is maintreatment foralcohol and cannabisdependancy
CognitiveApproach:Cognitivebehaviouraltherapy (CBT)• Jiminez-Murcia et al (2007)• Treated 290 pathologicalgamblers with CBT over 16weeks• After 6 months, success ratewas at 80%, but noticeddrop-outs & relapse towardsthe end• (More so with obsessivecompulsives)Talking about yourproblems. Accordingto Curran andDrummond (2005),CBT is maintreatment foralcohol and cannabisdependancy
Cognitive approach AO2:• No ethical issues• Uninvasive• No side effects• Relapse & attrition &individual differences –Jiminez-Murcia et al(2007)• Time consuming• Gotta train to do CBT• Individual differences
Operantconditioning:Contingencymanagement(CM)• Krishnan-Sarinet al (2006)• Looked at CBT and CM• 28 adolescent smokers who wanted toquit, randomly allocated into:1. CBT group2. CBT + CM group• Programme lasted 1 month• Urine samples tested• CBT + CM group given money twice aday for first 2 weeks. Frequencydecreased for next 2 wks• After 1 week, abstinence:CBT + CM = 77%CBT = 7%• After the month, abstinence:CBT + CM = 53%CBT = 0%Rewarded forsticking atsomething e.g.Getting moneyfor not takingheroin
Operantconditioning:Contingencymanagement(CM)• Higgins et al (1994)• USA• 28 cocaine addicts (all whitemales from Vermont)• Urine tested• Clear urine = money reward• Money increased the more cleansamples in a row• Given advice on best ways tospend their vouchers• Norm drug programme drop-outrates = 70% within 6 weeks• This programme: 85% stayed 12weeks2/3 stayed 6 months!Rewarded forsticking atsomething e.g.Getting moneyfor not takingheroin
Contingency management AO2:• Shown to work• Objective – Urine samplesin Krishnan-Sarin et al(2006)• Small sample size• Reductionist• Ecological validity? Woulda voucher scheme workwidespread? – politicalpalatability• Higgins (1994) – all whitemales, from Vermont =cultural bias +androcentric
Group counselling – Crits-Christophet al (2003):• National Institute of Drug Abuse (NIDA) study• Trying to intervene with social and personalproblems associated with drug abuse• 487 American patients randomly assigned to oneof four groups of various sorts of counselling• They found:- All treatments led to decrease in drug abuse- Combination therapies were most successful- Worked best if they were told how to adopt morepositive behaviours, and healthy relationships
Doctors advice – Russell et al (1979):• Looking at dr’s advise to help smokers quit• Carried out a study in five doctors’ surgeriesover 4 weeksTreatment offered:1. Follow up session – 0.3%2. Questionnaire about smoking habit + follow up – 1.6%3. Dr’s said to stop, questionnaire + follow up – 3.3%4. Leaflet, Dr said, questionnaire + follow up– 5.1%• More help they get, better treatment
Helplines – Platt et al (1997):• Assessing effectiveness of smokinghelpline (Smokeline) in Scotland• 848 of adult smokers, followed up 1year after their initial call• 143 of the 848 sample (nearly 24%)reported they’d stopped smoking• 88% said they’d ‘made changes’• During the 2nd year, smoking prevalencewas 6% lower than it was before thecampaign• It reached a lot of people, and helpedthem. Yay.
Public Health AO2:• Shown to work,especially Platt. Yay.• Some addicts may notfeel they can reach thesupport they need• Individual differences• Issues in assessing theimpact• Reductionist – notincluding biological