In this 1 hour introductory lecture you will learn about psychological theories of addiction At the end of this session you should: Understand the relationship between self control and behavior Be familiar with psychological theories of addiction Be able to distinguish between rational and irrational models of behavior

2. Choice and Self Control
Theories of Addiction
Dr Bob Patton
Addictions Department

3. In this 1 hour introductory
lecture you will learn about
psychological theories of
addiction
At the end of this session you should:
Understand the relationship between self
control and behavior
Be familiar with psychological theories of
addiction
Be able to distinguish between rational
and irrational models of behavior

4. All theories of addiction attempt to explain the processes that
underpin the onset and maintenance of drug taking
behaviors.
When considering the various theories remember that each
should be able to:
• Explain the onset of addiction
• Account for the maintenance of addictive behaviors
• Suggest mechanisms for treatment
There is NO single unified theory of addiction (although
attempts are being made to integrate existing ones – refer to
ALICE-RAP, 2011 for more details)
Theories of Addiction

5. Our lives are characterized by the regulation of behaviors by
rules and by situation.
We all know how to limit or indeed inhibit our behavior
according to circumstances.
We are able to engage in activities that might not have
immediate rewards.
Self Control and Behaviour

6. Behavior is mediated by control process
• Automatic / Regulatory
• Conscious / Reflective
These processes are in turn mediated by other factors:
• Psychological
• Social
• Economic
• Biological
The focus of todays lecture is upon psychological
components.
Self Control and Behaviour

7. Baumeister, 2003
Proposes three models of self regulation:
Energy model – control is a mental resource (limited)
Cognitive model – control results from thought processes
Skills model – control is learnt
The energy model offers the most plausible explanation as
self regulation is a limited resource – once expended the
individual is open to impulsive and appetitive behaviors.
Addiction is seen as a failure of self-control
Psychological mechanisms and addiction

8. Addiction is a choice – a decision process (based upon
reason) is undertaken and acted upon. For the addict, the
benefits of addiction seem to outweigh the costs.
Choice is important otherwise addicts could be viewed as
little more than “consumption robots” (Skog, 2000)
Is addiction a rational decision?
Are we rational people…?
Addiction as a choice

9. Frankfurt (1971) proposes three ‘types’ of addict:
Wanton Addicts simply engage in the addictive behaviour
without questioning their actions
Unwilling Addicts have thought about their addictive
behaviour, would rather not be engaging in it, but find
themselves unable to stop
Willing Addicts have thought about their addictive
behaviour, are happy with it, and have no intention or
desire to stop
Types of addict

10. Rationality is about behaving in ways that lead to you
achieving your goals
Cognitive scientists distinguish two types of rationality:
Instrumental Rationality
You behave in ways to maximise your goals
Epistemic Rationality
You engage in evaluations of your own goals, beliefs and
knowledge to ensure that they fit with the way the world is
presented to you
So What is Rationality?

11. So, we know that people do not always behave in completely
rational ways
This is largely because we are cognitive economists who
avoid expending mental energy whenever possible. But what
does this mean for our understanding of addiction?
Let’s think about addition from a rational and an irrational
perspective.
Rationality and addiction

12. Addiction (addictive behaviours) are preferable to any
alternate courses of action or endeavour.
The balance of consequences demonstrate that the benefits
outweigh the costs.
How are such judgements made?
Rationality and addiction

13. Expectancies refer to the likelihood of particular outcomes
from specific behaviours
These are seen as utilities – which are both positive and
negative values associated with rewards
The expectation that drugs are harmful can be mitigated by
the view that ‘self harm’ is of little consequence, and thus
has low utility, and thus behaviour is therefore likely.
Expectancies, Utilities and Addiction

14. When considering utilities, think about the risks and rewards
of drug taking
These are a few examples:
Risk and Rewards
Rewards
Enjoyment and pleasure
Group membership
Relief from stress & anxiety
Rebellion
Risks
Legal consequences
Morbidity & Mortality
Social exclusion

15. Addicts tend to believe that life is better with drugs than
without. (Davies, 1997)
The use of incentives and disincentives can successfully
modify addictive behaviors (Lussier, 2006)
HOWEVER
Awareness of the consequences and harms associated with
addiction does not predict relapse among those in recovery
(Mooney, 1987)
It is a well known fact that EDUCATION is the least effective
intervention for substance misuse – often showing no effect
whatsoever upon actual behaviors (Flay, 2009)
What is the evidence?

16. There are many different theories all based on the principals
of rationality.
• Theory of Rational Addiction
• Subjective Expected Utility Theory
• Theory of Planned Behavior
• Positive / Negative Expectancy Theory
Examples of ‘Rational’ theories

17. Becker & Murphy, 1988
Maximisation of consumption over time, increasing (or
decreasing) appetite according to exposure.
Explains binge behaviour, and ‘cold turkey’
Drug taking leads to further drug taking. Future behaviour
based on the apparent consequences / benefits of the
current
HOWEVER
Overly simplistic, difficult to test empirically and fails to
account for the differing ‘types’ of addict
Theory of Rational Addiction

18. Edwards, 1961
Different courses of action will lead to different outcomes.
Decision to engage in specific behaviors are based upon the
maximization of utility (the value of rewards)
Decisions are mediated by the likelihood of occurrence
(weighted utility)
Subjective expected utility model

19. Ajzen, 1991
This is based on the earlier Theory of Reasoned Action.
Actions are driven by intention.
Intention is made up of three separate components:~
1. The Subjective Expected Utility
2. The individuals perception of control
3. The influence of others opinions
Theory of planned behaviour

20. Jones et al, 2001
The consequences of potential actions are viewed as
certainties (no need to account for probability) and are
weighted by their positive and negative attributes
Positive & Negative expectancy theory

21. Perhaps a more robust premise when considering addiction
acknowledges that our choices and preferences are unstable
– they change over time and in response to cognitive and
emotional bias.
In these models addition is seen as a consequence of
emotional an other bias upon the processes of decision
making.
Are we really rational?

22. Addicts tend to express thoughts and motivations that
promote and support their drug taking. (Field et al, 2008)
HOWEVER
There is limited evidence on the extent to which emotional
bias actually affects behavior (Wiers et al, 2010)
Experimental manipulation of bias does not result in long
term modifications of behavior. (Field et al, 2009)
What is the evidence?

23. These are sometimes known as Biased Choice models:
• Decision-Making Deficit Model of Addiction
• Unstable Preference Theory
• Cognitive Bias Model
• Gateway Theory
Examples of ‘Irrational’ theories

24. Redish, Jensen and Johnson, 2008
The human ‘machinery’ of decision-making is said to be
vulnerable to particular kinds of intervention
(pharmacological and experiential) which can lead to
maladaptive decisions
Addiction is therefore seen as primarily a condition of
maladaptive decision making
Decision-Making Deficit Model of Addiction

25. Skog, 2003
Utilities vary as a function of time and circumstance.
This is a realist approach that acknowledges that people and
the situations they find themselves in change, and this is
reflected in the variability of how utilities are weighted
Unstable Preference Theory

26. McCusker, 2001
Behavior is based upon information processing bias that
tend to favor addiction. Expressed as positive responses to
the behavior leading to an elevated tendency to repeat the
experience.
Attentional Bias – Addicts are over-sensitive to cues &
stimuli related to addiction and this increases likelihood of
engaging in that behavior
Recall Bias – Addicts tend to focus upon and recall positive
outcomes
Cognitive bias model

27. Kandel et al, 1992
Engaging in one behavior will increase the utility of other
behaviors, and can lead to an escalation of activity.
Gateway Theory

28. • Self control is an energy that is expendable.
• Addiction can be viewed as a failure of self control.
• Choices about behavior are based upon rational and
irrational cognitive processes.
• Behaviors can change over time and are responses to
both cognitive and emotional bias
• There is no one over-arching theory of addiction.
In summary

29. ALICE RAP Project (2011), ‘Addiction and lifestyles in
contemporary Europe reframing addictions project’, online at:
https://sites.google.com/site/alicerapproject/home
West, R (2013). EMCDDA Insights 14: Models of Addiction,
doi: 10.2810/99994
Background reading