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Vicky Maile

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Transcript of addiction

Psychology in action
Models of addictive behaviour (initiation, maintenance and relapse)
Vulnerability to addiction
Reducing addictive behaviour
application to real life
What we will study...
Models of addictive behaviour
Key terms:
biochemical explanations
Tolerance & withdrawal
Biological, cognitive and learning approaches to explaining initiation, maintenance and relapse and their applications to smoking and gambling
Matching task
Dopamine = motivation and pleasure.

Substances (e.g. food, addictive drugs) = increases release of dopamine/ prevents reuptake = greater levels of dopamine in the brain.

= increases feelings of pleasure or satisfaction.
Tolerance = get used to the higher levels, = more substance is needed to have the same effect.

Withdrawal = stop taking a substance = shaking, sweating, aches, pains.

Repeating the addictive behaviour removes the withdrawal symptoms.
A) The process whereby individuals who have managed to give up their addictive habits start to show signs and symptoms of the behaviour

B) The process whereby people continue to behave addictively even in the face of adverse consequences

C) The process where individuals start to become addicted
Tolerance + withdrawal = maintenance

Withdrawal = anxiety = individual wants more to avoid this uncomfortable state.

Reward pathways are less able to respond = addict has to consume more and more to activate them.
Watch and make notes...
Addiction may be inherited...

Read the studies that support and criticise the idea that addiction is genetic.

Answer the following questions...
What does MZ mean?
What are the concordance rates for drug addiction?
Why is it a problem that they are not 100%?
What's the A1 variant all about?
Does the A1 variant explain all addictive behaviours?
Nature vs. nurture; Reductionism; Determinism; Psychology as a science
1. Explain what each of the issues above are
2. Choose two and apply them to the biological model of addiction - make a mini poster
3. Swap posters with someone who has the other two issues

Initiation - starting to become addicted to smoking
Genetics - Lerman et al (1999) showed that people with a particular gene are less likely to take up smoking than those without it. The gene, called SLC6A3-9, works in the dopamine system.
Comings et al (1996): nearly 50% of smokers and ex-smokers have the A1 variant.

Volkow et al. (2000) found that those with fewer dopamine receptors are more vulnerable to drug stimulation, which is why some people continue to take smoke or take drugs after first trying them, whereas others do not have more than one experience.
Biochemical - nicotine stimulates the release of dopamine, so smoking triggers a release of 'pleasure' chemicals in our brains.
+ Usefulness in understanding initiation (genetic 'vulnerability')
- Cause and effect
- Environment more important than biology in initiating behaviour
exam pointer
It is slightly less likely that you will be asked a question on initiation of smoking for the biological model - there is more/better research into maintenance and relapse - don't ignore this section though! You could use it in wider explanations of smoking.
Maintenance - continuing to be addicted to smoking
Stefansson et al (2010) studied over 140,000 participants and found that there were genetic mutations which increased the number of cigarettes smokers had daily, and these genes were related to nicotine dependence.
Sabol et al (1999) showed that the gene SLC6A3-9 was extremely important in enhancing people’s ability to stop smoking, and that those not carrying it were more likely to remain as smokers, maintaining their addictive smoking behaviour.
Shachter (1977) asserts that the physical dependence is relevant to smokers. He argues that smokers continue to smoke to maintain nicotine in the body at a level high enough to avoid any negative withdrawal symptoms.
- Cause and effect
- Population validity - research relies on heavy smokers, so we perhaps cannot generalise to casual/social smokers.
Relapse - returning to a smoking addiction
Lerman et al (2007) used a scanner to measure blood flow in the brain. They tested regular smokers just after a cigarette, and then after a single night where the smokers abstained from their habit. The results showed that after the night without smoking there was an increased blood flow to parts of the brain concerned with attention, memory and also reward. They concluded that these parts of the brain become particularly active when the person is craving a cigarette. The researchers also suggested that some people are more prone than others to cravings because of changes in brain chemistry
+ Usefulness in preventing relapse
exam question
Outline and evaluate the biological approach to explaining smoking behaviour (4+4)
Initiation - starting to become addicted to gambling
The biological model of the initiation of problem gambling is linked to the physical response that gambling generates.
Biochemical (stress hormones) - awaiting the outcome of a bet triggers the release of adrenaline, so the person feels more alert, experiencing a natural 'high'. The initiation of a gambling addiction is related to these positive feelings – to repeat the 'rush' a person may continue to gamble (see maintenance).
Genetics - Black et al (2006), Slutske (2010), and Comings et al (1996) all suggest there is a direct genetic element to the initiation of gambling addictions.

Alessi and Petry (2003) suggest that genetics work indirectly, influencing personality traits such as impulsivity, which in turn increases the likelihood of developing a gambling addiction
- Coventry and Brown (2006) suggest that although genes may influence impulsivity, gamblers who betted on horse racing were actually found to be lower on sensation-seeking than non-gamblers.
- Cause and effect
Maintenance - continuing to be addicted to gambling
Biochemical - Winning in gambling triggers the release of dopamine in the reward circuit in the brain. Repeated exposure to an addictive behaviour causes reduced sensitivity to the dopamine release. This means that more of the behaviour is needed to cause the same pleasurable psychological effect.
Chase and Clark (2010) found that pathological gamblers have increased activity in their reward circuit when they are gambling, and also when they anticipate gambling, compared to 'social' gamblers (casual gamblers).
Potenza et al (2003) investigated urge/craving states in men diagnosed with pathological gambling disorder. When viewing gambling tapes, and just prior to experiencing an emotional response, the gamblers showed different blood flow in their brains compared to non-gamblers.
+ Roy et al (2004) found higher dopamine levels in chronic casino gamblers and higher noradrenaline levels in chronic blackjack layers, which suggests a biological explanation for addiction.

- Reductionist

+ Can lead to effective treatments

- Clark et al (2009) suggests that cognitive, learning and biological explanations can be combined to explain gambling dependency.

Relapse - returning to a gambling addiction
Biochemical - Chase and Clark (2010) showed, pathological gamblers have increased activity in their reward pathways when they anticipate gambling. This suggests they may be more likely to trigger dopamine release by relapsing to gambling behaviours
+ Ciarrochi et al (1987) suggest that those addicted to gambling often have other problems such as addictions to alcohol or shopping. It has been reported that gamblers often simply transfer their addictive behaviours, and often switch back to gambling as a way of maintaining the positive feelings received from engaging in their addictive behaviours.

- Ethical issues

IDA Evaluations
Nature vs. nurture
Reductionism vs. holism
Determinism vs. free will
Psychology as a science
Diathesis-stress model
Learning model
Addiction is learned through...
association (classical conditioning),
reinforcement (operant conditioning)
social learning (social learning theory) from environmental experience
Classical conditioning
AKA Cue-reactivity theory
Items or ‘cues’ = associated with the addiction
Presence of cues = elicits conditioned responses (even without actual behaviour).
For example, repeatedly using a substance (e.g. heroin) in the same environment will lead to associations forming between the substance and the stimuli in the environment (e.g. needles, other addicts). When the user sees the stimuli, their body will expect to receive the substance.
Experience of being around friends/popularity
Feeling relaxed/happy
Exp of being around friends/popular
Feeling relaxed/happy
Feeling relaxed/happy
Complete the diagram for smoking
Operant conditioning
Pleasurable feeling = positive reinforcement = behaviour more likely to occur.

Withdrawal = unpleasant
Continuing a behaviour = removes unpleasant symptoms – = negative reinforcement = behaviour more likely to occur.
E.g. Winning a bet provides a reward (positive reinforcement), which means you are more likely to place another bet.

E.g. Smoking withdrawal may cause unpleasant feelings, so having another cigarette provides negative reinforcement by relieving those symptoms.
The extent of behaviour change depends on the schedule of reinforcement: partial reinforcement is more effective than continuous reinforcement.
Siegel et al (1982) - tolerance and withdrawal are conditioned responses to drug-related stimuli.

Read the rat study by Siegel et al and develop a PEE evaluation for it, based on the fact it uses animals...

P - The learning approach uses animals to study the effects of learning on addiction, which may be unrepresentative of human addiction.
E - For example, Siegel et al use rats to show how conditioning to drug-related stimuli leads to responses of tolerance and withdrawal.
E - We can argue that the behaviour of rats is difficult to generalise to humans as they are not as complex as humans.


Develop a 'C' for your PEE paragraph...

a Counter-argument
a Contradictory point
a Commentary on the evaluation
Robins et al (1975) - soldiers relapse in same environment

Meyer et al (1995) positive sensations occurred in addicts at the sight of a syringe

+ Usefulness in understanding addiction and treating it - real life applications for health campaigns
Usually operant conditioning is unable to explain acquisition - by definition a behaviour needs to be performed before it can be reinforced.
Social learning theory
Addiction = observe and imitate others

Vicarious reinforcement = observe others being rewarded = more likely to imitate addictive behaviour
DiBlasio and Benda (1993) found that peer group influences are the primary influence for adolescents who smoke or use drugs.
Bahr et al (2005) reported that drug taking by peers influenced dependency behaviour in adolescents, showing how SLT also plays a part.

application to real life

Initiation - starting a smoking addiction
Classical conditioning - Brynner (69) argues we associate smoking with maturity/popularity.
SLT - Akers & Lee (96) = positive correlation found between variables (such as whether friends smoke) and smoking in adolescents
NIDA (2000) - 90% smokers started smoking because they watched friends smoking.
- Methodological issues (self-reps, correlations

- Individual differences - Robinson & Berridge (93) - reward cannot be the other explanation - not everyone becomes addicted.
Maintenance - continuing a smoking addiction
Classical conditioning - a routine may be associated with smoking that supports the addiction being maintained (e.g. smoking after a meal, or with a drink).
Operant conditioning - withdrawal from nicotine provides negative reinforcement (Goldberg - monkeys)
Social learning theory - peer group influences are
primary for adolescents continuing to smoke
(DiBlasio & Benda)

SLT - links to 'outcome expectancy model' - we observe others smoking and it triggers certain expectations (such as being relaxed, having fun) - reinforced by multiple opportunities to observe smoking in society.
+ Usefulness in developing treatments (we can 'unlearn' cues)

+ SLT = links to outcome expectancy theory = acknowledges role of cognitions in maintaining addictive behaviour
Relapse - returning to a smoking addiction
Classical conditioning - associations already exist that generate cravings for cigarettes even after quitting
Operant conditioning - negative reinforcement for relapsing
SLT - Opportunities for observation/vicarious reinforcement are prevalent in society
SLT - Shiffman = smokers relapse when around others who smoke
+ Usefulness in preventing relapse

+ Operant techniques used in real life (+ve self-reinforcement used for quitting)

- Treatment isn't long term

Maintenance - continuing a gambling addiction
Initiation - starting a gambling addiction
Relapse - returning to a gambling addiction
Combined approaches are used to explain the initiation of gambling addiction...
1) Observe others gambling and being rewarded (vicarious reinforcement)
2) Their own gambling behaviour is reinforced through wins, excitement, etc.
3) The excitement they experience is associated with gambling overall (dressing up for the races, buying a lottery ticket - cues)
- No 'type of learning' alone is enough to explain initiation of gambling, particularly CC and OC

+ Usefulness - reducing gambling initiation
Operant conditioning - continuing gambling = rewards + schedule of reinforcement (not winning all the time)
Extension task = find out about schedules of reinforcement - which is most effective?
- Delfabbro & Winefield (99) = gamblers lose more than they win = extinguished?

- OC mainly explains slot machines, scratch cards (short intervals) but not skilled gambling (long intervals)
[Cognitive approach better?]
Classical conditioning (cue-reactivity) - association of environmental cues = triggers desire to gamble again
Operant conditioning - relapse reduces financial problems = negative reinforcement
SLT - regular vicarious reinforcement = opportunities to observe and re-imitate
+ Usefulness - prevent relapse

- Ethical concerns
The cognitive model
According to this model, faulty thinking and errors in decision making are considered to be the causes of addiction.

The approach might suggest that the thought processes that are behind addiction may be shaped by:
Attitude to the behaviour ('alcohol makes me feel confident')
Perception of others' opinions ('I need to drink to fit in')
Perception of own ability to control their behaviour ('I can't cope in social situations without a drink')

Anxiety/low mood
Doing the
addictive behaviour
caused by
Beck's vicious circle
Coping with stress
People engage in addictive behaviours to cope with stress in their lives.

Addiction serves three functions:

1. Mood regulation (increase positive, decrease negative).
2. Performance enhancement (feeling alert or more able to perform certain tasks).
3. Distraction (from less pleasant experiences)
+ Koski-Jannes (1992) addictions = ways of dealing with stressors = short-term positive results, but long-term negative consequences = vicious circle!

- Cases of addiction with no major psychological problems to be overcome = ‘coping’ is not a full explanation of addictive behaviour
Expectation effects = beliefs about what will happen if you engage in a behaviour. Expect actions to have negative consequences = they less likely to engage in that behaviour.

Expectancies about the EFFECT of an addictive behaviour = sometimes more of an influence than the actual changes it produces.

Expectancies do not have to be accurate in order for them to motivate our behaviour.
+ Hansen et al (1991), Southwick et al (1981) and Brown (1985) have all found that alcohol abusers are more likely to have positive expectations and not perceive the negative consequences of drinking (especially heavy drinkers).

- Focus is on alcohol (not representative)

- Gender bias

This means our beliefs in ourselves’

Whether we believe that we are capable of dealing with the effects of a particular behaviour.

Self-efficacy is thought to play a very important role in whether or not we start engaging in addictive behaviours (initiation), and whether we believe we can do anything about the addictive behaviour once it is established (relapse).
Individuals use drugs to treat psychological problems.

The drug a person takes is carefully chosen, for example a person smoking to relieve stress or anxiety.

The drug may not actually improve their life, but for the individual to become addicted it is more important that they think the drugs are relieving their symptoms.
Sanjuan et al (2009) - sexually abused women were more likely to turn to alcohol to remove sexual inhibitions.

- Cases of addiction where there are no major psychological problems = ‘self-medication' is not a full explanation of addictive behaviour.
Horizon: The power of the placebo (not directly about addiction but has links to expectancy effects, raises good points about ethics and the application of psychology to everyday life)
application to real life

Initiation - starting a smoking addiction
+ Kenny & Markou (2001) - people who smoke experience positive effects, including mild euphoria and mildly enhanced cognition (positive, subjective effects) = motivates further nicotine use.

- The cognitive approach does not explain initiation of smoking addiction (and other addictive behaviours) as well as other models might – i.e. biological and behaviourist. It is therefore restricted in its usefulness.

Relapse - returning to a smoking addiction
+ Usefulness - manipulate expectations to prevent relapse (Tate et al)

- Methodology - use of self-reports in cognitive model of addiction

Maintenance - continuing a smoking addiction
+ Ainslie (1992) = smokers consider greater weight given to the present, not future consequences (e.g. immediate rewards of a cigarette)
= ‘cognitive myopia’ (short sightedness).

+ Chiu et al = smokers lack the ability to consider what might happen if they quit compared to non-smokers. Smokers were able to register possible ‘alternative futures’, but did not use them in their decision-making.

Maintenance - continuing a gambling addiction
+ Koski-Jannes (1992) - addictions originate from ways of dealing with stressors [short-term positive results, long-term negative consequences].

+ Anholt et al (2003) - evidence of obsessive-compulsive thinking in dependent gamblers.

- (or +?) Sharpe and Tarrier (1993) - gambling is initiated by operant conditioning but excitement generated by gambling/occasional wins = further gambling. THEN cognitive mechanisms become more important in maintaining the behaviour - the way gamblers think/interpret their experiences is key.

I.e. use other models for initiation!
Initiation - starting a gambling addiction
Relapse - returning to a gambling addiction
- Dickenson and Baron (2000) - increased irrational talking (in Griffiths’ study) = due to demand characteristics (participants are trying to explain their behaviour to the researcher who is clearly observing them).

+ Grant et al (1996) - in periods of cravings = increased activity in prefrontal cortex (associated with decision making) = cognitive and biological models could be combined to explain dependency behaviours?
exam question
Outline and evaluate the cognitive approach to explaining problem gambling (4+6)
Expectancy - smokers’ expectations of the effects of nicotine are wide-ranging (true or not)...
reduces stress
control appetite
helps in social situations.
Coping - Heishman (1999) smoking increases concentration and attentional focus and performance - so perhaps smokers initiate a smoking addiction because they are having difficulties with these things.
Self-efficacy - smokers may know it is dangerous and addictive, but they believe they are able to control the behaviour and any problems that may arise from it.
Beck et al's 'vicious circle' = smoking maintained.
Expectancy - smoking addiction develops = more influenced by unconscious expectations (automatic processing) = loss of control

A smoker may also expect the withdrawal process to be extremely unpleasant, which in turn informs their ability to believe they can stop the addictive behaviour.

Self-efficacy = in initiation of smoking behaviour = feel capable of coping with the negative effects of smoking. Once smoking behaviour has been initiated = feel unable to cope with the withdrawal procedure associated with smoking = addiction maintained
Self-medication - addicted to smoking= trying to 'self-medicate' for psychological problem. Problems then become the withdrawal symptoms when trying to stop smoking!

Parrott (1998) - cigarette = short-term stress relief but long-term stress! = continue smoking

Coping - negative feelings of the withdrawal period can be relieved almost immediately by taking another cigarette - a return to smoking is the easiest and most immediate way to escape from this feeling.
Expectancy - Brandon et al = smoking behaviour governed by 'unconscious expectations' (not actively thought about) = loss of control over behaviour/difficulties experienced in abstaining which makes it easy to relapse.
Self-efficacy - relapsed smokers = given up once = feel able to do it again any time they want (had the experience of having given up previously).

Nordgren et al = smokers who said they had more ‘impulse control’ = more likely to have relapsed four months later AND less likely to try to avoid temptation (e.g. being around other smokers).

Faulty/irrational beliefs - gambling behaviour = provides = positive feelings (especially when successful) = positive thoughts

Once created these thoughts may be extremely difficult to change.

Experiences associated with gambling (the buzz of excitement, the environment, etc.) = similarly enhanced positive feelings, further strengthening existing positive cognitions about gambling.
Coping - experience of excitement/possibility of the occasional win = feel good and therefore less stressed. These events encourage gamblers to interpret their behaviour positively.
Expectancy - perceived benefits of gambling can be huge = the gambler sees the possibility that their actions will be life-changing: occasional wins will support these expectancies, so the gambler continues to gamble.
Self-efficacy - people do not see it as a problem (e.g. gambling and not realising it - e.g. National Lottery!)...

AND perceived positive effects of NOT gambling are not enough to make someone wish to stop...

PLUS withdrawal symptoms of gambling are not as serious as those from giving up smoking = may not see point in giving up (physical effects of giving up are relatively easy to cope with).
Cognitive biases - gamblers show biases in thinking (shortcuts in thinking that lead to bad decisions)...

Availability bias = belief something is more likely to happen because it has occurred in the past [e.g. only remembering previous times they've won, ignoring times they've lost] = want to play more.

Illusion of control = incorrectly believing they can influence the outcomes of the gambling activity (lucky socks!)

Griffiths (1994) = regular gamblers = more likely to express irrational thoughts, such as believing they had skill/control over the gambling machines.
Self-efficacy - gambler may not experience feelings of illness/withdrawal symptoms can be very mild SO consequences of relapse = return to winning money!

Less withdrawal = gamblers feel they can stop at any time.

Relapse is not seen as too much of a problem.
+ Usefulness of the findings - research on cognitive biases in gambling behaviour may help to provide insights into other types of addictive bias. (e.g. smokers/drinkers rationalise their behaviour following their actions in the same way in which gamblers do).

+ Marlatt’s relapse model
IDA Evaluations
Reductionism vs. holism
Individual differences
Cause and effect.
Cognitive biases reflect behaviour rather than cause it

How faulty is the cognition?
Skilful play (e.g. poker) - beliefs about control and skill may not be completely irrational.
Full transcript