Addiction Flashcards
What is Addiction?
Addiction is a disorder in which an individual consumes a substance i.e. nicotine, or engages in a particular behaviour i.e. gambling, that is pleasurable but eventually becomes compulsive with harmful consequences.
What is meant by the term PSYCHOLOGICAL DEPENDENCE in relation to addiction
- This is the mental and emotional compulsion to keep taking a substance as the individual believes that they cannot cope with work and social life without a particular drug e.g. alcohol, nicotine or behaviour e.g. gambling. It may increase their pleasure or lessen their discomfort.
- Absence of the drug/behaviour causes the individual to feel anxious or irritable and this leads to a craving for the substance.
What is meant by the term PHYSICAL DEPENDENCE in relation to addiction
- Physical dependence is a state of the body that occurs when withdrawal syndrome is produced from stopping the substance use/behaviour e.g. Nausea, headaches and shaking.
Explain what is meant by the term withdrawal syndrome
Withdrawal syndrome is the collection of psychological and physical symptoms an individual will experience when they no longer have a substance in their system/engage in a particular behaviour.
Withdrawal syndrome includes low mood, feeling nauseous, achy, in pain or experiencing tremors.
When an individual experiences withdrawal it is very unpleasant and so continuing to take the substance or engage in the behaviour is partly to avoid the withdrawal symptoms.
The seriousness of the withdrawal syndrome can depend on a variety of factors:
1. The substance used/type of behaviour
2. The amount of substance consumed
3. Drug-use/behaviour pattern
Explain what is meant by the term tolerance
Tolerance arises when you have taken a substance/maintained a certain behaviour for some time, and due to the repeat exposure the response to the substance/behaviour is reduced. When tolerance occurs an individual will need greater doses to feel the same physical and psychological effects.
Cellular Tolerance:
CT takes place when brain neurons adapt their responsiveness to higher levels of a substance
Metabolic Tolerance:
MT takes place when a substance has been metabolised quicker and therefore leaves the body
Behavioural Tolerance:
When individuals learn through experience to adjust their behaviour to compensate for the effects of the drug e.g. walking more slowly to avoid falling over when drunk.
Risk Factors in development of addiction: GENETIC VULNERABILITY
Two reasons genetic vulnerability can occur:
1. D2 Receptor
Within the brain we have a number of receptors that communicate with neurotransmitters.
D2 receptor is responsible for communicating with Dopamine – low levels of receptors associated with addiction.
An individual with LOW LEVELS of D2 receptors will not experience same amount of pleasure from substance for example, chocolate, as someone with regular number of D2 receptors therefore, they turn to more addictive substances such as nicotine to experience same feeling of pleasure.
The levels of receptors that an individual has is ultimately determined by their genetics.
- Metabolism
Some individuals are able to metabolise certain addictive substances a lot faster than others, therefore making it easier for them to become addicted as they may need more to have the same effects.
An individual’s rate of metabolism is inherited through their genes.
Risk Factors in development of addiction: STRESS
Stress is where an individual experiences a state of arousal that occurs when they believe they do not have the ability to cope with the perceived threat. Periods of chronic, long lasting stress and traumatic life events in childhood have been linked with increased risk of developing an addiction.
However, it has been found that it is not always the level of stress but how an individual perceives their ability to cope with the stress that makes them more vulnerable to addiction. For example, someone experiencing high stress levels may smoke in order to reduce the stress because they do not believe they can cope with it on their own, therefore leading to a nicotine addiction.
Risk Factors in development of addiction: PERSONALITY
Psychologists proposed an addictive personality suggesting correlation between certain traits and addiction. There are a number of personality traits that are linked to addictive behaviours. It is suggested that anti-social personality disorder leads to a high vulnerabity to addiction, which can include neurotic and psychotic personality traits.
- High levels of neuroticism = High levels of anxiety, irritability, and low self-efficacy.
- High levels of psychoticism = aggressive and sometimes emotionally detached.
Individuals who have these pathological personalities are more likely to become addicts as the behaviour/substance helps them and offers them relief.
Another key personality trait involved in addiction may be impulsivity, leading to risk taking and sensation seeking behaviour.
Risk Factors in development of addiction: FAMILY INFLUENCES
One family influence which can create vulnerability to addiction is perceived parental approval. This is the extent to which an adolescent believes that his or her parents have positive attitudes towards a specific behaviour/substance. If an adolescents believes their parents show positive attitudes towards a particular addictive substance/behaviour, then they will be more vulnerable to developing the addiction themselves.
Also adolescents who believe that their parents have little interest in monitoring their behaviour (e.g. internet use, peer relations) are significantly more likely to develop an addiction.
Also, exposure within family life to a substance/behaviour creates risk of developing an addiction. For example, adolescents are more likely to start using alcohol in families where it is an everyday feature of family life.
Also, Social Learning Theory could play a role. An individual could observe a family member (role model) engaging in addictive behaviour and imitate this behaviour as they identify with them and want to be like them.
Risk Factors in development of addiction: PEERS
Peers can influence an individual’s development during adolescence as they spend more time with them, and less with their family. Social Learning theory can explain addiction. Individuals may observe their peers (role models) engaging in an addictive behaviour and imitate this behaviour as they identify with them due to similarity and want to be like their peers.
Some psychologists may argue that peers may act as gateways to addictive behaviour.
O’Connell et al (2009) suggests that adolescents are at risk of developing alcohol addiction due to the influence of their peers because of three major elements:
- Attitudes and Norms to drinking alcohol – These can be influenced by groups of peers who drink alcohol.
- Opportunities to drink alcohol – The more experienced the peers are in drinking, the more opportunities to drink alcohol they can provide an individual with.
- Individual’s perception - An individual may over-estimate how much their peers drink, and therefore drink more to ‘keep up with them’.
Risk Factors in Development of Addiction- AO3
:) Risk Factors in the development of Addiction have Practical Applications. This is because doctors and psychologists can use them in order to create prevention and treatment strategies for addictive behaviours. For example, Tobler et al. created the Peer-Pressure Resistance Training to help adolescents avoid taking up smoking. Therefore, awareness of the risk factors in the development of addiction is an important part of applied psychology.
:( Most research into risk factors is based on retrospective data, because it relies on individuals trying to accurately recall information about addiction, family influences and stress from the past. Memory has found to be inaccurate in such research as participants may forget, for example, about the amount of perceived positive attitudes towards substance use within the family home during their adolescence, and therefore lie in their answers. If this is the case this reduces the internal validity of the research in risk factors, as well as weakening the support the research provides when looking at the risk factors in the development of addiction.
:( Findings of research into risk factors are not absolute, there are clear individual differences because not all people who are exposed to one or more of these risk factors go on to develop an addiction. This suggests that other factors must be involved in the development of addiction such as and individuals cultural/socio-economic background and/or unconscious motives. Therefore, there is still much to learn about risk factors in the development of addiction and more research must be carried out to do so.
EXPLANATIONS FOR NICOTINE ADDICTION: BRAIN NEUROCHEMISTRY
- Individual smokes a cigarette and inhales nicotine, and reaches the blood stream and the brain in less than 10 seconds.
- This indirectly stimulates the VENTRAL TEGMENTAL AREA, where many dopamine neurons are concentrated.
- Dopamine is released in to the LIMBIC SYSTEM and activates the NUCLEUS ACCUMBENS, which leads to the sensation of pleasure, euphoria and motivation.
- The activity in the limbic system then transfers messages to the PRE-FRONTAL CORTEX, which makes the decision to smoke again (in order to experience to the same euphoria).
- Therefore, explaining why people repeatedly smoke and become addicted to nicotine.
Brain Neurochemistry Explanation of Nicotine Addictions: AO3
:) The brain neurochemistry explanation of nicotine addiction has practical applications. This is because the principles of the theory, that nicotine addiction is caused by high levels of dopamine and an activation of the brain’s reward pathway has led to the treatment of nicotine replacement therapy (NRT). This is effective in reducing nicotine addiction by providing the individual with nicotine in a less harmful form and slowly reducing the dosage overtime, thus reducing the tolerance. Therefore, the brain neurochemistry explanation of nicotine addiction is an important part of applied psychology.
:( Brain neurochemistry as an explanation of nicotine addiction can be criticised for biological reductionism. This is because the theory reduces the complex human behaviour of addiction down to dopamine levels. This neglect a holistic approach, which takes into account how a person’s cultural and social context would influence and explain an individuals nicotine addiction. Therefore the brain neurochemistry explanation of nicotine addiction may lack validity as it does not allow us to understand the behaviour in context.
:( An alternative explanation for nicotine addiction is the Learning Theory. This suggests that addiction is due associations and reinforcements within in the environment. For example, and individual learns to smoke due to observing a role model being rewarded for smoking thus imitating their behaviour (vicarious reinforcement). This is rather than the brains reward pathway being activated due to high levels of dopamine as the brain neurochemistry explanation suggests. Therefore, the brain neurochemistry explanation is not the only explanation of addiction that should be considered.
LEARNING THEORY AS APPLIED TO SMOKING BEHAVIOUR INCLUDING REFERENCE TO CUE REACTIVITY
One plausible explanation is that smoking is a learnt behaviour through operant conditioning.
Forming the addiction:
Smoking behaviour could be explained by positive reinforcement. The individual is rewarded with the feeling of euphoria when they inhale nicotine, due to it’s impact on the dopamine system in the brain’s reward pathway. Therefore the person will smoke again to get the same reward of euphoria.
Maintaining the addiction:
Negative reinforcement can explain why an individual would continue to smoke. Cessation of nicotine leads to the appearance of withdrawal syndrome which has unpleasant symptoms such as disturbed sleep, agitation and poor concentration. These symptoms make it difficult for a smoker to abstain for long and therefore an individual would continue to smoke to avoid the unpleasant symptoms.
Nicotine addiction can also be explained by classical conditioning as a person may associate their nicotine addiction with pleasure.
Cues trigger cravings – cravings trigger addictive behaviour
The pleasurable effect of smoking is known as the primary reinforcer because of it’s rewarding effect on the dopamine reward system, this is not learnt.
Any other stimuli that are repeatedly present at the same time as the nicotine, or just before, (such as a lighter, certain friends, places), over time, become associated with this pleasurable feeling. These stimuli are called the secondary reinforcers, because they have taken on the properties of the primary reinforcer, and become rewarding in their own right.
These secondary reinforcers also act as cues, because their presence produces a similar psychological and physiological reaction to the nicotine itself – this is cue reactivity.
These reactions makes a person want to smoke again. This can explain why individuals sometimes relapse and/or maintain their addiction to nicotine.
Smoking behaviour as applied to learning theory AO3
Research to support the learning theory of addiction, in particular cue reactivity, was conducted by Carter and Tiffany. They conducted a meta-analysis of 41 studies into cue reactivity. They presented dependent, non-dependent smokers and non-smokers with smoking related cues. Self reported desire was measured alongside heart rate. They found that dependent smokers reacted most strongly to the cues for example increased heart rate and reported cravings to smoke. This supports cue reactivity as an explanation for smoking behaviour because the dependent smokers had learned secondary associations between smoking related stimuli and the pleasurable effects of smoking.
However, The learning theory of nicotine addiction is criticised for environmental determinism. This is because is it states that an individual is controlled by reinforcements and associations that cause behaviour. For example, if person is rewarded for smoking by the feeling of euphoria, they will inevitably smoke again to get the same reward. This neglects the role of free will and choice and individual has, for example, a person may choose not to continue smoking despite the pleasurable reward, for health reasons. The learning theory cannot account for this and therefore may not be a full explanation of smoking behaviour.
The learning theory of nicotine addiction has practical applications. This is because the principles of the theory, that addiction is caused by pleasant associations has led to behavioural interventions such as aversion therapy and covert sensitisation. This is effective in treating nicotine addiction by encouraging a patient to re-associate nicotine with negative feelings for example, nausea, rather than a feeling of pleasure. Therefore, the learning theory of smoking behaviour is an important part of applied psychology as it helps treat nicotine addiction in the real world.
LEARNING THEORY AS APPLIED TO GAMBLING, INCLUDING REFERENCE TO PARTIAL AND VARIABLE REINFORCEMENT
Forming the addiction:
Social Learning Theory
A gambling addiction can form due to the experience of observing a role model being rewarded for their gambling behaviour (vicarious reinforcement). The reward could be their enjoyment in gambling or the occasional wins and financial returns they gain. This observation doesn’t have to be direct it can be through newspapers, magazine or the media. For example, hearing about someone winning big on the lottery could make a person more likely to gamble to gain the same reward.
Maintaining the addiction:
Operant conditioning:
Gambling can provide two kinds of positive reinforcements; the reward of winning money and the ‘buzz’ excitement from gambling. Therefore, the gambling behaviour is likely to be repeated to gain the same reward.
Gambling can also be seen as a distraction for some from anxieties of everyday life. Gambling can act as negative reinforcement to distract the individual from their unpleasant feelings and anxiety. Therefore, they will continue to engage in gambling behaviour to avoid the negative consequence of anxiety.
Partial reinforcement is where a behaviour is reinforced only some of the time. If a person is rewarded every time they may become bored, therefore partial reinforcement enables a person to develop an addiction due to reinforcements being limited to only some of the time, and not consistently, therefore making the gambling more exciting (rewarding) as the individual is unsure when they will next win, so the behaviour does not extinguish, even when the wins stop.
Fixed Rate:
This is a type of partial reinforcement where behaviour is reinforced a predictable amount of times e.g. a slot machine paying out every tenth time. Or every 5 minutes. This does NOT form an addiction
Variable Reinforcement:
This is a type of partial reinforcement where behaviour is reinforced an unpredictable amount of times (at variable intervals) e.g. you win at black jack on the 15th time, then on the 2nd time, the on the 7th etc.
This highly more reinforcing (rewarding) as it is highly unpredictable and exciting and therefore leads to stronger, more persistent gambling behaviour
Learning Theory of Gambling Addiction AO3
Research to support the learning theory as an explanation for gambling addiction comes from Parke and Griffiths (2004).Their research supports the idea that gambling is reinforced due to the money, thrill and excitement but they said that the fact there is a sensation of a ‘near miss’ as well makes it reinforced even if there is a loss. This supports the idea of partial and variable reinforcement making gambling highly addictive, due to the unpredictability of winning and the associated excitement.
A further strength of the learning theory explanation of gambling addiction has practical applications. This is because the principles of the theory that addiction is caused by pleasant associations between gambling and excitement, has led to behavioural interventions such as aversion therapy. This is where gambling is re-associated with a negative stimulus i.e. electric shocks, rather than a feeling of pleasure and excitement. Therefore, the learning theory as an explanation of gambling addiction is an important part of applied psychology as it helps treat gambling addictions in the real world.
However, the learning theory as an explanation of gambling addictions can be criticised for environmental determinism. This is because is it states that an individual is controlled by reinforcements that cause behaviour. For example, if person is rewarded for gambling by the feeling of euphoria, or the occasional win, they will gamble again to get the same reward. This neglects the role of free will and choice and individual has, for example, a person may choose not to continue gambling, despite the ‘buzz’ due to being aware of the potential financial losses. The learning theory cannot account for this and therefore may not be a full explanation of gambling behaviour.
EXPLANATIONS FOR GAMBLING ADDICTION: COGNITIVE BIAS
Cognitive bias is where a person’s thinking, memory and attentional processes are faulty leading an individual to make irrational judgements and poor decisions. These biases influence how gamblers think about their behaviour, what they pay attention to, and what they remember and what they forget.
- Faulty beliefs of Skills and Judgment:
Addicted gamblers overestimate their ability to influence a random event (illusion of control)
For example, they believe they are skilled at choosing lottery number, making them more likely to gamble. - Engaging in Ritual behaviours:
Addicted gamblers believe they have a greater probability of winning over other people because they are lucky or superstitious
For example, touching a certain item of clothing before placing a bet - Selective Recall:
Addicted gamblers remember certain types of information better than others
For example, they are more likely to recall their wins but forget their loses describing them as unexplainable mysteries, leading them to be more likely to gamble - Faulty perceptions:
Addicted gamblers have distorted views about the operation of chance (gamblers fallacy)
Belief that a losing streak cannot last and will always be ended with a win, making them more likely to gamble.
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cog bias definition
4 biases- name/explain
8:
cog bias definition
4 biases
Cognitive Theory of Gambling Addictions- AO3
:) The cognitive theory and an explanation of gambling addiction has practical applications. This is because the principles of the theory, that addiction is caused by cognitive biases has led to the development of cognitive behaviour therapy. This is effective in treating behaviour by identifying and challenging irrational thought processes that have lead an individual to gamble. Therefore, the cognitive explanation of gambling is an important part of applied psychology as it helps people in the real world.
:( Many research studies into cognitive distortions in gambling have used self-report methods such as interviews and questionnaires. These methods can be criticised for social desirability, where the gamblers may lie about reasons for their addiction or their everyday behaviours whilst gambling to appear in the best possible light. For example, they may not tell the full truth about having to touch a lucky item of clothing (ritual behaviour) before gambling as they don’t want to researchers to see them as abnormal. This reduces the internal validity of the research into cognitive theories and therefore weakens the support the research provides for the cognitive theory in explaining gambling addictions.
:( An alternative explanation for gambling addiction is the learning theory. This would suggest that a gambling addiction is due to the social learning. For example, observing a role model winning money for gambling and then imitating that behaviour (vicarious reinforcement) rather than cognitive biases such as skills and judgement being the reason for gambling. Therefore the cognitive explanation is not the only explanation of gambling addiction that should be considered.
Drug Therapy for Nicotine Addiction
Nicotine replacement therapy - (agonist substitution)
Aim: Provide nicotine from a less harmful source e.g. patches, gum, nasal spray, rather than a cigarette
How it works:
NRT stimulates the nicotine receptors and activates the brain’s reward pathway, releasing dopamine into the limbic system, stimulating the nucleus accumbens and creating the same pleasurable feeling as smoking a cigarette does. This can lead to a reduction in the nicotine withdrawal symptoms and stops the cravings. The reduction in the withdrawal symptoms is an example of negative reinforcement as the NRT removes the unpleasant circumstances of quitting smoking.
NRT also desensitises the nicotine receptors in the brain by releasing small amounts of nicotine so that only some receptors are full with nicotine, but not all. Therefore, over time the number of nicotine receptors reduce meaning that cigarettes become less rewarding to smoke, therefore relapse is less likely to occur. The addict can gradually reduce the dosage of nicotine as their tolerance to nicotine is reduced.
Drug Therapy for Gambling Addiction
No specific drug treatment for gambling has been approved in the UK. There is ongoing research into several candidates, the most promising being an opioid antagonist such as naltrexone, which is conventionally used to treat heroin addiction. This has come about because of the similarities between gambling addictions and substance addictions.
Opioid Antagonist
Aim: Reduce the pleasurable feeling associated with gambling.
How it works:
Opioid Antagonists enhance the release of the neurotransmitter GABA in the mesolimbic pathway. The increased GABA activity reduces the release of dopamine in the nucleus accumbens. Some research has linked this with reductions in gambling behaviour.
Reducing Addiction – Drug Therapy AO3
Stead et al (2012) carried out research to support the effectiveness of nicotine replacement therapy (NRT). They reviewed 150 high-quality research studies that compared the use of NRT with a placebo. They found that all forms of NRT (gum, inhalers, patches) were significantly more effective in helping smokers quit than placebos and no treatment at all. Therefore, supporting drug therapy as a way of reducing addiction, as it has been found to be very effective.
However, a strength of drug therapy in reducing addiction is that it requires little motivation from the patient. This is because the patient just has to wear a patch or chew gum in order to reduce their addiction, unlike CBT which requires more effort and motivation from the patient as they will have to commit to CBT sessions over months and have to complete homework outside of these, so they must be very motivated to quit. Therefore, drug therapy may be seen as a more appropriate treatment for reducing addiction than others such as CBT.
However, a limitation of using drug therapy such as NRT and opioid antagonists (Naltrexone) are the negative side effects. Common side effects of these drugs include sleep disturbance, stomach problems, dizziness and headaches unlike CBT which is non-invasive as the individual is identifying and challenging irrational thoughts that have lead to their addiction. These side effects of drug therapy may cause an individual to stop treatment resulting in a relapse of symptoms, therefore, drug therapy would be ineffective at reducing an individual’s addiction.
BEHAVIOURAL INTERVENTIONS, INCLUDING AVERSION THERAPY AND COVERT SENSITISATION
Aversion Therapy:
Aim: The idea of the therapy is to use the principles of classical conditioning in order to change the pleasurable association with the addictive substance/behaviour and replace it with an unpleasant association in a vivo experience.
How it works for nicotine addiction:
One specific technique used is ‘Rapid Smoking.’ Individuals will sit alone in a room taking a puff of a cigarette every 6 seconds. They will begin to feel nauseous and sick and start to associate this feeling to smoking (principles of CC). This is repeated until the individual develops an aversion to smoking, thus reducing their addiction.
How it works for gambling addiction:
Electric shocks have been used for some behavioural addictions such as gambling. The shocks used do not cause permanent damage, but they are meant to avert people from gambling and therefore do cause pain. The addicted gambler thinks of phrases that relate to his or her gambling behaviour and write them down on cards, for example ‘lottery’, ‘casino’. Some non-gambling behaviours are also included e.g. ‘went straight home’. The participant is asked to read out each card and when they get to a gambling related phrase they are given a two second electric shock. The participant should then associate (classical conditioning) gambling with the painful shock, rather than pleasure and develop an aversion to gambling, reducing their addiction.
Aversion Therapy: alcohol addiction (NOT ESSAY)
A client is given an aversive drug such as disulfiram.
This interferes with the bodily process of metabolising alcohol into harmless chemicals. This means a person who drinks alcohol whilst taking disulfiram will experience severe nausea and vomiting.
The aim of this is for the individual to associate the alcohol with the nausea and develop an aversion to drinking alcohol as it would cause a conditioned response of nausea, reducing their addiction
Covert Sensitisation
Aim: The idea of the therapy is that the pleasurable association with the addictive substance/behaviour has to be broken down and replaced with an unpleasant association in a vitro experience.
How it works for nicotine addiction:
Client is encouraged to relax.
Therapist then reads from a script asking the client to imagine an aversive situation. For example, the client may imagine himself or herself smoking a cigarette followed by the most unpleasant consequences e.g. the experience of vomiting, or imagine themselves smoking a cigarette covered in faeces. The more vivid the imaginary scene is the better the treatment works. Therefore, the therapist will go into graphic detail about certain elements of the scene (smells, sounds, physical movements).
Towards the end of the session, the client imagines turning their back on the addiction and experience the resulting feelings of relief.
The participant should then associate the addiction with the unpleasant scenario, rather than pleasure, reducing their addiction.
Reducing Addiction – Behavioural Interventions AO3
McConaghy et al (1983) carried out research to support the effectiveness of behavioural interventions at reducing gambling addiction. They compared electric shock aversion therapy with covert sensitisation in treating gambling addiction. It was found that in a one year follow up; those who had received covert sensitisation were significantly more likely to have reduced their gambling activities. Therefore, suggesting covert sensitisation is more effective behavioural intervention for treating gambling addiction compared to aversion therapy.
Moreover, some may question how ethical aversion therapy is as a method of reducing addiction. It is thought that aversion therapy such as rapid smoking, electric shock therapy and Antabuse could cause physical and/or psychological harm such as making the person physically sick or giving them electric shocks. For this reason, covert sensitisation may be more appropriate as the therapy is carried out in a vitro (imaginary) experience, potentially reducing any physical or psychological harm, suggesting covert sensitisation may be more appropriate than aversion therapy at reducing addiction.
However, aversion therapy could be considered as ethical, this is because addiction to drugs and gambling is itself potentially dangerous to physical and psychological health where as aversion therapy is less dangerous. Individuals would be fully informed of what the therapy entails and they could give consent, moreover in electric shock aversion therapy individuals’ chose the intensity of the shocks so that they may be painful but they are not life threatening.
Cognitive Behaviour Therapy
Aim: To identify and challenge cognitive distortions that are causing an addiction as a way of coping and replace with more adaptive ways of thinking via cognitive restructuring.
COGNITIVE:
1. The first stage is functional analysis - A therapist will ask the client to identify the high-risk situations/triggers to their addiction e.g. walking past a betting shop, and ask them to report what they are thinking before, during and after the addiction. The relationship between the client-therapist is critical, it should be warm and responsive, but not cosy. This is because the therapist must challenge the client’s biased cognitions and not merely accept them.
- Cognitive restructuring: After analysis, cognitive restructuring (disputing) is used to change irrational/maladaptive thoughts to rational/adaptive ones. For example, if a person had an addiction to gambling, they may have irrational beliefs that they win more than they lose (selective recall), this could be challenged via empirical disputing for example, the therapist could ask ‘where is the evidence that you win more than you lose?’
BEHAVIOURAL:
3. Social Skills: Moreover, the addicted person will be taught social skills, for example an individual will learn how to refuse the addictive behaviour (gambling) or substance without embarrassment and fuss in social situations. This is done by the therapist teaching the patient how to act within a social situation, for example making eye contact and being firm in the refusal to gamble, in a safe and secure environment (role play). Moreover, the client would be taught avoidance strategies, where the client would learn to avoid situations that are likely to produce addictive behaviours (high risk situations identified in functional analysis) i.e. driving a different way home to avoid driving past a betting shop.
- Homework: The patient practices these social skills within the real world on their own and reports back to their therapist until they feel confident within social situations, where their addictive behaviour/substance is available. This leads to relapse prevention.
CBT AO3
Research to support the effectiveness of CBT in reducing gambling addiction was conducted by Perty et al (2006). They randomly allocated gamblers to a control group who received Gamblers Anonymous (GA) meetings or a treatment condition who received GA meetings and an eight-session CBT programme. It was found that the patients in the treatment condition were gambling significantly less than the control group of patients. Therefore, demonstrating the effectiveness of CBT in reducing addictions such as gambling by challenging distortions we can help reduce gambling.
However, a limitation of CBT in reducing addiction is that for some it may not be as effective as it require motivation from the patient. This is because the patient has to commit to a number of CBT sessions over months; they would have to challenge their irrational thoughts that are causing their addiction and would also be set homework to complete outside of the sessions such as avoidance strategies. This is unlike drug therapy where a patient just has to take a tablet or wear a nicotine patch/have nicotine gum to reduce their addiction. Therefore, CBT may be seen as a less appropriate treatment for reducing addiction than others such as drug therapy as patients may drop out of treatment and therefore relapse.
A strength of CBT as a way of reducing addiction is that it avoids chemical dependence. This is because the patients are taught the skills to identify and challenges their own cognitive distortions which are causing their addiction e.g. feeling they cannot cope without the substance/behaviour and so are taking control of their own addiction. This is unlike drug therapy where the patient is dependent on the drugs to control their addiction by regulating their levels of nicotine/dopamine. Therefore, it could be argues that CBT is a more appropriate way to reduce addiction as patients do not become dependent on a drug.
THE THEORY OF PLANNED BEHAVIOUR
TPB argues behaviour change is due to intention, but this is affected by three things.
ATTITUDES - If any individual has more negative attitudes towards their addiction than positive then they are less likely to intend to do to the addictive behaviour e.g. gamble, less likely to actually gamble and therefore more likely to change their addictive behaviour. (behaviour change by making people aware of risks of addictive behaviour)
SUBJECTIVE NORMS – if an addicted person believes that the people who matter most to them disapprove of the addictive behaviour then this would make them less likely to intend to engage in the addictive behaviour and therefore less likely to actually gamble/smoke and more likely to change their addictive behaviour. (behaviour change by national campaigns to educate people on addictive behaviour)
CONTROL – how much control a person feels they have over their own behaviour and ability to change influences their intention. This is based on:
* Internal factors e.g. how determined they are
* External factors e.g. support and time
* Past experience e.g. if they have successfully given up before
(behaviour change by improving social skills- just say no-, positive self talk)
This is the most important part of the model as without the control person is still vulnerable to addiction.
The theory of planned behaviour AO3
Research to support the theory of planned behaviour comes from Haggar et al (2011). They asked 486 ppts to complete questionnaires about their alcohol-related behaviours at the start of the research and then one and three months later. They found that personal attitudes and subjective norms correlated significantly with the intention to limit drinking to match guidelines. Perceived control predicted actual unit consumption. increasing its validity in explaining behaviour change in addiction. This supports the TPB as the three components interact to effect an individual’s intention to stop.
However, a problem with much of the research into TPB is that they rely on questionnaires which are prone to social desirability. Individual’s may lie about their intentions towards their addiction in order to present themselves in the best possible light. For example, they may say they intend to drink within guidelines to avoid being judged. Therefore, this reduces the validity of the research supporting TPB of behaviour change.
A strength of TPB is that it has led to practical applications. This is because the principles of TPB can be used to predict who therapy is most likely to be successful for example, if person missing one of the components e.g. attitudes they will not have intention to change and so will not be offered therapy. This will help the NHS prioritise their limited resources on individuals with high intention to change and reducing waiting times for therapy. Therefore, TPB is an important area of applied psychology.
PROCHASKA’S SIX STAGE MODEL OF BEHAVIOUR CHANGE
It is a cyclic model that takes a positive approach to addiction, where it explains where a person is in terms of behaviour change and which intervention to use.
Relapse is not failure but just a part of the process, simply return to early stage
six stages:
1. Pre-contemplation:
Individual does not consider themselves as having a problem. This could be due to denial or demotivation. Focuses on helping the addict to consider the need for change.
- Contemplation:
Individual is now thinking about changing their behaviour Drug treatment at this stage would not be helpful. Ways of helping the individual understand the pros of overcoming the addiction outweighs the costs. - Preparation:
They decide to change within the next month but maybe not exactly what they will do to change. The most useful form of intervention is support in constructing a plan e.g. making a GP appointment - Action:
This is when the plan is put into action. Developing coping strategies and maintain their change of behaviour. - Maintenance:
The individual has maintained some change of behaviour for more than six months. Applying the coping strategies to them to prevent relapse - Termination:
Abstinence become automatic. They are confident in their ability to resist the behaviour. No intervention is required.
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name 2/3 stages - explain-intervention
-contemplation, maintenance + 1
PROCHASKA’S SIX STAGE MODEL OF BEHAVIOUR CHANGE AO3
However, Prochaska’s six-stage model of behaviour change has been criticised as some argue that the stages of change are not well differentiated. Pa Kraft et al (1999) argue that the six-stages can be reduced to just two useful stages, pre contemplation plus the others grouped together, as the person is thinking about change in all of these later stages but not in the first. This has important implications as each stage in Prochaska’s model is matched with a specific intervention. Therefore, this could limit Prochaska’s usefulness as a model of behaviour change and for treatment recommendations.
However, Prochaska’s six-stage model of behaviour change can be praised because it takes a positive view of of relapse. The six stage model does not view relapse as a failure, but as an inevitable part of the dynamic, un-linear process of behaviour change. Although, relapse is more than a ‘slip’ the model takes it seriously and does not underestimate its potential to knock an addict off the course of recovery. This means the six stage model of behaviour change is more acceptable as a result of its positive outlook on relapse.
Finally, much of the research in to Prochaska’s six-stage model is based on self-report methods (questionnaire and interviews) which could lead to social desirability. Prochaska based this model on nicotine addicts and the changes in their thinking when giving up, they could have lied about how logical their thought processes were when giving up to present themselves in the best possible light. Therefore, this reduces the internal validity of the research into Prochaska’s six-stage model of behaviour change.
