addiction Flashcards
outline and evaluate explanations of nicotine addiction in terms of brain neurochemistry and the role of dopamine AO1
initiation: nicotine enters brain, binds to neurons in VTA
-neurons trigger release of dopamine in nucleus accumbens
- effects PFC (decision making) explaining why addicts might choose short-term benefits (smoking) over long-term
- release of dopamine produces reward & pleasure - pleasure & drive to repeat process that leads to addiction
maintenance - goes without nicotine (e.g., sleep) > metabolised
- acute withdrawal syndrome as nicotine receptors (nAChRs) are available but not stimulated > another cig
- chronic desensitisation (repetitive) > increase nicotine intake for same effect (tolerance)
- explains how addiction is maintained as smoker now has a cig to avoid withdrawal & feel normal
outline and evaluate explanations of nicotine addiction in terms of brain neurochemistry and the role of dopamine AO3
+ McEvoy studied smoking in schiz patients taking haloperidol (dopamine antagonist) - form of self-medication & attempt to achieve nicotine hit by increasing dopamine release > reinforces importance of dopamine reward system in nicotine addiction
+ practical applications (NRT patches/inhalers developed to overcome - controlled nicotine, manage withdrawal whilst activating dopamine reward pathway) > neurochemical explanations of addiction helped society through development of treatments, increasing validity
- too simplistic (one neurotransmitter system) - research complex interaction of several systems (GABA & serotonin pathways) involved > although dopamine central to addiction, need to assess how other neurotransmitters involved
- bio reductionist Choi (50% experimented became dependent + most adolescents dependent > peers who smoker/underachieving ) > argued crucial env & psych factors (peer pressure) in danger of being ignored by focusing on brain neurochem to explain addiction
outline and evaluate explanations of nicotine addiction in terms of learning theory and cue reactivity AO1
pos rein & initiation (consequence of behaviour rewarding > repeat)
- nicotine = powerful reinforcer due to physiological effect on dopamine reward system in mesolimbic pathway
- nicotine > release of dopamine in nucleus accumbens > euphoria
neg rein & maintenance (sustains from cig > withdrawal) - symptoms such as disturbed sleep patterns
- so, addiction maintained as smoking another cig neg rein as it stops unpleasant stimulus (withdrawal)
cue reactivity (smoking primary rein as rewarding on own)
- stimuli present associated w/pleasure of smoking (CC together - sec rein)
- refers to associations made between cues in env & smoking (self-reporting desire & physio changes)
- enters env/faced w/object associated w/nicotine > vulnerable to relapse due to craving
outline and evaluate explanations of nicotine addiction in terms of learning theory and cue reactivity AO3
+ carter & Tiffany meta-analysis incl. measures of self-reporting craving & physiological arousal in addicts & non-addicts following exposure of smoking cues (lighters) (addicts reacted more strongly to cues > cue reactivity does lead to craving cig plays a vital part in maintenance
+ practical applications - aversion therapy counter-conditioning by associating smoking w/aversion therapy (smith 52% received shocks, abstained after year) > effective applications of learning theory have measurable & sig practical benefits in terms of reducing NHS spending & improving health
- beta biased - Carpenter (women less successful at quitting smoking due to greater sensitivity to smoking-related cues & lowered confidence in ability to give up smoking, undermines attempts) > LT suggests CR is same across genders, weakening usefulness in explaining
- env determinist - pos rein is strong explanation, many adolescents smoke but few dependent > causations other than rein history which influences smoking > addiction, weakening usefulness
outline and evaluate drug therapies for reducing addiction AO1
aversives: pair behaviour w/unpleasant consequences e.g., vomiting (CC)
agonists: drug substitutes
- bind to neuron receptors & activate them
- produces similar effect to addictive drug & controls withdrawal effects
antagonists: block effects of drug (bind to receptor sites & block them)
- drug of dependence cannot produce its usual addictive effects
for nicotine: NRT (gradual release of nicotine into blood at lower levels than in cig
- controlled dose of nic, binds to NaChRs in brain > release of dopamine in nucleus accumbens > hedonic response
- gum, patches or inhalers to control cravings, improve mood & prevent relapse
-amount of nic can be reduced over time using smaller patches/ e-cig over time
outline and evaluate drug therapies for reducing addiction AO3
+ stead et al - NRT more effective than placebo/none (NRT 70% more likely to abstain from smoking after 6 months) > drug therapies useful in reducing addiction
- side effects - sleep disturbance, dizziness + headaches (naltrexone for gambling, risk patient will discontinue therapy) > risk of side effects should be carefully weighed against benefits of drug therapy & psychological therapies e.g., covert sensitisation
+ positive ethical implications - minimises harm to addicted individual by suggesting addiction has a neurochemical/genetic basis (changing view addiction is psychological/moral failure > reduced stigma) > strength as may encourage addicts to seek treatment
- don’t consider individual differences - don’t work in same way for everyone, genetic variations (Chung, alcoholics w/1 gene variant respond better to naltrexone) > drug treatments need to be tailored to individual genetic profiles if they are to be more effective
outline and evaluate behavioural interventions in reducing addiction AO1
learning theory - addiction (repeated presentations between addictive activity & pleasure) > behavioural therapy used (counterconditioning)
aversion therapy - CC
- 2 stimuli presented together > associated
- addictive behaviour associated w/aversive outcome
- based on idea aversive outcome has higher contiguity & overpowers reward addiction produces
- behaviour & addiction extinguished
covert sensitisation (type of AT)
- based on CC (frequently presented together > associated
- in-vitro (asked to imagine how it feels)
- asked to relax (relaxation techniques e.g., deep breathing)
- instructs client to imagine aversive situation (more vivid = better)
outline and evaluate behavioural interventions in reducing addiction AO3
+ (aversion therapies) Smith & Frawley - 600 ppts being treated w/aversion therapy for alc (12 months, 65% resisting alc) > effective over long periods of time
+ (CS) McConaghy compared aversion therapy to CS in treating gambling (1 yr follow up, CS more likely to reduced gambling (90%) compared to aversion (30%), fewer + less intense gambling cravings) > CS more effective at reducing gambling addiction than aversion
- (AT) serious ethical issues - psychological &physical harm (AT uncomfortable consequences e.g., nause + CS demands patient to imagine shameful situations) > poor compliance & high dropout rates, decrease usefulness
- (AT) methodological problems - review of 25 studies of AT for nicotine (blind procedures not used so researchers who evaluated outcomes knew which received therapy/placebo) > inbuilt bias made appear more effective > results need to be treated w/caution
outline and evaluate CBT in reducing addiction AO1
addiction maintained by thoughts ab behaviours
- help people change the way they think & learn new ways of coping w/circumstances
- identify triggers to problem, challenge IT & find better ways to cope w/feelings
early sessions: identify patient beliefs
- aware of cognitive biases which they base decisions on
- therapists educate clients ab nature of CB & gambling outcome due to change (ABCDEF)
- logical, empirical, pragmatic
behavioural techniques:
- assertiveness training (confront situations that cause stress/unpleasantness in rational way e.g., visiting casino)
- SS training (deal w/anxiety in SS, help client refuse alcohol to avoid embarrassment, may role model coping strategies before trial)
outline and evaluate CBT in reducing addiction AO3
+ Petry recruited gamblers & allocated to control (GA meetings) or treatment (GA + 8 CBT) - treatment group less gambling up to 12 months after > CBT effective at reducing gambling addiction for up to 12 months
- Cowlishaw CBT has definite beneficial effects for up to 3 months but after 9-12 months, no sig diff between CBT & control > not effective treatment after 3 months
- lack of treatment adherence, Cuijpers CBT drop out rates 5x more than other therapy (commitment to HW tasks also reduced over time) > CBT not effective long-term strategy as clients see it as too challenging
+ relapse prevention as incorporates likelihood of relapse into treatment, viewing it as further opportunity to recognise + challenge beliefs (rather than failure, seen as inevitable part of life but acceptable as long as improvement continues) > CBT considers how to reduce addiction at multiple stages, great strength
discuss the application of the theory of planned behaviour as a model for behavioural change in preventing addiction AO1
Ajzen - cog theory about factors that lead to decision to engage in behaviour
- decision to engage can be directly predicted by intention to engage
personal attitudes - entire collection of addicts attitudes towards addiction
- overall attitude formed from weighing up balance of favourable v unfavourable attitudes
subjective norms - belief about whether people approve/disapprove
- ideas of normality based on key people
- others unhappy > less likely
- most influential = perception of whether people closet approve/dis
perceived behavioural control- how much we believe we have (self-efficacy)
- perception of resources (external & internal)
- can influence behaviour directly: greater= longer & harder will try to stop
- can influence intentions: stronger self-efficacy = stronger intention
discuss the application of the theory of planned behaviour as a model for behavioural change in preventing addiction AO3
+ Hagger found 3 TBP factors predicted intention to limit drinking + intentions influence alc consumption after 1 & 3 months (but not able to predict all behaviour) > can predict some addictive behaviours, success may depend on addiction being studied
- machine reductionist as suggests always make rational decisions when deciding to partake in addictive behaviour (e.g., presence of strong emotions might explain why people fail to carry out behaviour even when in best interest > decreases validity of TBP as oversimplifies process of behavioural change
- methodological issues w/ TBP as components of model assessed using questionnaires, influenced by social desirability bias (e.g., express interest in quitting as saying no plan may be embarrassing/shameful) > intentions expressed on questionnaires are poor predictors of actual behaviour
- may not predict behaviour change - Armitage & Conner (meta-analysis: TBP successful in predicting intention to stop rather than actual behavioural change) > weakens TBP as cannot specify processes involved in translating intention into action
discuss the application of Prochaska’s six-stage model as a model for behavioural change in preventing addiction AO1
model of behavioural change used to explain how people overcome addiction - 6 stages & not immediate jump to healthy but stages
- not a constant state & relapse can occur at any time
pre-contemplation: no change
- denial: don’t believe they have a problem & are convinced
- demotivated: can’t quit as have failed before
-intervention focuses on helping them see they need to consider change
contemplation: realise they have a problem & consider change
- not yet committed to change as aware of costs v benefits
- intervention focus on seeing pros outweigh cons & help reach decision
preparation: accepted addiction is a problem & seek change as believe benefits outweigh costs
- haven’t decided when/how but begin to make plans
- intervention focus on constructing plan
action: taken action towards changing behaviour & changes to lifestyle
- action must reduce risk to continuing
- intervention focus on coping skills needed to quit
maintenance: continued to follow lifestyle changes & committed to avoiding returning to previous ways
- growing confidence that changes can continue long-term
- intervention focus on relapse prevention by encouraging coping skills & use of resources
termination/relapse
- desired change in complete & new is normal or, not everyone achieves this & returns to earlier stages
- intervention not required as not possible/realistic to reach point
discuss the application of Prochaska’s six-stage model as a model for behavioural change in preventing addiction AO3
+ parker & Parikh interventions tailed to stages effective at reducing unhealthy behaviours compared to one size fits all > models ability to recognise different stages will require dif interventions benefits society > increasing validity
- Aveyard found tailoring interventions didn’t increase effectiveness in trying to quit smoking > decreases validity as suggests each stage should have diff intervention if it were successful
- culturally biased - Arabian smokers, 62% pre-contemplation, 14% in prep v US (40% pre, 20% prep) >model doesn’t consider lower readiness to quit may be due to cultural norms so shouldn’t be applied universally
+ pos attitude to relapse - Diclemente (relapse is rule not exception - not viewed as failure but norm part of addiction, shifting blame from addict) > great strength as increases self-esteem & motivation from addictive behaviour
outline and evaluate learning explanations of gambling addictions AO1
SLT (initiation) -vicarious rein (experience of seeing others rewarded for gambling (pleasure + financial) - doesn’t have to be direct > may be enough to trigger desire
OC (maintenance) - pos rein (direct gain)
- neg rein (distraction from aversive stimuli)
partial rein - some behaviours rein but not all so, continues to gamble as winning follows some bets but not all
- difficult to quit due to uncertainty of rein
- makes extinction less likely
variable rein - behaviour rein after unpredictable no. responses
- continues to gamble as may win after placing 2 bets but others not until 20
- winning occurs, unpredictable & uncertainty of pay-out keeps playing longer
- learn won’t win every time but eventually win if persist
- extinction least likely
CC - cue reactivity - individual experiences many secondary reinforcers they associate w/ arousal from gambling e.g., atmosphere
- cues maintain gambling & cause relapse after period
