Addiction

Question 1

NHS definition for addiction

Answer 1

Not having control over doing, using or taking something to point it can harmful for you

Question 2

Who created criteria for addiction, how many need to be met

Answer 2

Mark Griffiths, all 6

Question 3

All 6 criteria :

Answer 3

(State examples too)
Tolerance - As individual continues to engage in behaviour, need more more of their chosen drug or behaviour to achieve same desired effects (gambler increases bets to get buzz)

Mood modification - As individual engages in behaviour, they achieve a temporary buzz or high but could also be an escape during depression. It is short lived so behaviour repeated frequently

Conflict - Addicts often experience breakdown in relationships with friends, family or compromising job, neglecting other activities that provide pleasure, also may experience personal struggle

Relapse - Addicts will continue to have a strong desire to return to the addictive behaviour, even after years of not engaging in it (smoker accepts a cigarette after long period of abstinence)

Withdrawal Symptoms - If behaviour is stopped or substance abstained from individual, they will experience uncomfortable side effects. Physical (nausea, headaches), psychological (inability to concentrate, irritation)

Salience- Activity becomes most important thing in the individual’s life, dominates their thoughts, feelings and behaviour. (First thing cocaine addict may think when waking up is to take a hit)

All 6 need to be met to be classified as addict

Question 4

Dopamine Hypothesis (BIOLOGICAL 1)

Answer 4

• Addictive behaviours and substances trigger release of dopamine
• Normal behaviours like eating, sex also trigger release of dopamine, making pleasurable experience, drug taking has same effect
• Mesolimbic pathway starts from VTA to the Nucleus Accumbens, associated with rewards sensation
• Mesocortical responsible for creating long lasting memories of drug, VTA to Frontal Cortex
• Crack cocaine causes rapid activation of dopamine receptors in mesolimbic pathway
• Heroin and cannabis work by mimicking natural neurotransmitters, bind to opiate and cannabinoid receptors.
• Incentive Sensitisation theory suggests continued exposure to drugs of abuse can lead to increased sensitivity of the brain to desirability
• Eventually leads to reduced activity of positive reward circuits through process called downregulation.
• Leads to chronic stress state as individual gets no pleasure from drug, as a result increases usage to achieve reward system making them tolerant
• Desire for drugs becomes most important to them as long lasting memories created from the drug, increases risks of relpase

Question 5

Strengths of Dopamine Hypothesis

Answer 5

• practical applications, botswick and bucci, man addicted to sex and strong appetite for porn and sexual gratification , treated with naltrexone which blocks release of dopamine associated with sexual activity, psychosexual functioning restored, drug therapies related to dopamine improves lives.
• supportive evidence, volkow et al, Ritalin given to group of adult volunteers, gently lifts dopamine levels, some people loved the feeling, others hated it, scans from brain showed that those who liked had fewer dopamine receptors than those who hated the feeling, explains why some develop addiction when experimenting with drug, idiographic

Question 6

Weaknesses of Dopamine Hypothesis

Answer 6

• Evidence to support that dopamine levels are not always raised. Stokes et Al found no significant difference in levels of dopamine in volunteers taking cannabis, Yoder et Al, found no consistent dopamaine increase in those taking alcohol. Suggests hypothesis must be approached with caution before suggesting all addictions attributed to dopamine
• Suggested that hypothesis is too simplistic when discussing role of dopamine. Bell suggests that it is “fashionable” to blame dopamine for range of problems Kim Kardashian of neurotransmitters, other factors not recognised such as avoiding unpleasant stimuli, dopamine levels raised war veterans who have PTSD who were reminded of combat, suggests role of dopamine not fully explained as to what triggers it.

Question 7

Biological Method Of Modifying

Answer 7

• Addictions are thought to arise due to activity in mesolimbic pathway. Activation of this part provides a sensation of reward.
• Any treatment for addiction might target this pathway, altering dopamine production
• Agonist substitutes (methadone) work by mimicking the action of dopamine so withdrawal symptoms can be managed.
• Individuals drug swapped with methadone which is safer until weaned off, not requiring both
• Antagonists block the action of dopamine by binding to, but not stimulating dopamine receptors, therefore unable to access making activity unpleasurable (naltrexone)

Question 8

Genes hypothesis (BIOLOGICAL 2)

Answer 8

• Useful in explaining why not everyone becomes an addict
• Goldman et Al concluded addictions are moderately to highly inheritable, +0.39 for hallucinogens, +0.72 for cocaine
• Many studies highlight role of D2 dopamine receptor gene like Noble et Al, found A1 variant present in more than 2/3 deceased alcoholics. Blum et al found increased prevalence of A1 variant in children born to alcoholics
• Individuals with A1 variant appear to have significantly lower dopamine receptors in brains pleasure centres
• Therefore people with A1 variant more likely to develop drug addiction or engage in “feel good activities”
• Diathesis Stress Model suggests interaction between genes and environment may cause addiction. predisposition makes it more likely to be prone to addiction when combined with right environmental factors

Question 9

Strength of gene hypothesis

Answer 9

• Supportive evidence, Kendler and Prescott interviewed 2000 twins, found genetic factor played most crucial role in addiction compared to environment and social factors, concordance rate for cocaine initiation in MZ was 54%, DZ was 42%. For dependence, 32% in MZ (identical) and 0% in DZ (non identical), suggests crucial role of genetics in addiction.

Question 10

Weakness of gene hypothesis

Answer 10

• Problems with prominent proposals, Comings et Al found A1 variant occurred in people with several disorders, autism and tourettes as often as it appeared in alcoholics, 45% in tourettes and 25% of controls. Creates problem that dopamine receptor gene is a “reward gene” as people with those conditions not thought to be pleasure seeking, so explanation limited

Question 11

Cognitive Biases (INDIVIDUAL 1)

Answer 11

• Khaneman and Tversky proposed humans have a particular way of approaching decision making, strategies known as heuristics
• These are mental shortcuts used to solve problems or make decisions, although useful, can lead to illogical decisions
• Two heuristics that are tend to be used especially within gambling addiction are representativity and availability biases.
• Representativeness is belief random events have a pattern. Example of where this a problem is gamblers fallacy, belief something happens more frequently than normal, it will happen less frequently in future.
• Famous case of Monte Carlo wheel applies this, run of black 26 times in succession, people believe red was due so rush to bet on red led to loads of people losing money. Gamblers may believe they are owed or due a win when adopting this style.
• Availability works on principle that event is more likely if easier to recall from memory. People make decisions based on how often they hear about something or how available information is rather than chance
• In case of gambling, pattern may encourage people to engage and continue behaviour in false belief they are likely to win.
• Casinos pack slots closely together so when people hear sound of coins rolling people winning, they think they have better chance of winning.
• Illusion of control is idea that you have control over random events ( people picking own lottery numbers)
• Hindsight bias is tendency to view events as more predictable than they really are after outcome of event.

Question 12

Strength of Cognitive Biases

Answer 12

Supportive evidence, griffiths compared verbalisations of 30 regular gamblers to 30 non regulars when using a fruit machine. regulars more likely to use irrational verbalisations than non regular (14% to 2.5). Verbalisations showed examples of two biases representativeness and availability, increases validity of research

Question 13

Weakness of Cognitive Biases

Answer 13

• Lack of applicability and predictability with cognitive biases model, cant predict what happens under certain circumstances. Griffiths evidence showed media reported no13 came up fewer times than any other number, those who used represntativeness pick 13 and those who used availabilty dont. Demonstrates lack of predictive power in this explanation of behaviour.
• Weakness is evryone tends to display these biases and patterns found in gamblers. Explanation needed as to why biases lead to addiction for some and not for others. Baboushkin suggests heuristics are useful for everyday situations, not for chance events. Limited explanatory power with cognitive biases model.
• Issues with research produced, cognitive biases requires self report, creates problems. Researchers have to decide what biases are shown, can lead to researcher bias, questionnaires by gamblers can lead to social desirability bias and demand characteristics, weakens validity

Question 14

Indiv Differences method of modifying

Answer 14

• Cognitive biases could be managed via cognitive restructuring, clients taught to appreciate thought they have while gambling are irrational
• Griffiths (1994) suggests verbalisations he asked gamblers to make could be played back to help them see irrational natures of thoughts. tried on small scale of his pps and regular gamblers surprised at what they heard, suggesting its useful in overcoming problems
• Fortune and Goodie report some studies have used these ideas as broad part of CBT while others focus on biases. Both shown success in treating gambling addiction so suggests that cognitions contribute to these problems.

Question 15

Personality (INDIVIDUAL 2)

Answer 15

• Eysenck suggested a resource model of where addiction develops as it fulfills a need relating to a persons personality
• Psychoticism is a personality pattern typified by aggressiveness and hostility. High levels linked to increased vulnerability to psychosis such as schizophrenia.
• Addicts when compared to control group showed high levels of psychoticism, one trait synonymous with it is impulsivity, often acting without thinking.
• Stevens et Al found impulsive individuals were less successful in their treatment programmes as more likely to drop out.
• Neuroticism is a trait that may link to addictive behaviours. People with high levels of this more likely to experience anxiety or depression, may self medicate with drugs, alcohol, tobacco
• Sinha highlighted role stress plays in initiation of an addiction, neurotic individuals more prone to stress and anxiety, leading turn to addictive behaviour
• Another characteristic is low self-esteem, Taylor et al found those with low self-esteem at age 11 were at higher risk for addiction in their 20s

Question 16

Strength of Eysencks personality

Answer 16

Prospective studies support addictive personality idea, Dong et al studies Chinese University students. Eysencks personality questionnaire was given to them before they started uni, two years later rates of internet addiction measured. Researchers found those scoring high on neuroticism and psychoticism more likely to show pathological internet usage. Therefore some validity in proposals.

Question 17

Weakness of Eysencks personality

Answer 17

Difficulty in establishing cause and effect, is low self esteem a cause or effect of addiction, does it lead to internet addiction or does internet addiction lead to social isolation and low self-esteem, must be cautious before suggesting certain traits cause addictive behaviour.

Question 18

Peer influences (Social psychological 1)

Answer 18

• Peer influences can be applied when discussing reasons people may engage in addictive behaviours
• Research suggests among adolescents, smokers tend to befriend smokers and non-smokers tend to befriend non-smokers (Eiser et al). Smoking seen as activity that promotes popularity
• Albert Bandura proposed that we can learn through observation and initiation of others. In order for learning to take place, the individual needs to be motivated by two key processes
• 1. Observing a role model, someone an individual identifies with
  2. Vicarious reinforcement, if behaviour is rewarding its repeated
• When social learning theory is applied to addiction, an individual may see their friend smoking which may be people they look up to (role model) and they may be rewarded through higher social status and they are enjoying it (vicarious reinforcement)
• This results in the individual imitating the behaviour. Once they start, experiences with the behaviour determine whether it persists
• Social norms are rules of behaviour that are considered acceptable within a particular social groups, there are two types.
• Descriptive norms are an individual’s perception of how much others engage in behaviours. Injunctive norms are what individuals perceive as others approval of the behaviour
• Perkins and Berkowitz found high proportion of students they surveyed believed intoxication was only acceptable in limited circumstances, however high proportion thought peers believed it was acceptable. They may see no need to reduce their behaviour as they think others are doing it more.

Question 19

Strengths of peer influences

Answer 19

• Strength is supportive evidence, Simmons-Morton and Farhart reviewed findings of 40 prospective studies into relationships between peers and smoking, found all but one showed correlation between the two. Therefore supports the link between behaviour of peers and engagement in addictive behaviours, therefore high levels of validity
• Clayton and Neighbours et al found number of factors related to alcohol consumption, found descriptive and injunctive norms were best predictor of alcohol consumption among US college students. However perceived social norms not effective at determining alcohol problems. Therefore although peers may influence individuals to engage in activity, other factors link to long term consequences.

Question 20

Weaknesses of peer influences

Answer 20

• Maintain caution with research in this area as key problem is determining whether peers influence individuals to engage in behaviour or individual chooses friend because they are also engage in behaviour. Likely that these two interact with each other. Demonstrates peer influences may not be only factor that determines addiction
• Another limitation is contradictory evidence, other evidence suggest that experimenting with drugs while alone is key factor in developing addiction. Recent work suggests that role of peers may have been overemphasised. This suggests more research needed as currently appears to be no correct answer for influence of peers

Question 21

SOCIAL Method of Modifying

Answer 21

Peer Influence/Social Norms marketing

• Perceptions of social norms among peer groups can have an effect on an individuals behaviour.
• If overestimation of social norms lead to students consuming more alcohol, then it may be possible to design interventions to correct such perceptions
• One approach is Social Norms Marketing Advertising, aims to alter students perceptions of peers drinking habits through use of mass media
• The adverts focus on providing info about how much students typically drink. The hope is that by giving accurate information it will help combat overestimation of social norms
• A trial in welsh unis by Moore et al used beer mats, leaflets containing phrases like “Those around you are drinking less than you think , Students overestimate what others drink by over 44% etc. Follow up surveys found that those who recalled the materials reported lower percieved norms than those who didnt.

Question 22

Role of Media (SOCIAL 2)

Answer 22

• Media has important role in shaping and reflecting human behaviours such as smoking, gambling, drinking
• Same theory applied to peer influence SLT, people continue to learn through observation and imitation of actors, celebrities who are role models
• Vicarious reinforcement would be seen if individual were to portray certain addictive behaviours as being glamorous
• Number of studies such as Lyons et al indicate portrayal of potential addictive behaviours is common in TV and film. Alcohol use portrayed in 86% of popular UK films and 40% of TV programmes
• Gunasekera et al reviewed 87 of most popular films in last 20 years for portray of sex and drug usage. Cannabis films (8%) other non injected drugs (7%), alcohol intoxication (32%), tobacco use (68%), tend to show use of drug positively, of 53 episodes of sex only 1 refer to condom use.
• Although various studies document portrayal of addictions in media, very few assessed whether such representations have an effect on viewer
• Sargent and Hanewinkel tested whether adolescents exposure to smoking in movies influenced their initiation into smoking. Found that in individuals who had not smoked when first surveyed, exposure to movie smoking over intervening year was strong predictor of whether they began to smoke.

Question 23

Strength of Role of Media

Answer 23

Research evidence available, harder to argue against, Chapman and Fitzgerald found that under age smokers preffered heavily advertised brands, Atkin et al found higher levels of advertisement were more likely to approve of underage drinking, strength as high in validity, media has significant effect

Question 24

Weakness of Role of Media

Answer 24

Alternative perspective, contrary to claims addiction is portrayed glamourously, Boyd argues films frequently display negatives (alcohol/drug dependence). Illegal drug use depicted by physical deterioration, Suggests various outlets of media take influence of addiction seriously.

Question 25

Method of Modifying 1
AGONIST AND ANTAGONIST SUBSTITUTES

Answer 25

• Agonist and Antagonist substitutes are derived from a biological explanation of addiction, whereby suffering created by the addiction is relieved by altering physiological mechanisms of body
• Agonist substitutes work by mimicking the action of another drug, they bind to receptor sites and cause a response
• Methadone is an example of an agonist substitute, given to addicts in order to mimic action of heroin in body, reduce cravings and withdrawal. It provides many same effects of heroin but to lesser degree. Idea is methadone dosage will be gradually reduced overtime, until user requires neither heroin or methadone
• NICE guidelines in UK suggest initial does between 10-40mg which increases by 10mg daily until no signs of withdrawal. Individual reaches maintenance dose between 60-120mg.
• Given orally in green liquid form, helps to prevent other issues associated with heroin addiction such as needle sharing and disease transmission
• Recommended that methadone given under supervision for first 3 months so dosage can be checked. Methadone should be offered alongside other psychosocial support
• Antagonist substitutes have blocking effect. They bind to, but do not simulate, receptor sites to prevent other substances from gaining access and having their action.
• Naltrexone is an antagonist substitute used in alcohol, opioid, gambling treatment. In preventing dopamine from accessing receptor sites, any pleasurable effects of addiction are stopped, making unenjoyable.
• NICE recommends that Naltrexone should be used by those who have already demonstrated some ability to abstain from addiction and are highly motivated. Should be offered alongside psychological intervention, can be used up to 6 month period.

Question 26

Effectiveness of Agonist and Antagonist

Answer 26

Strength

• Methadone, NICE assessed 31 reviews including 27 randomised controlled trials, They found higher levels of retention and lower rates of heroin use for people prescribed methadone than placebo or no treatment.

Weakness

• Naltrexone, NICE reviewed 17 studies and found conflicting results for naltrexone in the treatment of heroin addiction, no significant difference between naltrexone and a control treatment. However there was a reduction in relapse rates for those who who were highly motivated and offered additional support.

Question 27

Ethical implication of Agonist and Antagonist

Answer 27

Weakness

Unethical nature of Methadone as methadone based treatments involve the treatment of an addiction with an addiction. It is argued that this form of therapy does not put the needs of the patient first and does not directly address the situation. An addict could be prescribed methadone over many years. Office for national statistics report 429 people dies from methadone addictions alone in 2013.

Question 28

Social implication Agonist and Antagonist substitutes

Answer 28

Strength

Methadone and crime rates, National statistics treatment agency suggests that treating heroin users with methadone has an immediate positive effect on society by reducing criminality. Rates of reoffending are reduced by half when addicts are in treatment. However, there is concern that setting up methadone treatment programmes in a particular area allows addicts to convene in one place, could lead to increased crime and antisocial behaviour in locality.

Question 29

Method of Modifying 2
Aversion therapy

Answer 29

• Based on the principles of classical conditioning where addict associates negative feelings of disgust with addictive drug or activity
• Antabuse is an example of aversion based therapy used in alcohol addiction treatment, works by preventing metabolism of alcohol, can create unpleasant symptoms
• Antabuse is the UCS, leads to sickness, vomiting which is UCR. If individual was to consume alcohol NS, while taking Antabuse UCS, the addict experiences vomiting. Addicting will learn that the alcohol CS, leads to unpleasant symptoms CR
• Within 10 mins of alcohol consumption, addict can expect symptoms like sweating, heart palpitations, headaches, vomiting. Hoped that one association created, individual would avoid consumption and avoid triggers (pubs)
• NICE recommends that Antabuse be given a 200mg dose daily following withdrawal, drug can be increased if reaction to alcohol not aversive enough. Individual should be supervised for 6 months
• People taking medication will be careful not to ingest alcohol from other sources (mouthwash) or food that contains sufficient alcohol to instigate reaction
• Rapid smoking is other example of aversion based treatment for heavy smokers. Smokers sit in enclosed room and take puff of cigarette every 6 seconds until they finish specific number of cigs or until they feel sick
• Intensive smoking UCS, feelings of nausea UCR, cigs NS, when paired with UCS, creates side effects CR
• The idea is that individual will associate feelings of disgust with smoking until aversion develops
• Therapy may be repeated over a number of sessions in order to increase strength of aversion . This treatment used infrequently today due to development of other successful therapies which ate less distressing for patients

Question 30

Effectiveness Aversion therapy

Answer 30

Weakness

Ellis suggests Antabuse trials lack scientific rigour due to being short term and not applying full randomised control trials. There are also few comparison studies between Antabuse and other methods of treating alcoholism

Strength

McRobbie considered 100 smokers treated with rapid smoking compared to a control group who watched a video about smoking. The rapid smoking group showed a significant decrease in their urge to smoke in the 24 hours and week after the procedure. However, at 4 week, this difference in urge to smoke between the two groups were no longer significant, only had short term impact

Question 31

Ethical implication aversion therapy

Answer 31

Weakness

Both Antabuse and rapid smoking are going to involve a level of distress and discomfort for the addict. The negative effects experienced whilst undergoing treatment will be extremely unpleasant, however, this is how the therapy is designed to work. It is therefore essential that full informed consent is sought prior to treatment.

Question 32

Social implications of aversion therapy

Answer 32

Weakness

There are concerns over financial implications about dramatic in crease on spending in addiction treatment, Antabuse and other drugs used for addiction. NHS spent £2.25 million on Antabuse in 2008. However, some would argue that not to invest in treatment of addiction would be catastrophic as alcohol abuse costs taxpayer £21 billion a year. For example, addiction can lead to unemployment and claiming of benefits as well as breakdown of families, homelessnesses, crime