addiction

Question 1

addiction

Question 2

psychological dependence

Answer 2

compulsion to continue taking a drug for increase in pleasure/reduction of discomfort

Question 3

physical dependence

Answer 3

when abstaining from a drug/behaviour results in withdrawal syndrome

Question 4

withdrawal syndrome

Answer 4

collection of symptoms associated w abstinence of drug/behaviour

• indicates physical dependence
• motivation for taking drug stems from avoidance of these symptoms

Question 5

tolerance

Answer 5

when individuals response to drug is reduced due to repeated exposure to drug so that greater doses are needed to produce the same effect

cross tolerance - when tolerance of 1 drug reduces effect of another
e.g. individual w tolerance to sleep-inducing effects of alcohol require higher doses of anaesthetic in surgery.

Question 6

risk factors
GENETIC VULNERABILITY

Answer 6

any inherited predisposition for increased risk of developing an addiction

2 direct denetic mechanisms involved:

dopamine

• communication of DA depends on presence of DA receptors in the brain
• there are different types of DA receptors
• e.g. D2 receptors
• abnomally low levels of which are associated w addiction
• proportion of D2 receptors in brain is genetically determined

enzymes

• responsible for metabolising substances
• e.g. CYP2A6 enzyme is responsible for metabolising nicotine
• Pianezzi et al found that some people lack this enzyme
• and smokers w/o this enzyme smoke significantly less than smokers w/ the functioning enzyme
• presence of CYP2A6 enzyme is genetically determined

✔ research support

• Kendler et al looked at adults who had been adopted away as children from biological families w at least 1 parent w an addiction
• found that these people had a significantly greater risk of developing an addiction (8.6%) compared to those w/ no biological parents w an addiction (4.2%)

✔ indirect effects

• genetic factors may play an indirect role in developing addiction
• e.g. self control + ability to regulate emotion are partly genetic
• e.g. if a young person isn’t able to control their behaviour, may have difficulty concentrating in school
• don’t function well in school so turns to negative spiral + disruptive behaviour + turn to friends w similar characterisitics, may ultimately lead to involvment in drugs
• genetics also have indirect effects - may influence addiction more than it appears

Question 7

risk factors
STRESS

Answer 7

• increased risk linked to periods of chronic, long-lasting stress + traumatic events
• epstein et al found a strong correlation between childhood rape + adult alcoholism, but only w women w PTSD - stress increases vulnerability
• teicher suggests that early experiences of distress during a sensitive period damage the brain, creating a vulnerability to addiction in adolescence

✘ cause + effect

• research only demonstrates a correlation, not a cause + effect
• e.g. could just be that addiction causes greater levels of stress due to the negative impacts it has on life (e.g. relationships + finances)
• as stress and addiction co-relate, it’s more difficult to separate the effects of 1 on the other

Question 8

risk factors
PERSONALITY

Answer 8

• there is no ‘addictive personality’
• there are traits that are linked to addiction such as hostility + neuroticism
• strongest correlation is w APD
• its key component is impulsivity (risk-taking, lack of planning, desire for immediate gratification)
• ivanov suggested that impulsivity + addiction share a neurological basis

Question 9

risk factors
FAMILY INFLUENCES

Answer 9

perceived parental approval

• livingston et al found that final year high school students who were allowed by parents to drink at home, were more likely to drink excessively at college the next year
• adolescents that believe their parents don’t care are more likely to develop an addiction

exposure

• adolescents are more likely to start drinking if it’s an everyday feature of family life OR where there’s a family history of alcohol addiction

Question 10

risk factors
PEERS

Answer 10

considered most important risk factor in older children as they spend more time w peers than family

o’connell suggested 3 major elements to peer influence on alcohol addiction:

• attitudes towards drinking are influenced by associating w peers who drink
• peers provide more opportunities to drink
• individuals often overestimate how much their peers are drinking + so drink more to keep up w perceived norm

Question 11

risk factors
AO3

Answer 11

✔ practical application

• researchers believe that a focus on risk factors is a highly promising strategy for preventing + treating addictions
• understanding how risk factors interact can help identify those most at risk
• tobler et al created a peer-pressure resistance training program to help prevent young people taking up smoking
• suggests that a focus of risk factors can have useful and beneficial results

Question 12

nicotine addiction
NEUROCHEMISTRY EXPLANATION

Answer 12

desensitisation hypothesis:

• some neurons that produce DA have specific ACh receptors called nicotinic receptors (nAChR) that also respond to nicotine
• these neurons are concentrated in the VTA (ventral tegmental area) of the brain
• when nicotine binds to nAChR, neuron is stimulated + transmits DA
• nAChR shuts down + can’t respond to NTs, desensitising the neuron, causing downregulation (less active neurons available)
• when neuron is stimulated by nicotine, dopamine is transmitted along mesolimbic pathway to nucleus accumbens to be released in frontal cortex
• mesolimbic pathway is part of the brain’s reward + pleasure centres
• results in pleasurable effects (e.g. mild euphoria, reduced anxiety, increased alertness)
• these are now associated w intake of nicotine

nicotine regulation model:

• when smokers go w/o nicotine for a prolonged period of time (e.g. when asleep), nicotine disappears from the body
• nAChR becomes functional again, resensitising the neuron, leading to upregulation (more neurons available)
• as more nAChRs are available but not stimulated, smokers experience acute withdrawal symptoms (e.g. anxiety)
• meanwhile, nAChRs are at their most sensitive - explains why 1st cig = most enjoyable - reactivates dopamine reward system
• explains how dependence to nicotine is maintained through avoidance of unpleasant withdrawal symptoms
• chronic desensitisation of nAChR through repeated smoking leads to permanent decrease in no. of active receptors
• so tolerance develops as more nicotine is needed for the same effects

Question 13

neurochemistry explanation for nicotine addiction
AO3

Answer 13

✔ practical application

• a greater understanding of neurochemistry has led to the devlopment of new treatments for nicotnie addiction such as nicotine replacement therapy (NRT) in the form of patches + inhalers
• research has also indicated the possibility of nicotnie immunisation
• however, the potential benefits go beyond just nicotine addiction
• this is because many disorders have high co-morbidity w nicotine use, e.g. schizophrenia, depression + alcoholism
• so research offering treatments for nicotine addiction also hold out the prospect of greater advancements in treatments for these co-morbid disorders

✔ removal of addiction stigma

• encourages perception that addiction is a medical problem
• not a moral failure or sign of psychological weakness
• encourages more addicts to seek treatment

✘ limited explanation

• only considers role of dopamine + ignores influence of other NTs
• research shows involvement of many other neurochemical mechanisms
• complex interaction of several neurochemical systems, involving GABA, serotonin + endorphins
• nevertheless, the dopamine system is central to the neurochemistry of nicotine addiction and these other systems interact w it to have their effects

Question 14

nicotine addiction
LEARNING THEORY EXPLANATION

Answer 14

OPERANT CONDITIONING

positive reinforcement used to explain how people take up smoking in the first place

• nicotine acts a powerful positive reinforcer because of its physiological effects on the DA reward system
• stimulates release of dopamine in the nucelus accumbens, producing a feeling mild euphoria
• so positively reinforces smoking behaviour

negative reinforcement used to explain a smoker’s continuing dependence on nicotine

• abstinence leads to unpleasant withdrawal symptoms
• e.g. disturbed sleep pattern, agitation, poor concentration, anxiety, depression
• so they smoke again to reduce these symptoms
• behaviour is negatively reinforced as it avoids an unpleasant consequence

CLASSICAL CONDITIONING

• pleasurable effect of smoking is a primary reinforcer
• any other stimuli present at the same time become associated w the pleasurable effect + become secondary reinforcers
• e.g. being in a pub, favourite lighter, tobacco smell
• cue reactivity refers to the idea that cravings can be triggered by these stimuli as their presence produces a similar response to nicotine itself
• has 3 main elements:
• self-reported desire for cig
• physiological signs of reactivity
• objective behavioural indicators

Question 15

learning theory explanation for nicotine addiction
AO3

Answer 15

✔ research support for cue reactivity

• Carter et al conducted a meta-analysis of 41 studies into effects of cue-reactivity
• dependent, non dependent smokers + non-smokers were presented w images of smoking-related cues
• e.g. lighters, ashtrays + cig packets
• self-reported craving + physiological indicators (heart rate) were measured
• found that dependent smokers reacted strongly to cues
• so findings were consistent w cue reactivity theory

✔ practical application

• several behavioural therapies for nicotine addiction have been developed on the basis of conditioning principles
• e.g. both AT + CS work by creating an association between nicotine + unpleasant stimuli via counterconditioning
• AT may use electric shocks
• both successful forms of therapy for reducing addiction

✘ reductionist

• no more than half the ppl who experiment w smoking in adolescence, become dependent
• many adolescents smoke daily but few are dependent to the extent of experiencing withdrawal symptoms
• suggests likelihood of other causes of smoking behaviour, e.g. individual differences (biology/personality)
• learning theory alone is an insufficient explanation

Question 16

gambling addiction
LEARNING THEORY EXPLANATION

Answer 16

OPERANT CONDITIONING

vicarious:
- can explain how gambling is taken up in the first place
- seeing other people get rewarded for gambling by winning money via direct observation / media

direct:
positive - comes from direct gain (winning money) + buzz that accompanies gamble
negative - may offer an escape/distraction from anxiety

partial:

• used in gambling machines where not all bets result in a win
• creates sense of unpredictability about which gamble will pay off - enough to maintain gambling

variable:

• type of partial reinforcement where intervals between rewards vary
• takes longer for learning to be established but more resistant to extinction

CLASSICAL CONDITIONING

• pleasure from winning + accompanying buzz act as primary reinforcers
• any other stimuli that are present at the same time become associated w the arousal + become secondary reinforcers
• e.g. betting shops, colourful lottery cards
• cue reactivity refers to idea that cravings can be triggered by these stimuli
• difficult to avoid bc always in social + media env
• explains how gambling behaviour is maintained + how relapse occurs

Question 17

learning theory explanation for gambling addiction
AO3

Answer 17

✔ research support for partial reinforcement

• Skinner’s research w rats + pigeons found that a continous reinforcement schedules don’t result in persistent behavioural change
• once rewards stop, behaviour also disappears
• found that partial reinforcement led to more persistent behaviour change

✔ practical application

• increased understanding of role of learning theory in gambling addiction has led to gov policies being put in place
• e.g. video game ‘loot boxes’ aimed at young children have been outlawed + there have been regulations placed on gambling advertisements

✘ reductionist

• many people can occasionally gamble w/o developing an addiction
• suggests likelihood of other causes of gambling behaviour, e.g. individual differences (biological/psychological)
• learning theory alone is an insufficient explanation

Question 18

gambling addiction
COGNITIVE EXPLANATION

Answer 18

expectancy:

• gambler’s have expectations of the future benefits + costs of their gabling behaviour
• if they expect the benefits to outweigh the costs, addiction is more likely

cognitive biases:

• refers to the distortion of attention, memory + thinking processes
• which leads to irrational judgements + poor decision-making
• these biases have been classified into 4 categories:

skills & judgement
- gamblers have an illusion of control
- overestimate their ability to influence random events

personal traits/rituals
- gambler’s believe they have a greater chance of winning because they are especially lucky
- or because they’ve engaged in a superstitious behaviour

selective recall
- gamblers can remember details of their wins but forget/ignore/discount their losses

faulty perceptions
- gambler’s have distorted views about chance
- gambler’s fallacy is the belief that a losing streak must end in a win

self-efficacy:

• gamblers often have low self efficacy , making them more prone to relapse
• don’t believe they’re capable of giving up permanently
• sets up a self-fulfilling prophecy in which the individual behaves in a way that confims this expectation

Question 19

cognitive explanation for gambling addiction
AO3

Answer 19

✔ research support

• Griffiths used intropection to investigate the difference in cognitive processes between regular gamblers + occasional users
• ppts had to verbalise their thoughts which were classified using a content analysis into either rational/irrational
• ppts also interviewed to seek their opinion on degree of skill required to win
• found that regular gamblers made significantly more irrational verbalisations (14%) than occasional users (2.5%)
• also more prone to illusion of control
• overestimated degree of skill required to win
• HOWEVER, relies on methods of self-report
• may not reveal all their thoughts due to social desirability bias
• so findings may not represent what they truly think
• challenges internal validity

✔ practical application

• increased understanding of cognitive distortion in gamblers has contributed to the use of CBT to challenge their irrational thoughts (e.g. gambler’s fallacy)
• has been beneficial in treating addiction
• some researchers have also suggested that cognitive distortions have underlying causes in brain neurochemistry, introducing the prospect of drug treatment
• cognitive theory has stimulated research into both psychological + biological treatments

Question 20

reducing addiction
DRUG THERAPY

Answer 20

aversives

• pair addictive stimuli w unpleasant consequences (e.g. vomiting)
• e.g. disulfiram is used to treat alcoholism by creating a hypersensitivity to alcohol
• causes person to experience an instant hangover w severe nausea and vomiting

agonists

• act as drug-subsitutes
• bind to neuron receptors + activate them, producing similar effects to addictive drug
• e.g. methadone is used to treat heroin addiction by satisfying euphoria craving
• less harmful side effects + cleaner (administered medically)
• allows gradual reduction of dosage + there4 withdrawal symptoms

antagonists

• bind to receptor sites + block them
• so drug can’t produce its usual effects
• e.g. naltroxene is an opioid antagonist used to treat heroin addiction

nicotine replacement therapy (NRT):

• uses gum, inhalers + patches to deliver nicotine in less harmful fashion
• provides clean, controlled dose of nicotine which operates as normal
• use of NRT means amount of nicotine can be reduced over time
• so withdrawal symptoms can be managed

opioid antagosists:

• no officially approved drugs for gambling addiction but the most promising are opioid antagonists such as naltrexone (conventionally used to treat heroin)
• gambling taps into same DA reward system as nicotine + heroin
• OAs reduce release of DA in nucleus accumbens by increasing release of GABA in other parts of mesolimbic pathway
• reduces cravings + gambling behaviour
• but has unpleasant side effects

Question 21

drug therapy
AO3

Answer 21

✔ research support

• stead et al reviewed 150 studies into effectiveness of NRT
• concluded that all forms of NRT are significantly more effective in helping smokers quit than either placebo or no treatment
• nasal sprays found to be most effective
• research also found that they’re safer than cigarettes + don’t foster dependence

✘ side effects

• for NRT side effects include: sleep disturbances, dizziness + headaches
• side effects are a bigger concern in drug therapy for gambling addiction
• naltrexone requires bigger dose to have an effect on gambling behaviour so side effects are worse
• px may discontinue use, especially when they don’t feel the same sense of euphoria
• making it ineffective

✔ removal of addiction stigma

• encourages perception that addiction is a medical problem
• not a moral failure or sign of psychological weakness
• encourages more addicts to seek treatment

✘ individual differences

• drugs don’t work in the same way for everyone
• small genetic variations between individuals have a significant impact on the effectiveness of a drug
• e.g. effectiveness of naltrexone for alcohol addiction depends on variation of a single gene
• alchololics w 1 variant respond much more readily to treatment than those w another one
• drugs need to be more tailored to individual genetic profiles

Question 22

reducing addiction
BEHAVIOURAL INTERVENTIONS

Answer 22

aversion therapy

• based on classical conditioning + counterconditioning
• pair addictive stimuli w unpleasant consequences
• to create an association between the 2

for alcohol addiction

• disulfiram used to treat alcoholism by creating a hypersensitivity to alcohol
• causes person to experience an instant hangover w severe nausea and vomiting
• client learns to associate alcohol w nausea
• in order to avoid this, client doesn’t drink

for gambling addiction

• electric shocks used for gambling addiction
• gambler selects phrases related to gambling + some normal ones
• read out each phrase + when gambling-related phrase read out they receive 2 second shock
• gambling phrase becomes CS which elicits pain response (CR)

covert sensitisation

• type of AT but occurs in vitro
• instead of actually experiencing unpleasant stimulus, they imagine it

for nicotine addiction

• therapist gets them to imagine smoking, which is then followed by nausea + vomiting
• therapist goes into vivid details
• imagine being forced to smoke cigarette covered in faeces
• ends w/ client turning back on cigarettes + experiencing relief
• associations formed should reduce smoking behaviour

Question 23

behavioural interventions
AO3

Answer 23

✘ adherance issues w aversion therapy

• due to the highly unpleasant nature of AT, many pxs drop out before it’s completed
• therefore effectiveness can’t be assessed fairly
• as pxs who give up are less likely to have responded to treatment
• so research may be overoptimistic about effectiveness of AT
• covert sensitisation is much less traumatic + better alternative

✘ effects may be short term

• McConaghy et al found that AT was more effective in reducing gambling behaviour after 1 month than after 1 year
• in a long term follow up, it was found that AT was no more effective than placebo + that CS was more beneficial

✔ research support for covert sensitisation

• McConaghy et al found that 1 year gambling addicts who had received CS were much more likely (90%) to have reduced their gambling behaviour than those who had received AT (30%)
• ppts also reported experiencing fewer + less intense cravings

Question 24

reducing addiction
CBT

Answer 24

cognitive element - aims to identify, tackle + replace cognitive distortions via functional analysis

• client + therapist work together identify high-risk situations that lead to addictive behaviour
• reflect on what the client is thinking before, during + after the situation
• therapist challenges client’s cognitive distortions

behaviourist element - aims to develop coping behaviours to avoid triggers via skills-training

1. cognitive reconstructing
   - gambler’s faulty beliefs about probability + chance are addressed + challenged
2. specific skills
   - specific skills are taught to manage possible triggers
   - e.g. anger management training for anger
   - or assertiveness training for interpersonal conflicts
3. social skills
   - social skills are taught to help w social anxiety
   - e.g. trying not to drink at wedding
   - SST helps client to refuse alcohol by being firm + making eye contact
   - role play may be used to model coping strategies

Question 25

CBT
AO3

Answer 25

✔ relapse prevention

• CBT incorporates likelihood of relapse into treatment + views it as a further opportunity for learning + cognitive reconstructing
• doesn’t regard relapse as a failure but inevitable + acceptable as long as there’s improvement
• more realistic + places less pressure on addict

✘ effects may be short-term

• Cowlishaw reviewed 11 studies comparing CBT for gambling w controls
• found that CBT is only effective at reducing addictive behaviour for up to 3 months
• after 9-12 months, no significant difference
• also poor methodology so may have overestimated efficacy

✘ adherance issues

• CBT is v demanding
• was found that drop-out rates of CBT are 5x greater than other forms of therapy
• lack of adherence suggests CBT is ineffective in long term

Question 26

theory of planned behaviour
TPB

Answer 26

• theoretical model showing how a person decides to change behaviour
• changes in behaviour can be predicted from our intention to change
• intentions arise from 3 key influences:

1. personal attitudes

• refers to entire collection of addict’s attitude towards their addiction
• formed from weighing up positive + negative aspects
• amounts to whether their opinion of addiction is favourable or not

2. subjective norms

• addict’s beliefs about whether the people who matter most to them approve/disapprove of their addictive behaviour
• beliefs are based on what these people believe to be normal behaviour

3. perceived behavioural control

• how much control the addict believes they have over their behaviour / their ability to quit, i.e. self efficacy
• self efficacy can influence their intention to quit
• can also directly influence them to try longer + harder

Question 27

TPB
AO3

Answer 27

✔ research support

• Hagger et al tested TPB’s predictions on alcohol related behaviours
• found that the 3 factors all predicted an intention to limit drinking to a guideline no. of units
• intentions were also found to predict no. of units actually consumed after 1 month + 3 months
• PBC also predicted actual unit consumption directly

✘ methodological issues

• research based on methods of self-report
• ppts may not respond truthfully due to effects of social desirability bias
• ppts respond to make them look good
• may not reflect their actual intentions
• challenges internal validity

✘ limited explanation

• focuses on rational reasoning + logical processes
• doesn’t account for less rational factors that influence decision-making involving addiction
• e.g. emotions, cognitive bias, past experiences
• incomplete explanation

Question 28

prochaska’s model of behaviour change

Answer 28

6-stage model addicts go through to overcome addiction

• complex + cyclical process which may need to be repeated multiple times + can involves backward steps

based on 2 insights:

• people differ in how ready they are to change
• the usefulness of a treatment intervention depends on the stage a person has reached

1. precontemplation
   - not considering addiction as a problem
   - may be due to denial or demotivation
   - intervention should focus on helping addict consider need for change
2. contemplation
   - aware of need to change
   - worried about costs
   - intervention should focus on demonstrating that pros outweigh cons
3. preparation
   - have decided to change behaviour within next month
   - however haven’t decided how to do this
   - intervention should focus on forming a plan
   - e.g. seeing a counsellor/GP
4. action
   - have done something to change their behaviour in last 6 month
   - first 6 months of trying to change behaviour
   - e.g. cognitive treatment, removing temptation
   - intervention should focus on developing coping skills
5. maintenance
   - have abstained for more than 6 months + are confident they can continue
   - intervention should focus on relapse prevention
6. termination
   - abstinence is automatic + person no longer returns to addictive behaviours

Question 29

prochaska’s model of behaviour change
AO3

Answer 29

✔ realistic process

• acknowledges that recovery is a dynamic process that varies for each individual
• in contrast to earlier theories which suggested it either happens or doesn’t
• also accepts that relapse is likely + recovery can take several attempts - more realistic depiction
• places less pressure on addict

✔ can be individualised

• offers a different focus of intervention at every stage
• leads to more personally tailored treatments
• more likely to be successful than a “one size fits all” approach

✘ arbitrary nature of stages

• Sutton pointed out that if someone plans to stop smoking in 30 days, they are in preparation
• but if they decide to give up in 31 days, they are in contemplation
• Bandura claimed that first 2 stages aren’t quantitatively different
• as the only difference between them is qualitative - how much they want to change