addiction Flashcards
1
Q
addiction
A
2
Q
psychological dependence
A
compulsion to continue taking a drug for increase in pleasure/reduction of discomfort
3
Q
physical dependence
A
when abstaining from a drug/behaviour results in withdrawal syndrome
4
Q
withdrawal syndrome
A
collection of symptoms associated w abstinence of drug/behaviour
- indicates physical dependence
- motivation for taking drug stems from avoidance of these symptoms
5
Q
tolerance
A
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.
6
Q
risk factors
GENETIC VULNERABILITY
A
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
7
Q
risk factors
STRESS
A
- 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
8
Q
risk factors
PERSONALITY
A
- 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
9
Q
risk factors
FAMILY INFLUENCES
A
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
10
Q
risk factors
PEERS
A
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
11
Q
risk factors
AO3
A
✔ 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
12
Q
nicotine addiction
NEUROCHEMISTRY EXPLANATION
A
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
13
Q
neurochemistry explanation for nicotine addiction
AO3
A
✔ 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
14
Q
nicotine addiction
LEARNING THEORY EXPLANATION
A
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
15
Q
learning theory explanation for nicotine addiction
AO3
A
✔ 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
16
Q
gambling addiction
LEARNING THEORY EXPLANATION
A
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
17
Q
learning theory explanation for gambling addiction
AO3
A
✔ 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
18
Q
gambling addiction
COGNITIVE EXPLANATION
A
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
19
Q
cognitive explanation for gambling addiction
AO3
A
✔ 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
20
Q
reducing addiction
DRUG THERAPY
A
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
21
Q
drug therapy
AO3
A
✔ 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
22
Q
reducing addiction
BEHAVIOURAL INTERVENTIONS
A
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
23
Q
behavioural interventions
AO3
A
✘ 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
24
Q
reducing addiction
CBT
A
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
-
cognitive reconstructing
- gambler’s faulty beliefs about probability + chance are addressed + challenged -
specific skills
- specific skills are taught to manage possible triggers
- e.g. anger management training for anger
- or assertiveness training for interpersonal conflicts -
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
25
Q
CBT
AO3
A
✔ 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
26
Q
theory of planned behaviour
TPB
A
- 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:
- 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
- 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
- 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
27
Q
TPB
AO3
A
✔ 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
28
Q
prochaska’s model of behaviour change
A
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
-
precontemplation
- not considering addiction as a problem
- may be due to denial or demotivation
- intervention should focus on helping addict consider need for change -
contemplation
- aware of need to change
- worried about costs
- intervention should focus on demonstrating that pros outweigh cons -
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 -
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 -
maintenance
- have abstained for more than 6 months + are confident they can continue
- intervention should focus on relapse prevention -
termination
- abstinence is automatic + person no longer returns to addictive behaviours
29
Q
prochaska’s model of behaviour change
AO3
A
✔ 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
