Addiction

Question 1

Define what an addiction is

Answer 1

A disorder in which an individual consumes a substance eg. nicotine or engages in a particular behaviour eg. gambling, that is pleasurable but eventually becomes compulsive with harmful consequences

Question 2

What is Physiological Dependence?

Answer 2

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 eg. alcohol/nicotine or behaviour eg. gambling.

It may increase their pleasure or lessen their discomfort.

Absence of the drug/ behaviour causes individual to feel anxious or irritable and this leads to a craving for the substance

Question 3

What is Physical Dependence?

Answer 3

The state of the body that occurs when withdrawal syndrome is produced due to stopping the substance use/ behaviour eg. nausea, headaches and shaking

Question 4

What is Withdrawal Syndrome?

Answer 4

• collection of physiological and physical symptoms an individual experiences when they no longer have the substance in their system/ engaged in a particular behaviour
• withdrawal syndrome includes low mood, feeling nauseous, achy, in pain or experiencing tremors
• experiencing withdrawal is very unpleasant so continuing to take substance or engage in behaviour is partly to avoid the withdrawal symptoms
• seriousness of withdrawal syndrome can depend on:

Substance used/type of behaviour
Amount of substance consumed
Drug use/ behaviour pattern

Question 5

Define Tolerance

Answer 5

Arises when a substance is taken/ behaviour is maintained over long period of time and due to the repeated exposure, response to substance/behaviour is reduced

Individual needs greater doses to feel same physical and physiological effects

Question 6

What is cellular tolerance?

Answer 6

Takes place when brain neurons adapt in response to higher levels of a substance

Question 7

What is Behavioural tolerance?

Answer 7

when a person’s behaviour is less affected by a substance so they can complete daily activities while under the influence

Question 8

What is genetic vulnerability?

Answer 8

Some people inherit a genetic predisposition to addiction

Genetic vulnerability is explained as an interaction between genes and environmental factors as an individual will not become addicted unless they are exposed to a substance or opportunity

Question 9

One reason genetic vulnerability can occur is Metabolism. Explain this

Answer 9

Rate of metabolism is inherited through genes

Some individuals metabolise addictive substances faster than others

Making it easier for them to become addicted as they may need more to have the same effects, leading to overuse and addiction

Question 10

Another reason genetic vulnerability can occur is the effect of D2 receptors. Explain this in terms of addiction.

Answer 10

• D2 receptors are responsible for communicating with the neurotransmitter dopamine which is involved in feelings of pleasure and reward

• Number of D2 receptors an individual has is determined by genetics

• Having low levels of D2 receptors is associated with addiction as this leads to problems experiencing pleasure from everyday activities ie. chocolate

• Therefore, they turn to more addictive substances such as nicotine to experience some feelings of pleasure and compensate for their deficiency, leading to addiction

Question 11

AO3 for Genetic Vulnerability

Answer 11

Kendler et al

• used data from National Swedish Adoption Study

• looked at adults who were adopted as children and had at least one person with an addiction in their biological family

• these children had significantly greater risk of developing an addiction compared to adopted individuals with no addicted biological parent

• this gives validity to genetic vulnerability as a risk factor in addiction

Question 12

Explain Stress as a risk factor in addiction

Answer 12

• People who experience stress may turn to addictive substances or behaviour as a form of self medication for stress

• Periods of chronic, long lasting stress and traumatic life events in childhood have been linked with increased risk of developing an addiction

Anderson and Teicher

• found early experiences of severe stress have damaging effects on a young brain during sensitive period of development and can create vulnerability to later stress
• further stressful experiences in later life could trigger the vulnerability and make it more likely individual will self medicate with substances or behavioural addictions

Question 13

AO3 for stress

Answer 13

Based on correlational research

Can’t establish cause and effect

Addiction may cause stress (through loss of money, lack of sleep, effects on job) rather than stress causing addiction

Lacks internal validity

Question 14

Explain personality as a risk factor in addiction.

Answer 14

• Agree no such thing as “addictive personality” however, certain traits have been linked to increased likelihood of addiction

• suggested that antisocial personality disorder leads to high vulnerability to addiction

• Clodinger proposed 3 innate dimensions associated with addiction, in particular drug and alcohol abuse

• These are measured through a questionnaire

-Novelty seeking = tendency to get intensely excited by new stimuli and thus continuously seek new, more extreme experiences

• Inhibited Harm Avoidance = lack of inhibitions, worry and fear
• Increased Reward Dependency = tendency to respond more to rewards eg. social approval

Question 15

AO3 for Personality

Answer 15

Schneider et al

Found novelty seeking was the trait most associated with increased involvement with cannabis, alcohol and cocaine.

Further, research found a positive correlation between novelty seeking and relapse rates for several drugs of abuse among addicts

Gives validity to theory that high novelty seeking personality does increase vulnerability to addiction

However this may suggest that novelty seeking is more important in explaining characteristics of addiction than the other two dimensions

Question 16

Explain Family Influences as a risk factor in addiction.

Answer 16

Perceived Parental Approval

• If adolescent believes their parents show positive attitudes towards a particular addictive substance/ behaviour then they will be more vulnerable to developing an addiction themselves

Livingstone et al found that final year high school students who were allowed by parents to drink alcohol at home were significantly more likely to drink excessively at college the following year

• Adolescents who believe parents have little interest in monitoring their behaviour are significantly more likely to develop an addiction

• Exposure within family life to a substance/behaviour creates risk of developing addiction

• Social learning theory = individual observes a family member (role model) engaging in addictive behaviour and imitates this behaviour as they identify with them and want to be like them

Question 17

AO3 for Family Influences

Answer 17

Madras et al

•studied families with adolescents where parents used cannabis

• found strong positive correlation between parents use of cannabis and adolescents use of cannabis, alcohol, nicotine and opioids

• show that adolescents perceived that parents were accepting of drug use so went on to use drugs themselves

• and may have observed parents using cannabis and modelled this behaviour

Question 18

Explain Peers as a risk factor in addiction

Answer 18

• Some psychologist argue peers act as a gateway to addictive behaviour

•O’Connell et all suggest that adolescents are at risk of developing an alcohol addiction due to the influence of their peers because of 3 major elements

• Attitudes and Norms to drinking alcohol
• Opportunities to drink alcohol
• Individual’s perception = overestimate how much peers drink so drink more to keep up with them

Question 19

AO3 for Peers

Answer 19

Correlational research

Can’t establish cause and effect

Addiction may cause individual to seek out peers who share same addictive behaviour rather than peers and norms making them engage in addictive behaviour

Lowers internal validity

Question 20

Explanations for Nicotine addiction

Answer 20

1) Nicotine is inhaled and reaches nicotine receptors in the brain in less than 10 seconds

2) Triggers neurones in the ventral tegmental area to release dopamine

3) Dopamine travels down reward pathway called mesolimbic pathway

4) Dopamine stimulates D2 receptors in the nucleus accumbens which causes pleasure/ euphoria. Thus motivating the persian to want to smoke again, start of addictive behaviour

5) Dopamine also travels down a second reward pathway called mesocortical pathway

6) Dopamine stimulates the prefrontal cortex which makes the person pay attention to the smoking and everything associated with it so that it can be repeated

Question 21

Cellular changes in nicotine addiction

Answer 21

Upregulation

• When a person hasn’t smoked for a period of time, nicotine receptors become available/ sensitive so they experience withdrawal

• There is an increase in the number of nicotine receptors so more nicotine is needed to feel the same effects (tolerance)

Downregulation

• D2 receptors in the nucleus accumbens become less sensitive and reduce in numbers

• This means they don’t feel the same buzz from smoking so more nicotine is needed to feel a buzz (tolerance)

Question 22

AO3 for Brain Neurochemistry in Nicotine addiction

Answer 22

Mc Evoy

studied smoking behaviour in ppl with Schizophrenia who were taking a drug (Haloperidol)

This drug is a dopamine antagonist by blocking dopamine receptors, lowering level of dopamine activity in the brain

Found that ppl taking the drug showed significant increase in smoking

However, sample bias as has Schizophrenia, may not be same for neurotypical so can’t generalise findings on low dopamine activity and smoking behaviour on target population of smokers without Schizophrenia. Limiting research.

Question 23

Explain Learning theory in smoking behaviour

Answer 23

• Smoking is a learnt behaviour through operant conditioning

• explained by positive reinforcement

• Individual is rewarded with euphoria when they inhale nicotine due to its impact on dopamine system in brain’s reward pathway

• therefore, smoke again to get same reward of euphoria

• negative reinforcement can explain why an individual would continue to smoke (maintain addiction)

• Cessation of nicotine leads to appearance of withdrawal syndrome which has unpleasant symptoms such as disturbed sleep, agitation and poor concentration

• these symptoms make it difficult for smoker to abstain for long so individual would continue to smoke to avoid unpleasant symptoms

Question 24

Explain Cue Reactivity

Answer 24

• Based on Classical conditioning

• When an individual smokes, there are environmental stimuli present alongside the cigarette

• eg. holding a drink, certain friends, pubs, relaxing on sofa after evening meal

• Individual associates smoking nicotine (UCS) with these environmental stimuli (NS)

• After conditioning, the environmental stimuli becomes CS and acts as cue (trigger) to smoking leading to craving

• This explains why ppl maintain smoking behaviour as the cues lead to cravings so the person smokes to reduce psychological withdrawal

• Also explains relapse as many ppl quit smoking but when faced with cues, crave a cigarette and smoke again

Question 25

AO3 for Learning Theory

Answer 25

Carter and Tiffany

Meta analysis of 41 studies into cue reactivity

Presented dependent, non-dependent smokers and non-smokers with smoking related cues ie. lighter, ash tray

Self reported desire was measured alongside heart rate

Found that dependent smokers reacted most strongly to the cues eg. increased heart rate and reported cravings to smoke

Supports cue reactivity as dependent smokers had learned secondary associations between smoking related stimuli and the pleasurable effects of smoking

Question 26

Learning Theory for Gambling

Answer 26

Forming addiction

SOCIAL LEARNING THEORY

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 the media (news, social media, films or TV).

Maintaining addiction

OPERANT CONDITIONING

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.

Negative reinforcement to distract the individual from their everyday life e.g. unpleasant feelings and anxiety.

Therefore, they will continue to engage in gambling behaviour to avoid the negative consequence of anxiety.

PARTIAL REINFORCEMENT

If a person is rewarded every time this becomes predictable and boring, meaning the individual is less likely to repeat the addictive behaviour and develop an addiction.

Partial reinforcement is when the person is rewarded only SOME of the time. This is unpredictable and exciting and so increases the likelihood of repeating the gambling behaviour and developing an addiction.

Question 27

Name and explain the two types of partial reinforcement

Answer 27

FIXED RATE

• 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

• 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

leads to stronger, more persistent gambling behaviour.

Question 28

AO3 for learning theory of gambling

Answer 28

Parke and Griffiths

found that gamblers become addicted to the rewards provided by gambling such as money, thrill and excitement and ‘near misses” are reinforcing as it raises hope for future success.

This supports the idea of positive and variable reinforcement making gambling highly addictive, due to the unpredictability of winning and the associated excitement.

Question 29

Explain Cognitive Theory for Gambling

Answer 29

• argues addictive behaviour cognitive biases

• Cognitive bias is where a person’s thinking, memory and attentional processes are faulty leading an individual to make irrational judgements and poor decisions.

• Rickwood et al (2010) classifies cognitive biases into four categories:

• Skill Bias = overestimate ability to influence random events believing they have special skills or knowledge that’ll make them more likely to win
• Ritual Bias = believe they have greater chance of winning if they have engaged in lucky rituals/ superstitious behaviour
• Selective recall Bias = remembers wins but forget or minimise losses leading to them gambling more eg. loss described as “near win”
• Gamblers Fallacy = distorted views about chance as believe a run of losses must be followed by a win

Question 30

Describe self efficacy

Answer 30

• refers to a person’s beliefs about control or lack of control over their behaviour.

• addicts with low self-efficacy believe they cannot give up gambling and it will always be a ‘part of them’, thus leading to relapse.

• In turn, this leads to a self-fulfilling prophecy in which the individual continues to gamble because their belief is they cannot stop themselves.

• This causes their gambling addiction to be reinforced as the relapse confirms their beliefs “see I told you I couldn’t stop”

Question 31

AO3 for cognitive theory of gambling

Answer 31

Grifiths

carried out natural experiment on a sample of 30 regular gamblers comparing them to a control group of 30 occasional gamblers.

They played on a fruit machine and were asked to ‘think aloud’ and verbalise their thought processes whilst playing and were interviewed afterwards.

They found that regular gamblers saw themselves as ‘skilful’ at the fruit machine, made more irrational statements “I’m going to bluff this machine” compared to occasional gamblers. They were also more likely to explain losses as near wins’.

This supports the role of cognitive biases such as illusion of control in gambling addiction.

use of ‘thinking aloud’ research has been questioned.

This self-report method is used in a lot of studies in to the cognitive explanation of gambling.

Some psychologists believe that what people say in gambling situations does not necessarily represent what they really believe. ‘Off the cuff’ remarks made whilst gambling may not reflect an addict’s deeply-held beliefs about chance and skill.

Therefore, researchers may get misleading impression that gamblers’ thought processes are irrational when in fact they are not.

Limiting the validity of the research used to support the cognitive explanation of gambling.

Question 32

Drug Therapy for Nicotine addiction

Answer 32

Nicotine replacement therapy (NRT) - (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 through release of dopamine to stimulate the receptors in the nucleus accumbens 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 removes the unpleasant circumstances of quitting smoking and so continuing with NRT is negatively reinforced

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, in turn reducing cravings therefore relapse is less likely to occur. The addict can gradually reduce the dosage of nicotine as their tolerance to nicotine is reduced.

Question 33

Drug Therapy for gambling

Answer 33

No specific drug treatment for gambling has been approved in the UK.

There is ongoing research into several candidates, the most promising being an opiod 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 (Naltrexone) enhance the the release of the neurotransmitter GABA in the mesolimbic pathway.

The increased GABA activity reduces the release of dopamine in the nucleus accumbens (and ultimately pre-frontal cortex) therefore reducing urge to gamble.

Some research (e.g. Kim et al) has linked this with reductions in gambling behaviour

Question 34

AO3 for drug therapy

Answer 34

Stead et al

carried out research to support the effectiveness of nicotine replacement therapy (NRT).

reviewed 150 high-quality research studies that compared the use of NRT with a placebo.

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.

Question 35

Aversion therapy for Nicotine addiction

Answer 35

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.

Question 36

Aversion therapy for Gambling

Answer 36

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 (they are pre-selected by participants at the start of treatment).

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

Question 37

Aversion therapy for alcohol addiction

Answer 37

client is given an aversive drug such as disulfiram (Antabuse).

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.

Question 38

Covert Sensitisation for nicotine addiction

Answer 38

AIM
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.

Question 39

AO3 for behavioural interventions

Answer 39

McConaghy et al

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 (90% covert sensitisation compared to 30% aversion therapy).

Therefore, suggesting covert sensitisation is more effective behavioural intervention for treating gambling addiction compared to aversion therapy.

Question 40

CBT in addiction

Answer 40

Aim:

To identify and challenge maladaptive thinking that are causing an addiction and replace with more adaptive ways of thinking and coping behaviours to deal with high risk situations which might trigger relapse.

COGNITIVE

1) functional analysis - a therapist will ask the client to identify the high-risk situations in which the client is likely to engage in their addictive behaviour e.g. walking past a betting shop.

• They are asked to report what they would be thinking before, during and after the situation. This helps the therapist to identify any cognitive biases and then work with the client to challenge the faulty thinking.

2) 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) Skills training- the addicted person will be taught social skills to help them cope with situations which lead to addictive behaviour for example, teaching the client ways to refuse the addictive behaviour without causing embarrassment.

• The therapist teaches the client these skills and the client will practice these through role play before implementing them in real life situations.

• 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.

4) 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.

Question 41

AO3 of CBT in addiction

Answer 41

Perty et al

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.

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.