addiction Flashcards
who suggested the 6 criteria’s?
Mark Griffiths
what are the 6 criteria?
salience
tolerance
relapse
conflict
withdrawal symptoms
mood modification
what is salience?
the activity becomes the most important thing and it dominates their thoughts
what is tolerance?
as they continue to engage in the behaviour they will need more and more in order to achieve the same desired effects
what is relapse?
addicts will revert back to the behaviour after a long period of abstinence
what is conflict?
addicts will often experience a breakdown in relationships and a personal struggle as they continue to engage in the behaviour
what are withdrawal symptoms?
if the behaviour is stopped the individual will experience uncomfortable side effects. these can either be physical or psychological
what is mood modification?
when they engage in the behaviour they can experience a ‘buzz’ or a ‘high’ but this could also be a sensation of escape or numbness
what are the 2 biological explanations to addiction?
dopamine hypothesis
genes
what does the dopamine hypothesis suggest?
addictive behaviours and substances trigger the release of dopamine in the mesolimbic pathway
what is the mesolimbic region responsible for?
providing us with the sensation of reward
where does dopamine travel in the mesolimbic pathway?
from VTA to nucleus accumbens
what is the VTA?
what does it stand for?
ventral tegmental area
one of the key dopamine producing areas in the brain
what is the nucleus accumbens responsible for?
strongly associated with motivation and reward
what is the name of the other pathway and where does dopamine travel in this?
mesocortical
from VTA to the pre frontal cortex
what is the pre frontal cortex responsible for?
creating long lasting memories
what is the incentive sensitisation theory?
what are the names of the researchers?
repeated exposure to the drugs of abuse leads to increasing sensitivity of the brain to their desirability
Robinson and Berridge
what is down regulation?
what does this create?
what can it lead to?
- continued exposure eventually results in a reduction of the activity of positive reward circuits and the dopamine receptors become less sensitive to the effects
- creates a chronic stress (withdrawal symptoms)
- leads to tolerance
what is a strength of the dopamine hypothesis?
(hint: B&B)
what does this suggest?
- practical applications that result in effective treatments
- Botswick and Bucci describe the treatment of a young adult male patient who was addicted to sex.
- he had a strong appetite for pornography and in his 20s would spend up to 8 hours online searching for ‘sexually gratifying activity’.
- at 24 he was treated with naltrexone which blocked the release of dopamine. blocking the reward resulted in his addiction plummeting and his psychosexual functioning dramatically improved.
- this suggests that the drug therapies created in response to the dopamine explanation can go some way in improving the lives of real people
what is another strength of the dopamine hypothesis?
what does this explain?
- supportive research evidence which can account for individual differences in addictions
- Volkow et al gave Ritalin (gently lifts dopamine levels) to a group of adult volunteers. some loved the feeling of the drug but others didn’t.
- they then produced brain scans and found that those who liked the drug had fewer dopamine receptors than those who hated it.
- this explains why some people may go on to develop an addiction after experimenting with drugs whilst other with the same initial experience will not.
- this reflects real world human behaviour
what is a weakness of the dopamine hypothesis?
(hint: 2x evidence)
what does this suggest?
- there are significant shortcomings - not all addictions seem to increase dopamine levels.
- Stokes et al found no significant increase in levels of dopamine in volunteers taking cannabis.
- Yoder et al found no consistent increase in dopamine across the pps in their study who were given alcohol.
- this suggests that we must proceed with caution when suggesting that all addictions can be attributed to the action of dopamine on the brain, when apparently this is not the case.
what is another weakness of the dopamine hypothesis?
- explaining addiction as being wholly due to the action of dopamine is far too simplistic and fails to recognise that dopamine has a range of other functions.
- Lierzon et al showed increased activation in the mesolimbic pathway of war veterans suffering from PTSD when reminded of battle through combat sounds.
- Such findings are in direct opposition of what we would predict about dopamine if we are to believe that its action is responsible for addictive behaviours
what did Goldman et al conclude when studying genes?
what are the figures?
‘addictions were moderately to highly heritable’
ranges from +0.39 for hallucinogens to +0.72 for cocaine
what is the name of the specific gene?
DRD2 gene (D2 dopamine receptor gene)
what did Noble et al find? (genes)
the A1 variant of this gene was present in more than two thirds of deceased alcoholics but only one fifth of deceased non alcoholics had this variant
what did Blum et al find? (genes)
an increased prevalence of the A1 variant among children born to alcoholics possible reflecting the increased intra family risk
what do individuals with the A1 variant have?
significantly lower dopamine receptors in the pleasure centres of the brain
what is the name of the model in the genes explanation?
diathesis stress model
what does the diathesis stress model suggest?
suggests that a disorder such as addiction will only develop when a genetic predisposition to a particular condition is combined with the right environmental stressors
what is meant by the term concordance rate?
the rate of probability that 2 people with shared genes will develop the same organic disease
what is the strength of genes?
(hint: K and P)
what does this suggest?
- supportive evidence
- Kendler and Prescott interviewed 2000 twins and found that the concordance rate for cocaine initiation in MZ twins was 54% but for DZ twins was 42%.
- however when looking at dependance on cocaine there was a substantial different between MZ and DZ twins (35% and 0%).
- this suggests that there is a role for genetics when it comes to addictive behaviours
what is the weakness of genes?
- there are problems associated with one of its most prominent proposals.
- Comings et al found that the A1 variant occurred in people with several disorders including autism and Tourettes at least as often as it’s appeared in alcoholics.
- the A1 variant was present in 45% of the Tourettes patients compared with 25% of controls.
- this finding creates a problem for the idea that the DRD2 gene is a ‘reward gene’ since people with autism and Tourettes are not thought to be particularly pleasure seeking.
- thus the genetic explanation is limited in its ultimate usefulness
what are the individual differences explanation of addiction?
cognitive biases
addictive personality
what are cognitive biases?
mental shortcuts we use to make decisions and they can lead to irrational decisions
what are heuristics?
who proposed them?
Kahneman and Tversky proposed that humans have a particular way of approaching decision making and making judgements of probabilities. the strategies we have adopted are known as heuristics
what are the 4 main types of heuristics?
representativeness bias
availability bias
illusion of control
hindsight bias
define representativeness and give an example
the belief that random events have a pattern
e.g. Monte Carlo 1913 - the roulette wheel showed a run of black 26 times and gamblers believed that a red was ‘due’
define availability bias and give an example
an event is seen to be more likely if it can be recalled from memory
e.g. hearing the sound of coins falling in a casino will make a person believe they can win too
define illusion of control and give an example
the idea that you have a certain level of control over a random event
e.g. if a lottery player chooses their numbers they think they have more control over the outcome
define hindsight bias and give an example
the tendency people have to view events as more predictable than they really are
e.g. after an event people believe that they ‘knew’ the outcome before it actually happened
what is a strength of cognitive biases?
what does this suggest?
- supportive evidence available
- Griffiths compared the verbalisations of 30 regular gamblers with 30 non regular gamblers whilst playing on a fruit machine.
- he found that 14% of regular gamblers used irrational verbalisations compared to 2.5% of non regular gamblers - evidence of representativeness and availability bias.
- this suggest that there is a clear difference in the cognitions of problem gamblers and social gamblers -strengthens validity of the explanation
what is the other piece of evidence for the strength of cognitive biases?
include this in the jam
- Joukhador et al developed a Gambling Belief Questionnaire
- he reviewed responses on this questionnaire between 56 problem gamblers and 52 social gamblers
- found that across almost all of the different beliefs assessed, the problem gamblers scored higher
what is a weakness of the cognitive biases explanation?
what does this demonstrate?
- lack of applicability and predictability about real world addictive behaviours.
- Griffiths gives the example that the first time there was a triple rollover in the UK national lottery, the media spotted that the number 13 had come up fewer times than any other number - in this case those applying rep. bias would pick 13 but this adopting av. bias wouldn’t pick 13.
- this demonstrates the lack of predictive power within this explanation and as a result reduces its validity as an account of addictive behaviour.
what is another weakness of the cognitive biases explanation?
what was as a result of this?
- illogical thought patterns have been found in non gamblers and those who gamble but don’t become addicted
- Baboushkin et al suggests that this may be because heuristics are appropriate when applied in everyday situations but not appropriate when dealing with chance events which is what problem gamblers fail to recognise
- as a result there it does not provide full explanatory power as if most people think in the illogical way proposed, then more people should be addicts but are not
who suggested the personality types?
what are they?
Eysenck
psychoticism and neuroticism
define pyschoticism
what are the characteristics?
a personality pattern typified by aggressiveness and interpersonal hostility. high levels of this trait is linked to increase vulnerability to psychosis
- impulsive
- risk taker
- non conformist
- anti social behaviour
define neuroticism
a personality trait that includes anxious and nervous behaviour and a frequent feeing of fear and worry. these people respond worse to stressors and are more likely to self medicate as a coping mechanism
what is the evidence for psychoticism?
(not the rats)
Stevens et al found that impulsive individuals were less successful in their treatment programs as they were more likely to drop out and less likely to maintain their abstinence in the long term
what is the evidence for neuroticism?
Taylor et al analysed data from 872 boys collected over a period of 9 years. he found that those who had very low self esteem at age 11 were at higher risk for addiction (particularly drug dependancy) at age 20.
what is the strength of the personality explanation?
what does this suggest?
- there is evidence form prospective studies that supports the idea of an addictive personality causing addictive behaviours.
- Dong et al carried out a study on Chinese university students. they were given the ‘Eysenck personality questionnaire’ just after starting uni and 2 years later their rates of internet addiction were measured.
- the researchers found that these scoring high on neuroticism and psychoticism previously were more likely to show pathological internet usage.
- this suggests that there may be some validity in the proposals of personality traits causing addictions
what is the weakness of the personality explanation?
what does this suggest?
- difficulty in establishing cause and effect.
- one hypothesis states that addicts will score lower for self esteem as a sign of their neuroticism than the general population but it’s not certain as to whether low self esteem is a cause or an effect of the addiction.
- this suggests that one should be cautious before suggesting that holding a particular personality trait is the cause of addictive behaviours
what are the 2 social psychological explanations of addiction?
peer influences
the role of the media
what did Eiser et al suggest?
among adolescents smokers tend to befriend smokers and non smokers befriend other non smokers
what is the name of the theory that Bandura proposed?
how does this theory say we learn?
social learning theory
learn through observation and imitation
define role model
someone an individual identifies with and admires
define vicarious reinforcement
for a behaviour to be imitated it must be seen to be rewarding in some way
define direct reinforcement
the outcome of the behaviour will determine if it persists
what are perceived social norms?
rules of behaviour that are considered acceptable within a particular social group
what are the 2 types of social norms?
define them
descriptive - an individuals perception of how much others engage in a behaviour
injunctive - what an individual perceives as others’ approval of the behaviour
what did Perkins and Berkowitz find?
that a high proportion of the students that they surveyed believed that being intoxicated was only acceptable in limited circumstances. however interestingly a high proportion also thought that their peers believed that it was acceptable. therefore the individual acts in the way they think the group are acting in order to continue to be accepted
what is a strength of peer influences?
(hint: S-M & F)
what does this support?
- supportive evidence.
- Simons-Morton and Farhat reviewed the findings of 40 prospective studies into the relationship between peers and smoking and found that all but one showed a positive correlation between the two.
- this supports the link between the behaviour of peers and engagement in addictive behaviours. also the fact that the studies were prospective provides stronger evidence of a causal relationship between the two
what is another strength of the peer influences explanation?
what is the problem with this strength?
- Clayton and Neighbours et al compared a number of factors related to alcohol consumption and found that descriptive norms and injunctive norms were the best predictor of alcohol consumption amongst a sample of US students.
- This strengthens the explanation as a predictor of addictive behaviour.
- however perceived social norms were not effective at determining alcohol problems. therefore although peers may influence individuals to engage in an addictive activity in the first place, other factors may be more important in influencing whether this goes on to become an addiction
what is a weakness of the peer influences explanation?
what does this demonstrate?
- it’s important to maintain an element of caution as a key problem with research in this area is determining whether the peers influence the individual or whether individuals choose friends because they also engage in the behaviour (peer selection)
- Ennett and Bauman found that pps who were non smokers at the start of the study and who had smoking friends were more likely to be smoking by the point of the follow up.
- there was also evidence that individuals had changed their friendship groups in line with their smoking/non smoking behaviour.
- this demonstrates that it’s unlikely that peer influence is working alone to create addiction and that other factors are likely to be involved as well
what is another weakness of the peer influences explanation?
what does this suggest?
- contradictory evidence
- other evidence suggests that experimenting with drugs alone is a key factor in developing an addiction
- the classic image of a teenager experimenting with drugs whilst alone appears to be backed u by evidence
- recent work has suggested that the role of peers may have been over emphasised
- this suggests that more research is needed as currently there’s no correct answer as to the influence of peers
what is the social learning theory in reference to the role of the media?
people learn through through observation and imitation of film stars or celebrities. these acts as role models and vicarious reinforcement would be seen if the individual portrayed certain addictive behaviours as glamorous to leading to huge population and wealth
what did Lyons et all find in terms of exposure of addictive behaviours in the media?
alcohol use was portrayed in 86%of popular UK films and in 40% of TV programmes
what was Gunasekera et al’s research?
he reviewed 87 of the most popular films over the 20 years for their portrayal of sex and drug usage. he found films with:
cannabis 8%
other non injected illicit drugs 7%
alcohol intoxication 32%
tobacco use 68%
these films portrayed the drugs positively without showing negative consequences
what is the piece of research for the exposure having an effect?
what does this suggest?
Sargent and Hanewinkel surveyed 4384 adolescents aged 11-15 who were re surveyed a year later. they found that those who didn’t smoke when first surveyed, exposure to movie smoking over the year was a significant and strong predictor of whether they had begun to smoke when re surveyed a year later.
this suggests that there is research evidence pointing to the strong influence of the media in determining addictive behaviour
what is the strength for the role of the media?
what does this suggest?
- research evidence when looking at advertisement influencing your people
- Chapman and Fitzgerald found that under age smokers reported a preference for heavily advertised brands
- Wellman et al reviewed a number of studies looking at how exposure to tobacco advertsiing and the use of cigarettes in films influencd children’s attitudes to smoking
- the researchers found that exposure to media promoting smoking doubled the chances of starting to smoke
- this suggests that there is validity evident in the suggestion that the media had a significant influence in shaping addictive behaviours and attitudes of the public
what is the weakness for the role of the media?
what does this suggest?
- alternative perspective
- Boyd argues that films frequently represent the negative consequences of alcohol and drug addiction
- he claims illegal drug use and addiction is shown by:
physical deterioration
sexual degradation
violence and crime - this suggests that various outlets of the media take take the influence they have very seriously and try to portray a realistic image of addiction; showing positives as well as negatives
what are the 2 methods of modifying addictive behaviour?
agonist and antagonist substitutes
aversion therapy
what is an agonist?
a chemical thaat binds to a postsynaptic receptor and activates that receptor to produce a response
how do agonists work to reduce addictions?
mimick the drug and prevent any withdrawal symptoms
what is an example of an agonist that is used in the treatment of which addiction?
methadone - opiod drugs like heroin
what form is methadone usually provided in?
orally - green liquid
what would a methadone treatment programme look like?
- a doctor/pharmacist sees a patient every day for 3 months until they can continue w/o supervision
- in the beginning, they have an initial dose of 10-40mg
- then they work with their doctor to find a maintenance dose of 60-120mg and this is slowly reduced over time
- the supervision is to make sure they take the right dose, not multiple doses and don’t sell it to others
is methadone effective in the treatment of heroin addiction and why?
yes
- NICE assessed 31 reviews including 27 randomised controlled trials
- found higher levels of retention and lower rates of heroin use for people prescribed methadone than placebo or no treatment
is methadone and ethical form of therapy and why?
no
- involves the treatment of an addiction with an addiction
- doesn’t put the needs of the patient first and doesn’t directly address the addiction. an addict could be prescribed for many years
- danger of overdose - the office for national statistics report that 429 people died from methadone overdoses in 2013 alone
what are the positive social implications of methadone?
- rates of reoffending are reduced by half
- National Treatment Agency suggest that treating heroin users with methadone has an immediate positive effect on reducing criminality
what is the negative social implication of methadone?
there is concern setting up methadone treatment in a particular area as it could lead to increase in crime and anti social behaviour in the locality - addicts convene in one place
what is an antagonist?
binds to a receptor site and blocks the usual functioning of a substance
how do antagonist work to reduce addiction?
blocks euphoric and pleasurable effects associated with the subtsance and so there is no incentive to continue
what is an example of an antagonist and what is it used in the treatment of?
naltrexone - gambling, alcohol, opiod addictions
what form is naltrexone usually provided in?
orally in pill form
what would a naltrexone treatment programe look like?
- it would be taken alongside psychological intervention and should be used after withdrawal has occured
- can be used for up to 6 months and users are kept under supervision to check they haven’t relapsed
is naltrexone effective in treating addictions and why?
yes and no
- NICE reviewed 17 studies and found conflicting results for naltrexone in the treatment of heroin addictions - no significant difference between naltrexone and the control treatment
- however, there was a reduction in relapse rates for those who were highly motivated and offered additional support
is naltrexone an ethical form of therapy and why?
yes - more ethical than methadone
- not addictive
- tackles the addiction itself rather than replace it
- no risk of overdose
- more able to give informed and valid consent
- however, it could impact everyday sensations of reward
what are the 2 forms of aversion therapy?
antabuse and rapid smoking
what is antabuse used in the treatment of?
alcohol
what does antabuse affect? what does it cause?
how the body metabolises alcohol - causes a range of unpleasant symtpoms like sweating, heart palpitations, headached and vomiting
when does the affect of anatabuse occur and how long does it last?
occurs within 10 mins and lasts for a few hours
what are the stimuli and responses before antabuse?
UCS = antabuse
UCR = vomiting
what are the stimuli and responses during antabuse?
UCS = antabuse
NS = alcohol
UCR = vomiting
what are the stimuli and responses after antabuse?
now CS = alcohol
now CR = vomiting
what is the positive effectiveness evidence for anatabuse?
- Niederhofer and Staffen compared antabuse to a placebo
- used self report methods and screening for 90 days
- antabuse patients had significantly greater abstinence duration than placebo group
what is the negative effectiveness evidence for antabuse?
- Ellis did antabuse trials lack scientific rigour as it’s short term and doesn’t apply full randomised control trials
- also some comparison studies between antabise and other methods of treating alcoholism
what is the social implication of antabuse?
financial implications
- concerns about dramatic increase in spending on antabuse and other drugs in the treatment of addiction. NHS spent £2.25 million on antabuse in 2008
- however, not investing in the treatment would be catastrophic as alcohol abuse costs the tax payer £21 billion a year
how does rapid smoking work?
smokers sit in a closed room and take a puff on a cigarette every 6 seconds until they feel sick or finish a certain number
how does rapid smoking work in developing an aversion to the addiction?
the smoker would associate the unpleasant feeling with smoking
what is the effectiveness evidence for rapid smoking?
- 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 reduction in the urge to smoke in the 24 hours and week after the procedure
- however at 4 weeks this difference in the urge to smoke between the groups was no longer significant (short term)
what are the ethical issues for aversion therapy?
- treats the symptom not the problem
- risk of harm
explain why aversion therapy treats the symptom not the problem
- aversion therapy treats the behvaiour not the underlying cause
- the aversion towards a specific behaviour may remain but the underlying problem that caused the addiction is not addressed
explain the risk of harm for aversion therapy
both involve a level of distress and discomfort for the addict. the negative effects experienced whilst undergoing treatment will be extremely unpleasant but it’s how it’s desgined to work therefore full informed consent is essential prior to the treatment
