addiction Flashcards
define addiction
- compulsion to use a substance or engage in behaviour despite its harmful consequences and you are unable to stop
- lead to failure to meet work, social and family obligations
define tolerance and features of it
- when an individual has to take more and more of the substance to gain the same effect as their initial experience
- explained through homeostasis as the brain readjusts if we start to intake a substance regularly
define cross tolerance
need for more of a substance to gain the same effect as the body becomes tolerant, seen in all drugs and cross drug families
how does tolerance occur
metabolic tolerance- enzymes responsible for metabolising the drug do this more efficiently over time which leads to reduced concentrations in the blood and weaker effect
cellular tolerance- prolonged drug use leads to changes in resection density, reducing the response to the normal dose of the drug
learned tolerance- user will experience reduced drug effects because they have learned to function normally when under the influence of the drug
define withdrawal syndrome and features of it
- unpleasant feelings and symptoms after you stop taking the substance
- follows tolerance as the body seeks out the drug
- low mood, feeling nauseous and being achy
- withdrawal is opposite to the feelings induced by the drug
what does severity of withdrawal syndrome depend on
drug used- shorter half life leads to more intense withdrawal
amount consumed- if large amounts are consumed then the withdrawal will be greater
drug use pattern- greater dependence if the drug use is frequent and regular
define acute withdrawal
begins within hours of drug cessation and gradually resolves, and is characterised by intense physical cravings
define post acute withdrawal
emotional and psychological turmoil as addict experiences alternating periods of dysfunction and near normality as the brain tried to re-organise without relying on the substance
what is physical dependence and features of it
- occurs with long term usage when a person relies on a substance to feel normal
- does not mean they are addicted
- increased tolerance
- unpleasant physical withdrawal symptoms
what is psychological dependence and features of it
- drug becomes a central part of an individuals thoughts, emotions and activities
- strong urge to use the drug
- cravings
- person feels anxious if cravings are not met and feel they are unable to cope
how does Epstein suggest psychological dependence arises
- rational system- reasoning through conscious, analytical and emotion free decision making
- experiental system- precocious, autonomic and emotion driven, behave how we feel and often act irrationally
explain how genetic vulnerability is a risk factor
- some are more able to metabolise certain substances and less likely to experience negative effects so they consume larger amounts, European generally metabolise alcohol quickly, 50% of asians metabolise alcohol slowly so they feel nauseous after drinking small amounts
- Pianezza et al found some who lack fully functioning enzyme to metabolise nicotine, and they smoke significantly less
- some have low levels of dopamine and decreases ability to activate dopamine receptors with brain reward with way
- alcoholic with variant of dopamine receptor gene associated with decreased dopamine receptor availability
evaluation of genetic vulnerability as a risk factor
+ national swedish adoption study looked at adults who were adopted where one parent from biological family had addictions, found they 2x more at risk at developing addictions themselves
=> confounding variable if they still have contact with family
+ genetics also influences personality and ability to regulate emotions, which can affect their concept of self and lead to involvement with drugs to cope
- biological reductionism
explain stress as risk factor
- use of substances or behaviours as coping mechanism
- addiction less likely if there are mediating factors like social support
- “self medication” model by Gelkopf et al proposed that individuals intentionally use different forms of behaviour to “treat” psychological symptoms
- stress is one of the strongest predictors of relapse and increases drug cravings
- robins et al found almost half of US soldiers with PTSD used opium or heroin, and 20% developed dependence for heroin
- kessler et al found men with PTSD 34% reported drug abuse compared to 15%, women 27% vs 8%
- sexual abuse in childhood meant more women were 2x more likely to develop alcohol addiction
evaluation of stress as a risk factor strengths
+ research can be used to reduce risk of stress with addiction, Matherny and Weatherman carried a follow up study on smokers and found there was a relationship between use of stress coping resource and abstinence from smoking
evaluation of stress as a risk factor weaknesses
- hard to establish cause and effect, may only be correlational
- not established for all addictions, Arvelo et al found association between areas and illicit drug use, but not with stress and alcohol addiction
personality as a risk factor for addiction
- clonigers tridimensional theory
- impulsivity- lack of planning, high degree of risk taking
- anti social personality disorder (APD)- incorporates impulsivity, 44% in alcoholics and 70% in cocaine addicts
- psychoticism and neuroticism
- self efficacy- how strongly someone believes they are capable of doing something like changing their behaviour, those with no addiction have higher self efficacy
explain clonigers tridimensional theory
novelty seeking- need for change and stimulation and seek new environments and experience (high)
harm avoidance- amount a person worries about the negative elements (low)
reward dependence- someone reacts and learns from a rewarding situation quickly (high)
explain eysenck and eysenck theory of personality as risk factor
- psychoticism- egocentric, aggressive, impulsive
- extroversion- outgoing, happy, sociable
-neuroticism- anxious, moody
-people with addition score more highly on P and N scale
evaluation of personality as a risk factor
+ longitudinal studies support influence of impulsivity in predicting later addiction- adolescents who progressed to heavier levels of alcohol abuse scored higher in impulsivity
+ clear relationship between personality and addiction, so identifying vulnerable individuals can help prevent it
- personality is genetically determined- novelty seeking associated with D4 dopamine receptor gene
family influences as a risk factor
- social learning theory can explain how adolescents see family as role models and imitate their behaviour
- Reith and Dobbie found that gambling knowledge and behaviour was passed on through routines or everyday life
- vicarious reinforcement- if they see role models rewarded for such behaviour, e.g feelings of pleasure or calm
- schemas formed as we are infeluced on our desire to try substances
- perceived parental approval means you are more likely to try a substance if your parents are lenient
- if adolescents believe their parents have little to no interest in monitoring their behaviour they are more likely to develop an addiction
- older siblings are see as role models and have more influence as they are more like them, and thus gravitate towards peers who resemble and validate their behaviour
evaluation of family influences on addiction
+ quine and stephenson found that children were significantly more likely to have the intention to have drunk alcohol if their parents drank weekly
+ tolerant parental attitudes and sibling substances abuse were the characteristics most strongly associated with increased prevalence of binge drinking
- family intervention does not look at sibling influence
peer influence as a risk factor of addiction
- mary o’connell et al said elements were individuals attitudes about drinking are influenced by associating with peers who use alcohol, experienced peers provide more opportunities, and individual overestimates how much their peers are drinking
- creation of a group norm that favours rule breaking infeluces drug use
- peer pressure
- social identity theory- significant part of an individuals self concept is formed as a result of their ingroup
evaluation of peer influence as a risk factor
+ litt and stock found teenagers who viewed their peers facebook profiles that portray alcohol use were more willing to use alcohol
+ help with social norm interventions to influence adolescents misconceptions towards alcohol
- peers are less inferential as individuals get older
what is nicotine and its effect on smoking and addiction
- WHO estimates 36% of males and 7% of females smoke
- nicotine has effects including tranquillisation, decreased irritability, increased alertness and improve cognitive functioning
- nicotine paradox- both stimulant and relation effects, explained through the fact smoking appears relaxing as smokers are in mild nicotine withdrawal
- nicotine reaches peak levels in bloodstream and brain in less than 10s
what is dopamine and its effects
main neurotransmitters which causes feelings of pleasure, and many drugs act in brains reward system to heighten dopaminergic activity
role of neurotransmitters and enzymes in nicotine addiction
- nicotine attaches neurons in VTA, which triggers release of dopamine in nucleus accumbens
- nicotine also stimulated glutamate, which triggers additional release of dopamine and speed up activity of neurons
- GABA is meant to slow down neuron activity, but nicotine inhibits this
- cigarette smoke also has unknown substance which blocks action of enzyme MAO, which is responsible for breaking down dopamine
- effects of dopamine disappear in a few mins, so continued activation of dopamine enhancing neurons builds a tolerance and dependence
evaluation of brain neurochemistry explanation of nicotine addiction strengths
+ support for link between nicotine and dopamine as epilepsy drug GVG reduces surge of dopamine that occurs from nicotine, and reduced addictive tendencies
+ parkinson’s leads to loss of dopamine producing nerve cells, and smokers are less likely to get OD and treatment for PD used nicotine patches to help ease symptoms
+ research in blocking glutamate shows how it decrease nicotine seeking in animals, which also decrease when GABA was enhanced
+ help develop treatments like nicotine replacement therapy and can also help treat disorders with co-occurrence like schizophrenia
evaluation of brain neurochemistry explanation for nicotine addiction weaknesses
- biologically deterministic as some people can be occasionally smokers without becoming addicted
- nicotine effects men and women differently- women had effect on dorsal puta,en (habit formation) and men had effect on ventral striatum (reinforcement effect of drugs)
- too much focus on dopamine, perhaps GABA and serotonin
learning theory explanation of nicotine addiction
- can begin when you observe role models, which through vicarious reinforcement leads young people to expect positive consequences
- operant conditioning- nicotine is immediately rewarding (10s) and helps maintain addiction as smoking relieves irritation through negative reinforcement
- maintain smoking to avoid withdrawal symptoms and leads to physical dependence
- cue reactivity refers to associations made through classical conditioning- associate situations like meeting friends with rewarding effects of nicotine
evaluation of learning theory explanation of nicotine addiction strengths
+ levin et al found that rats would lick the nicotine- linked water sprout more often due to the reward
=> however, problems with extrapolation
+ study found dependent smokers were more likely to report craving when shown smoking related cues like lighters
+ help create treatment programmes like aversion therapy which used counter conditioning by associating pleasant effect of smoking with an aversive stimulus (electric shock)- 52% were still abstaining
evaluation of learning theory explanation of nicotine addiction weaknesses
- individual differences as women start smoking later than men, dependence grows more rapidly, and find it harder to give up
- does not explain how free will plays a role
- does not explain how some people can smoke but not get addicted
how can operant conditioning explain gambling addiction
- psychological, physiological, social and financial rewards- noise, excitement, peer praise
- gamblers are not always rational in their thinking, and therefore punishment from not winning is not as effective
- gambling is time contiguous as reward i immediately, meaning association is greater
- however, overall negative punishment does not arise until there is a series of losses
define contiguity
co-occurrence of reinforcement and punishment
define partial reinforcement
wins follows some bets but not all
define variable reinforcement and the different types
wins occur after an unpredictable number of bets
- variable ratio- reinforcement after unpredictable number of responses, most likely used by casinos as each play can potentially win
- variable interval- reinforcement after unpredictable time intervals, moderate yet steady response rate
different types of fixed reinforcement
fixed ratio- reinforcement at predictable number of responses, easily work out when you win
fixed interval- reinforcement at predictable time intervals, money spent is minimal
what is big win hypothesis
early experiences of “big wins” shape long term gambling as they desire to repeat that “peak experience”
what is “near miss” with gambling addiction
near misses are close to being wins which creates brief period of excitement and encouraged further gambling
how does classical conditioning explain gambling addiction
association with gambling environment itself- lights, sounds etc through cue reactivity
how does social learning theory explain gambling addiction
role models can encourage behaviour
evaluation of social learning theory to explain gambling strengths
+ sharpe found that early win hypothesis leads to overestimation of wins and underestimation of losses
+ practical application with successful treatments like aversion therapy
evaluation of social learning theory to explain gambling weaknesses
- cannot explain why some people gamble but do not get addicted
- difficult to explain same principles to different types of gambling, like bets that are not time contiguous (sports)
- different pathways for gambling addiction (behaviourally conditioned, emotionally vulnerable, antisocial impulsive) so there are individual differences
- does not explain why people start gambling
what is expectancy theory to explain gambling
gamblers have expectations about the future benefits and costs of their behaviour
what is cognitive bias in explaining gambling
- irrational belief that focuses on positive aspects of the behaviour and downplay the losses
- gamblers fallacy- completely random events are somehow influenced by recent/past events
- illusions of control- superstitious behaviours and exaggerates self confidence which influence their chance of winning
- “near miss” bias- close to a win so it is rewarding and believe they can nearly win
- recall bias- overestimate and remember wins but forget or rationalise losses
- “just world” hypothesis- deserve to win due to having lost often previously
evaluation of cognitive explanation for gambling strengths
+ griffiths found that regular gamblers on a fruit machine were more likely to make irrational statement, like humanising the machine and explain losses as near misses or winds
=> however, what they muttered does not represent what they actually thought
+ practical application as CBT can be used to correct cognitive biases showing they play a role in explaining the addiction
=> however, works on a slot machine and cannot guarantee it represents larger population of gamblers
+ support for neurological basis as Clark et al identified the insular, which when damaged makes people immune to cognitive biases showing
evaluation of cognitive explanation of gambling weaknesses
- beta bias as a study in australia found 1.3% of men to be addicted, but only 0.6% of women, and men are more likely to gamble for social reasons
- cognitive biases more likely with gambling machines than those engages in sports betting
what are aversives drug therapy
- counter condition behaviour by producing unpleasant consequences if taken with specific drugs
- if people consume alcohol with disulfiram, they experience nausea and vomiting
what are agonists drug therapy
- drug substitutes that bind to the same neuron receptors as the addictive drugs and produce similar effects
- allow for gradual and controlled withdrawal
what are antagonists drug therapy
- block the neural receptor sites and preventing the drug from having its usual effects
- other interventions should be used alongside
how does NRT treat nicotine
- works as an agonist
- gradually release nicotine into bloodstream at much lower levels without the harmful chemicals found in cigarettes
- help individual to control cravings and prevent relapse
- over time they are reduced in strengths so patient can gradually withdraw
how does varenicline (champix) treat nicotine
- nicotine free pill
- attached to nicotine receptions which allowed for continued release of dopamine
- if a cigarette is taken, it will block nicotine from acting on their receptors
how does bupropion (zyban) treat nicotine addiction
- initially antidepressant by inhibiting reuptake of dopamine
evaluation of drug therapies in treating nicotine strengths
+ hartmann- boyce et al conducted meta analysis with 65000 participants and found all for forms of NRT were significantly more effective than placebo or no treatment, increased rate of quitting by 60%
+ addictions becomes less biased
evaluation of drug therapies in treating nicotine weaknesses
- publication bias
- side effects- NRT also leads to sleep disturbances and dizziness
how does opioid antagonists (naltrexone) treat gambling
- enhance release of GABA which reduces release of dopamine
- kim et al found 12 week double blind placebo trial that naltrexone was effective in reducing frequency and intensity of gambling urges
how do antidepressants (SSRIs) treat gambling
- increase serotonin levels
- reduce symptoms of depression and anxiety
- lower impulsivity
evaluation of drug therapy in treating gambling addiction strengths
+ grant and potenza found gambling addicts in SSRIs improved for the next 3 months, but the person who received placebo found gambling symptoms returned in 4 weeks
=> however small sample size of 13
+ addiction becomes less stigmatised
evaluation of drug therapy in treating gambling addiction weaknesses
- opioid antagonists are basic and general as it can also cause some patients to lose pleasure in other areas of life too
- methodology concerns- small sample size, high dropout rates, low numbers of females
- side effects- greater as naltrexone is needed in higher doses
define aversion therapy
decrease undesirable behaviours associated with addiction by associating them with real unpleasant sensations through classical conditioning
explain aversion therapy for alcohol addiction
- alcohol is NS and pleasure is UCR
- disulfiram is UCS and gives negative reactions (UCR)
- through association, alcohol is now associated with the negative reactions of vomiting
explain aversion therapy for gambling addiction
- clients associate gambling related phrase with a small electric shock, which they administer themselves
- intensity and duration preselected by the client
- also keep behaviour diary
evaluation of aversion therapy
+ study of 600 patients being treated using aversion therapy, with 75 also being treated for cocaine, found 12 months later 75% were abstinent from alcohol, and 83.7% for cocaine
- ethical concerns- physical harm which leads to high dropout rates
=> however, can be argued addiction itself is potentially more dangerous
define covert sensitisation
- classical conditioning to eliminate unwanted behaviour through imagine sanrio’s
- must be good enough to experience considerable discomfort
how does can covert sensitisation be used to treat alcohol addiction
individuals should imagine themselves in situations associated with drinking, which turn into unwanted consequences
evaluation of covert sensitisation
+ kraft and kraft successfully eliminated patients cravings for chocolate in 4 sessions, and said it is effective in 90% of cases
+ research support suggests covert sensitisation was more likely to reduce gambling than aversion therapy (90% vs 30%)
+ more ethical
- more likely to be effective with patients with more vivid imaginations
evaluation of behavioural intervention
- only focuses on learned aspects and fails to address underlying cause, which makes individual vulnerable to developing further addictions
what are the different elements of CBT
- strong therapist-client relationship
- functional analysis
- skills training
- use of role play so therapist can model behaviour and client can imitate
features of functional analysis in CBT
- identify how the client thinks before, during and after the situation
- identify trigger or reasons for their addiction
features of skills training in CBT
- cognitive restructuring- help to tackle the biases that operate below the clients level of awareness e.g faulty beliefs
- assertiveness training can be used to help client tackle interpersonal conflicts in a controlled and rational way
- anger management to help cope with situation which would result in them taking a substance
- social skills builds on their ability to cope with anxiety e.g how to refuse alcohol with minimum fuss
evaluation of CBT in treating addiction strengths
+ Petry found pathological gamblers treated with CBT were gambling significantly less than control 12 months later, and also more improvement with a therapist as opposed to a book
+ can be delivered different ways like online, which is more flexible to a wider range of people
=> however it is difficult for researchers to identify which elements of CBT were more useful as no standard treatment
evaluation of CBT in treating addiction weaknesses
- found benefits may be short lived as there was no significant differences 9-12 months after treatment
- demanding therapy- over 10-15 one hour weekly sessions, “homework” which leads to high dropout rates
- over emphasis on cognitive thinking and not the stressful environments they are in
- more than CBT needed for addicts to shift lifestyle and change how they used to live, as otherwise they can easily fall back into old habits
different elements of theory of planned behaviour by Azjen
- attitude
- subjective norms
- perceived behavioural control
- intention
- behaviour
features of attiude in TPB
- refers to collection of the addicted persons attitude towards their addiction
- outweighs whether it is favourable or unfavourable
features of subjective norms of TPB
- belief whether the people closest to them approve or disapprove of their behaviour
- based on what they believe to be the “norm”
features of perceived behaviour control TPB
- extent to which we can control our behaviour- self efficacy
- resources available to them- money, time, support
- affects our intentions to behave
- can also directly affect behaviour if we perceive we have a high level of control
features of intention in TPB
- motivational factors that influence a behaviour
- how hard people are willing to try
application of TPB in reducing addiction
- ensure addict has access to treatment to change their behaviour attitude
- give data about the % of people engaging in risky behaviour to change subjective norm
- help addicts focus on willpower and effort to overcome addiction
evaluation of TPB strengths
+ useful in predicting intentions relating to alcohol use with all three factors contributing
=> however, cannot predict all types of addiction or even types of alcohol addiction
+ can be tailored to individual needs depends on which element they need most help in
evaluation of TPB weaknesses
- not all research shows a strong link with intention and behavioural change
- methodological concerns- social desirability bias, intention may differ when in that scenario
- too rational and does not consider the role of emotions and cognitive biases that people do not acknowledge themselves
- self determination theory may be better as it fails to consider motivation as factor, where it was found recovery was more successful in individuals who wanted to give up instead of being coerced
what is prochaskas six-stage model of behaviour change
- cyclical process that described various steps involved in overcoming addiction
- often stages can be skipped or returned to if needed
different stages of prochaskas six stage model of behaviour change
- precontemplation
- contemplation
- preparation
- action
- maintenance
- termination
- (relapse)
features of the precontemplation stage
- people are not considering changing their behaviour soon
- might be in denial or feel demotivated from previous attempts
- intervention should focus on helping them realise
features of contemplation stage
- become increasingly aware
- consider advantaged and close of changing
features of preparation stage
- individual has decided to change but has not yet got a plan
- help client decide on which support will be needed
features of action stage
- change their behaviour
- also formal methods of reducing behaviour like CBT
- relapse can happen
- practical help, praise and rewards
- actions must reduce the risk posed by the original addiction- complete withdrawal rather than partial
features of maintenance stage
- change is permanent and stable
- abstinence is automatic and no relapse
- only 1/5 reach this stage
- possible for lapses, but do not always lead to complete relapse of old behaviour
features of a potential relapse in prochaskas 6 stage model
- possible they can go back to old ways
- should reevaluate previous technique and try a different way to reduce addiction
evaluation of prochaskas 6 stage model strengths
+ positive outlook by understanding relapse is inevitable, which increases confidence and motivation
+ effective in treatments where you can even tailor depending on what stage individuals are in (22-26% success rate)
evaluation of prochaskas 6 stage model weaknesses
- conflicting research can be found where there were no beneficial effects to the staged intervention
- difference between contemplation and preparation is vague so it is questionable to have 6 distinct stages- can even be reduced to 2
- fails to acknowledge importance of social norms as found arab culture (heavy on smoking and drinking during events) made it more difficult to quit, with 62% in the pre contemplation stage compared to 40% in US and Europe
- arbitrary cut off at each stage
