Addiction Flashcards
1
Q
addiction today
A
Today we see addictions to heroin, gambling, sex, cocaine, cigarettes, alcohol, food (chocolate), caffeine, danger, phones, social media
2
Q
addiction def
A
A disorder in which an individual takes a substance or engages in a
behaviour that is pleasurable but eventually becomes compulsive with
harmful consequences
3
Q
Key features of addiction
A
- Dependence (physical and psychological)
- Tolerance
- Withdrawal syndrome
4
Q
Dependence (physical) def
A
a state of the body due to habitual drug use which results in a withdrawal
syndrome when the use of the drug is reduced or stopped
5
Q
dependence (physical)
A
We can only establish physical dependence once drug use has
stopped – we then can observe withdrawal symptoms
- Usually occurs after prolonged use of a substance (several weeks)
- Usually characterised by needed the drug to feel ‘normal’ – this does not necessarily mean they are addicted, they can just be
dependent
E.g. Meredith et al. (2013) – Caffeine dependence – caffeine withdrawal can include headaches, fatigue and difficulty concentrating – this can happen in those that drink just one regular cup of coffee a day
6
Q
Dependence (psychological) def
A
A compulsion to continue taking a drug because the use is rewarding – it
becomes a central part of the individual’s thoughts, emotions and activities
7
Q
Dependence (psychological)
A
Occurs when the drug leads to either an increase in pleasure
or decrease in discomfort
This can lead to the individual continuously taking the drug
until it becomes a habit, despite any harmful consequences
E.g. cravings – once cravings develop a person can begin to
feel anxious if cravings are not met and they may feel unable
to cope
The desire to use the drug can become so intense it can take
over thought processes completely
8
Q
Tolerance def
A
A reduction in the response to a drug, so that the addicted individual needs
more to get the same effect
9
Q
tolerance
A
Tolerance is caused by repeated previous exposure to the
effects of a drug. E.g. heroin addiction, sleeping pills, pain
killers
Examples:
Learned tolerance: when an individual learns to function
normally when under the influence of a drug – resulting in a
reduced effect
Metabolic tolerance: enzymes metabolise the drug more
efficiently over time – resulting in lower concentrations in the
blood, reducing its effect
Cross-tolerance: developing tolerance to one drug can reduce
sensitivity to another drug – e.g. the sleep-inducing effects of
alcohol leads to patients needing higher doses of anaesthetic
10
Q
Metabolic tolerance
A
enzymes metabolise the drug more
efficiently over time – resulting in lower concentrations in the
blood, reducing its effect
11
Q
Cross-tolerance
A
developing tolerance to one drug can reduce
sensitivity to another drug – e.g. the sleep-inducing effects of
alcohol leads to patients needing higher doses of anaesthetic
12
Q
Withdrawal syndrome def
A
A set of symptoms that develop when the addicted person abstains from or reduces their drug use
Symptoms are usually opposite to the ones created by the drug – they also indicate when physical dependence has developed
13
Q
exmple of withdrawl symptoms
A
withdrawal symptoms from nicotine include irritability, anxiety, increased appetite and weight gain
14
Q
Withdrawal usually takes place in two phases:
A
Acute withdrawal – after a few hours of abstinence the person experiences intense cravings (sign of dependence)
Prolonged withdrawal – symptoms that continue after weeks, months or years due to becoming sensitive to cues they associate with the substance (causing relapse)
15
Q
Explain how withdrawal might occur in someone who isn addicted to nicotine. Give two examples of the effects of
withdrawal. (4 marks)
A
- when nictotine is removed form their system they will experience withdrawl symptoms, which is when a person experienes unpleasant effects when avoiding the substance they are addicted to
- this may include weight gain, anxiety
- the addicted individual may induge in nicotine to avoid these withdrawl effects
16
Q
Using your knowledge of addiction, explain Nia and Aodhagan’s
behaviours. (4 marks)
A
Nia is displaying physical dependence and withdrawal syndrome. Nausea and anxiety are withdrawal symptoms of not taking heroin. Experiencing these after just 12 hours of not taking heroin suggests that she has a physical dependence and will continue to use heroin to reduce the symptoms.
Aodhagen is displaying tolerance and psychological dependence. Starting with scratch cards but now spending
most time in the casino suggests he needs to gamble more than he used to, to feel the effects he initially felt. His strong
urge to gamble when he feels down suggests he relies on gambling to feel normal, which is psychological dependence.
17
Q
Risk factors def
A
Any internal and external influence that increases the likelihood someone
will start using drugs or engage in addictive behaviours
18
Q
Risk factors examples
A
- Genetics
- Stress
- Personality
- Family influences
- Peers
19
Q
Effects of nicotine
A
Nicotine is the main active ingredient of tobacco – the
addictive ingredient
It has been found to have both stimulant and relaxation
effects on the body – known as the ‘nicotine paradox’
This has been explained as smoking only appears as
relaxing
It in fact has more stimulant effects, such as increased
alertness and improved cognitive functioning
However, Jarvis (2004) found that these effects are less
evident in regular smokers (tolerance built up)
20
Q
nicotine paradox
A
It has been found to have both stimulant and relaxation effects on the body
This has been explained as smoking only appears as relaxing
21
Q
Dopamine
A
Generally excitatory and associated with feelings of pleasure. Very low levels are associated with depression
22
Q
Dopamine
A
Nicotine is known to effect the dopamine reward system – the brain’s reward pathway
- 1-2mg of nicotine is inhaled per cigarette on average
- It is absorbed through the inside of the mouth, nose and lungs
- Nicotine reaches its peak levels in the brain and bloodstream in less than 10 seconds
- Nicotine then becomes addictive as it reaches the reward pathways in the brain
23
Q
Brain neurochemistry
The main chemical (neurotransmitter) involved in nicotine addiction
A
dopamine
23
Q
link between dopamine and addiction
A
But the link between dopamine and addiction is best explained with the neurotransmitter, acetylcholine (ACh)
24
acetylcholine pronounciation
Pronunciation:
Uh see tuhl kow leen
A ce tyl cho
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ACh
ACh plays a key role in all nervous system activity, meaning there are ACh receptors on many neurons in the CNS
One subtype of ACh receptor is the nicotinic acetylcholine receptor – nAChR – these can be activated by ACh and nicotine
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nAChRs stands for
(nicotinic acetylcholine receptors)
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nAChRs
- When activated by nicotine, the neuron transmits dopamine to the next neuron
But then the receptors immediately shutdown (within milliseconds) and temporarily cannot respond to other neurotransmitters that may diffuse across the synapse
This is desensitisation – the neuron becomes desensitised (less responsive) and overall, less neurons are active as fewer are available for synaptic transmission
Most nAChRs are found in the ventral tegmental area (VTA) of the brain, which plays a significant role in reward and motivation (the dopamine reward system)
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# risk factors A03
Genetics – gender differences
Gender differences in genetic vulnerability to alcohol addiction
Although research on male alcoholics has been generally consistent, studies on females have been inconsistent
McGue (1997) found that only 2 out of 4 adoption studies show a significant correlation between female alcoholics and their biological parents
Additionally, only 2 out of 5 twin studies found significantly higher concordance rates for MZ twins compared to DZ twins
Why is this a problem?
Genetics may only be a (consistent) risk factor for men – cannot be generalised as an important factor for everyone
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# risk factors A03
sress
Researchers have suggested that if stress leads to addiction, coping with stress should lead to abstinence
Matheny and Weatherman (1998) – carried out a follow-up study of 263 smokers who completed a national smoking cessation programme.
They found a strong correlation between use of coping resources (how well they dealt with stress) and ability to maintain abstinence
Resources included problem-solving, tension control and perceived confidence
Why is this a strength?
Use beyond explanatory power
If reducing stress can decrease likelihood of addiction, then stress is likely to be a valid risk-factor for developing addiction
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# Risk Factors AO3
Personality
Research support – several studies have shown that APD (antisocal personality disorder) and alcohol dependence are co-morbid
Bahlmann et al. (2002) interviewed 55 ppts with alcohol dependence and 18 of them also had a diagnosis of APD
From those 18 ppts, it was found that APD developed around 4 years before their alcohol dependency (APD developed first)
This suggests that personality traits (such as those associated with APD) are a valid risk factor for developing alcohol addiction
they could be taking mecication for APD that develops the alchohol addicted
correlation not causation, link could be coincidence
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# Risk Factors
Family influence
Limited approach
The factor has been criticised for only focusing on parents and ignoring sibling influences in developing addictions
Feinberg et al. (2012)
Suggested that failure to address sibling influences when treating substance abuse patients can reduce its effectiveness
Even if therapies are aimed at the user and their parents, they could be undermined by older siblings
Older siblings are more likely to engage in anti-social behaviours than younger siblings, so are likely to be a stronger influence
reductionist
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# Risk factor AO3
Peer influences
Practical application – how can our understanding of peer influence as a risk factor be used in the real world?
Social norm marketing advertising (SNMA) – used to correct misinformed perceived norms about drinking and drug use
For example, use of beer mats, posters and leaflets in bars and student unions can display accurate messaging
“students overestimate what others drink by 44%”
Such messages can change the way students perceive addictive behaviours
Strength?
Understanding peer influence as a risk factor for addiction has use beyond explanatory power
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# Risk factors AO3
Cause and effect
Research into most risk factors is often correlational
Eg. Many studies show strong correlations between stressful experiences and addiction.
However, many addictions have negative effects on lifestyle, relationships, finances, therefore causing stress
Therefore, it is unclear which direction the effect is in
Counter: how could cause and effect be established? - unethically, by making it into an experiment
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# Risk Factors AO3
Methodological issues
What method is mostly used to obtain data about risk factors?
Self-report is an issue due to its retrospective nature
Ppts are usually required to recall incidents of stress, trauma and family behaviours from the past (memory)
These accounts can be difficult to recall accurately due to possible associated stress/trauma
- lack of internal validity
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Role of dopamine: summary
- Dopamine is transmitted when nicotine binds to nAChRs – nicotinic acetylcholine receptors
- Once dopamine is transmitted, the neurons shut down and become desensitised (less responsive) to other neurotransmitters
- Dopamine is transmitted from the ventral tegmental area (VTA) to the frontal cortex via two routes
-Mesolimbic pathway 🡪 nucleus accumbens 🡪 frontal cortex
- Mesocortical pathway 🡪 frontal cortex
The rush of dopamine to the frontal cortex causes the rewarding effects, reinforcing the use of nicotine
36
# brain neurochemistry
Withdrawal
nAChRs are continuously desensitised while someone smokes – but after a prolonged period of not smoking (e.g. overnight) nicotine leaves the body and the neurons resensitise and become functional again
This is when the individual experiences withdrawal symptoms (anxiety, agitation, etc.)
Without nicotine in the system, the nAChRs become overstimulated with acetylcholine instead – this is when they are most sensitive
Therefore, when the first cigarette of the day is smoked, it is the most rewarding – nicotine binds to the nACHrRs, it strongly reactivates the dopamine reward system
37
# brain neurochemistry
dependence and tolernce
- A habitual smoker will experience constant desensitisation (while smoking) and resensitisation (while sleeping) of nAChRs
- this eventually causes long-term desensitisation (and therefore dependence)
- The constant exposure of nicotine to nAChRs then causes permanent changes to brain neurochemistry – a decrease in active receptors on neurons
- This eventually leads to less and less dopamine reaching the frontal cortex (and therefore tolerance)
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Developing addiction: summary
Withdrawal: nAChRs become resensitised once nicotine leaves the body (due to large amounts of ACh), making them more sensitive to releasing dopamine when nicotine binds to them once again
Dependence: the constant cycle of desensitising and resensitising leads to long-term desensitisation – no longer feeling normal without nicotine
Tolerance: constant exposure of nicotine reduces the overall number of receptors on the neurons, leading to more nicotine being needed to create the initial dopamine effects
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# brain neurochemistry explanation AO3
Research support
McEvoy et al. (1995) investigated smoking behaviour in patients with schizophrenia who were taking antipsychotic drugs for treatment
- reduced smoking hehaviour
Antipsychotics are dopamine antagonists (blockers) which reduce overall levels of dopamine
They found that patients smoked significantly more when taking the drug (presumably to compensate for depleted dopamine levels caused by the antipsychotics)
This (indirectly) validates the role of dopamine in nicotine addiction
We already know that the link between schizophrenia and dopamine is complex so this link may not be appropriate
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# brain neurochemistry explanation AO3
Practical application
- The brain neurochemistry explanation for nicotine addiction has led to a successful therapy
- Nicotine replacement therapy (NRT)
-NRT in the form of gum, patches and inhalers contain controlled doses of nicotine (the addictive substance) without the damaging effects of tobacco
-The nicotine binds to nAChRs, mimicking the effects of smoking – including the dopamine rush
- NRT satisfies cravings and safely reduces withdrawal symptoms as doses can be reduced over a few weeks
+safer, doesnt have the other harmful effects of smoking, practical application
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# brain neurochem explanation AO3
Determinism
The brain neurochemistry explanation is biologically deterministic – the effect nicotine has in the brain is out of our control which makes nicotine addiction inevitable
So?
Some individuals smoke cigarettes and do not form an addiction
Some can quit very easily and experience little to no withdrawal symptoms
Problem?
Furthermore, some researchers have argued that personality factors may explain these differences better
E.g. those with high levels of neuroticism (aware that you have a mental condition) experience worse withdrawal symptoms than those with low levels
Neuroticism, one of the Big 5 personality traits, is typically defined as a tendency toward anxiety, depression, self-doubt, and other negative feelings.
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# brain neurocemistry explanation
Association with Parkinson’s disease
PD is a progressive neurodegenerative disorder, characterised by a loss of dopamine-producing cells in the brain
Research has found that smokers are less likely to develop PD – why might this be?
Nicotine causes activation of dopamine release – it is unlikely that someone will develop PD if these cells are continuously activated (desensitised)
+practical application, apply the knowledge to help people
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Three phases of nicotine
addiction
- initiation
- maintenance
- cue reactivity (relapse)
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# Three phases of nicotine
addiction
Inititation
Explained with operant conditioning (positive reinforcement)
e.g. pleasure reward
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Mintenance
Explained with operant conditioning (negative reinforcement)
e.g. avoiding withdrawl effects
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Cue reactivity (relapse)
Explained with classical conditioning
e.g. socil events where your friends smoke may lead to you smoking as you assocate it with smoking e.g. drinking beer and smoke
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risk factors def
ny internal land external influence that increases the likelihood someone will start using drugs or engage in addictave behaviours
48
risk factors examples
genetics
stress
personality
family influences
peers
49
Genetics
Any inherited preesposition that increases the risk of a disorder or condition
amount of dopamine in brain is dependant on no of D2 receptors on each neruon - abnormally low numbers associated with addition - number of receptors are genetically determined
50
Genetics research
Pianezza et al
- found some more able to metabolise substances related to addition than others
- found ppl who lack nicotne enzyme CY2A6 smoke sigs less than those with fully functiomimg enzymes
- CYP2A6 breaks down nictotine and is genetically determined
- this suggests that thoe with fully functioning enzymes will smoke more and so are more likely to become addicted as they are able to develop a tolerance to nicotine
51
stress
a physiological and psychological state of arousal that arises when we belive we do not have the ability to cope with a percieved threat
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stress research
shown that early experiences of severe stress damage brains in a sensitive period of development, creating a vulnerability to addiction by adolesence
epslein
- looked at data from ationa woman study - found strong + correlation between childhood rape and adult alcholol addiction
- however only the case for wmen diagnosed with PTSD
this suggests that those with severe stress/ have experienced severe stress will likely form an addiction
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Personality
patterns of thinking feeling and behaving that differ between individuals. they are relitively consistent between situations and over time
54
personality research
robins
argues antisocial persnality disorder (APD) is causal risk factor for addiction. APD beguns in earky adolenece, characterised by impulsivity
- including norm-breaking, risk taking/ criminality and preference for immediate gratification
therefore inevitable that young people with APD witll try drugs as it combines norm-breaking , criminal behaviour and satisfaction
55
Family influences
effects other memebers of our families have on our thoughts, feelings and behaviours over the rouse of our development
most consistent factor is percieved parental approval. If adolescent percieves parent to have positive attitude ti drugs or little interest in monitoring their behaviour, more likely to become addicted to drug
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Family addiction research
Livingston et al
- used self report ith final year high schoolers
- found that those whose parents allowed them to drink at home were significantly more likely to drink excessively following year at college
this suggests that lenitent families lead to kids who are more likely to try and have more before those with stricter and more watchful parents
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Peers
people who share our interests and are similar age, social status, background to ourselves. they become more influential in adolescence when we spend more time with them and less time with family
this suggests the strongest psychological risj factor. even without concerning drug use, group vistim of vulnerability ill increase likelehood of drug taking
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# nictorine learning approach
Operant conditioning
**How does a nicotine addiction start?
**
Positive reinforcement
Nicotine initially has immediate positive consequences 🡪 increased frequency
Inhaling nicotine 🡪 dopamine release 🡪 dopamine reward system 🡪 euphoria/pleasure (reward)
**How is nicotine addiction maintained?**
Negative reinforcement
Withdrawal symptoms occur without nicotine (behavioural, cognitive and mood-related)
Symptoms are removed with smoking – smoking continues in order to remove the negative effects of withdrawal (dependence)
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# learnign apprach nicotine
Cue reactivity
Why do people relapse after abstinence from nicotine?
Individuals learn to associate the positive effects of smoking with smoking-related cues – secondary reinforcers
These include specific moods (frustration), situations (social smoking), environments (weather) and stimuli (e.g. lighters)
When exposed to smoking-related cues relapse is easily triggered
Classical conditioning
Sensory stimuli associated with smoking are conditioned from being a neutral stimulus to a conditioned stimulus
The new CS tricks the brain into thinking nicotine is entering the system – when this doesn’t happen the body responds, usually with withdrawal symptoms
This then increases the likelihood of relapse (giving the body and brain what it’s expecting)
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# cue reacitvity
Why do people relapse after abstinence from nicotine?
ndividuals learn to associate the positive effects of smoking with smoking-related cues – secondary reinforcers
These include specific moods (frustration), situations (social smoking), environments (weather) and stimuli (e.g. lighters)
When exposed to smoking-related cues relapse is easily triggered
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# cue reactivity
Classical conditioning
Sensory stimuli associated with smoking are conditioned from being a neutral stimulus to a conditioned stimulus
The new CS tricks the brain into thinking nicotine is entering the system – when this doesn’t happen the body responds, usually with withdrawal symptoms
This then increases the likelihood of relapse (giving the body and brain what it’s expecting)
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# leaning approach nicotine
research support
| positive reinforcment
Positive reinforcement
Levin et al. (2010) gave rats a choice of two water spouts to lick water from – the licking of one of them led to a dose of nicotine entering the body. The licking of the other did not
Results showed that the rats licked the nicotine-linked waterspout significantly more than the other one
No. of licks increased substantially over 24 sessions also
What does this suggest?
-(become more dependan on the nicotine)
Nicotine is positively reinforcing and increases the likelihood of nicotine-associated behaviour
This validates the role of operant conditioning/positive reinforcement in nicotine addiction
- extrapolation, higher level bein
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# Cue reactivity
Research support
Carter and Tiffany (1999) conducted a meta-analysis on 41 studies that had investigated cue reactivity
Studies involve presenting dependent smokers, ‘non-dependent’ smokers and non-smokers with images of smoking related cues (e.g. lighters, ash trays). Cravings are measured via self-report and physiological arousal is measured via heart rate
The studies consistently show dependent smokers to react most strongly to the cues, with higher heart rates and stronger cravings reported – even without any nicotine present
What does this research suggest?
Dependent smokers learn secondary associations between smoking-related stimuli and pleasures of smoking, validating the role of cue reactivity
- dependant smokers may already have a high heart rate
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# learning approach ao3
Gender differences
Research has shown there to be gender differences in both the initiation and maintenance of smoking
Lopez et al. (1994)- found that women start smoking later than men do
Baewert et al. (2014) – found that women are more likely to smoke in a stressful situation than men – suggesting women have a greater psychological dependence
Additionally, women experience withdrawal symptoms sooner than men do, so find it more difficult to quit
- beta bias, minimise gender differences as women measured against men's resction, depite the differences they have
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Lopez et al. (1994)
found that women start smoking later than men do
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Baewert et al. (2014)
found that women are more likely to smoke in a stressful situation than men – suggesting women have a greater psychological dependence
Additionally, women experience withdrawal symptoms sooner than men do, so find it more difficult to quit
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# learning approach nicotine AO3
Implication for treatment
If nicotine addiction is conditioned, then it can be tackled with counterconditioning
(replacing the learned association with a new association)
Aversion therapy – smoking can be paired with unpleasant stimuli (e.g. electric shocks) to replace the association with pleasure
Smith (1988) got ppts to self-administer electric shocks whenever they engaged in smoking-related behaviour
After one year, 52% of the ppts were still abstaining from smoking, more than double the usual 20-25% that remain abstinent after deciding to give up smoking
Strengths?
However, the study had no control or placebo group – so lack of cause and effect, correlation
There is no clear comparison so no clear effectiveness of the therapy – other therapies have better evidence and can claim better effectiveness – more recent studies on AT do not show long term benefits like this study
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Gambling addiction intro
Was re-classified on the DSM-V as an addictive disorder
This is because it shares many characteristics of substance abuse
It is currently the only addiction in the special category of behavioural addictions in the DSM
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# gambling
The learning theory explanation
Learning theory best explains gambling addiction through reinforcement (operant conditioning)
Types of reinforcement include:
Direct reinforcement (positive and negative)
Vicarious reinforcement
Partial reinforcement
Variable reinforcement
Explanation also includes cue reactivity (maintenance)
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# gambling
direct reinforcment
how us gambling positiveky reinfoced
- one positive reinforcer is money (winning)
- continuing to win money reinforces the continuation of betting/waging to win again in the future
- anothe positive einformce is the 'buzz' experienced when gamblig - the risk and uncertainty is exciting for many
-
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direct reinforcment
how is gambling negatively reinfoced
- gambling is an escape for many - it offers a distraction from everyday life
- debt, wining money removes the debt
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Vicarious reinforcement
Indirect reinforcement
The experience of seeing others being rewarded for gambling :
– their pleasure
- enjoyment
- occasional financial return
This can be via newspapers, TV – e.g. reports of lottery winners in the media, glamourised horse racing, etc.
This can trigger a desire to gamble in someone who has never gambled before
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Partial reinforcement
def
When a behaviour is reinforced only some of the time it occurs (e.g. every 10th time)
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partial reinforcment
Skinner’s research on rats and pigeons focused on continuous reinforcement
However, he did not find this type of reinforcement to produce the most persistent behaviour
He found that only rewarding the animals some of the time produced behaviour similar to gambling behaviour
When only some bets are rewarded there is an unpredictability about which gambles will pay off
This is enough for some to keep on gambling
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# gambling
variable reinforcment def
a type pf partical reinforcment in which a behaviour is reinforced after am unpredictable period of time/ number of responces
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Variable reinforcement
A variable ratio reinforcement schedule has been found to produce the most persistent learning
E.g. a slot machine may pay out after an average of 25 spins, but not on every 25th spin
It may pay out after the 11th, then 21st, then 38th, etc
It takes longer for learning to be established this way, but once it has it is much more resistant to extinction (behavuiur no longer needed)
This can explain why people continue to gamble even if they take big losses – they’ve learnt they will win eventually
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partial vs variable
every 5 spins
you dont know when you will win, can be 10,5,1
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# gambling
Cue reactivity
Similar to nicotine addiction, cue reactivity can explain how gambling addiction is maintained and why people may relapse
Gambling becomes associated with secondary reinforcers – these are stimuli associated with the excitement and arousal experienced with gambling
E.g. colourful scratch cards, betting shop atmospheres, horse-racing channels, internet/tv ads
These cues can trigger arousal that the gambler craves, increasing chances of relapse
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# Gambling learning approach AO3
Research support
Dickerson (1979) observed betting behaviour in two betting shops in Manchester over 14 weeks
He compared number of bets on horse races between individuals, and divided them into high-frequency gamblers and low-frequency gamblers
He found that the high-frequency gamblers were consistently more likely to place last minute bets, in under 2 minutes before the races start
-He suggested this is due to the ‘build-up’ and excitement that comes with gambling, regardless of whether they win or lose
- The most dependent (frequent) gamblers may delay the betting because the build-up is what they find most rewarding
This validates the role of positive reinforcement in gambling behaviour
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Can explain failure to stop
Learning theory can explain why gambling addicts fail to stop gambling, even if they intend to give up
Conditioning is an automatic process – we are not consciously aware of the associations made between the behaviours and reinforcers (we’re not aware that we’re learning addiction)
This means that a gambler does not need to make active decisions to continue gambling
So even when a gambler consciously chooses to stop gambling, the conscious desire may conflict with the automatic conditioning maintaining their behaviour
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# Learning theory AO3
Limitations
Learning theory is better at explaining some gambling addictions better than others
Gambling games vary in skill and chance
E.g. slot machines and scratch cards are completely down to chance
However games like poker require much more skill – there is more influence over chance of winning
Similarly, slot machine games are played consecutively whereas card
games have more delay between them
Conditioning is more likely to occur in consecutive games
- can rethink in card game
- slot machine more addictive, conditioning happens more in this kind of game
can generalise to al tpes of gambling, so treatment cant be applied to all
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# learnign approach gambling
Individual differences
Griffiths and Delfabbro (2001) argue that conditioning processes do not occur in everyone in the same ways
Responses to identical stimuli differ between individuals
Motivations also differ – some people gamble for relaxation and others for arousal
Some people stop gambling and never relapse, even when all exposed to the same cues
- explanation isn't complete
- alternative explanation: personality factors e.g. locus of control
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Different pathways to gambling
Nower et al. (2002) claim that there are two main pathways to gambling addiction
One pathway involves learning through exposure from role models and peers
Addiction can then be explained by SLT and conditioning
The other pathway involves individuals with anxiety and/or depression, poor coping skills and a history of negative events/experiences
These factors produce an ‘emotionally vulnerable’ gambler – these gamblers use gambling for relief and escape
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# Explanations for gambling: cognitive theory
Cognitive theory
Rather than trying to explain individual differences in addiction with genetics or reinforcement history, this theory explains the differences with how we perceive and interpret the addictive substances
Expectations: expectancy theory
- Gamblers have expectations about the future benefits and costs of their behaviour
- If the benefits outweigh the costs, the addictive behaviour is more likely – this is believed about gambling
- There may be unrealistic expectations about what gambling will provide (emotional support, riches, thrill)
- This is not a conscious process – therefore, rational decisions are not always made
We can already link this to evaluations of learning theory – we know that this is too simplistic to explain the complexities involved in addiction – therefore, cognitive explanations have the expertise when it comes to explaining individual differences.
Expectancy theory is just the basic, introductory AO1 of the theory – not the main chunk of content
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Cognitive biases def
A distortion of attention, memory and thinking that arises because of how we process information about the world – especially when done quickly
Irrational beliefs and distorted thinking patterns influence the maintenance of a gambling addiction
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Cognitive biases includes:
- Faulty perception - Gambler’s fallacy
- Skill and judgement - Illusions of control
- Personal traits/ritual behaviours (e.g. superstitions)
- Selective recall/recall bias
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Faulty cognition - gambler's fallacy
- this is the idea that random events are influenced by other recent events
- If a gambler has had a losing streak they have the belief that it cannot last and will always end with a win
E.g. flipping a coin and getting ‘heads’ 3 times in a row – this will be followed by ‘tails’ three times in a row
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Skill and judgment : illusions of control
- this is when a gambler oerestimates yheir ability to influence or manipulate the outcomes of an event
- e.g. being highly skilled at choosing lottery numbers
- oathological gamlblers have an esaggerated self confidence in their ability to 'beat the system'
- this is ually because they attribute their success (wins) to their personal skills/abilities and attribute their losses to bad luck
Check the description – you probably have the notes under different terminology.
This is like Gambler’s fallacy, but instead of believing there is external control, you believe there is internal control (from you) – this is when gambler’s again do not believe winning and losing is random or due to chance, they believe there is a way to “beat” chance – there is bias in when they pick and choose to believe they have control – they PERSONALLY are responsible for winning, but it’s “unlucky” or a “bad day” when they lose
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Personal traits/ ritual behaviours
Believing you are more likely to win because you are particularly lucky
Or because you have a lucky charm, saw subliminal messaging/clues or touched a ‘powerful’ object e.g. eldon's lucky coin
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Selective recall/ recall bias
gamblers remeber an overestimate details about their wins and ignore or discount details about their losses
- due to this, consistent loses do not oact as a disincentive for gambling
This is about memory bias – when it comes to recalling gambling related memories, wins are exaggerated and reported more than losses- as we already know, they don’t really perceive losses anyway, so this is expected.
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self-efficacy - relapse
- refers to our perception/beliefs about our ability to reach a desired outcome
- If you believe that you are not capable of quitting, you’re less likely to
- The expectation to gamble again creates a self-fulfilling prophecy – behaving in a way that confirms your expectations
- This reinforces the bias belief about being unable to quit
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key research - griffiths
- used introspection to see if there were any differences in cognitive processes of 60 regular and occasional slot machine gamblers
- ppts had to verbalise any thoughts that passed through their minds as they played
- they were also interviewed about their opinions on the egree of skill needed to win at the slot machines
he found tht regular gamblers made 6 x more irrational verbalisations than occasional gamblers (14% vs 2.5%)
- regular gamblers also overestimate the amount of skill required and the amount of skill they had or slot machine games
- demand characteristics, social desirabliity
improve reliability through inter observer relability
This is your key study – you can use this as AO1 or AO3 (research support)
It is important to have a clear conclusion related to the question (spec) – This shows that those who gamble more and more likely to have irrational thoughts and cognitive biases.
Evaluation? Lots to discuss here – introspection? Valid? Reliable?
Regular vs occasional gamblers – is once a week really regular? What is occasional then?
Where do you see the word addiction?? Are there any addicts in this study?
Self report – any reasons for ppts to lie?
Add answers to these in your notes – this could make a very strong PEECL
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# griffins study
Methodological issues
- self report
- introspection is not a suitabe way to measure a gambling addict's cognitive biases
- Dickerson and O'Connor argue that what a gambler says whilt gambling does not necessarily represents what they really think
- e.g. utterances made during a slot machine game may not represent deeply-held beliefs about skill and chance
this suggests that researchers may have a misleading impression about gambler's beliefs being irrational when they may not be
-low internal validity, dont knwo what cause sthe research to gamble
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# cognitive explanation for gambling
Research Support
McCusker and Gettings gave ppts a modified stroop task - ppts had to say the ame of the colour of the word and not the word
- rather than the words being nakes of colours, some words were random and some were gambling related e.g. slots, cases, bets
- there was no difference in time taken to do the task between gambling addicts and controls when the words were random
- But gambling addicts were significantly slower than controls when the words were gambling related
This suggests that gambling addicts have a cognitive bias to attend to gambling related information
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Practical implications
- ideas from cognitive theory have valuabe implications for effectice treatment (CBT)
- CBT can be used to correct cognitive biases (such as the gambler's fallacy) this woud conseuently reduce the motication to gamble
Echedurua found that CBT was particularly effective in preventing relapse in slot machine players
- they could lie
- Implications not application for practice – this is because CBT is not based on this explanation – CBT was used way before this explanation was made for gambling addiction – what is correct to say is that IDEAS from this explanation (cognitive biases) have been implemented in CBT (hence, implication)
keywords, practical implication, use beyond explanatory power, validity (if the ideas are used and are successful in treatment, it implies the concepts are valid in explaining the addiction)
Evaluation (counter) – look at the one liner research – plenty to critique in there for extra marks
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Drug therapy def
Treatment involving drugs that contain chemicals that have a particular effect on the functioning on the brain. This is done by altering neurotransmitter levels
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three types of drug therapy
aversives
agonists
antagonists
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aversives
drugs that produce unpleasant consequences e.g. vomiting
e.g. disulfiram treats achohol addiction by creating a severe hangover and nausea within 5 mins of being taken
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agonists
drug substitutes - they mimic the effects of a drug by binding to receptors and active neurons e.g. methadone
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antagonists
blockers, block receptor sites that usually receive the neurotransmitter that creates the feeling of euphoria, which reduces cravings (e.g. Naltrexone – opioid antagonist)
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drug therapy extra
Disulfiram works via classical conditioning as the negative effects (nausea) are associated with the addictive behaviour, causing a negative response to be conditioned overall
Methadone is given to heroin addicts as it mimics the effects of heroin, creating euphoria, but dosage is controlled and sources are clean
Naltrexone is also given to heroin addicts to block the euphoric effects and reduce psychological dependence – opioids are drugs that primarily reduce pain
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drug therapy for nicotine addiction
- Nicotine replacement therapy (NRT)
Uses gum, inhalers or patches to deliver nicotine without the harmful tobacco smoke
Nicotine still has the same effects on the dopamine reward system, but without the negative effects on health
- It is an agonist that binds to nAChRs, triggering a release of dopamine in the VTA, etc.
This system allows for the nicotine dose to be reduced over time, allowing for management of withdrawal symptoms
It usually takes around 2-3 months for withdrawal symptoms to be managed, therefore, reducing addiction
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Drug therapy for gambling addiction
There is currently no approved drug treatment for gambling in the UK
However, drug trials have shown to reduce urges and cravings to gamble
Opioid antagonists like Naltrexone is so far, the most successful candidate
(as we now know behavioural addictions have similar neurochemical effects on the brain as chemical addictions)
Other drug trials have tackled symptoms of anxiety and depression (which can trigger gambling) – example?
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Research support for NRT
stead analysed 150 trials that compared NRT with placeboos/control groups
- they concluded that all types of NRT were effectie in reducing nicotine adiction - nasal spray was most effective
- NRT users were 70% more liekly to abstain from smoking afetr 6 months compared to controls
+validates the effects of drug therapy
+Successful use in real life – good for the economy
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# drug theraoy ao3
however lack of blinding
some argue that NRT trails are not blind as ppts can clearly tell whether they are experiencing the 'rush' of nicotine
Mooney found that out of 73 double blind placebo controlled trials, only 17 asked ppts whether they believed that they had the real drug or placebo
- out of those 17, nearly 2/3 of ppts in the placebo condition were certain that they didndt have the real drug
- demand charactersistcs
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describe how brain neurochemistry is involved in nicotine addiction
- nicotine binds ith nicotonic receptors in the ventrak tegmental area
- this triggers release of dopamine in the nucleus accumbens in the mesolimbic system
- activation of reward pathway creates feeling of euphoria and reduced anxiety
- nicotine regulation model - abstinenece leads to increased senstivity of nicoine receptors and withdrawk cauing moivation to smoke
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# drug therapy AO3
side effects
- side effects of NRT icludes sleep disturbance, gastro-intestina problems, dizziness and headaches
similarly the dosages of opioid antagonists like Naltrexone have been increased over time to reduce gambling addiction - meaning stronger side effects
e.g. muscle spasms, anxiety, depression
- this can mean that patients are inducing more negative feelings and no positive feelings (all pain, no gain)
- people less likely to use it -> economic implications
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# Drug therapy AO3
reduces stigma
- it has been argues that use of drug therapy to reduce addiction also reduces the stigma around addiction in general -
- addiction is generally considered to be a psychological weakness that the individual should take responsibility for as soon as their behaviour spirals out of control
- Consequences of addiction are usually blamed on the individual, leading to
self-blame, depression and difficulty recovering
- Drug therapy encourages the perception that addiction has a
neurochemical basis rather than being psychological weakness and
choice
If addiction can be reduced with drugs it makes it more similar to other
disorders (like OCD, schizophrenia), leading to less self-blame and stigma
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# ```
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Behavioural interventions def
any treatment based on the behavourist principles of learning such as operant and classical conditioning
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# 1.
two main types of behavioural intervantion
- aversion therapy
- covert sensitisation
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Aversion therapy def
A behavioural treatment based on classical conditioning (associating the addictive behaviour with an unpleasant stimulus)
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aversion therapy
- a maladaptive behaviour is paired with unpleasant stimulus leading to an unpleasant response
- after multiple pairings the maladaptive behaviour alone is associated with the response reducing the behaviour
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types of aversives
- drugs
- electric shocks
- loud unpleasant/ noises/ images
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Explanation for how aversion therapy can be used to reduce smoking or gambing behaviour
- aversion therapy can be used to reduce smoking
- This can be done thorugh classical conditioning
- for e.g. evey time a person smokes, they have to give themselves an electric shock, the stimulus
- then when a person smokes you associate the initally neuteral stimulus with the electric shock
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Common examples of aversion therapy
Alcohol addiction – aversive drugs (emetics)
Used to induce vomiting when drinking (~10 minutes later)
Gambling addiction – electric shocks
More suitable for behavioural addictions
A gambler will make a list of phrases related to their gambling behaviour
When gambling-related behaviours are called out, a 2 second electric shock is given
Patients get to choose the severity of the shock themselves, bearing in mind that they should be painful but not distressing
- free will, not gonna work, low practical validty
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covert sensitisation def
A form of aversion therapy based on classical conditioning – instead of experiencing the unpleasant stimulus, the patient imagines how it would feel
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covert sensitisation def
A more popular alternative to traditional aversion therapy due to ethical concerns
The more vivid the imaginary scene the better – the therapist will go into graphic detail about elements including sight, smell, sound and physical movement
E.g. being asked to imagine smoking a cigarette whilst covered in faeces
In some cases, the therapist will incorporate stimuli chosen by the client (e.g. phobias)
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Steps of covert sensitisation
- The client will be asked if there is any specific aversive stimuli they would like to include in the therapy
- The therapist will read from a script instructing the client to imagine themselves smoking a cigarette
- The therapist will then describe unpleasant, graphic consequences which include multiple senses
- The client is then asked to imagine a scene of themselves ‘turning their back’ on cigarettes
- The client then experiences feelings of relief
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Evaluation: Which is the best treatment?
effective?
suitable?
- which is more liekly to work? which may be better long-term?
- which method is easier/ harder to test? can we test the placebo effect?
- ethics? implications?
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Research on traditional aversion therapy
fuller et al gave men with alcholol addiction disulfiram every day for a year - a control group was given a placebo version
- they were also all given weekly counselling sessions fr 6 months
- there was no significant difference in abstinence fro alcohol between the groups after one year
- aversion therapy is no more effective than placebo effect
- the councelling may have been more effective
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# behavioural intervention AO3
drop out rates
- clients and ppts are more liekly to drop out of tranditional aversion therapy due to the negative experiences
- stimuli used can be unpleasant, distirbing and sometimes traumatisisng
- high drop out rates: biased samples - those that do not drop-out be more resilient, dedicated- unrepresentative sample
- makes it difficukt for researchers to test real effectivness of the therpay (internal validity)
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# behavioual nterventions AO3
Ethical issues
- the popularity of aversion therapy has been dented by concerns abt inflicted exteme nausea, pain an d loss of dignity onto patients
- it can be considered unethicl to essentially punish people for their addiction
- - allowing ptients to choose their level of electrc shocks was an attempt to address the issue but a poor one
- due to this , covert sensitisation is preferred as t does not induce vomiting nd poseses fewer healt risks, allowing patients to keep their dignity and self-esteem
- however it could be argued that it is ethical it would be more unethical to not offer aversion therapy to an addict
drug/ gambli addiction is more physically/ psychologically harmful tha aversion therapy
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Cognitive behavioural therapy addiction
- usually given in 10 one hour sessions where cognitive biases are identified achallanged and replaced- the ncoping behaviours are taught to prevent replase
theraist should be warm, collaborative, responsie to an exntet
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# CBT
two phases
1. cognitive (functional analysis)
- high-risk situations are dentified
- therapist and client reflect on thoughts before, during and after the sitch
- any cognitive biases identified are challeneged and reconstructed (educated)
- its an ngoing process - the client may identify more challenged later on
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# CBT
Two phases: 2. behavioural (skills training)
- the client is taught to help them cope in situations that usually lead to the addictive behaviour
- specific skills: e.g. assertives training, anger managment training
- social skills SST may involve role play to teach the addict how to refuse engagement
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Applying theories/models
The purpose of these theories/models is to explain why the behaviour changes, not how
The models aim to predict the journey/cycle of behaviour change
These models aim to explain general behaviour, but have been applied to explain the process of behaviour change for addicts who decide to become abstinent
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theroy of planned behaviour def
change in behaviour can be predicted by on'es intention to change that behaviour
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# theory of planned behaviour
TPB suggests that one'sintention to engage in a behaviouor us determined by these factors:
- personal/ behavioural attitudes
- subjective norms
- percieved behavioural control
in the exam you will need to explain how each factr cotributes to one's intention to chang, as well as actual behaviour change – in the context of addiction
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Factor 1: personal attitudes
- this refers to the entire collection of he addicted person's attitudes towards their addictioon
- it amount to whether their opinon is favorabe or unfavourable
- to work this cout the addicted individual has to consider the outcomes assocated with their addiction
e.g."
## Footnote
cost / benifit analysis
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Factor 1: personal attitudes
This refers to the entire collection of the addicted person’s attitudes towards their addiction
It amounts to whether their opinion is favourable or unfavourable
To work this out, the addicted individual has to consider the outcomes associated with their addiction
E.g. “it gives me a thrill”, “it’s an escape from stress”, “I win a lot” vs
“I lose more than I win”, “I can’t stop”, I takes up so much time”
Weighing up the positive and negative evaluations form the overall attitude
If the overall attitude is positive, you are less likely to have an intention to abstain from the addiction
If the overall attitude is negative, you are more likely to have an intention to abstain
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factor 2: subjective norms
- these norms refer to one's belifs about whether the people that matter to them most have a favorable or unfavorable opinion about their addiction behaviour
- how would my froennds/ family react if they knew about my habit?
- do they ever gamble? is so how much?
- everyone my age is popping pills when theyre out"
if the individual comes to the conclusion that the opinions would be unfavorable they are less likely to continue the behaviour
- Important distinction: it’s not about the actual approval from others, it’s about the perceived approval from others
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Factor 3: perceibe behavioural control
- this refers to how much control one believes to have over their own behaviour - this is called self-efficacy
- does the addict belive he can uit easily/ not?
this depends on their perception of recourses avaliabke to them whuch can be
- external: money, time, support
- internal: ablility, skill, determination
Perceived behavioural control has two possible effects
It can influence our intentions to behave (more control 🡪 stronger intention) “I can do this!”
It can influence behaviour directly (more control, stronger behaviour)
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Prochaska’s six-stage model def
A model that explains the stages people go through to change their behaviour. The stages are not necessarily in linear order
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prochaska's six-stage model
Prochaska and DiClemente (1983)
Their theory came from noticing that smokers’ behaviour changed through a series of stages in attempts to quit
They recognise that overcoming addiction is a complex process that does not happen quickly or in a linear order
It can be linear, but usually involves a lot of returning to previous stages or missing some stages out completely
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Ach
Acetylcholine
Plays key role in all nervous system acititives meaning there are Ach receptors on many neurons in the CNS
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Subtype of Ach
Nicotonic acetylcholine receptor - nAchR
These can be activated by Ach and nicotine
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nArchRs desensitisation
When activated by nicotine, neuron transmits dopamine to the next neuron
But when the receptors immediately shot down (within milliseconds) and temporarily cannot respond to other neurotransmitters that may diffuse across the synapse
The neuron becomes desensitised (less responsive) and overall less neurons are active as fewer are available for synaptic transmission
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Where are most nAchRs found
Ventral tegmental area (VTA) of the brain which places a significant role in reward and motivation (the dopamine reward system)
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The transmission of dopamine
When nachos in the VTA are stimulated by nicotine they transmit dopamine via two routes:
- dopamine is transmitted along the Mesolithic pathway towards the nucleus acumen’s ( NA)
- dopamine is transmitted along the neskckrtical pathway
Via both, dopamine reaches together frontal cortex
Creates pleasureable effects ( mind euphoria, reduced anxiety)
Reinforce smoking habits- vpadiction then occurs via operant conditioning
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Role of dopamine summary
Dopamine is transmitted when nicotine binds to nAChRs – nicotinic acetylcholine receptors
Once dopamine is transmitted, the neurons shut down and become desensitised (less responsive) to other neurotransmitters
Dopamine is transmitted from the ventral tegmental area (VTA) to the frontal cortex via two routes
Mesolimbic pathway 🡪 nucleus accumbens 🡪 frontal cortex
Mesocortical pathway 🡪 frontal cortex
The rush of dopamine to the frontal cortex causes the rewarding effects, reinforcing the use of nicotine
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Withdrawal
nAchRs are constantly desensitised while someone smokes- but after a prolonged period of not smoking (e.g. overnight) nicotine leaves the body and neurons desensitised and become functional again
-this is when the individual experiences withdrawal symptoms (anxiety, agitation)
Without nicotine I the system the nAchRs become overstimulated with acetylcholine instead of-this is when they are most sensitive
-therefore when the first cigarette of the day is smoked it’s the most rewarded - nicotine binds to the nAchRs, it strongly reactivates the domaine reward system
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Dependence and tolerance
A habitual smoker will experience instant desensitisation (while smoking) and re sensitisation(while sleeping) of nAchRs
Constant exposure of nicotine to nAchRs then causes permanent changes to brain neurochemistry - a decrease in active receptors on neurons
-this eventuallly leads to less and less dopamine reaching the frontal cortex (therefore tolerance)
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Developing addiction : summary
Withdrawal: nAChRs become resensitised once nicotine leaves the body (due to large amounts of ACh), making them more sensitive to releasing dopamine when nicotine binds to them once again
Dependence: the constant cycle of desensitising and resensitising leads to long-term desensitisation - no longer feeling normal without nicotine
Tolerance: constant exposure of nicotine reduces the overall number of receptors on the neurons, leading to more nicotine being needed to create the initial dopamine effects
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# cognitive theory
Expectations: expectancy theory
- Gamblers have expectations about the future benefits and costs of their behaviour
- If the benefits outweigh the costs, the addictive behaviour is more likely – this is believed about gambling
- There may be unrealistic expectations about what gambling will provide (emotional support, riches, thrill)
- This is not a conscious process – therefore, rational decisions are not always made
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cognitive biases def
A distortion of attention, memory and thinking that arises because of how we process information about the world – especially when done quickly
Irrational beliefs and distorted thinking patterns influence the maintenance of a gambling addiction
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