Addiction Flashcards
What is meant by an Addiction
A disorder where an individual takes a substance or engages in a behaviour that is pleasurable but eventually becomes compulsive with harmful consequences
What are the 3 key characteristics used to mark whether a behaviour is an ‘addiction’?
- Physical & psychological Dependence
- Tolerance
- Withdrawal symptoms
When is physical dependence said to have occured?
When a withdrawal syndrome is produced by reducing or stopping intake
What is a psychological dependence?
Compulsion to continue taking a substance (or performing a behaviour) because its use is rewarding
Tolerance
A reduction in response to a substance, so that an addictive individual needs more to get the same effect
What is Tolerance caused by?
The repeated exposure to the effects of a substance
What are the 2 types of Tolerance?
(give examples of both)
Behavioural tolerance - when an individual learns through experience to adjust their behaviour to compensate for the effects of their substance
(e.g. people addicted to alcohol learn to walk more slowly when they are drunk to avoid falling over)
Cross-tolerance - developing tolerance to one type of substance can reduce sensitivity to another type
(e.g. people who have developed a tolerance to the sleep-inducing effects of alcohol need high doses of anaesthetic)
Withdrawal syndrome
Set of symptoms that develop when an addicted person abstains from or reduces their substance abuse
What are the symptoms created by a substance almost always?
(give an example)
The opposite to ones created by the substance.
e.g.
With nicotine= relaxing, calming
Without nicotine= anxiety, irritability
What are the 2 phases of withdrawal?
- The acute phase
- begins with hours of abstaining
- features intense cravings for the substance, reflecting strong physiological and psychological dependence
- symptoms gradually die down, usually over days - The prolonged phase
- symptoms that continue for weeks, months, and even years
- person becomes highly sensitive to the cues they associated with the substance
- this is why relapse is so common
What are risk factors?
An internal or external influence that increases the likelihood a person will start using addictive substances or engage in addictive behaviours
What are the 5 risk factors?
- Genetic vulnerability
- Stress
- Personality
- Family influences
- Peers
Risk factors: Genetic vulnerability
- what is it?
- what are the 2 plausible direct mechanisms that create a genetic vulnerability to addiction?
- any inherited predisposition that increases the risk of a disorder developing
- D2 receptors & Nicotine enzyme
Genetic vulnerability: D2 receptor
- what is dopamine transmission affected by?
- number of D2 receptors is … controlled?
- addicted people are found to have what?
- what does fewer receptors mean?
- number of dopamine receptors
- number is genetically controlled
- abnormally low number of D2 receptors
- fewer receptors= less dopamine activity= using drugs acts as a way of compensating for this deficiency
Genetic vulnerability: Nicotine enzyme
- what are some individuals more able to do?
- who did research into this?
- what did they find out?
- the expression of this enzyme is … determined
- metabolise certain substances
- Pianezza et al
- some people lack a fully functioning enzyme which metabolises nicotine
- these people smoke significantly less than those smokers with the fully functioning version
- genetically determined
Risk factors: Stress
- how does this link to addiction?
- what does stress include?
- who highlighted the role of adverse childhood experiences in later addiction?
- what did they argue?
- what does this create?
- what can stressful experiences in adolescence & adulthood do?
- people who experience stress may turn to drugs as a form of self-medication
- past and present events (e.g. childhood trauma)
- Andersen & Teicher
- early experiences of server stress have damaging effects on a young brain in a sensitive period of development
- created a vulnerability to later stress
- trigger the early vulnerability & make it more likely that the person will self-medicate with drugs or other behavioural actions
Risk factors: Personality
- how does this link to addiction?
- what else is addiction linked to?
- most people with what are also addicted substance abusers?
- what did … argue? and why
- would would someone with APD take drugs?
- various traits can increase an individual’s risk of addiction e.g. impulsivity
- disordered personality
- APD - antisocial personality disorder
- Robins=argued that APD is a causal risk factor for addiction= having APD means that a person breaks social norms, is impulsive and may behave criminally
- APD= will try drugs at young age bc drug taking offers a combination of norm breaking, criminal activity & also satisfying one’s own desires
Risk factors: Family influences
- what is it?
- who did research into this? and what did they find out?
- what is also believed about adolescents?
- what is the key determinant here?
- what is this seen as?
- how much the at-risk individual believe his or her parents approve of addictive substances or behaviours
- Livingston et al:
- final-year high-school students allowed by parents to drink alcohol at home= significantly more likely to drink excessively the following year at college
- adolescents who believe their parents have little or no interest in monitoring their behaviour= more likely to develop an addiction
- The adolescents perception
- seen as more important than whether parents really monitor the adolescent’s behaviour
Risk factors: Peers
- Who suggested that there are 3 major elements to peer influence as a risk factor for addiction?
- what are they?
- what matters when it comes to peer attitudes that influence substance abuse? (the creation of what)
- O’Connell et al
1. An at-risk adolescents attitudes and norms about drinking are influenced by associating with peers who use alcohol
2. These experiences peers provide more opportunities for the at-risk individual to use alcohol
3. The individual overestimates how much their peers are drinking, which means they drink more to keep up with the perceived norm - the creation of a group norm that favours rule-breaking generally
RISK FACTOR EVALUATIONS: Strength - Genetic vulnerability
P - supported by adoption studies
E - Kendler et al
- looked at adults who has been adopted away, as children, from biological families where at least one parent had an addiction
- these children later had significantly greater risk of developing an addiction, compared with adopted-away individuals w/ no addicted parent in their biological families
E: shows genetic vulnerability
L:
- supports role of genetic vulnerability as an important risk factor
- supported by other research (e.g. twin studies)
RISK FACTOR EVALUATIONS: Limitation - Stress
P: Issue of causation
E:
- many studies shown strong positive correlation between stressful experiences and addiction
E:
- does not necessarily mean that stress is a risk factor
- some people become addicted without experiencing any significant life stress
- their addictions then cause greater levels of stress in their lives bc of the negative effects of the lifestyle
- this would still produce a positive correlation but in this case addiction cased the stress rather than vise versa
L: cannot conclude stress is a significant risk factor based on correlational studies alone
RISK FACTOR EVALUATIONS: Strength - Personality
P: support for link between addiction and APD
E:
- several studies show APD & alcohol dependence are co-morbid (frequently occur together)
- Bahlmann et al interviewed 55 alcohol-dependent people, with 18 also diagnosed with APD
- for these 18 participants= researchers found that APD developed four years before their alcohol dependency, on average
L: findings suggest that APD is indeed a personality-related risk factor for alcohol addiction
RISK FACTOR EVALUATIONS: Strength - Family influences
P: research support for family influences as a risk factor
E: Madras et al
- found strong positive correlation between parents use of cannabis & their adolescent children’s use of cannabis, nicotine and opioids
E:
- may be that adolescents observe their parents using a specific drug (e.g. cannabis) and model this behaviour
- also may infer that their parents approve of drug use generally, so go on to use other drugs
L: supports view that parental substance abuse is a potential risk factor for wider addiction in adolescent offspring
RISK FACTOR EVALUATIONS: Strength - Peers
P: real-world application
E:
Social norms marketing advertising (SNMA)= an intervention to change mistaken beliefs about how much peers are drinking
- uses mass media advertising to provide messages & statistics about how much people really drink
(e.g. messages with statistics on beer mats in student union bars)
E:
- students then get more accurate picture to correct their overestimations
L: means that identification of risk factors can suggests ways to reduce the influence of such factors
What is the hypothesis proposed by Dani & Heinemann?
- what does it suggest?
Desensitisation hypothesis of nicotine addiction
- suggests that prolonged exposure to nicotine leads to reduced sensitivity of nicotine acetylcholine receptors
Desensitisation hypothesis of nicotine: nAChRs and dopamine
- what in the brain produces what neurotransmitter?
- what do these neurotransmitters have and what can they bind to?
- what does this cause the receptors to be and what does this lead to?
- what is this process immediately followed by?
- what has happened to the neuron?
- what does this lead to?
- neurons in the brain produce the neurotransmitter acetylcholine (ACh)
- have nicotine receptors (nAChR) which can bind with nicotine
- causes nAChR receptors to be activated which leads to the neuron transmitting dopamine
- these receptors shut down and temporarily cannot respond to neurotransmitters
- neuron has been desensitised
- Downregulation, reduction in number of active neurons bc fewer of them are available
Desensitisation hypothesis of nicotine: Creating a pleasurable effect
- where are nAChRs concentrated?
- what happens when these receptors are stimulated by nicotine?
- what does this trigger the release of?
- what happens at the same time?
- what pathways are part of the brain’s reward system?
- what activated this system?
- what does this result in? (give examples)
- what do the effects become associated with?
- concentrated in the ventral tegmental area of the brain
- dopamine is transmitted along the mesolimbic pathway to the nucleus accumbens
- triggers release of more dopamine from the NA to frontal cortex
- dopamine also transmitted along mesocortical pathway to be released directly in the frontal cortex
- the mesolimbic & mesocortical pathways
- nicotine activated this system
- results in pleasurable effects (e.g. mild euphoria, increased alertness & reduction in anxiety)
- smoking through operant conditioning
Desensitisation hypothesis of nicotine: Withdrawal
- what happens to nAChRs when a person is smoking?
- what happens when a person goes without smoking for a long time (e.g. overnight)
- what does this allow the nAChRs to become? and what is this process known as?
- at this time what is the person experiencing?
- how can the experience of withdrawal be explained?
- what do these symptoms include?
- they are continually desensitised
- nicotine disappears from their body
- allow them to become resensitised (upregulation)
- experiencing withdrawal from the lack of nicotine
- nAChRs become overstimulated by ACh (bc no nicotine to bind with them) so smoker experiences an acute withdrawal syndrome
- symptoms include anxiety & agitation due to consequence of decreased dopamine functioning
Desensitisation hypothesis of nicotine: Dependence and tolerance
- what does the smoker avoid by doing?
- what does this cause during day and night time?
- what does this create?
- what does continuous exposure of nAChRs to nicotine cause?
- how does a tolerance develop?
- smoker avoids unpleasant physiological & psychological withdrawal states by smoking another cigarette
- a constant cycle of daytime downregulation and night-time upregulation
- creates long-term desensitisation of nAChRs (dependence)
- changes to brain neurochemistry like decrease in number of active receptors
- when the smoker has to smoke more to get the same effects
BRAIN NEUROCHEMISTRY EVALUATION: Strength - research support
P: dopamine explanations of nicotine addiction is supported from human research
E: McEvoy et al
- studied smoking in people with schizophrenia taking the antipsychotic drug haloperidol
- drug acts as antagonist (blocks dopamine receptors in brain)
- people taking drug showed significant increase in smoking
- form of self-medication to increase their dopamine levels
E:
- research has provided indirect support for role of dopamine
L: supports view that dopamine has a key role in the neurochemistry of nicotine addiction
BRAIN NEUROCHEMISTRY EVALUATION: CA - research support
P: explanations of nicotine addiction that only consider role of dopamine are limited
E:
- dopamine system is central BUT research shows complex interaction of several neurochemical systems
- Watkins et al found that nicotine addiction was linked to other neurotransmitter pathways (e.g. serotonin & GABA)
E:
- so oversimplifies the causes of smoking by linking to one biochemical (dopamine)
- when actually there are several involved
L: neurochemistry of nicotine addiction cannot be fully understood if looking only at dopamine
BRAIN NEUROCHEMISTRY EVALUATION: Strength - real world application
P: neurochemistry leads to new treatments
E:
- nicotine replacement therapy (NRT) to help smoker quit
- developed after nicotine was identified as the addictive component in cigarette smoke with effects on nAChRs
-NRT products (e.g. patches, inhalers, gum) deliver a controlled dose of nicotine
E:
- acts neurochemically and binds with nAChRs= mimicking effects of nicotine from cigarettes, including dopamine release
- satisfies cravings
- allows user to reduce withdrawal symptoms safely= gradually reducing their nicotine dose over weeks
L: greater understanding of neurochemistry has led to effective treatment for nicotine addiction
BRAIN NEUROCHEMISTRY EVALUATION: limitation - withdrawal symptoms
P: neurochemical explanations doesn’t fully explain withdrawal
E:
- theory suggests that withdrawal symptoms depend mainly upon amount of nicotine in the body
- Gilbert points out these factors are not strongly correlated
- instead someone’s personality & environment are better predictors of the degree of withdrawal they experience
E:
- more nurture than nature
L: withdrawal effects can be explained in other ways without reference to amounts of nicotine
LEARNING THEORY for nicotine addiction:
How does this theory nicotine addiction is learnt?
Through operant & classical conditioning and cue activity
LEARNING THEORY for nicotine addiction: Operant conditioning
- what can nicotine addiction be partly explained by?
- explain how
- how is nicotine a powerful reinforcer?
- what does the drug stimulate the release of and where?
- what does this produce for the smoker?
- what does this do to their behaviour?
- what is the other type of reinforcement?
- what does this better explain?
- what does the termination of nicotine lead to for a smoker?
- give examples of behavioural effects
- give examples of cognitive effects
- give examples of mood disturbances
- what does having such a wide range of withdrawal symptoms mean for the smoker?
- so what is smoking a cigarette doing?
- the concept of positive reinforcement
- consequences of behaviour is rewarding= behaviour more likely to occur again
- bc of its physiological effects on the dopamine reward system of the mesolimbic pathway
- stimulates release of dopamine in the nucleus accumbens
- mild feeling of euphoria which the smoker finds rewarding
- this positively reinforces their smoking behaviour
- negative reinforcement
- better explains a smoker’s continuing dependence on nicotine
- acute withdrawal syndrome with several unpleasant symptoms
- e.g. agitation & disturbed sleep
- e.g. poor concentration
- e.g. anxiety & depression
- makes it harder for smoker to abstain so they reduce these effects by smoking again
- negatively reinforcing as it stops unpleasant stimulus
LEARNING THEORY for nicotine addiction: The role of cue reactivity
- what does cue reactivity explain?
- what is the pleasurable effect of smoking known as? and why?
- what are other stimuli called? and why?
- where does cigarette smoking generally happen? (give an example)
- what happens overtime & with repeated associations? (give some other examples)
- what do smoker associate these … with?
- how an individual addicted to nicotine associated the behaviour with a variety of smoking-related cues, e.g. lighters
- primary reinforcer - rewarding (not learned) due to its effects on brains dopamine reward system
- secondary reinforcers - take on properties of primary reinforcer & become rewarding in their own right
- in certain environments with certain people, e.g. pub gardens with friends
- these environments and friends become secondary reinforcers
- others include a favourite lighter, lighting up, smell of tobacco, etc
- with the pleasurable effects of nicotine
LEARNING THEORY for nicotine addiction: cue reactivity
- what do the presence of secondary reinforcers produce for the smoker?
- what is this response called?
- what are the 3 main elements to this response? (give examples for 2nd one)
- a similar physiological and psychological response to nicotine itself
- cue reactivity
1. craving for cigarette, which is self-reported
2. physiological signs of reactivity, including automatic responses, e.g. heart rate & skin temperature
3. Objective behavioural indicators, e.g. how much ‘draws’ are taken on a cigarette & how strongly
LEARNING THEORY EVALUATION for nicotine addiction: Strength - research support
P: support for the learning approach from animals
E: Levin et al
- rats could lick two water spouts
1st= triggered intravenous dose of nicotine
2nd= no reward
- rats licked nicotine-linked watersport significantly more often
- numbers of licks also increased over the 24 sessions
E:
- substantial body of research with non-human animals confirming role of operant conditioning in nicotine addiction
L:
- suggested that effects of nicotine positively reinforced self-administration in rats
- implying similar mechanisms in humans
LEARNING THEORY EVALUATION for nicotine addiction: Strength - support for cue reactivity
P: support from research with humans for effects of cues
E: Carter & Tiffany
- conducted meta-analysis of 41 studies into cue reactivity
- studies presented dependent & non-dependent smokers (and non-smokers) images of smoking-related cues
e.g. lighters, ashtrays, cigarette packets
- self-reported desire (craving) measured along with indicators of physiological arousal (e.g. heart rate)
Dependent smokers= reacted most strongly to cues - showed increased arousal (physiological) & reported strong cravings to smoke (psychological), even when nicotine not present
L: shows that dependent smokers learn secondary associations between smoking-related stimuli & pleasurable effects of smoking
LEARNING THEORY EVALUATION for nicotine addiction: Strength - real world application
P: nicotine treatment programmes based on classical conditioning principles
E:
- aversion therapy uses counterconditioning to treat nicotine addiction= by associating unpleasant effects of smoking with aversive stimulus (e.g. painful electric shock)
- found to be effective by some researchers
E: Smith
- Smith’s participants gave themselves aversive electric shocks= when engaged in any smoking-related behaviours
1 year= 52% participants still abstaining
- higher than 20-25% people who continued not to smoke after deciding to give up
L: treatments based on learning theory can: - save NHS resources
- Improve health
- save lives
LEARNING THEORY EVALUATION for nicotine addiction: CA - research support
P: Smith’s study did not use control group
E:
- comparison made in study= proportion of people who continue not to smoke after deciding to give up
- not valid measurement of effectiveness
E:
- also evidence for higher-quality studies that the benefits of aversion therapy are relatively short-lived
- especially compared to other therapies
L: suggest that counterconditioning may not be an effective method of addiction treatment
What is Vicarious reinforcement in terms of gambling?
The experience of seeing others being rewarded for their gambling through pleasure, enjoyment and occasionally money.
How can the observations of vicarious reinforcement be done?
Directly - observing someone else’s behaviour
Indirectly - e.g. positive report on big lottery winners in a newspaper/media OR a broadcast on the excitement of horse racing
What does this vicarious reinforcement lead the person to do?
Imitate the gambling behaviour to experience in order to get the same reinforcement
What can vicarious reinforcement be enough to do?
Trigger a desire for the same reinforcement in someone who hasn’t gambled before
Once a person has started to gamble, what are the two sources of direct positive reinforcement?
- Winning money
- The ‘buzz’ that accompanies a gamble - reinforcing bc its exciting
What is a negative reinforcement to gambling? and why (give an example)
Gambling being an escape for people
- offers a distraction from aversive stimuli, e.g. anxieties of everyday life
What did B.F. Skinner find out about a continuous reinforcement schedule?
A continuous reinforcement schedule, which rewards every ‘correct’ response from the animal, does not lead to the most persistent behaviour
- once rewards stop, targeted behaviour quickly disappears (process called extinction)
What is partial reinforcement?
When a behaviour is reinforced only some of the time it occurs (e.g. every 10th time or at variable intervals)
What does a partial reinforcement schedule create on the other hand? (give an example of how)
The kind of persistent behaviour that is seen in gambling
Only some bets rewarded= so unpredictability about which gambles will pay off= enough to maintain gambling even when most gambles are not rewarded
What is variable reinforcement?
A type of partial reinforcement in which behaviour is reinforced after an unpredictable period of time or number of responses
How is behaviour reinforced under a variable reinforcement schedule?
(give an example)
Behaviour is reinforced at regular intervals
- A slot machine might pay out after an average of 8 spins, but not on every 8th spin
- so first payout might come after 3rd spin, the next after 4th spin, the next after the 12th spin, and so on
- gambler learns they will not win after every gamble, but will eventually win if they persist
Variable reinforcement:
- does it take shorter or longer for learning to be established under this schedule?
- once established what is it much more resistant to?
- what can a gambler continue to do, even when what?
- takes longer
- extinction
- gambler can continue to place wagers for a long time even when their behaviour is no longer reinforced
What does cue reactivity explain, in terms of gambling?
How a behavioural addiction like gambling can be maintained and reinstated after relapse
Cue reactivity for gambling addiction:
- what do experience gambler encounter many of?
- give examples of these secondary reinforcers
- what can the presence of these … do, and even before what?
- what do these cues make difficult and why?
- what do they offer?
- what else do they make difficult?
- what outcome do these make predictable for many?
- secondary reinforcers (stimuli that become reinforcing bc of their associations with exciting arousal)
- atmosphere of a betting shop, colourful look of lottery scratchcards, TV horse-racing channel, exciting sounds of internet betting sites
- can cue the arousal that the gamblers crave, even before bet is placed
- make it difficult for the abstaining gambler to avoid bc these cues are everywhere (in social & media environments)
- continuous low-level reminders of the pleasures of gambling
- relapse
LEARNING THEORY EVALUATION for gambling addiction: strength - research support
P: support from research outside lab situations
E: Dickerson
- observed behaviour of gambler in two betting offices in Birmingham
- compared gamblers who placed most bets on horse races (high-frequency gamblers) Vs those who placed few bets (low-frequency gamblers)
- found that high-frequency gamblers consistently more likely to place bets in last 2 minutes before start of race= suggested gamblers find the ‘build up’ exciting regardless of the result, especially high-frequency ones
E:
- excitement is rewarding as they might have delayed betting to prolong it
L:
- evidence for role of positive reinforcement in gambling in real-world setting rather than lab
- study has external validity
LEARNING THEORY EVALUATION for gambling addiction: CA - research support
P: Dickson’s study had some methodological issues
E:
- gambling behaviour directly observed in betting shops over period of 14 weeks by one observer
E:
- single observer= no way of checking the reliability of the observations
- should have used two observers (inter-observer reliability) to measure agreement between them
L: observer bias not eliminated so finding of study may not be valid
LEARNING THEORY EVALUATION for gambling addiction: limitation- learning theory struggles to explain some types of gambling (limited explanation)
P: learning theory struggles to explain some types of gambling
E:
- can explain gambling addiction in games where there is almost no delay between placing the bet and knowing the outcome
- harder for learning theory to explain addiction in gambling in which the outcome is known some time after placing the bet
(e.g. horse racing)
E:
- because the reward (outcome) comes a long time after the behaviour (betting)
- so conditioning (learning) should be less effective
L: Therefore, learning theory is limited bc does not provide a general explanation of all gambling addiction
LEARNING THEORY EVALUATION for gambling addiction: strength - explains why most gamblers cannot stop gambling
P: learning theory explains why most gamblers cannot stop gambling
E:
- learning theory explains 2 things:
1. why gambling addiction starts
2. how it is maintained
E:
- conditioning (learning) is an ‘automatic’ process & does not require gambler to make any active decisions= gambler not aware they are learning to be addicted
- so even though most addicted gamblers are extremely determined to give up= their conscious desire to give up may conflict with the conditioning process that drive them to continue gambling
L: learning theory explains the common everyday experience of most addicted gamblers who find it hard to stop gambling
Explanations for gambling addiction: Cognitive theory
What is meant by cognitive biases?
- what’s an example of a cognitive bias?
- what do these biases influence?
A pattern of thinking and processing information about the world that produces distorted thoughts and beliefs
- mistaken beliefs about luck
- how gamblers think about their behaviour, what they do and do not pay attention to & what they remember and forget
Who classified cognitive biases into 4 categories?
Rickwood et al
What are the 4 categories of cognitive biases
- Skill & Judgement
- Personal traits
- Selective recall
- Faulty perceptions
Cognitive biases: Skill & Judgement meaning
- give an example
Gamblers feel in control so overestimate their ability to influence a random event
- e.g. being skilled ay choosing lottery numbers
Cognitive biases: Personal traits meaning
- give an example
Addicted gamblers believe they have a greater probability of winning bc they are especially lucky or engage in a superstitious behaviour
- e.g. touching a certain item of clothing before placing a bet
Cognitive biases: Selective recall meaning
Gamblers remember details of their wins but ignore their losses so carry on gambling as they remember the positives of gambling
Cognitive biases: Faulty perceptions meaning
Addicted gamblers have distorted views about the operation of chance, gambler’s fallacy is the belief that a losing streak cannot last and must always be followed by a win
Cognitive explanations for gambling: Self-efficacy meaning
- what is this a key element of?
- why is it a cognitive process? what’s it based on?
The expectations we have about our ability to achieve a desired outcome
- key element of relapse
- based on expectations & perceptions
How does relapse happen in gambling?
- what does this set up?
When person has biased belief that they are not capable of abstaining permanently so expect to gambler again
- sets up a self-fulling prophecy= individual behaves in a way that confirms this expectation
Who investigated cognitive biases in gamblers?
Griffiths
Research into cognitive biases - Griffiths et al
(PROCEDURE & FINDINGS)
PROCEDURE:
- used ‘thinking aloud’ method (form of introspection) to compare cognitive processes of regular slot machine gamblers
- p’s had to verbalise any thoughts that passed through their minds when playing the machines
- content-analysis classified these into rational/irrational
- semi-structured interview used to ask p’s about degree of skill required to win slot machines
- behavioural measures recorded, e.g. total winnings
FINDINGS:
- no difference between regular & occasional gamblers in objective behavioural measures (e.g. regular didn’t win more money)
Regular gamblers
1. made almost x6 as many irrational verbalisations than the occasionals (14% compared to 2.5%
2. more prone to an illusion of control (‘I’m going to bluff this machine’)
3. overestimated amount of skill required to win slot machines & considered themselves to be especially skillful at doing so, compared with occasionals
Would would be an example of a rational & irrational verbal thought when playing on the slot machines?
Rational= ‘Wow, I won ten pence’
Irrational= ‘This machine likes me’
COGNITIVE THEORY EVALUATION for gambling addiction: Strength - Research support for role of cognitive biases by Michalczuk
P: One strength of cognitive theory is support for role of cognitive biases
E: Michalczuk
- studied 30 addicted gamblers attending the National Problem Solving Clinic in the UK
- compared with 30 non-gambling control participants
Addicted gamblers=
1. showed significantly higher lvls of gambling-related cognitive biases of all types
2. more impulsive & more likely to prefer immediate rewards even when reward were smaller than rewards they could gain if they waited
E:
- addicted gamblers make gambling decisions impulsively
- have a powerful tendency towards biased thinking during play
L: support view that there is a strong cognitive component to gambling addiction
COGNITIVE THEORY EVALUATION for gambling addiction: CA - Research support for role of cognitive biases
P: Michalczuk study - cognitive biases measured using The Gambling-related cognitions scale (GRCS)
E:
- This scores respondents on 5 types of bias
- e.g. illusions of control & the gambler’s fallacy
E:
Score= gambler has frequent biased cognitions
OR
Score= might reflect gambler’s tendency to use their beliefs to justify their behaviour
- therefore their thinking wasn’t biased at all
L:
- findings of study may not reflect a gamblers actual beliefs about gambling
- lacks validity
COGNITIVE THEORY EVALUATION for gambling addiction: Further research support - McCusker & Gettings
P: further research support for cognitive biases
E: McCusker & Gettings
- used a modified stroop task
- P’s had to identify ASAP ink colour which words were printed
- so had to pay attention to one thing (ink colour) whilst ignoring another (word meanings)
Addicted gamblers= took longer to perform this task than controls only when words related to gambling
E:
- unable to prevent word meanings from interfering with intended task
- suggests gamblers have a cognitive bias to pay attention to gambling-related info that does not exist in non-gamblers
L:
- increases external validity of research/role of cognitive biases
COGNITIVE THEORY EVALUATION for gambling addiction: Methodological problem - in use of ‘thinking aloud’ method
P: One limitation is use of ‘thinking aloud’ method
E:
- self-report method used a lot in studies to access the cognitive biases of addicted gamblers
- e.g. Griffiths
E: Dickerson & O’Connor
- what people say in gambling situations= does not necessarily represent what they really think
- these off-the-cut remarks during slot machine sessions may not reflect an addicted gambler’s deeply-held beliefs about chance and skill
- researchers may instead get a misleading impression that gambler’s thought processes are irrational when they are not
L: findings may not be valid because gamblers’ utterances do not express their genuine feelings
What are the 3 ways of reducing addiction?
- Drug therapy
- Behavioural interventions
- CBT
What are the 3 types of drug therapy?
- Aversives
- Agonists
- Antagonists
What do Aversives aim to do?
Give an example:
- what’s it used to treat?
- how does it do this?
Produce unpleasant consequences such as vomiting
EXAMPLE: Disulfiram
- used to treat alcoholism
- by creating hypersensitivity to alcohol
- creates severe hangover just minutes after taking alcohol
What do Agonists aim to do?
Give an example:
- what’s it used to treat?
- how does it do this?
- what makes them good and why?
- what does it do to the addicted person?
- what does this allow for?
Bind to neuron receptors to produce similar effects to the addicted substance but without the euphoria or harmful side effects
EXAMPLE: Methadone
- used to treat heroin addiction
- satisfy the addicted person’s craving for a state of euphoria
- fewer harmful side effects & are ‘cleaner’ bc administered medically
- stabilise the individual= used to control the withdrawal syndrome
- allows for gradual reduction in dose and symptoms
What do Antagonists aim to do?
Give an example:
- what is it?
- what’s it used to treat?
- what should be used alongside it? why?
Bind to receptor sites and block them preventing the addicted substance from having an effect, especially the feeling of euphoria people with addictions crave
EXAMPLE: Naltrexone
- an opioid antagonist
- used to treat the physiological dependence of heroin addiction
- other interventions
(like counselling) should be used alongside to tackle the psychosocial causes of the addiction
Which drug therapy produces unpleasant consequences?
Aversives
Which drug therapy blocks receptor sites meaning no usual effects
Antagonists
Which drug therapy triggers neuron receptors and acts as a substitute?
Agonists
Drug therapy for nicotine addiction:
- what is used to treat nicotine addiction?
- what’s it in the form of/how is it done?
- what does this provide the user with?
- how and what does this operate as?(aversive, agonist or antagonist)
- what do they activate and where?
- what does this stimulate the release of?
- what does using this specific drug therapy mean?
- what can therefore be managed?
- Nicotine replacement therapy (NRT)
- uses gum, inhalers or patches= delivers the psychoactive substance of tobacco smoke but in a less harmful fashion
- a clean, controlled dose of nicotine
- operates neurochemically as an agonist
- activates nAChRs receptors in the mesolimbic pathway of brain
- stimulates release of dopamine in nucleus accumbens (like when smoking)
- means amount of nicotine can be reduced over time (using smaller and smaller patches)
- withdrawal syndrome can be managed over period of 2/3 months= reducing unpleasantness of withdrawal symptoms
Drug therapy for gambling addiction:
- are drugs used to treat gambling addiction?
- what is used instead?
- give a example (what’s it conventionally used to treat)
- how has this come about?
- what do they do instead?
- how does this have an impact
- Is this linked to any research, if so by who?
- no drugs currently
- opioid antagonists
- e.g. naltrexone - used to treat heroin addiction
- due to similarities between gambling & substance addiction= taps into same dopamine reward system as heroin, nicotine & other drugs
- enhance release of neurotransmitter GABA in mesolimbic pathway
- GABA activity reduces release of dopamine in nucleus accumbens (& frontal cortex)
- Kim et al - showed subsequent reductions in gambling behaviour
DRUG THERAPY EVALUATIONS: Strength - research support - Hartmann-Boyce et al
P: research shows it’s effective
E: Hartmann-Boyce et al
- conducted meta-analysis of 136 high-quality research studies into effects of NRT
- concluded= all forms of NRT significantly more effective in helping smokers quit than both placebo and no therapy at all
E:
- NRT products increased rate of quitting by up to 60%
- research also indicated that NRT does not appear to foster dependence
L: NRT is an effective therapy which may save lives and reduce costs to the NHS
DRUG THERAPY EVALUATIONS: CA - Research support - Hartmann-Boyce et al
P: Hartmann-Boyce et al meta-analysis research may lack validity
E:
- researchers only included in their analysis research studies that had been published
- risk of publication bias= published studies more likely to show ‘positive’ results
E:
- studies with non-significant results or that show no effect= not normally published
- researchers note that they wrote to manufacturers of NRT producers to track down unpublished studies but ‘the response was poor’
L: NRT may not be as effective as the findings of this meta-analysis suggest
DRUG THERAPY EVALUATIONS: Limitation - side effects
P: one limitation of all drug therapies is that they have side effects
E:
- risk of side effects= client will discontinue the therapy
- NRT common side effects= sleep disturbances, dizziness & headaches
- side effects much greater concern in drug therapies for gambling addiction= dose required for naltrexone to have an effect is much higher than when to treat opiate addiction
E:
- means that side effects are worse
- include symptoms like= muscle spasms, anxiety & depression
L:
- therefore side effects should be weighed up against the benefits of the drug therapy and the cost/benefits of other therapies
- e.g. psychological therapies
DRUG THERAPY EVALUATIONS: Strength - reduces stigma
P: addiction becomes less stigmatised through association with drug therapies
E:
- many hold the opinion that addiction is a psychological weakness
- even if start of an addiction is responsibility of the individual= soon spirals out of their control
- stigma attached addiction= can lead to self-blame & depression making recovery more difficult
E:
- stigma being eroded by continuing successful use of drug therapy
- encourages perception that drug addiction has a neurochemical basis
L:
- could be argued that perceiving addiction as something that can be treated with drugs= helps people with addictions avoid self-blame and assists recovery
What are the two behavioral interventions?
- Aversion therapy
- Covert sensitisation
What is Aversion therapy based on? (explain)
Classical conditioning
- try to associate addictive behaviour/substance with consequences
What’s it called when we try to associate behaviour/substances that are pleasurable with consequences to reduce addiction?
Counterconditioning
Create a flow diagram of what happens in Aversion therapy for Alcohol addiction
- explain what happens during & after conditioning
During:
Alcohol (NS) + aversive drug (UCS)= Nausea/vomiting(UCR)
After:
Alcohol (CS)= Nausea/vomiting(CR)
What is the aim of aversive therapy treatment?
- how is this done when taking an aversive drug?
- what is the result of this?
For client to learn a new association
- makes client vomit= so when they drink alcohol they will soon expect experience of nausea/vomiting
- puts them off drinking
Aversion therapy for gambling addiction:
- what is used instead of aversive drugs for behavioural addictions?
- why could it also be used as an alternative?
- what does an addicted gambler do during this therapy?
- what else are included? (give example)
- what does the client do after?
- when are they given a shock?
- what should the shocks be like?
- what are preselected by the client?
- electric shocks
- for people whose medical conditions might be worsened after frequent vomiting
- writes down on a card phrases related to their gambling behaviour
- non-gambling behaviour too (e.g. ‘Went straight home’)
- reads out each card
- when get to gambling-related phrase = given 2 second shock
(device attached to wrist) - painful but not distressing
- the intensity & duration of the shock
Create a flow diagram of what happens in Aversion therapy for gambling addiction
- explain what happens during & after conditioning
During:
Gambling behaviour (NS) + electric shock (UCS)= pain (UCR)
After:
Gambling behaviour (CS)= pain(CR)
Aversion therapy EVALUATION: Limitation - Methodological problems
P: Studies of aversion therapy have methodological problems
E: Hajek & Stead
- reviewed 25 studies of aversion therapy for nicotine addiction
- found was impossible to judge effectiveness of aversion therapy bc most studies had ‘glaring’ methodological problems
E:
- failure to ‘blind’ the procedures
- researchers knew which p’s received therapy or placebo
L: tells us little about value of aversion therapy
Aversion therapy EVALUATION: Limitation - Lack of long-term benefits
P: Lack of long-term benefits
E: Fuller et al
- gave one group of p’s addicted to alcohol disulfiram every day for 1 year
- Another group received a placebo
- Both groups also had weekly counselling sessions for 6 months
E:
- No significant difference in total abstinence from drinking between these groups after 1 year
L: Aversion therapy for alcohol addiction is no more effective than placebo - may be bc counselling had bigger impact
What is Covert sensitisation?
- how is it different to aversion therapy?
A form of aversion therapy based on classical conditioning
- client imagines how unpleasant stimulus would feel rather than experiencing it in real life
What are the steps to covert sensitisation?
- Client encouraged to relax
- Therapist reads from specific script instructing client to imagine an aversive situation
- Client sees themself smoking cigarette followed by imagining most unpleasant consequences (e.g. vomiting after smoking a cigarette)
- The more vivid= the better which is why therapist goes into graphic detail about elements of the imagery (sights, smells, sounds, physical movements, etc)
- By end of session, client imagines scene of ‘turning their back on cigarettes’= experience rewarding feeling of relief
What is one unpleasant technique (imagery) used in covert sensitisation for nicotine addiction?
- what else can be added for more unpleasantness?
Client imagines being forced to smoke cigarette covered in faeces
- the therapy may incorporate aversive stimuli chosen by client
Covert sensitisation EVALUATION: Strength - Good research support
P: Good research support
E: McConaghy et al
- compared covert sensitisation & electric shock aversion therapy for gambling addiction
- After 1 year= covert sensitisation had significantly better results for reducing gambling
(90% covert p’s compared with 30% aversion p’s)
E:
- covert sensitisation p’s also reported experiencing fewer, less intense gambling cravings
L: suggests covert sensitisation is a highly promising behavioural intervention
Covert sensitisation EVALUATION: Limitation - Methodological criticism
P: Many CS studies have methodological criticism
E: As they do not include a suitable comparison group (e.g. McConaghy et al)
- e.g. use non-behavioral therapies as a comparison
- instead just compare CS with AT
E:
- addiction has many non-learning causes (e.g cognitive factors)
- non-behavioural therapies (e.g. CBT) address these
- Covert sensitisation & Aversion therapy DO NOT
L: means the benefits of CS may be exaggerated
What is CBT used to develop?
C…
S…
&
the S…
Coping skills
Strategies
&
the Strength
necessary to deal with the addiction-related cues or triggers
What does Cognitive behavioural therapy (CBT) aim to challenge?
Maladaptive ways of thinking & behaving associated with substance or behavioural addictions
What are the 2 elements of CBT?
- Functional analysis (cognitive)
- Skills training (behavioural)
CBT 1st element: Functional analysis (cognitive) 1/2
- what do client & therapist do?
- what does therapist reflect on?
- therefore, what is critical?
- what should the session be?
- what must the session NOT be?
- work together to identify high-risk situations where client is likely to gamble/use substance of addiction
- therapist reflects on what client is thinking before, during and after such situation
- quality of client-therapist relationship
- warm, collaborative & responsive
- must NOT be cosy= therapist must challenge client’s biased cognitions & not accept them
CBT 1st element: Functional analysis (cognitive) 2/2
What key feature happens during functional analysis?
- what does this aim to do?
- give a gambling-related example
- what is done by the therapist?
- what element is there during this bit?
- what is functional analysis?
- what does it do at the early/late phases of therapy?
Cognitive restructuring= change client’s addiction related cognitive biases
Gambling related example= restructuring addresses client’s faulty beliefs about probability, control, gains & losses
- these are confronted & challenged by therapist
- educational element
- an ongoing process
Early phase= helps client identify the triggers for their addiction
Late phase= helps client work out further skills training which may be needed
CBT 2st element: Skills training (behavioural)
What 1st key feature happens during skills training?
- what does this aim to do?
- give an example
What 2nd key feature happens during skills training?
- what does this aim to do?
- give an example
Specific skills:
- client learns specific skills to help them cope with situations that trigger their addiction
- e.g. anger management training can help cope with situations that make them angry enough to resort to drinking
Social skills:
- learning skills that help client cope with social situations
- learning how to refuse alcohol with minimal fuss in ways that avoid embarrassment
- e.g. being firm in refusing an offer of a drink
Is the application of behaviourist principles in Aversion therapy Nomothetic or Idiographic? and why?
Nomothetic - Everyone is presumed to respond the same way
Is application of behaviourist principles in Covert sensitisation Nomothetic or Idiographic? and why?
Idiographic - allows for some individual decision in the images created by the individual person (they are personal to them)
Is the principles involved in CBT Nomothetic or Idiographic? and why?
Idiographic - allows the thought process of the individual to be listened to & moderated
In CBT what can functional analysis identify and help?
May identify that client lacks a specific skill - which can later on be learnt by suing skills training
CBT EVALUATION: Limitation - Short-term only
P: may only be effective in the short term
E:
- meta analysis of 11 studies compared CBT for gambling addiction with control conditions
- Period of up to 3 months after treatment= CBT had medium to very large effects in reducing gambling behaviour
- After 9-12 months= no significant differences in outcome between CBT & control groups
E: studies may have overestimated the benefits of CBT bc they were of such poor quality
L: CBT is one of short-term benefit BUT long-term disappointment
CBT EVALUATION: CA - Short-term only
P: Is some high-quality research that challenges the short-term view of CBT
E: Petry et al
- randomly allocated pathological gamblers to either control or treatment condition
Control condition= anonymous meetings
Treatment condition= GA meetings + 8-session individual CBT programme
E:
12 months later= treatment clients gambling significantly less than control participants
- study has high internal validity= random allocation
L: this study (methodologically better) suggests that CBT is effective in reducing gambling addiction beyond the short-term
CBT EVALUATION: Limitation - High drop out
P: many clients drop out of CBT
E:
- was notes that drop out rates in CBT treatment groups= 5x greater than any other form of therapy
E:
- may be because CBT is a demanding therapy
- also client’s use it as a short-term thing to get rid of recent crisis then drop out when crisis is somewhat sorted
L: high drop out rate= major obstacle to success of CBT in reducing addictions
CBT EVALUATION: Strength- Relapse prevention
P: CBT especially useful in preventing relapse
E:
- CBT presents very realistic view of recovery & incorporates likelihood of relapse into treatment
- as relapse bound to happen for many
E:
- relapse viewed as opportunity for further cognitive restructuring & learning rather than as a failure
L: Therefore, when client sticks with therapy, CBT can help them to avoid relapse by maintaining a stable lifestyle
Theory of planned behaviour
A theoretical model showing how person decides to change their behaviour & has been applied to range of addictive behaviour
What are the 3 key influences of TPB?
- Personal attitudes
- Subjective norms
- Perceived behavioural control
Theory of planned behaviour: Explain Personal attitudes
If addict has overall negative or positive opinion of their addicted behaviour
(e.g. drinking is an important part of my social life vs drinking is causing significant health issues)
Positive opinion= will lead to more interest in addiction-related behaviour
Negative opinion= will lead to reduced interest in addiction-related behaviour
Theory of planned behaviour: Explain Subjective norms
The addicts belief about their support network’s view on their addictive behaviour
&
do the views of those around them create a social pressure to quit OR continue the addictive behaviour
(e.g. all friends drink on a friday night)
Theory of planned behaviour: Explain Perceived behavioural control
How much control we believe we have over our behaviour (self-efficacy)
- difficult or easy to give up?
- depends on their perception of the resources available to them, both external (time, support) and internal (ability, effort)
Has 2 possible effects=
1. can influence our behaviour indirectly via our intentions to behave (believe I can stop= stronger intention to stop)
2. Only TPB component that can influence behaviour directly (greater perceived control= longer & harder I will try to stop)
How can Subjective norms have application?
Campaigns against substance abuse combat this by providing messages that reveal true extent of substance abuses (e.g. it’s only a minority)
- source of message has to be credible= our subjective norms are most influences by views of people we respect
How can Perceived behavioural control have application?
Increasing gambler’s self-efficacy can help them quit and/or avoid relapse.
- can be done by encouraging an optimistic outlook and confidence in their ability not to gamble
TPB EVALUATION: Strength - research support
P: Research support
E: Armitage et al
- conducted meta-analysis 185 studies on TPB
- found it successful in predicting both behaviour & intention
(but better for intention)
- subjective norms is weakest predictor of intention & behaviour
TPB EVALUATION: Limitation - TPB is too rational
P: TPB is too rational
E:
- highlighted by Armitage et al
- fails to account for humans to be governed by irrational thoughts or emotions
- model assumes behaviours are always conscious, reasoned & planned= not always true with addicts
E:
- therefore, role of free will is not factored into this model
L: Lacks validity
Prochaska’s model - The six stage model of behaviour change
- what does it say?
The process of behaviour change is not linear but cyclical= series of stages needed to be repeated multiple times, with frequent backwards steps
Prochaska’s model: What are the six stages of behaviour change?
- Precontemplation - not currently considering addiction as a problem/thinking there is need for a change (may be bc of denial or demotivation)
- Contemplation - starts to consider a change in addictive behaviour
- Preparation - decided to take action, planning how to reorganise life
(e.g. avoiding events with addictive substances) - Action - Is in first 6 months of trying to stop addictive behaviour/substance
- Maintenance - person has maintained some change of behaviour for more than 6 months
- Termination - the addictive behaviour has stopped & individual no longer feels addictive temptations
