Addiction Flashcards
Define addiction
Periodic or chronic intoxication produced by repeated consumption of drugs, natural or synthetic’
Give a second definition of addiction
A disorder where the individual engages in a behaviour that was pleasurable but becomes compulsive and has harmful consequences
Which is the only 1 non drug addiction in the DSM 5
gambling
How many addictions are in the DSM 5
10`
Give 4 criteria of an addiction in the DSM 5
wanting to quit but cant
not managing to do what you should (work)
needing to do it more often than when you started
carrying on despite physical harm it may cause
Name the six characteristics of addictive behaviour
salience mood modification tolerance withdrawal symptoms conflict relapse
Explain salience
the behaviour is the most important thing in your life
Explain mood modification
it provides excitement
Explain conflict
problems with those directly around you as a result of the addiction
Explain relapse
repeating behaviour after trying to stop
What are the 4 things usdd to describe addiction in the specification
withdrawal syndrome
tolerance
physical dependance
psychological dependance
What is withdrawal syndrome
a collection of symptoms when the substance is no longer present
What is dependance
a need for substance that causes withdrawal symptoms
What is tolerance
a lowered response to a substance due to repeated use
What is cross tolerance
a tolerance to one drug that leads to a tolerance of another drug
Name a study into cross tolerance/vulnerability to addiction
Marks et al (1997)
alcoholics more likely to have a nicotine dependancy
Name a study into tolerance
Begg (2001)
normal drinkers 8g
alcoholics 16g
Name a study into withdrawal symptoms
Grabus (2005)
mice showed withdrawal symptoms from nicotine and over time their physical response decreased
What do geens create for drugs
a predisposition
What are low levels of dopamine receptors linked with
addiction as dopamine is linked with reward and pleasure
Why are Asians less likely to become addicted to alcohol
50% of asians metabolise alcohol slower than europeans so feel more sick drinking it and therefore drink it less
Name a study looking into genetic vulnerability
Kendler et al 2012
individuals with one addicted parents who were adopted away at a 9% risk, double normal
Evaluate genetic vulnerability
nativist-interactionalist arguement with evdience from twin studies
bio determinism doesnt account for free will
socially sensitive as says people dont have a choice
bio reductionist enables controlled research but oversimplifies a complex phenonemon
What does increased stress lead to
increased vulnerability
What are the different types of stressors
acute (severe short term)
chronic (long term)
Name a stress study
Tovalacci et al 2013
highly stressed uni students more likely to become nicotine, alcohol and the internet
Evaluate the importance of stress
cause and effect hard to establish, stress could be caused by the addiction
Name a study that looks at personality and addiction
Eysenck (1997)
individual develops an addictive habit because it fulfuls a purpose related to their personality traits
Which personality type is closest linked to addiction
impulsivity
Name a study to do with impulsivity
Ivanov et al 2008
impulsivity and drug use closely linked
What type of risk factor is personality
proximal risk factor
What is percieved parental approval
people thinking that their parents have a positive attude to a behaviour
Name a study into percieved parental approval
Livingston (2010) high school students who were allowed to drink at home are more likley to excessively drink as college students
Name some issues with this study
self report
difficult to separate and measure family and other influences
correlation not causation
Name another risk factor in addiction
peers
What are the 3 ways O’Connell (2009) suggests peers increase addiction risk to alcohol
peers behaviour
peers provide opportunity and access
an individual overestimates how much their peers drink
What are some issues with peer studies
influence of peers changes with age
difficult to separate cause and effect
doesnt account for social factors
What are some practical applications of looking at risk factors
when we understand the risks can lead to treatment and preventation
What are the two key brain neurochemistry explanations for nicotine addiction
desensitisation model
nicotine regulation model
Who came up with the desensitisation hypothesis
Dani and Heinemann 1996
Name the two branches of the desensitisation hypothesis
ACh receptors
Dopamine transmission
Explain ACh receptors
nicotine molecules bind with a receptor, and initially causes dopamine to be released
but then immediately after, the nicotine receptor shuts down and can temporarily not respond to neurotransmitters
leads to desensitisation and downregulation, a reduction in number of active neurons
Explain dopamine transmission
When receptors are stimulated by nicotine, dopamine is released into the mesolimbic pathway which is part of the brains reward and pleasure centre
How does ACh become nACh
by nicotine binding with the receptor
Explain the nicotine regulation model in terms of withdrawal
overnight, the receptors become resensitised and more active, so the cravings come back
this is why many say the first cig of the day is the best as it reactivates the dopamine reward system
Explain the nicotine regulation model in terms of dependance and tolerance
smoker is motivated to keep smoking to avoid the unpleasurable withdrawal symptoms
daytime downregulation and nighttime upregulation creates chronic desensitisation to nAChs
Explain the supporting research evidence for the role of neurochemistry in nicotine addiction
McEvoy et al (1995)
haloperidol increased smoking in sz patients as it produces a nicotine hit by increasing dopamine release
importance of dopamine in the reward system of the mesolimbic pathway seen through brain imaging studies (Ray et al 2008)
Explain the real life applications of neurochemistry explanations
new treatments such as nicotine replacement therapy in the form of patches and inhalers
smoking has high co-morbidity with other mental diseases, so can help us with preventation and treatment of those also
Explain why neurochemistry is a limited explanation
role of dopamine over-emphasised as more research showing there are other mechanisms involved such as GABA and serotonin
reductionist view at a low level as it ignores hugher level factors such as social and psychological as only 50% become nicotine addicts
How does operant conditioning help with addiction to smoking
positive - early days, pleasurable consequences from nicotine
negative - taking away withdrawal symptoms
Explain Levin et al study (2010) with operant conditioning
trained rats to self administer nicotine from waterspout
rates increased dose every time
issues of exploration as rats differ significantly from humans
also humans enjoy experience of smoking tobacco
How does classical conditioning affect smoking addiction
pleasurable reward from smoking is primary reinforcer
secondary reinforcers can be friends, pubs, drinkings
What are secondary reinforcers also known as
cue reactivitiy
Explain two cue reactivity studies
Carter and Tiffany (1999)
dependant smokers reacted more strongly to cues than non dependant smokers
Calvert (2009)
strong activation in nucleus accumbens when pack of cigs shown
How does social learning theory explain initiation of smoking
vicarious reinforcement, seeing role model to it and imitating
Explain a study looking at SLT and smoking
Mayeux et al (2008)
longitudinal study
correlation between smoking at 16 and populatiy 2 years later in boys but not girls
How does SLT have practical applications
young people taught necessary skills to resist social influence (Botvin 2000)
What does SLT not explain
why people smoke and not come addicted
why women have more problem quitting and relapsing
What is addiction due to
distorted/dysfunctional thinking
What do self fulfilling beliefs lead to
an inability to direct attention away from addictive substances
What theory is linked to the cognitive explanation of gambling
expectancy theory
What is the expectancy theory
they expect certain outcomes and believe that the positives outweigh the negatives so carry on the addiction
Explain Beck’s (2001) ‘vicious cycle’
low mood - gambling - finance/social problems - low mood
What is gamblers fallacy
a belief in which a person believes the probability of an outcome has changed, so if they lose 10 times they believe they must win the 11th
What are the 4 cognitive biases/irrational thought processes that Rickwood et al (2004) found in gamblers
skill and judgement
personal traits/rituals
selective recall
faulty perceptions
What is skill and judgement
bad illusion of control over events, overestimates ability
What is personal traits
beleive they are lucky and do rituals to increase luck
What is selective recall
remembering wins but underestimating losses
What is faulty perceptions
a distorted view of probability (gamblers fallacy)
Explain Griffiths (1994) cognitive biases study
30 gamblers 30 non gamblers
£3 on fruit machine
have to aim to stay on for 60 games
cognitions assessed by content analysis of verbalisations
What was the outcome
gamblers overestimate skills required ans their own skills
presence of cognitive biases so supports cognitive explanation
Name some of the verbalisations in the study
be nice to me machine - 0.9 non 2.64 gamblers
If you have a high self-efficacy you can do what?
quit
Explain the evidence of automatic behaviour from McCusker and Gettings (1997)
Stroop procedure
colour in which words were printed
gamblers took longer to do the words relating to gambling
brain has a cognitive bias that pays attention to gambling words
Why can individual differences lead to gambling addiction
Burger and Smith (1985) found that people with the personality type of high level of control motivation are more likely to become addicted to gambling as they believe they can control the outcomes
Why is the cognitive approach good for real life applications
can lead to effective treatment such as CBT
What are the methodlogical issues with the cognitive approach
as self report is usually used to understand thought processes, it is not an accurate way of seeing what they believe and spur of the moment saying at a slot machine may not reflect ones deeply held beliefs
What re the three types of drug therapy
aversives
agonists
antagonists
Explain an aversive
produces unpleasants consequences such as vomiting
eg disulfiram for alcoholism, produces severe hangovers 5 minutes after alcoholic drink
Explain agonists
drug substitutes
bind to receptors and give pleasant feeling
better as they have fewer harmful side effects and are cleaner as medically administered
help with withdrawal symptoms as dose can be gradually reduced
eg methadone for heroin
Explain antagonists
bind to receptor sites and block other substances having an effect
dependance cannot have usual positive benefits
eg naltrexone for heroin
What is an issue with agonists and antagonists
people may still seek out the drug and can lead to overdoses
Which is the only one that prevents withdrawal symptoms
agonists, so other treatments may have to be used alongside other things
Name 3 different types of NRT’s
gum, inhalers, patches
What is an NRT
nicotine replacement therapy
What do NRT’s do
give nicotine in safe clean way
binds to receptor in mesolimbic pathway stimulating release of dopamine in nucleus accumbens
withdrawal symptoms managed as dose can be lessened over time
What did Stead et al (2012) find
that all NRT’s are more effective than placebos or no treatment, especially nasal sprays
What drug has been suggested to use for gambling addictions
naltrexone as increases level of GABA
this is an inhibitory neurotransmitter, which slows down release of dopamine and reduces pleasurable feeling
Explain the support for using naltrexone for gambling addiction
Kim et al (2001)
12 week double blind placebo-controlled trial
reduced gambling in 45 pathological gamblers
What is a negative of naltrexone
it produces significant side effects such as drowsiness and anxiety as higher doses are needed for gambling
could lead to non-compliance and reduced effectiveness
What are the positive evaluations of drug therapy
more time/cost effective than CBt as only prescription needed and may impact a persons life less
by focusing on bio problem it reduces the stigma of addiction as rules out ‘choice’
What are the negative evaluations of drug therapy
raises ethical issues as there can be more serious side effects and some addicts may b=not be well enough to give informed consent
issues of compliance as addicts may have lost memory through addiction and forget to take the drug
does not address the difficulties that might have led to addiction in the first place such as stress
Who found that drug treatment may not be effective by itself
McLellan et al (1993)
group of addicts on methadone with pscyhological help responded better than those with no psychological help
What does aversion therapy use
counterconditioning where they replace the positive association with a negative one
What type of intervention is aversion therapy
behavioural
What does aversion therapy successfully exploit
the principle of contiguity
What is the principle of contiguity
where two stimuli become associated as they occur frequently together
How is aversion therapy done for alcoholics
given averse drug which causes nausea
given strong alcoholic drink
then throw up
now associates alcohol with nausea
What is another version of aversion therapy for alcoholics
given disulphiram
stops metabolism of alcohol
immediate horrible hangover after alcohol drinking
How is aversion therapy done for gamling addiction
addict creates key phrases associated with their gambling that thye say to themselves
self administer two second electric shock for each phrase
aim to be painful but not distressing
What is covert sensitisation
aversion therapy but in vitro
meaning they have to imagien what it would be like to drink then throw up
How is covert sensitisation used for nicotine addiction
asked to relax
then therapist goes into graphic detail about smoking and then unpleasant consequences following
gets them to imagine smoking a cigarette with faeces on it
What is the positive evaluation of aversion therapy
Meyer and Chesser (1970) found that 50% alcoholics absatined for 6 months after therapy
more successful than no therapy
shows effectiveness
What study goes against aversion therapy
Hajek and Stead (2011)
reviewed 25 AT studies
all but 1 had methological issues
means results must be treated with caution
What are the negative evalutaions of aversion therapy
compliance is low due to unpleasant nature
ethical issues such as physical harm and loss of dignity to CS is preferred now
Name a study supporting covert sensitisation over aversion therapy
McConaghy et al (1983)
after 1 year 90% of CS patients had reduced gambling over only 30% of AT
suggested CS has better long term benefits
What are some issues with behavioural therapies in general
relapse as addictions take place away from controlled environment where aversion is created
does not address underlying cause such as bio, cog or social eg the things causing the addiction in the first place
What is the aim of CBT
changethe faulty ways of thinking that lead people to use drugs/addictions as maladaptive ways of thinking
What is the first stage of CBT
functional analysis
identify and tackle the cognitive distortions that are leading to addictions replacing them with more adaptive ways of thinking
What is the second stage of CBT
skills training
help the client develop coping behaviours to avoid the high risk situatrions that lead to trigger action related behaviour
What is very important in CBT
client patient relationship
trusting but not cosy
What does functional analysis include
talking about how the feel before, during and after use
how they feel about the consequences
how they experience cravings
Does functional analysis happen once or is it ongoing
ongoing as it is needed to assess the success of the therapy and guide its future direction
What are the three skills included in skills training
cognitive restructuring
specific skills
social skills
What is cognitive restructuring
tackling biases and distortions that lead to a behaviour
What is specific skills
CBT is a broad spectrum treatment so this focuses on certain people such as having anger management classes if someone drinks when angry
What is social skills
helps people learn necessary skills to refuse alcohol or drugs in situations where it is available, such as making eye contact and being firm
What else is used in social skills
role playing
Who studied the effectiveness of CBT
Petry (2006)
gamblers attending GA vs gamblers attending GA and CBT
second group gamble significantly less 1 year on
What is another strength of CBT
provides skills to resist social pressure and deal witg everyday situations thus helps with relapse and addiction substitution
Who found that CBt has no long term effects
Cowlishaw (2012)
reviewed 11 CBT studies
good short term effects but no long term effects
What does CBT not account for
biological factors
Why is CBT time consuming
10-15 one hour weekly sessions and homework
only motivated clients benefit
5X drop out rate of other treatments
What does CBT ignore
the fact that it does not help home stressors such as stressful home life
Who formulated the theory of planned behaviour
Azjen (1985)
What is the theory of planned behaviour
an attempt to explain how we change behaviours which we can exercise self control
What is central to this theory
intention
The theory suggests that intentions arise from what three key infleunces
personal attitudes
subjective norms
percieved behavioural control
What are personal attitudes
the sum of all of our knowledge, attitudes and prejudices
weighing up the positives and negatives
eg gambling gives me a thrill but it makes me lose money
What are subjective norms
what we think other people think about our behaviour , particulary family and friends
our perception of other peoples attitudes
What is perceived behavioural control
the extent to which we believe we can control our behaviour (self-efficacy)
What is the most powerful influence
perceived behavioural control
What two possible effects come with perceived behavioural control
influence our intention to behave in a certain way
influence behaviour directly
Who provided some research support for TPB
Hagger et al (2011)
all 3 factors predicted behaviours for alcohol addictions
however did not predict binge drinking
suggested some addictions override intention meaning TPB isnt always applicable
Who found that TPB doesnt always predcit behaviour
Miller and Howell (2005)
teen had positive attitudes, subjective norms and percieved control over buying lotto tickets but didnt actually carry out the behaviour
makes it question the focus of youth intervention programmes
Why is there methodological issues with TPB
most use self reports to assess behaviour
What is a strength of TPB
takes into account influence from peers which is significant in initiation and maintenence of an addiction
What does TPB ignore
the role of emotions such as sadness and frustration which can play an important role in influencing behaviour
What does Prochaska’s six stage model recognise
that overcoming addiction is a complex process that does not happy quickly or in a tidy linear order from the first to last stage, its a circular process where steps may be repeated or missed totally
What is Prochaska’ six stage model based on
two major insights about behavioural change
firstly people differ at how ready they are to change their behaviour
secondly how useful treatment is depends on the stage they are in
What are the six stages of behavioural change
precontemplation contemplation preparation action maintenance termination
Explain the precontemplation stage
not thinking about changing behaviour in near future
could be due to denial or demotivation
Explain the contemplation stage
thinking about making a change in the next 6 months
aware of benefits but also the costs
Explain the preparation stage
beleives benefits are greater than costs
change within next month
havent decided when or how
most useful treatment - calling a helpline, talking to doctor
Explain the action stage
action taken to reduce the risk
such as pouring alcohol down sink
most useful treatment - focus of developing coping skills to maintain behaviour
Explain the maintenance stage
maintained behaviour for more than 6 months
focus on relapse prevention such as avoiding cues
Explain the termination stage
newly acquired behaviours become automatic
they not longer return to addiction as a coping mechanism
relapse is inevitable for some
no intervention is required
What are some positive evaluations of the six stage model
looking at change as a series allows us to match interventions to the stage someone is in instead of a one size fits all method
meaures being developed to allow people to classify their stage and receive tailored help
it has a realistic view of relapse as an inevitable part of the process rather than failure which helps with self efficacy
What are some negative evaluations of the six stage model
David (2006) and Cahill (2012) believe interventions based on the model are no more successful than other approaches
The difference between stages is often “blurry” e.g. the difference between contemplation and preparation is vague as its the difference of 1 week
Descriptive but not predictive
