Addiction

Question 1

What Is Addiction?

Answer 1

A disorder in which an individual takes a substance or engages in a behaviour that is pleasurable but eventually becomes compulsive with harmful consequences.

Question 2

What is physical dependence?

Answer 2

Estate of the body due to habitual drug use and which results in a withdrawal syndrome when use of the drug is reduced or stopped.

Physical dependence occurs when withdrawal syndrome is produced.

Question 3

What is psychological dependence?

Answer 3

A compulsion to continue taking a drug because it’s use is rewarding.

The person wants to experience the effects of the drug, increase pleasure or avoid discomfort. If psychological dependence occurs, the person will continuously take the drug until it becomes a habit, despite the harmful consequences.

Question 4

What is tolerance?

Answer 4

Tolerance occurs when an individual’s response to a given amount of a drug is reduced. This means they need an even greater dose to produce the same effect on behaviour.

Tolerance is caused by repeated previous exposure to the effects of the drug.

Question 5

What is cross-tolerance?

Answer 5

A type of tolerance where developing tolerance to one drug (alcohol, for example) can reduce sensitivity to another type (benzodiazepines - a sleep-inducing drug. These people need higher doses of this anaesthetic in surgery.

Cross tolerance can be used therapeutically by giving benzodiazepines to people withdrawing from alcohol to reduce the withdrawal syndrome.

Question 6

What are risk factors for the development of an addiction?

Answer 6

A risk factor for addiction is an internal/external influence that increases an individual’s use of an addictive substance/behaviour.

They include:

• Genetic vulnerability,
• Genetic mechanisms,
• Stress,
• Personality,
• Family influences,
• Peers.

Question 7

‘Describe and evaluate the risk factors for the development of an addiction’ (16) AO1?

Answer 7

A risk factor for addiction is an internal/external influence that increases an individual’s use of an addictive substance/behaviour.

Genetic vulnerability explains why, when someone is exposed to a drug, they become dependent whilst others do not. There are two genetic mechanisms that influence addiction; the lower the amount of D2 receptors on neurons, the higher the vulnerability to addictive substances because more substance is needed to release dopamine; and the lack of presence of an enzyme (CYP2A6) contributes to a lower risk of developing a nicotine addiction. If someone is genetically vulnerable, they have a predisposition to becoming an addict.

Epstein believed stress to be a risk factor. He found a strong correlation between individuals who suffered from post-traumatic stress disorder and alcohol addiction.

Personality traits are risk factors. Psychologists found there is a strong correlation between antisocial personality disorder (which involves impulsivity) and addiction-related behaviour.

Perceived parental approval (a family influence) is the extent to which an adolescent believes their parents have positive attitudes towards an addictive substance/behaviour. Adolescents who believe their parents have little interest in monitoring their behaviour were significantly more likely to develop an addiction.

O’Connell suggested three major risks in peer relationships for alcohol addiction; an adolescents norms and attitudes being influenced by peers; peers providing more opportunities to drink alcohol; and an adolescent over-estimating how much their peers are drinking and so drinks more to keep-up.

Question 8

‘Describe and evaluate the risk factors for the development of an addiction’ (16) AO3?

Answer 8

Strength - Kendler et al Used data from the National Swedish adoption study. They looked at adults who had been adopted as children But who had a biological parent with an addiction. These people had a significantly greater risk of developing an addiction (8.6%) compared with adopted children adults with no addicted parent in their biological family (4.2%). This suggests a genetic vulnerability is an important risk factor.

Strength - Real life application. Hawkins et al believes that a focus on risk factors is a highly promising strategy for preventing and treating addictions. If we can understand what the risk factors are, then we have an opportunity to identify those in the population who are most at risk. Tobler et at created a peer-pressure resistance training program to help prevent young people taking up smoking. If we can identify individuals at risk, we can use programs like these to prevent addictions in future.

Weakness - Methodological issues. Assessing some of the major risk factors requires participants to recall incidence of stress, trauma, and family behaviours from the past. This may be difficult to recall accurately because of related stress, trauma or memory decay. This may reduce reliability of risk factors in the development of addiction.

Weakness - Research into risk factors is often correlation studies, which raises issues of cause and effect. Many studies have shown there was a strong correlation between stressful experiences and addiction related behaviours. However, many addictions can create greater levels of stress because of their generally negative effect on lifestyle, relationships, financial affairs and so on. It is difficult to separate the effects of an addiction and the causes of an addiction.

Question 9

What Are The Explanations For Nicotine Addiction?

Answer 9

1. Brain neurochemistry - the biological explanation.

2. Learning theory - psychological explanation.

Question 10

What is withdrawal syndrome?

Answer 10

A collection of symptoms associated with abstaining from a drug or reducing its use.

They indicate that a physical dependence has developed.

For example, effects of nicotine withdrawal include anxiety, restlessness, increased appetite and weight gain.

These symptoms increase motivation for continuing to take the drug and therefore avoid the withdrawal symptoms. This is a secondary form of psychological dependence.

Question 11

Explanation For Nicotine Addiction - Brain Neurochemistry AO1?

Answer 11

The brain neurochemistry explanation for nicotine addiction:
The ‘desensitisation hypothesis’ and ‘nicotine regulation model’ make up this explanation.

Desensitisation hypothesis: 
Acetylcholine receptors (ACh receptors) lie on neurons. There is a subtype of acetylcholine receptor called the nicotinic receptor (nAChR) receptors can be stimulated by ACh or nicotine. 

When nAChRs are activated by nicotine, the neuron transmits dopamine along the mesolimbic pathway to the nucleus accumbens (NA), triggering the release of more dopamine to the frontal cortex.
The VTA is made up of the mesolimbic pathway and NA - the VTA generally has more nAChR receptors than other areas of the brain.

nAChRs are desensitised after, which leads to downregulation (a reduction in the number of active neurons). At this point, the nAChR is said to be desentisied. Whilst a person is smoking, nAChRs are continuously desensitised.

However, once nicotine leaves the bloodstream, nAChRs can become available again (resensitise), causing a person to experience withdrawal as nAChRs become overstimulated by ACh as nicotine no longer binds to them. This is upregularion.

Repetition of this process overtime creates chronic desensitisation of nAChR. This can only be overcome by increasing nicotine intake. Tolerance develops.

The process of withdrawal and tolerance is called ‘the nicotine regulation model’.

Question 12

Explanation for nicotine addiction - brain neurochemistry AO3?

Answer 12

Strength - the neurochemistry explanation is the ability to apply the explanation in the real-world.

After nicotine was identified as the addictive component in cigarettes, nicotine replacement therapy (NRT) products (e.g. patches) were produced. NRTs work because nicotine enters the bloodstream via the product and binds to nAChRs, causing dopamine to release and cause euphoria. Withdrawal effects are reduced gradually by reducing nicotine intake over a period of weeks, allowing smokers to stop smoking. The understanding of the neurochemistry explanation has allowed addicts to be treated.

Weakness - the explanation is criticized for being biologically reductionist. The explanation suggests humans become addicted to nicotine due to the dopamine reward system; a biological process beyond our control. This suggests nicotine addiction is inevitable when a person starts smoking. Gilbert provided research support that concluded withdrawal symptoms depend much more on the environment and personality of a person. For example, people who are neurotic generally experience worse withdrawal symptoms than people who are emotionally stable. This research suggests other factors, such as personality and environment influences nicotine addiction.

Weakness - the theory only considers the role of dopamine. Research shows that there are many other neurochemical mechanisms involved such as neurotransmitters GABA and serotonin (5-HT), plus other systems such as endogenous opioids (endorphins). This suggests that the explanations is limited and more research should be conducted to understand the roles of other neurochemical systems and their association with nicotine addiction.

Question 13

Explanation for nicotine addiction - the psychological learning theory AO1?

Answer 13

Nicotine addiction can be explained by reinforcement. Nicotine stimulates the release of dopamine, resulting in euphoria (positive reinforcement). The smoker will then avoid withdrawal effects (e.g. anxiety) and so nicotine use is maintained (negative reinforcement). Cue reactivity further enforces nicotine addiction. The pleasure experienced is a primary reinforcer due to the dopamine reward system. Any other stimuli present at the time of nicotine intake also becomes associated with the pleasurable effect and therefore, becomes a secondary reinforcer. The secondary reinforcer (e.g. cigarette packet) then produces the same effects as nicotine.

Question 14

Explanation for nicotine addiction - the psychological learning theory AO3?

Answer 14

Strength - the learning approach is the ability to apply the explanation to the real-world.

Aversion therapy uses counterconditioning to treat nicotine addiction by associating the pleasant effects of smoking with an aversive stimulus (electric shock). Research by Smoith found this to be effective; 52% of participants were still abstaining after one year using this method, compared to the usual 20-25% of people who abstain without using this method. This research shows that knowledge of the learning approach has allowed for a successful treatment for nicotine addiction.

Strength - There is further research to support the learning explanation for nicotine addiction. Carter and Tiffany conducted a meta-analysis of 41 studies into cue reactivity. The analysis showed that dependent smokers acquired the most psychological arousal to the cues, even without nicotine being present. Both investigations show how the learning explanation has resulted in a successful treatment for nicotine addiction.

Weakness - gender bias (ISSUES AND DEBATES). Women are generally less successful at giving up smoking than men. Carpenter et al suggested that young women are more sensitive to smoking related cues, which makes it more difficult for them to stop smoking and prevent relapse. This could be explained by self efficacy. It may be that female smokers have less confidence in their ability to give up smoking, which undermines their attempts to do so.

Question 15

What is behavioural tolerance?

Answer 15

One type of tolerance is behavioural tolerance. It happens when an individual learns through experience to adjust their behaviour to compensate for the effects of a drug.

For example, people addicted to alcohol learn to walk more slowly when they are drunk to avoid falling over.

Question 16

What Are The Explanations For Gambling Addiction?

Answer 16

1. Learning theory - psychological explanation in terms of conditioning.
2. Cognitive theory - in terms of distorted thinking.

Question 17

Explanation for gambling addiction - the learning theory AO1?

Answer 17

During gambling, a reward is given but not every time the stimulus is present (partial reinforcement). Variable reinforcement is a type of partial reinforcement; where a behavior is reinforced after an unpredictable period of time or number of responses. For example, a gambler placing money into a slot machine, not knowing if/when the machine will return the money. Partial reinforcement explains how gambling creates an association between a stimulus and possible pleasure, providing an explanation for the addiction.

The learning theory attempts to explain gambling addiction. Classical conditioning creates a primary reinforcement during gambling (e.g. excitement/winning money) and a secondary reinforcement (any other stimulus present at the time of the primary, e.g. slot machine). This association causes the secondary reinforcer to produce psychological effects in the future, causing the stimulus to become a cue to gamble. This explains how a person’s gambling addiction is maintained.

Question 18

Explanations for gambling addiction - the learning theory AO3?

Answer 18

Strength - The learning theory is supported by research conducted by Dickerson. He observed and compared behaviour from gamblers who placed the most bets on horse races (high-frequency gamblers) to those who placed few bets (low-frequency). He found that high-frequency gablers were more likely to place their bets in the last 2 minutes, suggesting that dependent gamblers delay betting in order to prolong the excitement (reward). This study provides evidence for primary reinforcement in a natural environment.

Strength - the theory is supported because it explains why dependent gamblers fail to stop gambling. The theory provides an explanation for not only why gambling is addictive (partial/variable reinforcement), but how the addiction is maintained (classical conditioning). Classical conditioning is an automatic process which cannot be controlled and is unknown to the gambler, which suggests why most gambling addicts find it extremely difficult to stop gambling.

Weakness - although the theory explains why gambling is addictive and how it is maintained, the theory is criticized as it fails to explain what causes the initial beginning of gambling. Vicarious reinforcement is the experience of seeing others being rewarded by pleasure and/or the receiving of money. For example, a son witnessing his mother in excitement about her winnings from a slot machine (direct). This suggests why a person initially gambles. A more convincing explanation would involve social learning as well as the learning explanation.

Weakness - Furthermore, the explanation is criticised further because it fails to explain why some people who gamble and experience pleasure from winning money do not become dependent whilst some people do. The explanation fails to incorporate individual differences and how they impact addiction. Brown supports this lack of explanation, suggesting that other social and cultural factors are ignored. Both criticisms of the learning explanation provide valid ideas as to why the explanation lacks knowledge.

Weakness - ISSUE AND DEBATE - This highlights a third issue; the explanation is too reductionist. The explanation simplifies gambling addiction to partial reinforcement and classical/operant conditioning. The theory fails to include biological and cognitive factors that may also impact gambling addiction. A more reliable explanation would include all social, cultural, biological and cognitive factors.

Question 19

Explanation For Gambling Addiction - The Cognitive Theory AO1?

Answer 19

Gambling addiction is explained in this theory by the expectancy theory and cognitive biases. Self-efficacy explains why gamblers relapse.

Expectancy theory: Unrealistic expectations explain the initiation to gamble. Most dependant gamblers believe the benefits of gambling (e.g. winnings) will outweigh the costs (e.g. financial losses) and also have unrealistic expectations of how gambling will help cope with their emotions (e.g. alleviate stress through excitement). People with unrealistic expectations are more likely to begin gambling, and therefore become addicted.

The maintenance of gambling addiction is due to cognitive bias; the distortion of attention, memory or thinking. Cognitive bias can lead to irrational beliefs, including; the belief of being in control due to enhanced skill; remembering wins and not loses; having a faulty perception of chance and believing a losing streak will not last (‘gambler’s fallacy’); and believing to have a greater chance of winning due to luck.

Self-efficiency refers to the expectations a person has of their ability to achieve a desired outcome (e.g. quit gambling). It is believed to be the main cause for relapse because a dependent gambler creates a self-fulfilling prophecy about whether or not they can stop gambling, e.g. the biased belief “I don’t have the motivation to stop gambling” will then cause the gambler to relapse.

Question 20

Explanations for gambling addiction - the cognitive theory AO3?

Answer 20

Strength - Griffiths investigated cognitive bias by comparing the cognitive processes of regular gamblers and non-regular gamblers by using the ‘thinking aloud’ method’. Griffiths found there was no difference between behavioural measures of regular and non-regular gamblers (e.g. regular gamblers did not win more money). Regular gamblers, however, had significantly more irrational thoughts and illusions of control when compared to non-regular gamblers. This study provides evidence to support how cognitive bias is apparent in dependent gamblers and how this can significantly contribute to gambling addiction.

Weakness of Griffiths study - However, this study is criticised for methodological issues. The use of ‘thinking aloud’ in research cannot be assumed as a reliable representation of what participants actually, genuinely think according to Dickerson and O’Connor. Due to this, findings from Griffiths study may not be valid.

Strength- The cognitive explanation is supported by research investigating cognitive bias. Michalczuk compared dependent and non-dependant gamblers (control group). Dependent gamblers showed significantly higher levels of cognitive bias (e.g. illusion of control) and were more impulsive than the control group, which shows the biased thinking during play. This research shows the strong link between biased thinking and gambling addiction.

Strength- Furthermore, the cognitive explanation is supported by further research. Rogers found that there was a cognitive bias in the reasoning behind buying lottery tickets in regular gamblers (e.g. belief in personal luck and unrealistic perception of chance). These two studies provide evidence to support how cognitive bias causes irrational beliefs that drives gambling behaviour. These results can be generalised to all different types of gambling due to the variety of gambling methods investigated in the studies.

Weakness - However, whilst both studies suggest there is a distorted cognitive pattern in dependent and non-dependant gamblers, it is impossible to establish a cause and effect. It is possible that cognitive bias is a result of gambling addiction, rather than it being a causal factor to becoming an addict, like these studies suggest.

Weakness - Furthermore, an alternative view would suggest cognitive bias only partly explains gambling addiction and that other social and biological factors (e.g. neurochemistry) would be included in a stronger explanation of the causation for gambling dependency. COULD SAY ITS TOO REDUCTIONIST?

Question 21

What are the three therapy’s for reducing addiction?

Answer 21

Drug therapy - therapy based on brain neurochemistry explanation (biological explanation).

Behavioural interventions - based on learning theory.

Cognitive behavioural therapy, CBT - based on thinking differently.

Question 22

Reducing addiction - drug therapy AO1?

Answer 22

There are three main types of drug therapy; aversives, agonists and antagonists. Aversives work by associating a drug with unpleasant consequences (classical conditioning). For example, disulfiram is a drug that when taken with alcohol, causes severe hangover effects (e.g. nausea). A person taking this drug will eventually avoid alcohol due to the new conditioned outcomes.

Agonists work by activating neurone receptors and therefore, providing a similar effect to an addictive substance. For example, methadone is used to treat heroin addicts. It works by creating the same euphoria effects as heroin whilst being a safer option. Agonist doses are then gradually reduced to reduce withdrawal symptoms, helping an addict eventually quit.

Antagonists work by blocking receptor sites so that addictive substances cannot produce its usual effects (e.g. euphoria). For example, naltrexone is an opioid antagonist used to treat the physiological dependence on heroin. However, other therapies should be used alongside this drug therapy (e.g. counselling) to tackle the psychosocial causes for the addiction.

Question 23

Reducing addiction - drug therapy AO3?

Answer 23

Strength - Stead analysed 150 research studies into the effectiveness of nicotine replacement therapy (NRT) and concluded that all NRT products are significantly more effective than any placebo in aiding addicts to quit smoking. This shows the effectiveness of drug therapy as a treatment for addiction.

Weakness - Drug therapy is also criticised because it includes taking medication every day, which can be more sustainable than attending therapy sessions and doing homework, however addicts live a chaotic lifestyle, making them too disorganized and unmotivated to take daily medication.

Weakness - ISSUE AND DEBATE. Ethical issues. NRTs can cause sleep disturbances, dizziness, headaches and emotional distress such as humiliation and embarrassment. Therefore, drug therapies are criticized for being significantly more unethical in comparison to CBT.

Weakness - Drug therapy is criticized for individual differences. Small genetic variations between individuals have a significant impact on the outcome of drug therapy. For example, the effectiveness of naltrexone as a treatment for alcohol dependency depends on the variation of a single gene, meaning alcoholics with a different variation may not respond as readily to the treatment. Chung et al suggests drug therapies need to become more tailored to the individual taking them if they are to be as effective as possible.

Question 24

Reducing Addiction - Behavioural Interventions AO1?

Answer 24

Theres two different behavioural interventions: aversion therapy and covert sensitisation.
Based on learning theories.

Aversion therapy works by counterconditioning a person’s previous associations made between an addictive substance and pleasure. To treat alcohol addiction, a client takes an aversive drug (e.g. disulfiram) which causes unpleasurable effects (e.g. vomiting) when alcohol is ingested. This causes a new association (classical conditioning) in which alcohol, along-side disulfiram, is the conditioned stimuli and unpleasurable effects are the new, conditioned response. Therefore, the client avoids drinking alcohol in order to avoid the unpleasurable response.

To treat gambling addiction, a client writes down phrases related to gambling alongside non-gambling phrases onto cards. The client then reads outloud the cards and will experience an electric shock when a gambling-related card is read. Gambling (conditioned stimulus) becomes associated with pain (conditioned response), which reduces the clients cravings to gamble.

Covert sensitisation is a type of aversion therapy. It works in vitro (imagination) rather than vivo (real experience). During covert sensitisation, a therapist reads from a script instructing the client to imagine themselves performing their addictive behaviour, and then experiencing unpleasant consequences (e.g. vomiting and nausea). The description of senses is used to make the imagination more vivid. The client then imagines turning their back to their addiction and the feeling of relief.

Question 25

Reducing addiction - behavioural interventions AO3?

Answer 25

Strength - McConaghy et al compared electric shock aversion therapy with covert sensitisation in treating gambling addiction. After a one year follow-up, 90% of covert sensitisation participants compared with just 30% undergoing a vision had significantly reduced their gambling habits. They also reported experiencing fewer and less intense gambling cravings than the aversion treated patients. This suggests that covert sensitisation is a highly promising behavioural intervention.

Strength - Ashem and Donner investigated the efficacy of covert sensitisation and found that 40% of patients were abstaining from alcohol 6 months after treatment compared to the 0% of patients from the control group.

Weakness - However, covert sensitisation requires motivation and imagination. Aversion therapy must be used in some cases because some people are incapable of this imagination and motivation.

Weakness - Hajek and Stead criticised the effectiveness of aversion therapy. They suggested it was not possible to conclude the effectiveness of a therapy without the use of a ‘blind’ study in which a placebo is used. Without the use of this methodology, there is a possibility of bias within the research of eversion therapy and therefore appear more effective than it is.

Weakness - ISSUE AND DEBATE. Furthermore, aversion therapy is criticised for its ethics. Aversion therapy inflicts extreme nausea, pain and emotional distress (humiliation). These factors suggest that covert sensitization may be more effective and more ethical than aversion therapy.

Weakness - However both aversion therapy and covert sensitisation are criticised because neither address the root cause of the addiction, such as CBT.

Question 26

Reducing addiction - CBT AO1?

Answer 26

Cognitive behavioural therapy (CBT) aims to change the irrational thinking which leads to drug dependence. CBT involves functional analysis; ongoing therapy sessions in which a therapist analysises the thoughts of a patient before, during and after a theoretical situation in which the addictive substance is readily available. Then, skills training; the therapist teaches the client strategies to cope with stress/issues to replace the need for the addictive substance. This involves cognitive restructuring (tackling the unconscious biases of the client), specific skills (teaching the client personalised techniques, such as anger management) and SST (teaching the client to cope with anxiety in social situations and refuse the offer of their addictive substance).

Question 27

Reducing addiction - CBT AO3?

Answer 27

Strength - Petry and colleagues recruited gamblers and randomly allocated them to a control group (gamblers anonymous) or CBT. It was concluded that gamblers undergoing the CBT were gambling significantly less than the control group up to 12 months later. This shows the effectiveness of CBT as a therapy for addiction.

Strength - Less ethical issues than other therapy (like drug therapy). CBT does not cause any emotional or physical distress. Infact, CBT therapists teach patients to avoid emotional distress such as guilt and anger when relapsing by providing new perspectives on failure. E.g. “Relapsing is an inevitable part of an addicts life” and “This is not failure, this is an opportunity to learn and grow stronger”. This suggests that CBT may be a more ethical way of treating addiction.

Weakness - criticised for methodology. Cuijpers emphasised the demanding characteristics of CBT, including homework and attending therapy sessions. This can be hard for addicts, making the drop-out rate for CBT five times higher than other therapies. The lack of treatment adherence for CBT makes it difficult to understand the true effectiveness of the therapy.

Question 28

Theory of planned behaviour (TPB) AO1?

Answer 28

This theory explains how we change behaviour that we can control. It can be applied to addiction.

The theory of planned behaviour (TPB) explains how someone initially decides to change a behaviour through three key influences. Personal attitudes refers to the addicted individuals beliefs towards their addiction. For example, a dependent gambler may have favourable beliefs towards gambling (e.g. “it makes me feel good”), and unfavourable attitudes (e.g. “I lose a lot of money”). The addicts overall attitude towards their addiction is calculated by weighing up the positive and negative beliefs.

Subjective norms refers to the individuals beliefs about whether the people closest to them approve or disapprove of their addictive behaviour. For example, these people might have unfavourable views about gambling (e.g. “gambling is a waste of money”,) or favourable views about gambling (e.g. “gambling is so much fun!”). These beliefs influence the addicted gamblers beliefs and therefore, influence decisions about whether or not they should change their behaviour.

Perceived behavioural control is the extent to which a person believes they are in control of their behaviour (self-efficacy). This depends on external (e.g. money) and internal (e.g. determination) resources available to the addict. This can have two effects; influence desire to behave to withhold control; or directly influence how hard or long a person will try to quit their addictive behaviour.

Question 29

Theory of planned behaviour (TPB) AO3?

Answer 29

Strength - The theory has been used in the real world. Health economics and health psychology look at the cost effectiveness of treatments. This suggests how high in validity the theory is because it is used by trusted practitioners who value the predictive power of the theory.

Strength - Practitioners also use this theory to decide whether a treatment is going to be effective so that time, money and effort is not wasted.

Weakness - Methodological issues. The TPB is based on research that uses self-report methods (Ogden). This needs to be done because attitudes, norms and behavioural control are subjective variables and so the answers can only be found through self-report. However, social desirability bias may occur whereby participants respond to questions in a way that they think will make them look good. Addicted individuals also think irrationally and may not perceive their addiction to be as problematic or damaging compared to what it really is. This lowers the reliability of the study.

Weakness - The TPB is a limited exclamation of addicted related behaviour because it over emphasises rational reasoning in decision-making and choice. It has difficulty in accounting for other factors that influence intentions and behaviours involving drugs such as, emotions cognitive biases or even past experiences.

Question 30

Prochaska’s six-stage model AO1?

Answer 30

This model explains the stages people go to in order to change their behaviour.

Prochaska’s six stage model is a cyclical process which attempts to explain how addictive behaviours are overcome. The stages are not necessarily followed in a linear order.

The stages:
Precontemplation,
Contemplation,
Preparation,
Action,
Maintenance,
Termination. 

Precontemplation describes an individual who is not thinking about changing their addictive behaviour in the near future. Precontemplation is due to denial (the person does not believe they have a problem) or demotivation (the person does not have the energy to try).

Contemplation describes an individual who has become aware of their need for change and is considering changing their addictive behaviour in the near future.

Preparation describes an individual that believes the benefits of quitting their behaviour will outweigh the costs. The individual will decide to change their behaviour in the next month and will begin seeking advice on how to do so.

Action describes an individual who has attempted to quit their addictive behaviour in the last six months.

Maintenance describes an individual who has maintained change of behaviour for more than 6 months. The focus of a person who is in this stage is on relapse prevention - avoiding cues which trigger the addictive behaviour.

Termination describes an individual who’s newly acquired behaviours such as abstinence become automatic. The person no longer returns to the addictive behaviour to cope with emotions. This stage is not always possible for people to achieve.

Question 31

Prochaska’s six-stage model AO3?

Answer 31

Strength - Velicer conducted a meta analysis and found that there was a 22-26% success rate when people tried to quit smoking using this model, compared to other interventions. No demographic differences in success (Gender/age).

Strength - The attitude to relapse. (This can be used as double with below). DiClemente et al ‘relapse is the rule rather than the exception’. The model does not view relapse as failure, but rather than an inevitable part of the untidy, non-linear, dynamic process of behaviour change. The model also takes relapse seriously though, because when relapse does occur, the person starts again from the begging of the stages.

Strength - Realistic view of addiction (valid explanation) - earlier theories focused on all or nothing events, in contract the model provides more flexibility e.g different lengths of stages, ability to go back and forth/ skip stages. This suggests the model provides a realistic view of the complex nature of addiction. The model recognises that addictive behaviours are continuing process and overcoming them is a dynamic process.
(My idea: this also allows for individual differences to be reduced. Some people take longer/skip stages/relapse more. There is no structured schedule on overcoming addiction and individuals are different and so experience overcoming addiction differently. This model is flexible and realistic for everyone).

Weakness - The nature of the stages is too arbitrary. Sutton points out that if an individual plans to stop smoking in 30 days, they are in the preparation stage but if they plan to stop smoking in 31 days, they are still in contemplation stage. Bandura further suggests that the first two stages - precontemplation and contemplation - are not qualitatively different, only quantitively different. This suggests that the model is too arbitrary and could possible be reduced to two useful stages, without the quantitive measurements; precontemplation and the rest of the stages together.

Weakness - Contradictory research evidence. Taylor et al analysed the evidence available at the National Institute for Health and Care Excellence (NICE). Taylor concluded that stage based approaches are no more effective than alternatives in treating nicotine addiction. A later analysis by Kate Cahill et al Came to precisely the same conclusion. Robert west is brutal in his assessment of the six stage model. He concludes that “the problems with the model are so serious… It should be discarded. The model has been little more than a security blanket for researchers and clinicians “.