Addiction AO1

Question 1

Explanations for nicotine addiction: Learning theory

Answer 1

• Operant conditioning, positive reinforcement, behaviour is rewarding (feeling of pleasure) likely to occur again - nicotine powerful reinforcers bc dopamines effect of mesolimbic pathway. Positive reinforcement explains early addiction
• Negative reinforcement, continuing dependence bc of fear of withdrawal symptoms. Stops unpleasant stimulus (later on in addiction)
• Cue reactivity, pleasurable effect is the primary reinforcer (intrinsically rewarding). Other stimuli present at the same time become associated (secondary reinforcers) E.g. certain environments and certain people.

Question 2

Explanations for nicotine addiction: Brain neurochemistry

Answer 2

• ACh- subtype is nAChR
• nicotine activates nAChR then immediate shutdown (downregulation)
• Mesolimbic/mesocortical pathways (brain dopamine rewards system) leads to pleasurable effects
• Withdrawal (no nicotine in the body) means nAChR ar functional again (upregulation)
• Avoid withdrawal with cigs- causes long term desensitisation and increases tolerance

Question 3

Risk factors for developing an addiction

Answer 3

• Genetic vulnerability - gene-environment interaction (can’t be addicted if not exposed), just inherit predisposition, genetic mechanisms (low levels of D2 receptor)
• Stress (increase stress=increased vulnerability, maladaptive coping) chronic/trauma, stress of quitting/financing = stress maintenance
• Personality - Antisocial personality disorder, high likelihood of addiction, seek to satisfy desires, behave criminally, impulsive etc
• Family Influences - perceived parental approval (+ve attitudes), little to no monitoring = increased vulnerability. SLT - exposure factor, adult role models, learn vicariously (see reward)
• Peers - Positive attitudes & experimentation increase risk, blame initiation and maintenance on peer pressure. 3 elements; Association, opportunities, overestimation

Question 4

Drug therapy for addiction

Answer 4

Agonist - A drug that binds to the receptor, producing a similar response to the intended chemical and receptor

Antagonist - Drug that binds to receptor on either primary site or another site which stops the receptor producing a response

Aversives - Disulfiram (agonistic drug) utilizes unpleasant consequences after reacting to alcohol. Severe hangover symptoms in minutes.

Methadone - (agonist) Binds and activates receptors to produce similar effects (euphoria) to the drug (heroin). Slower onset and longer duration (less sife effects)

Nicotine replacemet therapy (NRT) - replaces cigarettes (gum, patches), provides positive reinforcement from reward system, reduces withdrawal, desensitises nicotine receptors.

Question 5

Psychological interventions

Answer 5

• Aversive therapies - use unpleansant stimuli alonside addictive substance
  E.g. emetic substance after alcohol discourages further drinking
  E.g. NRT (explain it)
• Covert senseitization - specific form of aversive conditioning
  mental imagery (consuming addictive substance while experiencing aversive stimuli)
  E.g. smoking cigarettes with faeces on
  Negative associations = decreased desire

Question 6

Reducing addiction; CBT

Answer 6

• Aims to identify & deconstruct the false beliefs and reduce cravings
• Assumes addictions maintained by irrational thoughts (need to learn new ways to cope)
• CBT involves strategies of avoidance, increase will-power/self-control

Cognitive part;
1) Functional analysis - identify high risk situations
- Reflects on thinking before, during, after situation
- Challenge faulty cognitions & replace thinking

2) Cognitive restructuring - tackle bias that operates below client’s awareness
- Education about chance & challenges beliefs

Skills training - 1) Anger management - maladaptive coping mechanisms deal with anger
2) Social skills training when alcohol is available. Minimum fuss & avoids embarassment e.g. encourage eye contact & firm voice

Question 7

Explanations for gambling addiction: Cognitive theory

Answer 7

• Expectations; about future benefits and costs of behaviour and expect benefits to outweigh costs, benefits can be overstimated, unrealistic expectations to cope with emotions (distorted)
• Cognitive bias; mistaken beliefs about luck, influence behaviour, overestimate chances of winning ignore info about challenges this belief (selectively remember)
  Rickwood;
  1) Skills and judgement- illusion of control, overestimate ability to influence random event
  2) Personal traits/ritual behaviours - believe greater probability of winning, lucky/superstitious behaviour
  3) Selective recall - can remember details of wins but forget/ignore losses
  4) Faulty perceptions - distorted views of operation of chance, gambler’s fallacy (losing streak can’t last)
• Self-efficacy - expectations ability to achieve desired outcome (relapse). expectations/perceptions, self-fulfilling prophecy which confirms expectation (reinforced)

Question 8

Learning Theory of gambling addiction

Answer 8

• Vicarious reinforcement - experience of seeing others being rewarded (pleasure/enjoyment/money), doesn’t have to be directly can be magazines etc, desire for same reinforcement
• Positive reinforcement, winning money, ‘buzz’
• Negative reinforcement, escape/distraction from aversive everyday stimuli
• Partial reinforcement, Skinner (pigeon had continuous reinforcement schedule which rewards ‘correct’ responses, doesn’t lead to persistent behaviour, when reward stops behaviour stops - extinction). Partial reinforcement creates persistent behaviour seen in gambling
• Variable reinforcement, reinforced intermittently, reward given in an unpredictable number of responses, takes longer to be established but is more resistant to extinction, continue betting even when behaviour not reinforced.
• Cue reactivity (experienced gamblers encounter secondary reinforcers due to associations, atmosphere of betting shop, look of scratchcards

Question 9

Theory of planned behaviour

Answer 9

• Personal beliefs - our attitudes to our beliefs around favourable and unfavourable behaviours
• Subjective norms - approve/disapprove of their addicted behaviour. This can be through behaviour/opinion
• Perceived behavioural control - self-efficacy - impacted by resources - external (time/support & internal (ability/effort))
• Impacted behaviour indirectly through our intentions
• More control = stronger the intention
• Directly = impact my actual addiction habits

Ajzen 1989 - general cognitive model health behaviour, considers the factors that lead to engaging in a particular behaviour

Question 10

Prochaska’s six stage model

Answer 10

• Prochaska noticed smokers behaviour changed during time they were trying to quit
• Cyclical process (progress can return to previous stages or some could be missed)
  1) Precontemplation - thinking about change in near future due to denial or demotivation. Intervention = convincing them of need for change

2) Contemplation - thinking about change in near future , aware of the need and the cost, can be chronic. Intervention = sees pros of overcoming addiction

3) Preparation - benefits outweigh costs. Change likely but not sure how/when. Intervention = plan/options

4) Action - Done something recently e.g. threw away alcohol. Intervention - develop coping strategies

5) Maintenance - change for 6 months +. Intervention = relapse prevention, coping skills and using sources

6) Termination - Abstinence is autonomic, doesn’t need coping mechanism, may not be possible for some. No intervention