Addictions

Question 1

Describing addictions
-Physical dependence

Answer 1

-A result of long term use i.e. daily use for weeks/months
-A physiological need for a drug, marked by unpleasant withdrawal symptoms when the drug is discontinued
-Normal day-to-day functioning can become reliant on the substance
-Often accompanied by tolerance, i.e. the user requires increased doses

Question 2

Describing addictions
-Psychological dependence

Answer 2

-The condition that exists when a person must continue to take a drug in order to satisfy intense mental and emotional craving for the drug
-The individual feels they cannot cope with work and social life without a particular drug such as alcohol
-Absence of the drug causes the individual to feel anxious and stressed
-The addiction is in the mind and becomes the central focus to a persons life

Question 3

Describing addictions
-Tolerance

Answer 3

-The diminishing effect with regular use of the same dose of a drug, requiring the user to take larger and larger does
-Can occur in 3 ways;
1.Metabolic tolerance -> Enzymes breaking down the drug become more effective
2. Neuroadaptation -> Where changes at the synapse occur. This reduces the effect of the drug
3. Learned tolerance -> Is the result of practice as the person has learned how to function without taking the drug

Question 4

Describing addictions
-Withdrawal

Answer 4

-Unpleasant physical/psychological effects following discontinued use of a drug
-Can include shakes or tremors, vomiting, blood pressure and heart rate changes
-This often leads onto relapse as users find withdrawal symptoms intolerable

Question 5

Risk factors in the development of addiction
-Personality

Answer 5

-The ‘addictive personality’ tends to see key traits as the cause of addictive behaviours. This dispositional factor is appealing because it can explain why some people become addicted and why some don’t
-Eysenck’s (1967) theory suggested 3 main personality traits;
1.Extraversion -> Extraverts are chronically under aroused so have to take addictive substances to stimulate themselves
2.Neuroticism -> Neurotics have low emotional stability and a low tolerance for stress so they turn to addictive substances
3. Psychoticism -> Individuals with this trait are generally antisocial and impulsive -> leading to addictive substances more than not
-The key trait is impulsivity leading to risk taking, sensation seeking and a chaotic lifestyle

Question 6

Risk factors in the development of addiction
-Personality research (Cao + Su)

Answer 6

-Cao and Su (2006) used a volunteer sample with 260 school kids from 4 schools and completed a survey measuring personality variables
-64 students were diagnosed as suffering from internet addiction, this equated to a prevalence of 2.4%. This group had significantly higher scores on neuroticism and psychoticism
-The prevalence of internet addiction in Chinese adolescence, and it appears psychological variables can largely explain this variable

Question 7

Risk factors in the development of addictions
-Stress

Answer 7

-According to the ‘tension-reduction hypothesis’ (Cappell and Greeley, 1987) people may engage in addictive behaviours such as alcohol dependency in an attempt to reduce tension and anxiety
-Tension creates a heightened sense of arousal, and much addictive behaviour will reduce this state
-Everyday stress; chronic and unmanaged stress is correlated with the onset of addiction
-Kobasa (1979) mentioned the 3 C’s for hardiness;
1. Commitment -> Strong sense of purpose
2. Control -> Those with an internal LoC belive they can avoid becoming addicted
3. Challenge -> Individuals see addictions as a challenge to beat rather than a threat

Question 8

Risk factors in the development of addictions
-Stress research

Answer 8

-Driessen et al. found that traumatic events exposed individuals to addictions
-30% of drug addicts and 15% of alcoholics had some form of early trauma in their lives

Question 9

Risk factors in the development of addictions
-Peer groups

Answer 9

-Peer networks replace parents in becoming the primary source of reinforcement from about the ages of 12-14
-This impressionable age is when many adolescents experiment with some addictive behaviours e.g. smoking, drinking
-O’Connel (2009) suggested 3 major features of drinking and peer pressure:
1.An at-risk adolescents attitudes and norms about drinking are influenced by associating with peers who drink alcohol
2.Experienced peers provide more opportunity for the at-risk person to drink alcohol
3.The at-risk individual estimates how much their experienced peers are drinking and overdrinks to ‘catch up’
-Social learning theory and NSI also influence peer groups

Question 10

Risk factors in developing addictions
-Peer groups research (Sussman and Ames’)

Answer 10

-Sussman and Ames’ (2001) research has shown that peer use of drugs was one of the best predictors of future drug use by others
-It was believed that peers helped create normative perceptions (or subjective norms) that such behaviours are socially acceptable

Question 11

Risk factors in developing addictions
-Genetic influences

Answer 11

-Genetic factors have been implicated in creating a genetic vulnerability in developing addictive behaviours
-It has been suggested that pathological gamblers may inherit a faulty A1 DRD2 gene that in effect, reduces the number of dopamine receptors in our pleasure centres within the limbic system. This means individuals with this variant are less sensitive to rewards and may seek out extra stimulating activities like gambling to compensate
-Blum et al (1996) called this the rewarding deficiency syndrome and outlined how this creates genetic vulnerabilities in many compulsive disorders

Question 12

Risk factors in developing addictions
-Genetic influence research (Shields et al.)

Answer 12

-Shields et al. (1962) examined the concordance between 43 pairs that were reared apart.
-Only 9 pairs were actually discordant, showing how genetic similarity is a major factor in starting to smoke

Question 13

Risk factors in developing addictions
-Family influences

Answer 13

-Many see the role of the family as critical for socialisation and development, and their influence is likely to be seen in addictive behaviours and attitudes to addictive behaviours
-SLT suggests that we model our behaviour on key role models and some of the most critical role models are in the home i.e. parents and siblings
-When relating to addiction we can see that if we are led to believe that some addictions like alcohol and smoking relieve stress and boredom, we may initiate this behaviour for the rewards
-Parenting style also affects our addictions. Permissive parents are over-indulgent and give too much attention to their kids. Neglectful parents don’t give enough attention and love. Authoritarian parents give too many rules and are too strict.

Question 14

Risk factors in the development of addictions
-Family influences research (Goddard 1990)

Answer 14

-Goddard completed longitudinal research to examine factors that may predict youngsters’ smoking behaviour
-The main finding was that if parents smoke, the kids are far more likely to themselves

Question 15

Explanations for nicotine addictions
-Brain neurochemistry

Answer 15

-One explanation is that some people inherit a genetic vulnerability to start smoking and ultimately develop an addiction
-One candidate gene for smoking and other addictions is the A1DRD2 variation
-It seems to code for defective and insufficient dopamine receptor’s in the brain’s reward circuitry, meaning some individuals cannot produce pleasure naturally and so turn to smoking to raise dopamine levels
-Dopamine amplification -> Cigarette smoke also contains substances that block dopamine monoamine oxidase (MAO). It is responsible for the breaking down of dopamine, so if it is blocked, dopamine will stay at higher levels for longer

Question 16

Explanations for nicotine addictions
-The role of dopamine

Answer 16

1. Nicotine stimulates specific acetylcholine receptors (NaCR) which increases alertness, memory function and learning
2. This action causes a rise in dopamine acting in the UTA: a critical area in the brain’s reward circuitry which is highly populated with NaCR. This gives nicotine it’s rewarding sensation
3. The VTA activity caused by nicotine is then projected to the nucleus accumbens, a producer of dopamine that is located deep in the mesolimbic dopamine pathway
4. The nucleus accumbens is a primary reward centre in the brain and with the increased activity, dopamine rises, causing users to evaluate smoking as pleasurable
5. At the same time, the nucleus accumbens is encouraged to release more dopamine as nicotine also stimulates endorphins that reduces GABA activity

Question 17

Explanations for nicotine addictions
-Nicotine regulation model

Answer 17

1. When the smoker does not take nicotine for a prolonged period of time, the nicotine is metabolised and excreted, and the nicotine receptors become sensitised again giving a rise to feelings of agitation and anxiety, which motivate the individual to smoke
2. The smoker can very quickly remove these unpleasant symptoms by smoking a cigarette, releasing nicotine into the synaptic cleft and shutting down the nicotine and acetylcholine receptors
   -Most smokers will tell you that their first cigarette of the day is the most pleasurable
   -Time contiguity -> The extent to which you learn/reinforce a behaviour after immediately doing it

Question 18

Explanations for nicotine addictions
-Learning theory

Answer 18

-Smoking initiation: SLT -> Mediational processes, such as attention, retention, reproduction, motivation (ARRM)
-According to Skinner, immediate reinforcers (such as feelings of mild euphoria) take precedence over LT consequences of addiction (such as increased risk of cataracts)
-Milton et al (2008) found that young smokers identified peer influence as an important factor in smoking, and the rejection from a peer group as key

Question 19

Explanations for nicotine addictions
-Cue reactivity

Answer 19

1. Maintenance -> Negative reinforcement
   -As the effects of tobacco start to wear off with repeated exposure users can experience unpleasant withdrawal symptoms. Taking nicotine stops these unpleasant symptoms and maintains the behaviour. Maintaining pleasurable effects from tobacco acts as a positive reinforcer (Thorndike’s Law of Effect)
2. Relapse = Cue reactivity
   -Classical conditioning claims smoking are often maintained and relapsed due to triggers or cues in the environment that we have learnt to associate with smoking addiction. Through classical conditioning, these cues will elicit conditioned responses even in the absence of the actual smoking behaviour

Question 20

Explanations for nicotine addictions
-Nicotine research support (Ennett et al.)

Answer 20

-Ennett et al (2010) found that the ‘family and peer context where primarily implicated’ in the onset of smoking, suggesting a strong link between social learning and nicotine consumption
-Adolescent -> Smoking
-Family -> Family smoking and parent-child closeness
-School -> Student smoking and bonding
-Peers -> Peer smoking and friend closeness
-Neighbourhood -> Neighbourhood smoking (affluent vs non-affluent)

Question 21

Explanations for gambling addictions
-Learning theory

Answer 21

-Roughly 1 in every 100 people have a gambling disorder. A further 4 to 7 people in every 100 gamble at risky levels that can become a problem in the future
-The SLT approach explains that one of the main factors in beginning to gamble stems from vicarious reinforcement
-If higher status role model are seen to enjoy gambling, the behaviour appears acceptable, attractive and rewarding
-Cue reactivity explains how triggers or cues in our environment that we have learnt to associate with gambling maintain the behaviour
-Classical conditioning explains how there are conditioned responses and responses to create the feelings of arousal when gambling

Question 22

Explanations for gambling addictions
-Operant conditioning/reinforcement schedules

Answer 22

-In operant conditioning a behaviour may be reinforced every time (continuous reinforcement) or only some of the time (partial reinforcement -> this is where gamblers become obsessed with continued to play to ‘chase the win’)
-Reinforcement schedules;
1. Fixed interval -> The 1st response after given interval of time is reinforced e.g. rewards may be given after every 5 minutes on the machine
2. Fixed ratio -> Every nth response may be reinforced, e.g. on a fruit machine every 25th play may be reinforced
3. Variable interval -> On average, the 1st response after a given interval of time is reinforced, but this may vary. e.g. could be 25 minutes one day and 5 minutes the next
4. Variable ratio -> Every nth number is reinforced but the actual gap between reinforcement varies and can be very large.e.g. A fruit machine only pays out 25% of the time but may only occur in a small time scale and there is a long ‘winless’ streak

Question 23

Explanation for gambling addictions
-The cognitive explanation

Answer 23

-Rickwood (2010) suggested that gamblers have 4 types of cognitive distortions;
1. Skill and judgement -> Gamblers try to overestimate the amount of control they have
2. Personal characteristics -> They perceive themselves to be lucky or engage in ritualistic behaviors
3. Faulty perceptions -> Irrational thought processes
3. Self-medications -> They gamble to help them overcome poverty or the boredom of everyday life

Question 24

Explanations for gambling addictions
-Cognitive biases

Answer 24

1. Cognitive myopia -> Suggests that gamblers focus on the immediate gratifying state far more than the long term consequences of heavy gambling
2. The Gambler’s Fallacy -> The mistaken notion that the odds for something with a fixed probability increase or decrease depending upon recent occurrence
3. Hindsight bias -> Gamblers look back at big wins and big losses and say they expected it. This gives an irrational sense over gambling
4. Flexible attribution -> When they win, it is down to their skill. When they lose, it is down to factors outside of their control
5. Availability bias -> The notion that because some thing has happened in the past, it will occur again in the future.

Question 25

Explanations for gambling addictions - Research Evidence
-Griffiths

Answer 25

-Griffiths gave £3 to gamblers and non-gamblers
-If they got to 60 gambles on a fruit machine, they could keep the money or carry on
-He concluded that whilst gamblers are skilful, they’re think they’re more successful than they are + they humanise the machines more often

Question 26

Explanations for nicotine addictions - Research Evidence
-Robinson and Berridge (1993)

Answer 26

-Robinson and Berridge argue that many people try drug taking yet do not become addicted despite the rewarding experiences on offer
-This suggests other factors must also be at work, that allow some yet others to become full blown addicts

Question 27

Drug therapy - Research Evidence
-Stead et al. (2012)

Answer 27

-Stead et al. reviewed 150 studies into the effectiveness of NRT and found it to be more effective than placebo treatments or no treatments at all with NRT users up to 70% more likely to be abstaining from smoking 6 months after quitting than the other groups

Question 28

Reducing addictions
-Drug therapy

Answer 28

-There is no 1 treatment for all addictions. Drug therapy is used to counter idiosyncratic effects of the drug
-Reducing addictions is not about the cessation of taking the drug, as this can result in DTs (delirium tremens)
-Antagonist drugs inhibit a physiological response by binding to neuron receptors and blocking them thus preventing the addictive drug from having its normal effect
-Agonist drugs initiate a physiological response by binding to neuron receptor sites and activating them
-Aversive -> Aims to produce unpleasant symptoms (such as smoking) when the drug (emetic) is taken

Question 29

Reducing addictions
-Drug therapy -> agonist substitution: nicotine replacement therapy (NRT)

Answer 29

-The therapy works by delivering therapeutic doses of nicotine in the early stages of stopping smoking.
-This release of nicotine is absorbed much more slowly and steadily than tobacco
-NRT can come in many forms including; gums, inhalers and patches

Question 30

Reducing addictions
-Drug therapy -> antagonist : Bupropion

Answer 30

-Bupropion is an antagonist at nicotinic receptors and may work - in part - by blocking nicotine effects so there is a rise in dopamine levels when you smoke a cigarette
-Bupropion is a weak inhibitor of dopamine and noradrenaline reuptake, which leads to an overall increase in dopamine whilst taking the drug. This may help to relieve withdrawal symptoms and/or reduce depressed mood to reduce relapse rates
-The treatment generally lasts 7 to 12 weeks with a week of treatment before the smoker attempts to stop smoking

Question 31

Reducing addictions
-Behavioural interventions -> Aversion therapy (classical conditioning)

Answer 31

-This therapy works on the principle of association and tries to replace positive associations to addictions (e.g. smoking relives stress) with negative associations (e.g. smoking makes me feel sick)
-The instant ‘punishment’ improves the contiguity of the treatment, giving an immediate ‘hangover’
-For alcohol dependency, alcohol is paired with an Antabuse which induces severe nausea when paired with booze
-This has been applied to ‘rapid smoking’, which promotes a person to sit in a room and chain smoke every 6 seconds. This rapid inhalation and exposure to fumes forms a new response to smoking which is nausea (unpleasant)

Question 32

Reducing addictions
-Behavioural interventions -> Covert sensitisation

Answer 32

-This therapy is similar to aversion therapy - moving positive associations to negative associations of smoking
-The difference is, is that clients are asked with ‘imagining how it would feel’ (an in vitro method)
-The new UCS, such as vomiting, produces a new negative association and a new CR, such as disgust/nausea to the CS, such as smoking/gambling
-Covert sensitisation was put in place instead of aversion therapy as there were little ethical issues from covert sensitisation

Question 33

Reducing addictions
-Behavioural interventions -> CBT

Answer 33

-The cognitive explanation of addictions emphasises irrational thought processes and suggests that addicts are essentially making a series of misattributions about their addiction e.g. relief from smoking
1. Cognitive reframing -> Works on the principle that changing an addicts’ thoughts about addictive behaviours can lead to successful abstinence
2. Functional analysis -> Understanding the thought process when clients find themselves in high risk situations. Works to help the client rescue themselves when in these situations
3. Relapse prevention -> The therapist and addict identify situations of high risk for relapse, both intrapersonal (e.g. stress or negative emotions) and interpersonal reasons (social pressures)
-It helps to identify distracting techniques for the addict

Question 34

The theory of planned behaviour (behaviour change to addictive behaviour)

Answer 34

-Azjen and Fishbein (1967) focuses on what beliefs a person has about their behaviour and 3 key processes that suggest whether or not we will be successful:
1.Attitude towards behaviour -> If the addict recognises the behaviour is negative, it increases chances of recovery
2.Subjective norms about behaviour -> Refers to the belief of the group that the addict belongs to
3. Internal locus of control (perceived) -> If an addict has an external locus of control, they will feel their attempts will be fruitless and they could never beat the addiction
4. Increasing self-efficacy -> By increasing an individuals self-efficacy, it encourages the individual in their own belief to abstain from their addictive behaviours
-The theory neglects motivation

Question 35

Prochaska’s six stage model (behaviour change to addictive behaviour)

Answer 35

-The model does not view change as a ‘single event’ but emphasises the gradual nature of change
-The model includes ‘pre-action’ and ‘post-action’ stages and is cyclical: individuals move up through the stages in order, but relapse to a prior stage might occur at any pint (the model is over 6 months)
1. Pre-contemplation -> Individual is aware they have unhealthy habits but don’t do anything to change
2. Contemplation (6 months) -> Individuals show an awareness that they need to take action, but they don’t
3. Preparation (3 months) -> The first point in which action is taken and behaviour change has greatest chance of succeeding.
4. Action -> This is when the plan is put into action and CBT is most effective if behaviour changed in 6 months
5. Maintenance -> This is an important stage and starts to ensure that the initial motivation when first started is maintained
6. Termination -> A stable state and there is no longer any temptation and there is maximum confidence in the ability to resist the addictive behaviour

Question 36

Theory of planned behaviour - Research Evidence
-Godin et al. (1992)

Answer 36

-Found that one of the most important predictors of actual smoking behaviour was perceived behavioural control
-This suggests that strategies to help people break smoking addictions should focus on developing will power and informing individuals of the effort that will be required to stop smoking