Psychological Models of Addiction

Question 1

What are the core features of addictive behaviour?

Answer 1

• Salience (importance/dominance)
• Mood modification (rush and escape)
• Tolerance
• Withdrawal
• Conflict (interpersonal, intra-psychic, loss of control)
• Relapse

Question 2

What are the different models which attempt to explain addiction?

Answer 2

Moral Model - people become addicted due to weakness

Dispositional Disease Model - disease causes patient to have no restraint from addiction. Can only cure disease by complete abstinence

Personality Model - patient has low self esteem and poor impulse control

Bion Model - person craves warmth/safety/protection like that of a mother (try to find this in their addiction)

Biological/Medical - addictive substances thought to change brain structure and impede decision making

Question 3

What evidence supports the biological/medical model of addiction?

Answer 3

• Addiction = 50% heritability

- And proof that discrete neural circuits are involved in different stages of addiction

Question 4

What neural circuit is involved in the initial binge/intoxication stage of addiction?

Answer 4

Ventral-Tegmental Area (VTA)

Ventral striatum

Question 5

What are the limitations of the medical model?

Answer 5

• Medical treatments effectively reduce harm BUT are less effective in promoting abstinence
• Addiction = primarily a disorder of behaviour (compulsivity and impulsivity)

Question 6

What part of the brain is associated with the withdrawal and negative effect of addiction?

Answer 6

amygdala

this part of the brain craves use of the substance to get rid of withdrawal feeling

Question 7

What part of the brain is involved in the Preoccupation/anticipation of addictive substance?

Answer 7

Cortex
hippocampus
insula
cingulate gyrus

Question 8

Patients often describe the anticipation of taking a drug/addictive substance is better than actually using the drug itself. TRUE/FALSE?

Answer 8

TRUE

Question 9

What is the difference between Associative Learning and Instrumental Learning?

Answer 9

Associative Learning - Ability to associate any stimuli with a pleasurable experience if they are paired together

Instrumental Learning - Positive reinforcement by being given reward

Question 10

What is the difference between positive and negative punishment?

Answer 10

Positive - (adding something in)
=> A patients partner shouting at them for using drugs is a positive punishment

Negative (taking something away)
=> Losing family/friends due to use of drugs
=> This type can have opposite effect and cause patients to use more

Question 11

What group of patients is most at risk of drug overdose?

Answer 11

Patients who have just come out of prison
=> their tolerance has decreased during stay
=> if they go back to using same high dose, they will overdose and have high risk of dying

Question 12

What is a habit?

Answer 12

An acquired behaviour pattern regularly followed until it becomes almost involuntary
=> AUTOMATIC

Question 13

How does addiction influence cognitive function?

Answer 13

Attention bias - causes patients to notice things associated with their substance of choice

Memory bias - patients remember the good parts of using substance, but pre-frontal cortex shuts down and does not remind them of the bad parts

Question 14

What type of thinking do we want patients to use when regarding their addiction?

Answer 14

NOT AUTOMATIC

• don’t want patients to act on impulse
• slow/ deliberate/ effortful

Question 15

What are the two main functions that patients with addictions try to get out of their addictive behaviour?

Answer 15

• “Feel Good” factor

- Escape/avoidance

Question 16

What thinking “errors” can be seen to present in addiction?

Answer 16

“It’s a treat” (permission-giving)

“It’s only one” (minimisation)

“I haven’t used for a whole week!” (rationalisation)

“I can use and stay in control” (denial)

“She made me angry so I had to use” (blaming)

Question 17

What is the Biopsychosocial Model of addiction?

Answer 17

Interaction between:

• biological factors (e.g. physical health, genetics),
• psychological factors (e.g. mental health)
• social factors (e.g. finances, social support etc)
• Holistic approach, no factors = dominant

Question 18

What biological/physical factors are involved in addiction?

Answer 18

• Current non-prescribed OR prescribed drug use
• Physical dependency (Withdrawal /Tolerance)
• Drug use Hx (+/- treatment for it)
• Injecting
• High risk sexual behaviour
• General physical health
• Treatment goals (and drug use goals)

Question 19

What psychological factors are involved in the biopsychosocial model?

Answer 19

• personal / developmental history
• Functional analysis of current drug use
• Beliefs about drug use
• Coping skills
• Cognitive functioning
• Past Psych health/ usu of services
• Psychological treatment goals

Question 20

What social factors are addressed in the biopsychosocial model?

Answer 20

Relationships
Housing
Employment
Financial
Legal
Social treatment goals

Question 21

What categories are involved in the FORMULATION of an addiction history?

Answer 21

Predisposing Factors - adverse childhood events
e.g. trauma, parent separation, bullying, ADHD/ASD diagnosis

Precipitating Factors - current triggers
e.g. Friends overdosing, relationship breakdown

Maintaining Factors - causing it to go on for longer
e.g. family conflict, spending time with other users

Protective
e.g. Good family relationship/support network

Question 22

Why are emotions such as anger a potential cause of drug use in patients trying to be abstinent?

Answer 22

Emotions like anger can cause physiological symptoms of withdrawal via anxiety

=> patient cant tell it is anxiety and not withdrawal
=> accepts craving and uses drugs