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The psychology of Addictive Behaviour

CWs

The Biological Approach to Gambling
Initiation: Role of genetics SHAH ET AL  Twin study  Evidence of genetic transmission of gambling in men BLACK ET AL  1ST degree relatives of pathological gamblers more likely to also be pathological gamblers than more distant relatives

Maintenance: Underactive pituitary-adrenal response to gambling stimuli PARIS ET AL  Measured gamblers’ cortisol levels (cortisol associated with pituitary-adrenal response) before and after watching video of preferred mode of gambling  Recreational gamblers high levels whereas pathological gamblers no cortisol increase in response to videos

ZUCKERMAN  Individual differences in stimulation  High sensation seekers have lower appreciation of risk and anticipate arousal as more positive than low sensation seekers  Therefore more likely to gamble .

Relapse: BLASZCYNSKI ET AL  Poor tolerance to boredom may contribute to repetitive gambling behaviour  Pathological gamblers significantly high boredom prone scores than control groups of non gamblers .

Reduces complex phenomenon down to simple explanation Deterministic . Incentives (nature side of nature/nurture debate) .Suggests individuals bound by their biology/genetics and have no choice or free will in their actions .Why some people develop pathological gambling and yet others who experience same environment do not .Ignores importance of external factors in development of behaviour eg.Evaluation of Biological Approach to Gambling Explains individual differences .Diathesis-stress model also states how some may be more vulnerable to addiction due to a genetic predisposition Reductionist .

BONNAIRE ET AL  Pathological gamblers who bet at race racks had higher sensation seeking scores than those playing games available in cafes  Concluded 2 subgroups: .cafe gamblers (to avoid boredom) Most popular current view is that gambling is a product of biological factors plus external factors .racetrack gamblers (arousal) .

The Biological Approach to Smoking Initiation: Role of genetics VINK ET AL  Dutch twin study  Individual differences in smoking initiation due to 44% genetic and 56% environmental influences BOARDMAN ET AL  Identical twins and same sex fraternal twins estimate heritability for regular smoking to be 42% .

Maintenance: Nicotine causes release of dopamine. which creates short-lived feelings of pleasure which must be repeated to avoid withdrawal symptoms VINK ET AL  Nicotine dependence influences by genetic factors .

Relapse XIAN ET AL  Twin study to test whether genetic risk factors contributed to failed attempts to quit smoking  Found 54% of risk for quit failure attributed to heritability UHL ET AL  Attempted to identify specific gene clusters associated with quit success and nicotine dependence with aim of matching treatments to benefit smokers trying to quit .

Social context of behaviour .however regarding smoking as biological problem creates possibility it may be treated by pharmacological methods .Evaluation of Biological Approach to Smoking THORGEIRSSON ET AL  Identified gene variant that influences nicotine dependence/no. of cigarettes smoked a day  Suggests genetics may not determine initiation but make it more likely that some smokers will become addicted should they start Reductionist .Neglects other possible determining factors eg.

Deterministic .Suggests individuals bound by their biology/genetics and have no choice or free will in their actions LERMAN ET AL  Genetic testing of individuals allows therapists to choose most effective therapy to maximise likelihood of quitting successfully .

The Cognitive Approach to Gambling Initiation: Self medication GELKOPF ET AL  Individuals use pathological behaviours to treat psychological symptoms  Activity chosen is perceived as helping particular problem  Gambling might not actually make things better but is judged as doing so by the individual to become an addiction .

Maintenance: OEI + GORDON  Problem gamblers have irrational perceptions about abilities in influencing the outcomes of their gambling eg. Illusions of control and superstitious behaviours  They also show a self confidence in ability to ‘beat the system’ with success being attributed to skill .

Relapse: Just World Hypothesis BLANCO ET AL  Gamblers overestimate wins and underestimate losses  Individuals believe they will eventually be rewarded for their efforts and are motivated to return based on belief they ‘deserve’ to win having lost on previous occasions .

Evaluation of the Cognitive Approach to Gambling LI ET AL  Pathological gamblers who gambled to escape reality as opposed to those gambling for pleasure.Correlation .Does not mean depression cause of gambling . significantly more likely to have other substance dependencies  Supports self medication explanation BECONA ET AL  Depressive disorder evident in majority of pathological gamblers .May be consequence due to personal/financial costs of gambling .

BENHSAIN + LADOUCER  Possessing relevant knowledge does not make people less susceptible to cognitive distortions  No difference found in trained statistics students and non stats trained students in susceptibility to irrational gambling related cognitions Implications for treatment.In case of self-medicating gamblers. might be more beneficial to treat underlying problems firstly . .More than one motivation for becoming pathological gambler implies there should be differing treatments .

The Cognitive Approach to Smoking Initiation: Expectancy Theory BRANDON ET AL  Behaviours escalate into addiction because of expectations individual has about costs and benefits of the activity MERMELSTEIN  Expectancy of positive mood states have been shown to be reasons for adolescents beginning to smoke .

Maintenance: BRANDON ET AL  As an addiction develops. more by unconscious expectancies involving automatic processing  Explains loss of control smokes experience and difficulties in abstaining . activity influenced less by conscious expectancies.

Relapse: Expectations of costs and benefits of smoking affect an individual’s readiness to quit and likelihood of them relapsing Individuals who perceive smoking to have many benefits and quitting to have only few are most likely to relapse .

Therefore positive expectancies do not generalise to NRT which explains modest success rates for smoking cessation (implication for treatment) .Research might focus on ‘problematic behaviour’ eg. Heavy smoking but does not consider ‘loss of control’ JULIANO + BRANDON  Smokers reported greater expectancies that cigarettes alleviate negative mood states and had a positive effect on weight control compared with different forms of NRT .Evaluation of Cognitive Approach to Smoking Much research relating to expectancy theory is concerned more with excesses of a particular behaviour rather than addiction to it .

Focus of research into expectancy theory and addiction largely been on positive findings with negative results receiving far less attention .Constitutes a publication bias .Selective publication of positive results gives unrepresentative view of research .

psychological rewards (near miss) and social rewards (praise from peers) – also financial awards if they win  Although they generally lose. greater weight is given to the experience of winning and so person continues .The Learning Approach to Gambling Initiation: Operant Conditioning GRIFFITHS  Gamblers playing slot machines become addicted because of physiological rewards (buzz from winning).

Maintenance: Positive reinforcers Intermittent reinforcement People become used to long periods without reward and their gambling is reinforced by the occasional payout Social approval LAMBOS ET AL  Peers/family members of problem gamblers more likely to approve of gambling  Respondents of such reinforcement gambled more than others and intended to continue doing so .

Relapse: Classical Conditioning Addicts associate other stimuli with gambling behaviour (eg. any form of flashing lights/slot machine type sounds) and therefore if they come into contact with these conditioned cues they are at higher risk of relapse .

Suggests other factors involved in transition from gambling behaviour to gambling addiction .Unclear whether time period affects reinforcer in any way Aspects of gambling this approach does not address .Many gamblers experience reinforcements however do not become addicts .Evaluation of the Learning Approach to Gambling Difficult to apply operant conditioning to all forms of gambling .Some have short time between behaviour and consequence (scratch cards) whereas others have longer period of time between two (sports betting) .

The Learning Approach to Smoking Initiation: KANDEL + WU  SLT explanations of smoking propose young people begin smoking as consequence of observing social models around them who smoke MAYEUX ET AL  Positive correlation between smoking at 16 and boys popularity 2 years later  Suggests popularity among peers serves as positive reinforcer in initiation of smoking .Cannot establish cause and effect from correlations .

sensory cues become conditioned stimuli and activate same brain areas as nicotine.) and reinforcing effects of nicotine Over time.Maintenance: Repetition leads to conditioned association between sensory aspects of smoking (sight of cigarettes/smell of smoke etc. making cessation difficult .

Relapse: Cues associated with receiving nicotine (smell of smoke etc.) increase likelihood smoker will respond to these by smoking LAWRENCE + RUBINSON  Those who frequently smoke have less confidence in their ability to abstain and are more likely to relapse .

almost twice as likely to take up smoking  8 times more likely if close friends smoked  Supports parents/peers as models important for initiation THEWISSEN ET AL  Repeatedly presented smokers with cues predicting smoking  in 2nd room presented smoking unavailability cues  Cues predicting smoking led to greater urge to smoke therefore highlighting importance of conditioned cues .Evaluation of The Learning Approach to Smoking KARCHER + FINN  Youth whose parents smoked.

LOPEZ ET AL  Gender bias in smoking addiction research  Women start smoking later than men and contexts of smoking differs between genders  Explanations often fail to address these differences. reducing validity of data .

Risk Factors in the Development of Addiction .

Stress Everyday stress: • People report that they drink. 15% alcoholics also suffered from PTSD . smoke. take drugs. gamble etc. as a means of coping with daily hassles (relationship problems/workplace stress) Traumatic stress: • People exposed to severe stress (parental loss/child abuse) more vulnerable to addictions DRIESSEN ET AL  30% drug addicts.

Stress may be the result not cause of addiction .Stress may be risk factor for smoking addiction but smoking doesn’t have desired effect in reducing stress CLONIGER  Type 1 alcoholics drink to reduce tension  Type 2 drink to relieve boredom Therefore stress may explain vulnerability for some alcoholics (type 1) but not all Cannot establish cause and effect: .Many smokers smoke to reduce stress yet smoking may actually increase stress levels .

Peers Peer pressure cited as reason for why adolescents start smoking/drug taking. SLT: • Learned through observation of others • Subsequent imitation of their behaviour SIT: • Group members adopt behaviours important to social identity of group • If status as ‘smoker’ or ‘non smoker’ central to social identification of group. Increased levels of smoking linked to peer approval and encouragement. individuals will have similar smoking habits .

Unknown whether adolescents will conform to behaviours if their conflict with own concerns .SUSSMAN + AMES  Friend and peer use of drugs was a strong predictor of drug use among teenagers WAGNER + ANTHONY  Cannabis smokers more likely to progress to cocaine usage due to being in peer groups where there are opportunities for new drug experiences SIT: Little known about extent to which groups influence their members to smoke .

Age Influence of peers on smoking/drug use habits decreases in later adolescence. BROWN ET AL  Close friends/romantic partners become increasingly important as an influence on attitudes and behaviours as we get older  Peers have a greater impact on young adolescents .

This implies artificial link between age and addiction . therefore youth appear more vulnerable .Older people may become addicted but do not engage in it publically/less media attention .Implications for Treatment: Suggests public health interventions should be targeted at specific age groups (teenagers) at most risk of addiction Potentially skewed data: Addiction in young people most publicised.

Personality
Concept of ‘addictive personality’ can explain why some people become addicted when others don’t, despite both trying the same experience.
EYSENCK  Personality based on 3 dimensions: - extroversion (seek external stimulation to increase arousal) - neuroticism (experience negativity, depression, anxiety) - psychoticism (related to hostility/impulsivity) FRANCIS  Link between addiction and high scores on both neuroticism and psychotism  These individuals more prone to develop addiction as a means of relieving everyday stressors

CLONIGER  3 personality traits predispose individuals towards substance dependence: - Novelty seeking - Harm avoidance - Reward dependence

ROUNSAVILLE ET AL  Link between alcohol addiction and personality disorders SLUTSKY  Link between alcohol and conduct disorder Research is only correlational: - Some traits may be common among addicts however this does not mean they cause addictive behaviour Practical Application: - Findings could be used to identify individuals who may be most prone to addiction and levels of neuroticism/psychotism/stress can then be reduced

Media Influences on Addictive Behaviour Film representations of Addiction: SULKUNEN  Analysed 61 scenes from films that represented addictions to alcohol. gambling and sex  Competent use of drugs represented in a way of alleviating a particular problem WAYLEN ET AL  Found a significant relationship between adolescent smoking and no. tobacco. drugs. of films they had seen depicting smoking  Suggests media representations of smoking influence teenagers to take up the habit .

exposure to movies with smoking over the year between surveys was a strong predictor of whether they had begun to smoke – exposure effect BYRNE  Films important as they can educate public about addiction by creating stereotypes eg.SARGENT + HANEWINKEL  Surveyed adolescents and re-surveyed a year later  Of individuals who had not smoked when first surveyed. Trainspotting REAL WORLD APP: Guidelines for film/tv writers recommend illegal drug use should be communicated as unhealthy/harmful and no references should be made to recreational drug use. .

Antidrug Campaigns: 2008 TV/internet campaign launched to warn teenagers of cocaine dangers HORNIK ET AL  Campaign had negative effects as gave implicit message that drug use is commonplace JOHNSTON ET AL  Youths took message that peers were using drugs and so were more likely to start taking drugs themselves .

many people are exposed regularly but not everyone becomes an addict .Shows media is not the only influence in developing addictions .General Evaluation of Media Influences on Addictive Behaviour People may look to media to help their addiction however there is also the addiction to the media itself Danger of alienating and demonising addicts through negatively portraying them in the media .May prevent them from seeking support with their addiction The media affects people differently.

TPB as a Model for Addiction Prevention Intention to engage in a particular behaviour is a function of 3 factors: 1) Behavioural Attitude 2) Subjective Norms 3) Perceived Behavioural Control .

individual’s attitude towards the behaviour .beliefs of consequences of performing behaviour SLATER ET AL  Targeting attitudes is key to success of anti-drug campaigns  US Office of National Drug Control Policy (ONDCP) launched campaign to lower teenage marijuana use  Campaign created different attitude towards effects of drug (inconsistent with achieving aspirations) and this is thought to be why it was successful .Changing Behavioural Attitude .

individual’s subjective awareness of norm relating to behaviour eg. Injunctive norm (perceived right thing to do) and descriptive norm (what others actually do) WILSON + KOLANDER  Anti-drug campaigns seek to give adolescents actual data about % of people engaging in drug taking behaviour  Accurate statistical information corrects subjective norms and contributes to an effective campaign .Changing Subjective Norms .

Changing Perceived Behaviour Control . stronger their intentions to perform it will be GODIN  3 elements of TPB explain intentions of smoking behaviour whereas perceived behavioural control most important predictor of actual behaviour  Therefore prevention programmes should help smokers to focus on the willpower required to give up MAJER ET EL  Encouraging addict’s belief in ability to abstain related to a positive outcome  Enhancing self-efficacy should form primary goal of treatment plans .More control people believe they have over a behaviour.

) caused the behavioural change .Not clear whether any one component of model (behavioural attitude.Evaluation of TPB WALKER ET AL  TPB most popular and widely used social cognition model in health psychology ARMITAGE + CONNER  Meta-analysis of studies using TPB  Model successful in predicting intention to change rather than actual behavioural change  Suggests TPB primarily an account of intention formation rather than specifying processes involved in translating intention into action Research on TPB almost entirely correlational . perceived behavioural control etc.

ARMITAGE ET AL  TPB fails to take into account emotions/compulsions of other irrational determinants of human behaviour Attitudes/intentions tend to be measured when sober whereas actual risky behaviours are often performed when under influence of alcohol/drugs MACDONALD ET AL  When p’s had taken alcohol they showed increased intentions to engage in risky behaviours  Therefore sober measurements may be invalid of actual behaviour .

Methadone mimics effects of heroin but it less addictive .Types of Intervention and their Effectiveness Biological Interventions Agonist Substitution eg.Drug user given increasing amounts of methadone to increase tolerance to drug .Also found to be effective in reducing gambling behaviour .Does then decreased until addict no longer needs methadone or heroin Antagonist Substitution eg. Methadone for heroin addiction . Naltrexone for alcohol addiction .Blocks the action of neurochemicals that provide rewarding feelings as result of drinking alcohol .

Immunotherapy .When substance consumed.Prevent it from reaching brain CARRERA ET AL  Developed antibodies for cocaine in rats  Rats no longer experienced effects of cocaine after consumption . antibodies bind to it .Antibodies created according to addictive substance .

created a black market in methadone KIM + GRANT  Naltrexone led to proven to be successful after 6 weeks of treatment .Consumption is unsupervised.Stats show more than 300 methadone-related deaths in 2007 in UK .Evaluation of Biological Interventions Some addicts can become just as reliant on methadone as they were on heroin and therefore one addiction is merely being substituted for another Use of methadone is controversial: .

results from rats cannot directly be applied to us . extensive human trials firstly need to be conducted as the original study was carried out on rats and due to their different physiological and genetic makeup to humans. .However. although data looks promising.Biological interventions may ignore the underlying reason for the addiction in the first place Addicts may relapse one the treatments (drugs) are halted REAL WORLD APP + IMPLICATIONS FOR FURTHER RESEARCH CARRERA ET AL’s research suggests soon vaccinations for heroin. cocaine and nicotine will be available for addicts in attempts to reduce or halt their addictions.

Rewards act as positive reinforcers and so people continue to not engage in the behaviour SINDELAR ET AL  Tested people on methadone treatment  One group rewarded each time urine samples tested negative  End of programme and reward group had 60% more negative urine samples than control group .Reward people for not engaging in the behaviour .Psychological Interventions Reinforcement .

CBT . cognitive errors play part in maintenance. CBT aims to correct these errors SYLVAIN ET AL  Pathological gamblers given CBT and social skills training  Resulted in improvements maintained at 1 year follow up .Eg. in gambling.Goal is to help people change the way they think about their addiction and learn ways of coping efficiently .

If triggers still present in the person’s environment then psychological interventions may only be successful for a short period of time as they do not address underlying causes of addiction As much evidence proves addictions to be source of faulty cognitions. so many different areas to CBT difficult to know which are most effective eg. gambling or alcoholism started in the first place . CBT makes sense as an effect form of intervention .Evaluation of Psychological Interventions Psychological interventions focus on principles of operant and classical conditioning (aversion therapy) rather than why smoking.However. Teaching patients to correct erroneous thinking or motivational interview .

Public Health Interventions Telephone smoking ‘Quitlines’ STEAD ET AL  Smokers who received repeated quitline calls.1% of smokers advised by their doctors were able to refrain from smoking for 12 months afterwards . increased their odds of stopping smoking by 50% compared to smokers who only received self-help materials Doctor’s Advice OGDEN 5.

However.No.Increased outdoor smoking • Increasing cost of cigarettes • Controlling sales of cigarettes and alcohol . followed by a ‘rebound effect’ . of government legislation changes also enforced in attempts to prevent addiction eg: • Smoking ban in public places .

Problem gambling during adolescents can lead to adverse outcomes and interventions are preventing these .Evaluation of Public Health Interventions BECKHAM ET AL  Combination of Quitline counselling and NRT highly effective in treating US military veterans Government sponsored NIDA intervention reduced cocaine use and unprotected sex Public interventions are proactive approaches to addressing potentially devastating social issues .