addiction

• what is physical dependence


  a state of the body due to habitual drug use which results in a withdrawal syndrome when use of drugs is reduced
• what is psychological dependence


  a compulsion to continue taking a drug because it is rewarding/pleasing/comforting
• tolerance


  the need to take more of a substance to achieve same effect as previously achieved by smaller dose
• genetic risk factors in the development of addiction

  genetic vulnerability - inherited predisposition

  genetic mechanisms - low numbers of D2 (dopamine) associated w/ addiction - proportion of all receptors determined genetically

  some are more able to metabolise substances.
• Pianezza et al (1998)


  found some people lack a fully funtioning enzyme (CYP2A6) which is responsible for metabolising nicotine.
• other risk factors in the development of addiction

  stress

  personality

  family influences
• how does stress affect addiction

  Andersen and Teicher suggest early experiences of severe stress have damaging effects on the brain in a sensitive period of development, creating a vulnerability to addiction by adolescence
• how does personality affect addiction

  no such thing as 'addictive personality'. But strongest correlation has been found between addiction and antisocial personality disorder. (impulsivity, risk-taking, chaotic lifestyle)
• how do peers affect addiction

  O'Connell suggests three major elements

  • attitudes and norms about drinking influenced by associating with peers who use alcohol
  • experienced peers provide more opportunities for individual to use alcohol
  • individual over-estimates how much peers are drinking, so they drink more
• AO3 - Risk factors

  interactions between all risk factors - different combos of factors determine nature and severity

  the factors can be protective and make addiction less likely, it is more complex

  cause and effect - correlational research - many addiction can create stress due to negative effects on lifestyle.

  proximate and ultimate risk factors to better understand - ultimate = genetic ususally - proximate = novelty-seeking personality

  irl application - tobler created peer-pressure resistance training
• desensitisation hypothesis

  focus on brain neurochemistry - nicotinic acetylcholine receptors (nAChRs).

  When nicotine binds wth nAChRs the neuron becomes stimulated and transmits dopamine. But after this, the nicotinic receptor shuts down and can't respond to neurotransmitters - this neuron is desensitised and this leads to downregulation, a reduction in no. of active neurons.
• dopamine transmission


  nAChRs concentrated in ventral tegmental area (VTA). When they are stimulated by nic, dopamine is transmitted along the mesolimbic pathway to the nucleus accumbens (NA). This triggers release of dopamine from the NA into the frontal cortex. dopamine is also transmitted along the mesocortical pathway to be released in the frontal cortex. These pathways are part of brain's reward and pleasure centre, so nic activates this system and results in euphoria//reduction of anxiety.
• what is the nicotine regulation model

  when smokers go without nicotine for a prolonged period nicotine disappears from the body allowing nicotinic receptors to become functional so dopamine neurons resensitise (upregulation)

  withdrawal - more nAChRs are available and overstimulated by ACh, contributing to acute withdrawal syndrome.

  dependence and tolerance - smoker then motivated to avoid unpleasureable withdrawal states by having another cigarette. Repetition of the cycle of daytime downregulation and night time upregulation creates chronic desensitisation. Tolerance develops
• AO3 - Brain neurochemistry explanation

  Real life application - development of new treatments such as nicotine replacement therapy NRT in form of patches and inhalers

  Reductionist

  Limited explanation - doesn't include NT pathways such as GABA and serotonin
• learning theory explaining addiction

  operant - positive reinforcement - pleasurable physiological effects on the dopamine reward system of the mesolimbic pathway - drug stimulates release of dopamine in the nucleus accumbens producing euphoria.

  negative - Cessation leads to withdrawal syndrome, smoke to decrease effects

  classical - pleasure is primary reinforcer - other stimuli such as location are secondary reinforcers. They act as cues as their presence produces similar responses to the nicotine itself (cue reactivity)
• AO3 - learning theory

  Real world application - aversion therapy

  gender differences - women less successful at giving up than men. Cannot explain this

  Limited-likely to be several other causes of smoking -not all people develop dependence
• learning theory of gambling addiction

  partial reinforcement - unpredictability about which gambles will pay off, keeping the gambling going even when rewards are rare.

  variable reinforcement - type of partial reinforcement - gambler learns that they will not win everytime but will eventually win if they persist.

  cue reactivity - secondary reinforces e.g. betting shop, scratch card colours
• AO3 - learning theory of gambling addiction

  dickerson - found gamblers who placed the most bets on horse races were more likely to place their bets in the last two minutes. They may have delayed betting to prolong the rewarding excitement they felt.

  griffiths and delfabbro - argue conditioning processes do not occur in everyone in the same ways. Stimuli effects can differ. Some people gamble to relax, others to be aroused.
• cognitive theory of gambling addiction

  expectancy theory - if they expect the benefits to outweigh the costs, addiction is more likely

  cognitive biases:

  • skills and judgement: illusion of control
  • personal traits/ritual behaviours: believe they have better chance because they are lucky or engage in superstitious behaviur
  • selective recall: can remember wins but ignore/discount losses
  • faulty perceptions: distorted views of chance
• Mark Griffiths (1994)


  'thinking aloud' method to see difference in cognitive processes between regular gamblers and non-regulars. content analysis split these into rational or irrational thoughts. semi-structured interview and observations found regular gamblers made almost 6x as many irrational verbalisations than the occasionals. Particularly prone to illusion of control. Overestimated skill required to win on slot machined and considered themselves skillful
• What is self-efficacy


  our expectations that we have the ability to behave in a way that achieves a desired outcome.
• AO3 - cognitive theory of gambling addiction

  real world application - CBT addressing distorted thinking

  self-report methods

  individual differences - people differ in their motivation to achieve control over their lives.
• drug therapies for addiction - three A's

  aversives - produce unpleasant consequences such as vomiting

  agonists - drug substitutes - bind to neuron receptors and activate them. allow for gradual reduction in dose and symptoms.

  antagonists - bind to receptor sites and block them so drug cannot have usual effects
• Drug therapy for nic addiction

  NRT (nicotine replacement therapy) gum, inhalers, patches to deliver psychoactive substance in tobacco smoke but less harmful. NRT clean and controlled dose binding to ACh receptors in mesolimbic pathway stimulating release of dopamine in nucleus accumbens. amount of nic can be reduced overtime.
• Drug therapy for gambling addiction

  most promising drug = opioid antagonists such as naltrexone which is used to treat heroin addiction. Gambling taps into same dopamine reward system as heroin and nic. They reduce effect of dopamine in nucleus accumbens by enhancing release of GABA. This dampens cravings.
• AO3 - Drug therapy

  Lindsay Stead et al - 150 studies into effectiveness of NRT. Concluded all forms are more effective than placebos/no treatment. NRT users up to 70% more likely to be abstaining from smoking 6 months after quitting

  Side effects - sleep disturbances, dizziness, headaches. Naltrexone unpleasant and high dose, high relapse rate.

  Limited treatment-people may be too unorganised or unmotivated to take daily medication. not effective for everyone
• Behavioural interventions for addiction

  aversion therapy for alcohol - aversive drug = vomiting

  aversion therapy for gambling - electric shocks/participant reads out cards of phrases they say during gambling and shocked when said

  covert sensitisation for nic - relax, therapist reads from script of aversive situation e.g. vomiting after cig.
• AO3 - Behavioural interventions

  methodological issues-hajek and stead 25 studies - impossible to judge effectiveness due to method errors e.g. no blind procedures.

  McConaghy - ps who got CS were 90% more likely to gamble less compared to electric shock therapy

  ethical issues - inflicting extreme nausea, pain and loss of dignity - is it worth it? could be traumatising
• CBT for addiction


  Functional analysis - identify high risk situations and tackle cognitive distortions - replace w/ adaptive ways of thinking

  Skills training - cognitive restructuring & specific skills e.g. social skills, anger management
• AO3 for CBT


  Petry - gambler treatment grp gambled significantly less than control 12 mo later - face to face CBT more effective

  Cujipers et al - indicate drop out rates can be up to five times greater than other forms of therapy as it is demanding. people may take it less seriously. lack of treatment adherence

  which part of CBT actually works? flexible and different in every situation e.g. through phone
• Theory of planned behaviour (TPB) Icek Ajzen


  Personal attitudes - favourable or unfavourable

  Subjective norms - beliefs of whether people who matter most to them approve or disapprove of their behaviour

  Perceived behavioural control - how much control we believe we have over our behaviour influences intentions to behave and behaviour itself
• AO3 - Theory of planned behaviour

  Hagger - tested TPB prediction. found the three factors all predicted an intention to limit drinking. Intentions were also found to influence the number of units actually consumed.

  Doesn't explain addiction behaviour: cannot account for intention-behaviour gap. Miller and Howell - model didn't predict the occurrence of actual gambling behaviour

  based on self-report methods.
• What are Prochaska's six stages?

  Precontemplation

  Contemplation

  Preparation - constructing plan

  Action - done something to change behaviour in last 6 months

  Maintenance - maintained change for 6+ mo.

  Termination - new behaviours automatic.
• AO3 - Prochaska's 6 stages


  recognises change is a dynamic process - ppl move back and forth which other models ignore

  Bandura - precontemplation and contemplation are the same. Kraft - two stages necessary = precontemplation and all the others grouped together.

  Taylor and Cahill - stage-based approaches no more effective than alternatives in treating nic addiction