2. What we have to cover:
1. Defining Addiction
2. Models of addictive behaviour (biological,
social learning theory, cognitive)
3. Factors affecting addictive behaviour (Individual
differences, vulnerabilities and social context)
4. Reducing addictive behaviour (Prevention and
treatments)
3. So, we have to start from basics…
Define addiction…
‘Addiction is a persistent, compulsive dependence
on a behavior or substance’
Addictions can be of ANYTHING, be it sex,
gambling, drugs, or even your mobile phone!
4. Gambling addiction:
• Estimated that 5% of the adult
population have a gambling addiction.
• Higher percentages are found in young
adults, mentally ill individuals and the
prison population.
Shaffer et al (1999)
• Pathological gambling recognised by
the DSM as a mental disorder in 1980.
5. Smoking addiction:
• Smoking dependency is the
most prevalent. (Anthony et
al,1994)
• Also recognised as a mental
disorder in the DSM under
‘dependency on a substance’
6. Components of addiction – Griffiths
(2005)
1. Salience – The importance of the behaviour to
an individual, all they think about.
2. Mood modification – The experience reported
by people whilst carrying out their addictive
behaviour i.e. behaviour helps to ‘wake up in
morning’ or ‘calm down at night’
3. Tolerance – Increased amount to achieve same
effect
4. Withdrawal Symptoms – Unpleasant
feelings/physical effects experienced when
behaviour stops
5. Relapse – Reverting back to addiction after
stopped (esp. when stressed)
9. Genetics – Comings (1996):
• 48.9% of smokers compared to
25.9% of general population
carried A1 variant of DRD2 gene.
• supported by A1 variant of the
DRD2 dopamine receptor linked
to severe alcoholism (Noble et
al, 1991)
• A1 variant means less
dopamine receptors
I am a
Nobleman
(NOBLE 1991)
10. Genetics – Lermanet al (1999):
• Found that people with SLC6A3-9 gene are
less likely to take up an addiction than
someone without the gene
Im a LERRRMAAANN
(1999)
11. Biological – Genetics and
biochemistry:
• Family and twin studies
• Looking at alcohol
dependency
• Found heritability at 50-
60% (McGue, 1999)
• An example of a gene that
is linked to addiction is the
A1 variant of the DRD2
gene…
12. Supporting genetics – Kendler et al
(2004):
• Investigating genetic risk & family
conflict in nicotine addiction
• 1676 female twins
• No. of cigarettes smoked in
lifetime calculated
• Self report interviews on fam,
twins
• Found that increased family
conflict caused increased smoking
levels
• Also found high levels of
heriditability
13. Supporting genetics - Blum et al, 1991:
• Blum et al, 1991 found that the
A1 variant of the DRD2 gene had
higher prevalence in families with
history of alcoholism
• Also appeared to show fewer
dopamine receptors in their
‘pleasure centres’ of their brains.
• Therefore they are more likely to
seek behaviours that increase
their dopamine levels
15. Maintenance smoking – Fowler et al
(2007):
• 1214 twin pairs
• Investigated to see
importance of genetics with
initiation of alcohol, nicotine
and cannabis addiction
• Found environmental forces
were more important
• However, genetics influenced
EXTENT of the addiction
16. Maintenance – Smoking, Schachter
(1977) – Nicotine regulation:
• Smokers regulate their nicotine intake
• 11 34-52 year olds smoked high or low
nicotine content in alternating weeks
• Heavy smokers smoked more low-
nicotine cigarettes
• Light smokers did not appear to
regulate consistently
• Has implications to real life e.g. taxing
cigarettes depending on nicotine
content
17. Maintenance Gambling – Meyer et al
(2004):
• During casino blackjack gambling,
heart rate and
noradrenaline/norepinephrine
measured
• (which cause inc. heart
rate/bp/pupil dilation – fight or
flight response)
• …become elevated to a greater
degree in men with gambling
problems as compared to those
without (Meyer et al. 2004).
18. Tolerance – As tolerance builds, you need
more of behaviour to get same buzz
Low dopamine – People with addictions may have either
low levels of dopamine, or fewer receptors than most,
causing them to need more of a substance to get the
same feeling
Maintenance:
20. Relapse:
Withdrawal Symptoms – Unpleasant symptoms
In gamblers – Withdrawal symptoms can be physical (Rosenthal and Lesieur, 1992
found that extent of symptoms positively correlated with no. of hours spent gambling)
In smokers – Those with a sensitive mesolimbic pathway are more susceptible to
relapsing
Also, Lerman 2007 found that smokers had increased CBF (cerebral blood flow) which
could lead to relapse
21. Biological model AO2:
• Objective – empirical
evidence, such as Lerman
(2007) using brain scans to
measure CBF, reliable
• Application to everyday life –
Can affect anybody, looks at
treatment of symptoms, quick
treatments. Doesn’t combat
the cause of the addiction.
Often treated with drugs.
• Reductionist – Simplified into
genetics &biochem, not
psychological or social
• Deterministic – Born with
Genes &biochem, could cause
passive patients, unwilling to
change, ‘no blame’
• Individual differences –
SLC6A3-9 gene, A1 of DRD2,
doesn’t include gender,
personality. Shows that genes
do influence
23. Initiation of smoking and gambling –
Gelkopfet al, 2002:
• Individuals intentionally use
drugs to treat psychological
symptoms from which they
suffer
• One that’s perceived as
being helpful to the
individual
• Could smoke to relieve
stress/anxiety, and gamble
to relieve depression
25. Maintenance of Gambling - Griffiths
(1994):
• 30 gamblers & 30 non-gamblers
• Got them to verbalise their
thoughts as they played
• Found that gamblers personified
fruit machines, saying whether
they were in a ‘good mood’ or a
‘bad mood’
• Regular gamblers also treated
losses as ‘near wins’
• Cognitive bias of ‘skill level’
• Gambling is a rational choice
26. Maintenance of smoking – Tate et al,
(1994):
• Showed withdrawal symptoms
were based on expectancy i.e.
they were mainly psychological
• as by telling a group of smokers
they would expect no negative
experiences during a period of
abstinence
• It led to fewer somatic and
psychological effects than a
control group.
27. Maintenance - Cohen and Lichtenstein
(1990):
• Vicious circle – Smoking alleviated stress,
causes illness, creates stress
28. Relapse – Self efficacy, Bandura (1994):
• Self-efficacy is a person’s belief in his or her
ability to succeed in a particular situation.
• Bandura described these beliefs as
determinants of how people think, behave,
and feel
• If people have a weaker self-efficacy, they’re
more likely to engage in addictive behaviours,
or take up previous ones.
29. Relapse – Self medication in smoking
and gambling:
• Self medicate in times of…
• Stress (smoking)
• Crisis (gambling)
30. Relapse:
Coping – Withdrawal symptoms may make it difficult to
cope without the substance.
Expectancy – especially with smoking, it may seem
easier to quit 2nd time round
Excitement – life without gambling may seem dull
31. Cognitive model AO2:
• Free Will – Individuals may
feel they can change but
may feel they’re to blame
• Ecological
validity/Application to real
life – Addictions affect lots
of people
• Treatments – If it’s based on
faulty thinking, it should be
able to be cured
• Social desirability bias –
people may lie about how
often they smoke/gamble,
could affect reliability
• Subjectivity – Methods of
diagnoses are not scientific
• Self-report methods used to
gather data, lowered
reliability, higher
subjectivity
33. Initiation (smoking) – Vicarious
reinforcement:
• Bandura said we learn through vicarious
reinforcement, which is the observation of
others
• We learn from our peers and parents etc
34. Initiation (gambling) – Glautieret al
(1991):
• Classical conditioning – Good feeling from
addictive behaviour, associate the two
35. Initiation (smoking/gambling) – White
(1996):
• Positive feelings – act
as positive
reinforcement for the
behaviour (operant
conditioning) – due to
dopamine in the
mesolimbic system
• Takes a biological
approach too! OOHH
SYNOPTICITY?
36. Maintenance (smoking) – Classical
Conditioning of a daily ritual:
• When you do certain
things at the same time
of day, such as smoking in
the mornings,
• You become classically
conditioned to do it
• Association is hard to
break
• Like cue reactivity!
Where you see
something associated
with behaviour e.g. pub
for alcoholics
37. Maintenance gambling – Cue
reactivity:
• Seeing something
associated with
behaviour e.g. Scratch
card or bookies for
gamblers
• Brings back the initial
‘buzz’ making it hard to
resist
38. Maintenance of gambling – Operant
conditioning:
• Gambling is
maintained through
small wins, which
provide operant
conditioning through
positive feelings
39. Maintenance (smoking/gambling) –
West, 2006:
• Approach-avoidance
conflict where the addict
wants to both use the
drug/carry out addiction
but also to avoid it because
they know it is wrong
• And there may also be
negative side effects
• Both positive and negative
reinforcers for operant
conditioning
40. Relapse (smoking) – Cue reactivity,
Glautieret al (1991):
• Note: In the book, this is under ‘initiation’ but it
feels like it could easily link to relapse also!
• Alcohol-related stimuli (sight or
sound of a pub) were shown to
cause the same physiological
responses as alcohol itself
• E.g. Increased heart rate and
arousal
• Could be generalisable to other
addictions
• Can also be maintenance
41. Relapse (smoking/gambling) Marlatt
and George (1984):
• Marlatt and George found that
multiple trigger cues increase
the chance of relapse
• As if an addict comes into
contact with a trigger cue of
substance after a period of
abstinence…
• They have that classical
conditioning of association
with that trigger, making them
more likely to relapse
42. Relapse – Negative reinforcement
(operant?):
• To avoid the negative reinforcement of
withdrawal symptoms
• Could link to the fact that Rosenthal and
Lesieur (1992) found the positive correlation
between number of hours spent gambling and
the extent of their withdrawal symptoms
43. Social learning theory AO2:
• Nature/nurture? Based
on nurture, as it’s the
idea that behaviour is
learned from the env.
Born as a TABLEAU
RAZA (blank slate)
• Subjective – based on
observational methods
• Reductionist – Doesn’t
consider individual
differences, or
extraneous variables.
45. Personality factors – Self esteem:
Refers to what an individual feels about
themselves, for example their
confidence, and feelings of self-worth.
Research suggests individuals with low
self-esteem are more prone to
addiction.
Found a negative correlation between
self-esteem in boys and frequency of
cannabis use – Valeskaet al (2009)
I hate myself
46. Self esteem – Kaufman and Augustson
(2008):
• To investigate factors influencing
smoking behaviour
• 7000 girls aged 13-18
• Assessed on perceived weight, and
whether they were trying to lose
weight or not
• Questionnaires were used
• After ONE YEAR, those with low
self-esteem were more likely to
smoke
47. Kaufman and Augustson (2008) AO2:
• Large sample size • All girls
• Longitudinal study
• No cause/effect can be
established
• Questionnaires were
used, which are
subjective
• May also be influenced
by social desirability
bias
48. Personality factors – Attribution
theory:
Proposed that behaviour is down to:
1. Situational attributes (external factors which
cannot be controlled, such as peers/work)
2. Dispositional attributions (internal factors the
individual can control, such as self-esteem)
However, we are more likely to use dispositional
attributes to blame others for their addictions,
and use situational attributes on ourselves =
ACTOR-OBSERVER EFFECT
49. Attribution theory – Hatgiset al (2008):
• Internal attributes (dispositional)
about drug taking varied between
- those who had never taken drugs
before and
- those who had experienced or had
friends that experienced drugs before
• Internal attributes more common on
cannabis use than alcohol or heroin
50. Attribution bias – Seneviratne and
Saunders (2000):
• Investigate attributions by alcoholics
• 70 alcoholics, interviewed to find out
reasons why they relapsed after
abstinence, which were compared to 4
relapse scenarios of others
• Situational attributions used for
alcoholic’s own relapse, such as party:
everyone was drinking
• Dispositional factors for the other
scenarios, such as lack of will power
• = Shows actor-observer bias
51. Vulnerabilities – Stress:
Everyday stress:
• People smoke, gamble, and
drink to deal with
stress/daily-hassles
• Stresses could lead to
addiction, and add to both
maintenance and relapse
Traumatic stress:
• PTSD (post-traumatic-stress-
disorder) linked to addiction
• Driessenet al (2008), found
that 30% of drug addicts
and 15% of alcoholics suffer
from PTSD
52. Vulnerabilities - Stress AO2:
• Relates to real life as
many people have
addictions, therefore
has ecological validity
• Arguably, mundane
realism
• Quantitative data
collected on those with
PTSD, increases
reliability etc
• Individual differences
(hardiness etc)
• Extraneous variables
• Simplistic? Only looks at
stressors, not biology?
53. Vulnerabilities – Peers:
Social Identity Theory:
• States that the in-group will
discriminate against the
out-group to enhance their
self-image.
- Normative behaviour
Social Learning Theory:
• States that social behavior
(any type of behavior that
we display socially) is
learned primarily by
observing and imitating the
actions of others
- Vicarious reinforcement
Splits into SIT and SLT (Social Identity Theory) and (Social Learning Theory)
54. Vulnerabilities – Peers:
• Eiseret al (1989) – Positive rewards
such as popularity and social status
(smoking), smokers befriend other
smokers (Eiseret al, 1995) – SIT
• Duncan et al (1995) – Exposure to
peers that carry out behaviour increase
likelihood of smoking - SLT
• McAlister et al (1984) – Smoke due to
increased popularity and peer approval
- SLT
55. Vulnerabilities – Age:
• Brown et al (1997) – Close friends
and romantic partners are influential
on attitudes and behaviours. Peers
more likely to influence you in
adolescence.
Botvin (2000) – More prone during
adolescence
Individual differences
56. Role of the media in
promotion/prevention of
addiction:
Promotion/prevention
57. Promoting addictions – Sulkunen
(2007):
• 140 scenes from 47 films
• All included scenes of either alcohol, drug,
sex, gambling or tobacco use
• Films such as American Beauty, and
Trainspotting depicted drug use in a positive
light, compared to the ‘dullness’ of real life
• Historical validity? Smoking rules are harsher
• Individual differences at how they would
affect
• Lots of different films used
58. Prevention - In film - Boyd (2008):
• Contrary to Sulkunen (2007) who said
addictions were shown positively
• Boyd found ‘films do represent the negative
consequences of addiction’ shown through…
- Physical deterioration
- Sexual degradation
- Moral decline
59. Attempted prevention - Anti Drugs
Campaign – (1998-2004):
• Aimed to educate US youths to
reject illegal drugs, to prevent
initiation of drug use, and to
stop those already using
• Raised self-efficacy (self
beliefs?) & showed negative
consequences of drug use
• Horniket al (2008) examined
results, and lead to an increase
in marijuana use… (awkward!)
60. Promotion - Boyd contrasted by –
Sargent and Hanewinkle (2009):
• 4384 adolescents, (11-15)
• All were surveyed to see whether or not they
smoked
• Exposed to smoking in movies over a year
• Whether or not they had smoked at the start was
a strong predictor that they would be smoking in
the year later
Ethical issues (could cause smoking = harmful)
Social factors not considered (reductionist)
Longitudinal
62. Theory of planned behaviour (cog) –
prevention:
Attitude:
Assessment and evaluation
of outcome of behavior
Subjective norm:
Motivation to meet
perceived expectations of
important others
Perceived behavioural
control:
Perception of how
easy/hard it would be to
carry out behaviour
Behaviour
intention
Behaviour
Actual behavioural
control
63. Theory of planned behaviour:
Term Definition
Attitude What the person believes the outcome of
the behaviour will be – i.e. whether it’s
going to give them a positive, or negative
outcome.
A smoker may think that they’ll get
popularity, or seem ‘cool’.
Subjective norm What significant others (friends/peers)
think of the behaviour. This affects you
because you want to comply with social
expectations.
If your friends smoke, you may also.
Perceived behavioural control Whether behaviour is easy or hard to
carry out.
If you’re 18+, going and buying cigarettes
is pretty easy.
64. • If you have a positive outlook for the
attitudes, perceived behavioural control, and
also want others to be happy with you, you
are likely to carry out the behaviour.
65. Supporting TPB – Marcoux and Shope
(1997):
• Large sample of 14 yr olds
• Using TPB to predict alcohol
use
• Peer pressure/peers were
important variables
• Model led to
recommendations for
prevention of alcohol abuse
• Reducing how readily
available alcohol was (taking
control away from individual)
66. Supporting TPB – Wall et al (1998):
• Used TPB for undergrad.
students
• Useful in predicting
excessive drinking
• Researchers believed it
could be improved if it
included gender-specific
alcohol outcome
expectancies.
67. Refuting TPB – Ogden (2003):
• Major fault of TPB is that it uses
self-report methods
• Could be affected by social
desirability, and make the
reliability questionable
• However, there isn’t really another
way to test opinions/beliefs.
• Subjectivity may therefore be OK?
68. Biological treatments - Agonist:
Agonist – maintenance/substitution treatment:
- Maintain effects of substance using a safer drug
- Manages withdrawal symptoms
e.g. Smoking – NRT (Nicotine replacement theory…
Patches/gum, maintains nicotine in prefrontal
cortex of mesolimbic system
Drugs – Methadone (can be used alongside
counselling too!
69. Biological – Antagonist:
Antagonist – blocks the effects of substances
on the brain, so no longer get the ‘buzz’
e.g. Smoking – Buproprion(SSRI – selective
serotonin reuptake inhibitor)
Heroin (opiates) – Naltrexone
Antagonistic treatments are usually used as
more of a last resort.
70. Biological treatments – AO2:
• Biological
• Safer than the opiates or
tobacco
• Cheap
• Quick/fast
• Deterministic – removes
blame from the patients
• Still reliant on a drug (agonist)
• Drug can become addictive
also
• Side effects
• Black market for methadone
• Methadone can kill you
• Reductionist, should be
catered to an individual’s
needs
• Individual differences doesn’t
look at social/psychological,
treatments may not be
appropriate
• Deterministic – patients may
feel they can’t be cured
72. Classical
Conditioning:
Aversion therapy
• Owen (2001) – Assessed
aversion therapy in alcoholics
• 82 hospitalised alcoholics
• 5 treatments over 10 days
• Given emetic (makes you
sick) after alcohol (of their
choice)
• Followed by behavioural &
cognitive questionnaire
• Positive alcohol-related
behaviours were reduced
• Found to be effective
‘Associating an
addictive behaviour
with something
negative’
73. Classical
Conditioning:
Aversion therapy
• Kraft & Kraft (2005) – Used
hypnosis to pair addictive
behaviour with nausea
• Only 4 sessions (Cost
effective)
• Long term success =
questionable
‘Associating an
addictive behaviour
with something
negative’
74. • Siegel et al (1987) said
once put back into a real
environment, physical &
mental changes led to
relapse
75. Aversion therapy AO2:
• Fast, cheap treatment
• Shown to work with
alcoholics (Owen 2001)
- wasn’t so reductionist
due to both treatment &
questionnaires
- However, was subjective
• Individual differences
• Reductionist
• May not be long-term
• Siegel et al (1987) said
once put back into a real
environment, physical &
mental changes led to
relapse
• Ethical – protection from
harm
• Consent?
76. Cognitive
Approach:
Cognitive
behavioural
therapy (CBT)
• Killen et al (2008) - found
CBT + telephone
counselling was more
effective than phone
counselling alone.
(who becomes a psychiatrist with the surname ‘killen’ ?
I mean seriously)Talking about your
problems. According
to Curran and
Drummond (2005),
CBT is main
treatment for
alcohol and cannabis
dependency
77. Cognitive
Approach:
Cognitive
behavioural
therapy (CBT)
• Cavalloet al (2007)
compared
- weekly CBT @ 45mins
- to behavioural counselling
for 10-15mins 3x a week
• CBT was more effective for
adolescents who wanted to
stop smoking
Talking about your
problems. According
to Curran and
Drummond (2005),
CBT is main
treatment for
alcohol and cannabis
dependancy
78. Cognitive
Approach:
Cognitive
behavioural
therapy (CBT)
• Jiminez-Murcia et al (2007)
• Treated 290 pathological
gamblers with CBT over 16
weeks
• After 6 months, success rate
was at 80%, but noticed
drop-outs & relapse towards
the end
• (More so with obsessive
compulsives)
Talking about your
problems. According
to Curran and
Drummond (2005),
CBT is main
treatment for
alcohol and cannabis
dependancy
79. Cognitive approach AO2:
• No ethical issues
• Uninvasive
• No side effects
• Relapse & attrition &
individual differences –
Jiminez-Murcia et al
(2007)
• Time consuming
• Gotta train to do CBT
• Individual differences
80. Operant
conditioning:
Contingency
management
(CM)
• Krishnan-Sarinet al (2006)
• Looked at CBT and CM
• 28 adolescent smokers who wanted to
quit, randomly allocated into:
1. CBT group
2. CBT + CM group
• Programme lasted 1 month
• Urine samples tested
• CBT + CM group given money twice a
day for first 2 weeks. Frequency
decreased for next 2 wks
• After 1 week, abstinence:
CBT + CM = 77%
CBT = 7%
• After the month, abstinence:
CBT + CM = 53%
CBT = 0%
Rewarded for
sticking at
something e.g.
Getting money
for not taking
heroin
81. Operant
conditioning:
Contingency
management
(CM)
• Higgins et al (1994)
• USA
• 28 cocaine addicts (all white
males from Vermont)
• Urine tested
• Clear urine = money reward
• Money increased the more clean
samples in a row
• Given advice on best ways to
spend their vouchers
• Norm drug programme drop-out
rates = 70% within 6 weeks
• This programme: 85% stayed 12
weeks
2/3 stayed 6 months!
Rewarded for
sticking at
something e.g.
Getting money
for not taking
heroin
82. Contingency management AO2:
• Shown to work
• Objective – Urine samples
in Krishnan-Sarin et al
(2006)
• Small sample size
• Reductionist
• Ecological validity? Would
a voucher scheme work
widespread? – political
palatability
• Higgins (1994) – all white
males, from Vermont =
cultural bias +
androcentric
84. Group counselling – Crits-
Christophet al (2003):
• National Institute of Drug Abuse (NIDA) study
• Trying to intervene with social and personal
problems associated with drug abuse
• 487 American patients randomly assigned to one
of four groups of various sorts of counselling
• They found:
- All treatments led to decrease in drug abuse
- Combination therapies were most successful
- Worked best if they were told how to adopt more
positive behaviours, and healthy relationships
85. Doctors advice – Russell et al (1979):
• Looking at dr’s advise to help smokers quit
• Carried out a study in five doctors’ surgeries
over 4 weeks
Treatment offered:
1. Follow up session – 0.3%
2. Questionnaire about smoking habit + follow up – 1.6%
3. Dr’s said to stop, questionnaire + follow up – 3.3%
4. Leaflet, Dr said, questionnaire + follow up– 5.1%
• More help they get, better treatment
86. Helplines – Platt et al (1997):
• Assessing effectiveness of smoking
helpline (Smokeline) in Scotland
• 848 of adult smokers, followed up 1
year after their initial call
• 143 of the 848 sample (nearly 24%)
reported they’d stopped smoking
• 88% said they’d ‘made changes’
• During the 2nd year, smoking prevalence
was 6% lower than it was before the
campaign
• It reached a lot of people, and helped
them. Yay.
87. Public Health AO2:
• Shown to work,
especially Platt. Yay.
• Some addicts may not
feel they can reach the
support they need
• Individual differences
• Issues in assessing the
impact
• Reductionist – not
including biological
