Explanations for Addiction - Including models of behaviour, factors affecting addictive behaviour, reducing addictive behaviour.

2. Specification: ADDICTION
1. Models of addictive behaviour – (Biological,
Learning and Cognitive approaches) applied to
smoking and gambling addictions.
2. Vulnerability to addiction -
Risk factors and Media Influences.
3. Reducing addictive behaviour – TPB,
interventions and their effectiveness.

3. A Definition of Addiction
‘Addiction is a persistent, compulsive
dependence on a behaviour or substance…Even
if it has negative consequences’.
Addictions can be varied e.g. sex, gambling,
drugs, or even social media!

4. Specification: Models of addictive behaviour
1. Biological
2. Learning
3. Cognitive
You need to know models for explaining addiction
proposed by three approaches.
These approaches are: -
+
+
You need to be able to show how each model explains
the stages of: -
• Initiation (starting an addiction)
• Maintenance (keeping an addiction going)
• Relapse (returning to the habit)

5. 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)

6. Application 1: 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’

7. Application 2: 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 is recognised
by the DSM as a mental disorder in
1980.

8. Principles: Genetics and biochemistry
- Initiation, maintenance and relapse
– inc. case studies

9. 1. The Biological Model
a) Neurological
influences b) Genetic
influences

10. 1. The Biological Model
• This model covers brain function (in the form
of neurotransmitters) and inherited
predispositions (via our genes).
• There is a complex relationship between the
two.

11. 11
Brain function is controlled by a network of neurons that are stimulated
by biological and psychological triggers. Each neuron relays its activation
to the apporpriate neighbouring neuron across a synapse (gap bridged by
chemicals).

12. Neurological - What happens at a ‘synapse’ (gap
between neurons)?
Electrical impulse triggers the release of a neurotransmitter. This crosses
the synapse and triggers the electrical impulse in the next neuron.

13. Neurotransmitter level sensitivity
• Natural thresholds are set for appropriate quantities of neurotransmitters
to be released. Certain drugs alter these thresholds and impact on the
neurological pathways.
• Activities that stimulate high neurotransmitter release can have the same
effect as taking drugs.
• These alterations have behavioural and mood consequences.

14. The link between
types of
neurotransmitter,
behaviours and
addictions...
(Neurotransmitters are
next to the red arrows).
Neurotransmitter
effects

15. Categories of Neurotransmitter
• EXCITATORY Transmitters: Glutamate, Aspartate.
• INHIBITORY Transmitters: GABA, Glycine.
• OTHERS: Noradrenaline, Adrenaline, Dopamine, Serotonin,
Actylcholine, Histamine, Endocannobinoids - Endogenous
Opoid Peptides - Enkaphalins, Endorphins, Dynorphins.
15
These chemicals operate in a homeostatic way to keep brain
function in balance. This means that compensation occurs if
thresholds are artificially raised. This is very significant in
addiction.

16. How transmitters work e.g. DOPAMINE
• Dopamine is the neurotransmitter most commonly
associated with addiction.
• It is similar to adrenaline in that it affects brain
processes that control: -
– movement
– emotional response
– the ability to experience pleasure and pain.
• Both the ‘highs’ and ‘lows’ of addiction can be explained at
the activity of neurotransmitters such as Dopamine.

17. Neurotransmitter level sensitivity
• Natural thresholds are set for appropriate quantities of
neurotransmitters to be released. Certain drugs alter these
thresholds and impact on the neurological pathways.
• Activities - such as gambling - that stimulate high neurotransmitter
release can have the same effect as taking drugs.
• These alterations have both behavioural and mood consequences.
• Dopamine levels can be effected in two ways: -
a) Increased release of dopamine.
b) Prevention of its re-uptake at synapses, leaving more.

18.  Once the dopamine has been removed from the synapses (re-
uptake) this pleasant feeling disappears.
 In order to regain it, one needs to take more of the substance.
 If the substance is used repeatedly, the body adapts to higher
levels of dopamine. Both the rate at which it is broken down
and its re-uptake are increased.
 This means more of the substance is required to produce the
same effect.
 This threshold adjustment is known as ‘tolerance’.
Neurological - DOPAMINE

19. DOPAMINE – The link in addiction
• Addictive drugs differ in the following ways: -
– They activate different neurotransmitter systems.
– They produce different psychoactive effects.
– Heroin acts on the opiate system.
– Whilst nicotine acts on the cholinergic system.
– Cocaine acts on the dopaminergic and noradrenergic
systems.
• However, all either stimulate dopamine release (heroin,
nicotine) or enhance dopamine action (cocaine) in the nucleus
accumbens.
19

20. b) Genetics
• It has been suggested that
predispositions to some addictions
are inherited. This can be
investigated by examining
concordance rates in identical (MZ)
twins.
• Twins separated at birth and
raised in different environments
provide the best evidence for
genetic predispositions.
• If addiction was totally genetically
controlled, one would expect to
find 100% concordance.

21. Genetics - Is addiction pre-
determined?
 Typically, concordance rates in genetically identical
twins (MZ) are around 50 - 65%.
 This suggests that addiction is not inevitable, though
vulnerability to addiction may well be?

22. Genetics - ‘Pedigree’ research
• A pedigree is a genome analysis. It can reveal whether or not a
trait has a genetic component. That is, whether or not addiction
is passed down from parent to child by way of genes.
• Researchers can construct pedigrees of large families with
addiction, as a first step to understanding the ‘disease’.
•They begin by comparing DNA sequences of
individuals who have the disease with those who
do not. They can then narrow down the
possibilities to identify a small number of so-
called "candidate genes" for addiction.
Source:http://learn.genetics.utah.edu/content/addiction/genetics/

23. • There are many ways that genes could cause one
person to be more vulnerable to addiction than
another: -
1. In initiating addictive behaviour.
2. In continuing with additive behaviour.
3. Easily activating the reward system.
4. Intense or easily accessible feelings of pleasure.
• There could well be a specific gene/s for each!
• Remember: Susceptibility to addiction is the
result of many interacting genes and is a very
complex trait. Many factors determine the
likelihood that someone will become an addict.

24. 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)

26. Initiation - neurotransmitters
Initiation introduces new levels of a neurotransmitter. This stimulates the
‘mesocorticolimbic dopamine pathway’ (MDP) – REWARD pathway - and a sensation of
intense pleasure is experienced. Experience of pleasure provides motivation to further
engage in the addictive activity.

27. Genetics – Lerman et 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)

28. Biological – Genetics and biochemistry
• Family and twin studies
regarding 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…

29. Supporting research – Kendler et al
(2004)
• Investigated genetic risk and family
conflict re nicotine addiction.
• 1676 female twin participants.
• No. of cigarettes smoked in lifetime
calculated.
• Self report interviews on family and
twins.
• Found that increased family
conflict correlated with
increased smoking levels.
• Also found high levels of
heritability.

30. Supporting research - Blum et al (1991)
• Blum et al found that the A1
variant of the DRD2 gene had
higher prevalence in families
with history of alcoholism.
• Also fewer dopamine receptors
seemed to be present in the
‘pleasure centres’ of their
brains.
• Therefore, they suggested users
are predisposed to seek
behaviours that increase their
dopamine levels, e.g. drinking.

32. Maintenance –
The role of Neurotransmitters
• Dependence develops when neurons adapt to changed levels
and only function normally in the presence of chemicals from
the new ‘addicted state’.
• The neural pathways in the brain have adjusted to need the
substances generated from the addictive activity, in order to
function.
• Without the substance/activity that generates the new levels
of neurotransmitter, the user experiences withdrawal and
intense cravings. This motivates the individual to engage in
the addictive activity to reduce these negative sensations.
32

33. Maintenance –
The role of Desensitisation
• When the brain is activated excessively and repeatedly
neurochemical homeostatic changes result in dopamine
receptors becoming less sensitive. This means that more
dopamine has to be generated to achieve the same effect.
• Not only is a greater amount needed, the desire for it is also
heightened too – a double whammy!
• Addicts need larger and more frequent doses to achieve the
desired effect.

34. 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

35. Maintenance – Smoking, Schachter
(1977) – Nicotine regulation
• Smokers regulate their nicotine intake.
• X11, 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 applications to real life e.g. taxing
cigarettes according to nicotine
content.

36. 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).

37. 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:

39. 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

40. The story of John & James.
• John Crawford has an identical
twin. His 16-year-old brother,
James, is his clone.
• John has brown hair, brown eyes,
and a cheeky smile. So does
James.
• John weighs about 160 pounds.
Ditto for James.
• The brothers walk the same, talk
the same—their friends tease
them because they even laugh
the same.
The reason, of course, is that identical twins share exactly the same genes, those tiny units
of hereditary material (DNA) that carry instructions for forming all the cells in the body,
directing their activity... and for behaviour and emotions?

41. Can addiction run in families?
Let us assume John & James have a parent who struggles with alcoholism…
Q: Are they destined by genetics to face the same fate?
A: Well the good news is that no single factor determines whether a person will
become addicted to drugs. That’s because genetics, biology, and environment all
influence a person’s risk for addiction (defined as a chronic yet treatable brain
disease characterized by compulsive seeking and use).
• So… while the saying may be that substance abuse, in particular , “runs in the
family,” as we will see later, a whole list of other risk factors, in addition to genes,
determine whether a person actually gets hooked: -
– Age
– Presence of other diseases
– Diet
– Stress
– Peer pressure

42. Research evidence
• Small et al. (2001) – used brain imaging to discover eating
chocolate was associated with increased blood flow in the
MDP. Motivation to eat more chocolate activated the same
parts of the pathway as did drug cravings.
• Comings et al. (1996) – concluded that neurotransmitters play
a role in behaviours such as gambling.
• Koepp et al. (1998) – concluded neurotransmitters were
implicated in addiction to video game playing.

43. The AAD Model
• There has been a historical negative stereotypical view of addicts. This view
presupposes that addiction is a disease with biological and environmental origins
(Hammersley 1999).
• It is known as the Addiction As Disease model (AAD).
• This view labels people, undermines the development of self-control and
stigmatizes them.
It’s assumptions: -
• Addiction is an illness
• The problem lies in the individual
• The addiction is irreversible
• You cannot be ‘slightly addicted’

44. Evaluation of neurological explanations
Friends
• Helps to account for vulnerabilities and
susceptibilities and also provides
information on why some may relapse
more than others (individual differences).
Foes
• Neurotransmitters have complex
effects which are not fully
understood. Which neurotransmitters
produce which rewards? Nicotine can
negatively effect memory and learning
and increase arousal but also positively
reduce stress...thus it is difficult to assess.
• Social interaction is underrated. Social
contexts as a motivator - e.g. Vietnam
soldiers took drugs but stopped once back
home (Robins et al 1975).Don't forget other
evaluative points too!
(Methods, IAD, Keywords
etc.)

45. More neurological model evaluation (AO2)
Reliability:
+ Objective – empirical evidence,
such as Lerman (2007) using brain
scans to measure CBF. Repeatable
and consistent methodology.
• + Application to everyday life –
Can affect anybody, provides
treatment of symptoms.
• + Treatments have a rapid effect.
• - Doesn’t combat the cause of the
addiction. Symptoms treated with
drugs.
Reductionist:
– Simplified into genetics and
biochemistry. Ignores
psychological or social
dimensions
Deterministic:
– the AAD model could cause
passive patients, with no sense of
responsibility.

46. The
model of addiction

47. Cognitive models of addiction
• Cognition is thinking – information processing.
• The Cognitive model sees addiction as due to ‘distorted
thinking’ relating to ‘dysfunctional beliefs’.
• These faulty processes relate to mood and impaired
decision making abilities and can be self-fulfilling.
• A person may come to rely on drugs or even gambling as
a way of coping with life’s problems.
• When these coping mechanisms are used excessively
they may create more problems than they solve.

48. Outcome of faulty cognitions
• Faulty thinking leads addicts to: -
a) Focus on positive features of their habit.
b)Minimise the negative consequences.
c) Have impaired decision making abilities.
• There is a focus on the immediate benefits
and ignoring of the long-term downside.

49. Cognitive explanations of gambling.
Faulty Thinking
• “I will win, I can control the
odds, if I use my lucky
numbers I'll be rich one
day.”
Irrational biases
• Overestimate the extent to
which they can predict or
influence the outcomes.
This also leads to a under
estimation of how much has
been lost/won.
• See Griffiths (1994)
Gamblers irrational
cognitive biases.

50. How do Heuristics apply to addictions
e.g. Gambling?
• Rule of thumb :The usual rules apply.
• Hindsight Bias: ’I knew that would happen’
• Flexible attribution: ’I’m really good at Blackjack, I lost on the roulette
because of the other bloke’
• Absolute frequency bias: ’I dont think about the
losses...I won loadsa money.....’
• Availability bias: Look how many people have
won the lottery....loads!!

52. Initiation of smoking and gambling –
Gelkopf et al, 2002
• Individuals intentionally use
drugs to treat psychological
symptoms from which they
suffer.
• It’s perceived as being helpful
to the individual.
• They could smoke to relieve
stress/anxiety, and gamble to
relieve depression, for
example.

53. Theories
1. The Relapse Prevention Model (RP)
• Dependency starts with a perception that ‘discriminative stimuli’ can
identified that are associated with a positive outcome.
• This perception provides the motivation to start the behaviour and then
maintain it..
• Relapse occurs when this perception has not been modified, so the
addition is still relied upon to provide the positive experienced in the
past.
• This model suggests that relapse will NOT occur if the beliefs/thinking
about reward have been modified AND (most importantly) the
belief/thinking that they do actually have the capacity to deal with the
trigger.

54. Initiation:
Expectancy – Smokers may think
they look cool.
Relieving boredom Positive feelings

56. Theories
2. Cognitive Dissonance
• This is the conflict between two opposing beliefs e.g….
“I am a drug addict”
+
“I want to be drug-free”
• People are suggested to cope with this conflict by establishing some
sort of justifying criteria (belief) for their failure to change . This
belief is used to support why they have no choice but to maintain
their addiction.
E.g. I don’t have the will power/I always fail.

57. 3. Beck el al (2001) ‘The Vicious Circle’
• Low mood can be relieved by addictive behaviour.
• Addiction can lead to problems.
• These problems lead to low mood.
• The circle begins again...
Low mood Using (smoking / gambling)
Financial, Medical, or social problems
Theories

58. Maintenance - Cohen and Lichtenstein
(1990):
• Vicious circle – Smoking alleviated stress,
causes illness, creates stress

59. 4. COPING: The Self Medication
Model
Initiation:
• Individuals intentionally use the addictive behaviour to
cope with stress / psychological problems.
• The particular addiction is not chosen at random but has
been selected as it is perceived to help a specific problem.
• It fulfils 3 major functions: -
1. Mood regulation
2. Performance management
3. Distraction
Maintenance and Relapse:
• Many smokers mention ‘stress relief’ as a major reason
why they persist with their habit.
Theories

60. 5. Self Efficacy Theory - Bandura (1997)
• Self-efficacy refers to a belief in oneself to be able to
organise and control any actions that are required to
meet particular goals.
• Self-efficacy plays an important part in whether or
not a person will start to engage in addictive
behaviour (initiation)…and whether they believe
they can do anything about it once established
(maintenance and relapse)
Theories

61. Key Research
Cognitive bias in fruit machine gambling -
Griffiths (1994)
• Compared 30 regular gamblers with 30 non regular
gamblers and measured their verbalisations as they
played a fruit machine.
• Regular gamblers believed they were more skilful than
they actually were and were more likely to make
irrational verbalisations during play (e.g. “putting only a
quid in bluffs the machine”) they tended to treat the
machine as if it were a person (e.g. “this fruity is not in a
good mood”).
• They also explained away their loses by seeing ‘near
misses’ as ‘near wins’. Something which justified their
continuation = irrational thinking.

62. 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.

64. Relapse – Self medication in smoking
and gambling:
• Self medicate in times of…
• Stress (smoking)
• Crisis (gambling)

65. Relapse:
Coping – Withdrawal symptoms may make it difficult to
cope with everday life without the emotional support
of the substance.
Expectancy – especially with smoking, it may seem
easier to quit 2nd time around?
Excitement – life without gambling may seem dull?!

66. Evaluation of the COGNITIVE Model
Strengths
 Cognitive explanations help explain individual
differences: e.g. millions of people have gambled but
not all get addictive, as not all develop faulty
cognitive biases (irrational thinking patterns)

67. Weaknesses
 Griffiths (1994) – found that regular players seemed
capable of gambling without attending to what they
were doing (on auto pilot), -they weren’t thinking
about it.
 This suggests that cognitive process were not a major
role in the maintenance of their addictive behaviour.
Evaluation of the COGNITIVE Model

68. Weaknesses contd.
• Publication Bias - Many studies have supported a link
between positive expectations and drinking behaviour and
other drug uses.
• However studies which have failed to show a link may not
have been published, which means we gain an
unrepresentative view of the research area
 Cognitive explanations may be limited to particular
addictions
 Have less effect in chemical addictions (smoking), but
more of a pronounced effect in gambling
Evaluation of the COGNITIVE Model

69. Cognitive model AO2
• Free Will – Individuals may
feel they can change but
also may feel they’re to
blame.
• Ecological
validity/Application to real
life – Addictions affect lots
of people in populations.
• Treatments – If it’s based on
faulty thinking, it should be
possible to be cured.
• Social desirability bias –
people may lie about how
often they smoke/gamble,
could affect reliability.
• Subjectivity – Methods of
diagnosis are not scientific.
• Self-report methods used to
gather data, lowered
reliability, increased
subjectivity.

71. • According to this approach, addiction is a
learnt behaviour.
• It is acquired via CLASSICAL, OPERANT or
SOCIAL LEARNING.

72. Reinforcement and biology
-a crossover!
• Classical and Operant
conditioning involves
stimulating pleasure centres in
the brain.
• Research: Olds & Milner (1954)
discovered rats would press a lever
for the reward of mild electrical
stimulation in specific areas of the
brain (artificial). They also pressed
the lever for stimulation of other
rewards such as food or sexual
activity (natural).

73. Role
modelling?
Social Learning

74. Things that make you go hmmm!!!
• Pleasure is an
important factor in
healthy development.
Would you eat
McDonalds/bar of
chocolate again if it
were not pleasurable?
• These feelings act as
reinforcers...therefore
pleasure encourages
essential behaviours...
or in some cases
unhealthy behaviours.

76. 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 .

77. Initiation (gambling) – Glautieret al
(1991)
• Classical conditioning – Good feeling from
addictive behaviour, associate the two

78. 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?!

80. 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

81. 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.

82. Maintenance of gambling –
Operant conditioning
• Gambling is
maintained through
small wins, which
provide operant
conditioning via
positive feelings.

83. 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

85. Relapse (smoking) – Cue reactivity,
Glautier et al (1991)
• 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 apply to
‘maintenance’.

86. Relapse (smoking/gambling) Marlatt
and George (1984)
• Marlatt and George found that
multiple trigger cues increase
the chance of relapse.
• If an addict comes into contact
with a trigger cue of
substance, after a period of
abstinence…
• They gain classical
conditioning – an association
with the trigger, making them
more likely to relapse.

87. Relapse – Negative reinforcement
(operant?)
• To avoid the negative reinforcement of
withdrawal symptoms.
• Could link to the fact that Rosenthal and
Lesieur (1992) found a positive correlation
between the number of hours spent gambling
and the extent of their withdrawal symptoms.

88. Learning theory AO2
• Nature/nurture? Based
on nurture, as it’s the
idea that behaviour is
learned from the
environment. We are
regarded as being born
as a TABLEAU RAZA
(blank slate)?
• Subjective – based on
observational methods
• Reductionist – Doesn’t
consider individual
differences, or
extraneous variables.

90. Areas covered: -
a) Individual Differences
- Personality
- Stress
- Peers
- Age
b)
- The influence of the Media

91. 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 

92. Self esteem – Kaufman and Augustson
(2008)
To investigate factors influencing smoking
behaviour...
• x7000 girls aged 13-18.
• Assessed regarding self-esteem,
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.

93. Kaufman and Augustson (2008) AO2
• Large sample size.
• Longitudinal study.
• All girls
• Longitudinal study
• No cause/effect can be
established.
• Questionnaires were
used, which can be
subjective.
• May also be influenced
by social desirability
bias?

94. Personality factors – Attribution theory
Proposes 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 for ourselves = ACTOR-OBSERVER
EFFECT.

95. Attribution theory – Hatgis et al (2008)
• Internal attributes (dispositional)
about drug taking varied between
a) those who had never taken drugs
before and b) those who had
experienced drugs or had friends that
experienced drugs before.
• Internal attributes more common with
cannabis use than alcohol or heroin.

96. Attribution bias – Seneviratne and
Saunders (2000)
Investigated attributions by alcoholics.
• 70 alcoholics were interviewed to find out
reasons why they themselves relapsed after
abstinence. These were compared to their
assessments of 4 relapse scenarios of other
people:
• Situational attributions were used for
alcoholic’s own relapse, such as party:
everyone was drinking.
• Dispositional factors were given for the
other scenarios, such as lack of will power.
• Shows actor-observer bias.

97. 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.

98. Vulnerabilities - Stress AO2
• Relates to real life as
many people have
addictions, therefore
has ecological validity
• Arguably, has mundane
realism.
• Quantitative data was
collected on those with
PTSD, which increases
reliability etc.
• Individual differences
(hardiness etc.).
• Extraneous variables.
• Simplistic? Only looks at
stressors, not biology?

99. 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 Social Identity Theory (SIT) and Social Learning Theory (SLT)

100. 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

101. 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?

103. Promoting addictions – Sulkunen
(2007)
• 140 scenes from 47 films were analysed.
• 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
today.
• Individual differences disregarded?
• Lots of different films used.

104. 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

105. 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 drugs.
• Raised self-efficacy (self help) and
showed the negative consequences
of drug use
• Hornik et al (2008) examined
results, which lead to an increase in
marijuana use… (awkward!)

106. Promotion - Boyd contrasted by –
Sargent and Hanewinkle (2009)
• 4384 adolescent participants (11-15).
• All were surveyed to see whether or not they smoked.
• All were exposed to watching smoking in movies over one
year.
• Findings: Whether or not they had smoked previously was a
strong predictor that they would still be smoking at the end of
the year.
Ethical issues (could cause smoking = harmful to participants)
Social factors not considered (reductionist).
Longitudinal study.

108. Theory of Planned Behaviour (TPB)
(cognitive)
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

109. 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 gain
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 do also.
Perceived behavioural control Whether behaviour is easy or hard to
carry out.
If you’re 18+, going and buying cigarettes
is pretty easy.

110. • If you have a positive outlook regarding
relevant attitudes, perceived behavioural
control, and also want others to accept you,
you are likely to carry out the behaviour.

111. Supporting TPB – Marcoux and Shope
(1997)
• Large sample of 14 yr old
participants.
• Using TPB to predict their alcohol
use.
• Peer pressure/peers were
significant variables.
• The model led to
recommendations for prevention
of alcohol abuse
• Reducing how readily available
alcohol was (taking control away
from individual)

112. 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.

113. 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?

114. 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!

115. 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.

116. 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

117. Psychological treatments:

118. 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’

119. 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’

120. • Siegel et al (1987) said
once put back into a real
environment, physical &
mental changes led to
relapse

121. 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?

122. 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

123. 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

124. 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

125. 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

126. 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

127. 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

128. 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

129. Public health interventions and
legislation:

130. 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

131. 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

132. 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.

133. Public Health AO2:
• Shown to work,
especially Platt.
• Some addicts may not
feel they can reach the
support they need
• Individual differences
• Issues in assessing the
impact
• Reductionist – not
including biological