The Psychology of Addictive Behaviour...khyxtdrzwxetrcytvubyiunoimiknoubyiutvcrytxecrfyvubyiunoim
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The psychology of
Addictive BehaviourCWs
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The Biological Approach to Gambling
Initiation: Role of genetics
SHAH ET AL
Twin study
Evidence of genetic transmission of gambling in
men
BLACK ET AL1STdegree relatives of pathological gamblers
more likely to also be pathological gamblers than
more distant relatives
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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
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ZUCKERMAN
Individual differences in stimulation
High sensation seekers have lowerappreciation of risk and anticipate arousal as
more positive than low sensation seekers
Therefore more likely to gamble
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Relapse:
BLASZCYNSKI ET ALPoor tolerance to boredom may contribute to
repetitive gambling behaviour
Pathological gamblers significantly highboredom prone scores than control groups of
non gamblers
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Evaluation of Biological Approach to Gambling
Explains individual differences
- Why some people develop pathological gambling and yet others
who experience same environment do not
- Diathesis-stress model also states how some may be more
vulnerable to addiction due to a genetic predisposition
Reductionist
- Ignores importance of external factors in development of
behaviour eg. Incentives (nature side of nature/nurture debate)
- Reduces complex phenomenon down to simple explanation
Deterministic
- Suggests individuals bound by their biology/genetics and have no
choice or free will in their actions
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BONNAIRE ET AL
Pathological gamblers who bet at race racks had higher
sensation seeking scores than those playing games available
in cafesConcluded 2 subgroups:
- racetrack gamblers (arousal)
- cafe gamblers (to avoid boredom)
Most popular current view is that gambling is a
product of biological factors plus external
factors
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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%
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Maintenance:
Nicotine causes release of dopamine, whichcreates short-lived feelings of pleasure which must
be repeated to avoid withdrawal symptoms
VINK ET AL
Nicotine dependence influences by genetic
factors
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Relapse
XIAN ET ALTwin 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 clustersassociated with quit success and nicotine
dependence with aim of matching treatments to
benefit smokers trying to quit
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Evaluation of Biological Approach to Smoking
THORGEIRSSON ET AL
Identified gene variant that influences nicotinedependence/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. Social context
of behaviour
- however regarding smoking as biological problem creates
possibility it may be treated by pharmacological methods
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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
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The Cognitive Approach to Gambling
Initiation: Self medication
GELKOPF ET AL
Individuals use pathological behaviours to treatpsychological 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
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Maintenance:
OEI + GORDONProblem 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
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Relapse: Just World Hypothesis
BLANCO ET ALGamblers 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
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Evaluation of the Cognitive Approach to Gambling
LI ET AL
Pathological gamblers who gambled to escape realityas opposed to those gambling for pleasure,
significantly more likely to have other substance
dependencies
Supports self medication explanation
BECONA ET AL
Depressive disorder evident in majority of
pathological gamblers
- Correlation
- Does not mean depression cause of gambling
- May be consequence due to personal/financial costs of
gambling
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BENHSAIN + LADOUCER
Possessing relevant knowledge does not make people less
susceptible to cognitive distortions
No difference found in trained statistics students and non statstrained students in susceptibility to irrational gambling related
cognitions
Implications for treatment;
- More than one motivation for becoming pathological gambler
implies there should be differing treatments
- In case of self-medicating gamblers, might be more beneficial to
treat underlying problems firstly
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The Cognitive Approach to Smoking
Initiation: Expectancy Theory
BRANDON ET AL
Behaviours escalate into addiction because ofexpectations individual has about costs and
benefits of the activity
MERMELSTEINExpectancy of positive mood states have been shown
to be reasons for adolescents beginning to smoke
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Maintenance:
BRANDON ET AL
As an addiction develops, activity influenced less by
conscious expectancies, more by unconscious
expectancies involving automatic processing
Explains loss of control smokes experience anddifficulties in abstaining
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Relapse:
Expectations of costs and benefits of smokingaffect an individuals 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
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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
- Research might focus on problematic behaviour eg. Heavy
smoking but does not consider loss of control
JULIANO + BRANDONSmokers reported greater expectancies that cigarettes alleviate
negative mood states and had a positive effect on weight
control compared with different forms of NRT
- Therefore positive expectancies do not generalise to NRT whichexplains modest success rates for smoking cessation
(implication for treatment)
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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
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The Learning Approach to Gambling
Initiation: Operant Conditioning
GRIFFITHS
Gamblers playing slot machines become addicted
because of physiological rewards (buzz fromwinning), psychological rewards (near miss) and
social rewards (praise from peers)also financial
awards if they win
Although they generally lose, greater weight isgiven to the experience of winning and so person
continues
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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 gamblingRespondents of such reinforcement gambled more
than others and intended to continue doing so
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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
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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 laterSuggests popularity among peers serves as positive
reinforcer in initiation of smoking
- Cannot establish cause and effect from correlations
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Maintenance:
Repetition leads to conditioned association between
sensory aspects of smoking (sight of cigarettes/smell of
smoke etc.) and reinforcing effects of nicotine
Over time, sensory cues become conditioned stimuliand activate same brain areas as nicotine, making
cessation difficult
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Relapse:
Cues associated with receiving nicotine (smell of
smoke etc.) increase likelihood smoker will respond to
these by smoking
LAWRENCE + RUBINSONThose who frequently smoke have less confidence in
their ability to abstain and are more likely to relapse
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Evaluation of The Learning Approach to Smoking
KARCHER + FINN
Youth whose parents smoked, almost twice as likely totake 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 2ndroom presented smoking unavailability cuesCues predicting smoking led to greater urge to smoke
therefore highlighting importance of conditioned cues
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LOPEZ ET AL
Gender bias in smoking addiction research
Women start smoking later than men and contexts of
smoking differs between gendersExplanations often fail to address these differences,
reducing validity of data
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Risk Factors in the Development of
Addiction
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Stress
Everyday stress:
People report that they drink, smoke, take drugs, gamble etc. as ameans 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, 15% alcoholics also suffered from PTSD
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Many smokers smoke to reduce stress yet smoking may actually
increase stress levels
- Stress may be risk factor for smoking addiction but smoking
doesnt 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:- Stress may be the result not cause of addiction
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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
- Unknown whether adolescents will conform to behaviours iftheir conflict with own concerns
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AgeInfluence 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 weget older
Peers have a greater impact on young adolescents
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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, therefore youth
appear more vulnerable
- Older people may become addicted but do not engage in it
publically/less media attention- This implies artificial link between age and addiction
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PersonalityConcept of addictive personality can explain why some people
become addicted when others dont, 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
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CLONIGER
3 personality traits predispose individuals towards substance
dependence:
- Novelty seeking- Harm avoidance
- Reward dependence
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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
di fl ddi i h i
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Media Influences on Addictive Behaviour
Film representations of Addiction:
SULKUNEN
Analysed 61 scenes from films that represented addictions
to alcohol, drugs, tobacco, gambling and sex
Competent use of drugs represented in a way of alleviatinga particular problem
WAYLEN ET AL
Found a significant relationship between adolescentsmoking and no. of films they had seen depicting smoking
Suggests media representations of smoking influence
teenagers to take up the habit
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SARGENT + HANEWINKEL
Surveyed adolescents and re-surveyed a year later
Of individuals who had not smoked when first surveyed,
exposure to movies with smoking over the year betweensurveys was a strong predictor of whether they had begun to
smokeexposure effect
BYRNE
Films important as they can educate public about addiction bycreating stereotypes eg. 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.
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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 drugsand so were more likely to start taking drugs
themselves
General E al ation of Media Infl ences on Addicti e
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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, many people are exposed
regularly but not everyone becomes an addict
- Shows media is not the only influence in developing addictions
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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
Ch i h i l i d
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Changing Behavioural Attitude
- individuals 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 isthought to be why it was successful
Ch i S bj i N
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Changing Subjective Norms
- individuals 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 dataabout % of people engaging in drug taking behaviour
Accurate statistical information corrects subjective
norms and contributes to an effective campaign
Ch i P i d B h i C l
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Changing Perceived Behaviour Control
- More control people believe they have over a behaviour,
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 ELEncouraging addicts belief in ability to abstain related to a
positive outcome
Enhancing self-efficacy should form primary goal of treatment
plans
E l ti f TPB
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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 tochange 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
- Not clear whether any one component of model (behavioural
attitude, perceived behavioural control etc.) caused the
behavioural change
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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 ALWhen pshad taken alcohol they showed increased
intentions to engage in risky behaviours
Therefore sober measurements may be invalid of actual
behaviour
Types of Intervention and their
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Types of Intervention and their
Effectiveness
Biological Interventions
Agonist Substitution eg. Methadone for heroin addiction
- Methadone mimics effects of heroin but it less addictive
- Drug user given increasing amounts of methadone toincrease tolerance to drug
- Does then decreased until addict no longer needs
methadone or heroin
Antagonist Substitution eg. Naltrexone for alcohol addiction
- Blocks the action of neurochemicals that provide rewarding
feelings as result of drinking alcohol
- Also found to be effective in reducing gambling behaviour
Immunotherapy
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Immunotherapy
- Antibodies created according to addictive substance
- When substance consumed, antibodies bind to it
- Prevent it from reaching brain
CARRERA ET AL
Developed antibodies for cocaine in rats
Rats no longer experienced effects of cocaine afterconsumption
E l ti f Bi l i l I t ti
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Evaluation of Biological Interventions
Some addicts can become just as reliant on methadone as they
were on heroin and therefore one addiction is merely beingsubstituted for another
Use of methadone is controversial:
- Stats show more than 300 methadone-related deaths in2007 in UK
- Consumption is unsupervised, created a black market in
methadone
KIM + GRANT
Naltrexone led to proven to be successful after 6 weeks of
treatment
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REAL WORLD APP + IMPLICATIONS FOR FURTHER RESEARCH
CARRERA ET ALs research suggests soon vaccinations for heroin,
cocaine and nicotine will be available for addicts in attempts to reduce
or halt their addictions.
- However, although data looks promising, extensive human trialsfirstly need to be conducted as the original study was carried out on
rats and due to their different physiological and genetic makeup to
humans, results from rats cannot directly be applied to us
Biological interventions may ignore the underlying reason for
the addiction in the first place
Addicts may relapse one the treatments (drugs) are halted
Psychological Interventions
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Psychological Interventions
Reinforcement
- Reward people for not engaging in the behaviour- Rewards act as positive reinforcers and so people continue to
not engage in the behaviour
SINDELAR ET ALTested people on methadone treatment
One group rewarded each time urine samples tested
negative
End of programme and reward group had 60% morenegative urine samples than control group
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CBT
- Goal is to help people change the way they think about their
addiction and learn ways of coping efficiently- Eg. in gambling, cognitive errors play part in maintenance,
CBT aims to correct these errors
SYLVAIN ET ALPathological gamblers given CBT and social skills training
Resulted in improvements maintained at 1 year follow up
Evaluation of Psychological Interventions
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Evaluation of Psychological Interventions
Psychological interventions focus on principles of operant
and classical conditioning (aversion therapy) rather than
why smoking, gambling or alcoholism started in the first
place
- If triggers still present in the persons 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, CBT makes sense as an effect form ofintervention
- However, so many different areas to CBT difficult to know
which are most effective eg. Teaching patients to correct
erroneous thinking or motivational interview
Public Health Interventions
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Public Health Interventions
Telephone smoking Quitlines
STEAD ET ALSmokers who received repeated quitline calls, increased
their odds of stopping smoking by 50% compared to smokers
who only received self-help materials
Doctors Advice
OGDEN
5.1% of smokers advised by their doctors were able to
refrain from smoking for 12 months afterwards
N f l i l i h l f d i
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No. of government legislation changes also enforced in attempts
to prevent addiction eg:
Smoking ban in public places
- However, followed by a rebound effect
- Increased outdoor smoking
Increasing cost of cigarettes
Controlling sales of cigarettes and alcohol
Evaluation of Public Health Interventions
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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
- Problem gambling during adolescents can lead to adverseoutcomes and interventions are preventing these
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