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ADDICTION PSYCHOLOGY
Amanda =]

MODELS OF ADDICTION
Biological model of addiction, including explanations for initiation, maintenance, and relapse

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GENES- DOPAMINE Initiation:

y y

Heritability estimates are 45%-79% Family studies:

Study of alcohol-use disorder showed high rates among relatives 36% of relatives of the individual diagnosed H/e difficult to separate the effects of genetic and environmental influences

Gene that predisposes people to dopamine-increasing activities + Role of dopamine:

y y y y

y y y y

Compensatory. Stimulate reward circuit. Repeated exposure=sensitised to desirability A1 variant of DRD2 gene has been linked to many addictions, like alcohol, cocaine heroine, nicotine A1 variant: fewer dopamine receptors in pleasure centre of the brain- DRD2 the reward gene People who inherit A1 variant more likely to become addicted to drugs that increase dopamine levels, as this compensates for the deficiency by stimulating what few dopamine receptors they do possess Research has shown addictive drugs stimulate reward circuit in the brain, causing release of dopamine, which tells the brain to repeat the behaviour. The mesolimbic dopamine system registers the value of important experiences, thereby creating lasting memories that link drug to pleasurable reward. Repeated exposure leads to increasing sensitivity of brain to desirability, which persists even in absence of continued exposure to drug. So they take drugs because seemingly rewarding and desirable. Predisposed to finding them rewarding. Evidence for this gene in addicts:

Alcohol: D2 Dopamine receptor gene has been linked to severe alcoholism. A1 variant was present in 2/3 if deceased alcoholics, whereas only 1/5 of deceased non-alcoholics has the A1 variant of the DRD2 gene. Researchers found increased prevalence of A1 variant in children of alcoholics. Smoking: Research found increased incidence of A1 variant in smokers- 49% compared to 26% of population. Men with A1 variant also started smoking earlier and had shorter periods of abstinence.

EVALUATION OF INITIATION

D2D2 and other disorders:

y y y

Comings et al found A1 variant occurred in people with many disorders like Tourettes equally to alcoholics. Present in 45% with Tourettes compared with 25% of controls This is problematic for DRD2 being a reward gene, as people with Tourettes arent thought to be especially pleasure seeking

Inconsistent research findings:

y y

Meta analysis found that 48% of severe alcoholics, 32% of less severe alcoholics, and 16% of controls are carriers of the A1 variant, supporting theory However several subsequent studies have failed to find any relationship

Does environment influence effect of dopamine?

y y y y

Experiment on monkeys found dopamine system can be influenced by social interactions Animals that lost social status also lost D2 receptors This has implications for humans- especially those with stress/poverty Volkow says that those who grow up in stimulating environment are protected- even if they dont have a naturally responsive dopamine system, because they can get excited about natural stimuli, and they dont need an artificial boost

Research support on mice:

y y y y

Researchers found that mice engineered to lack a particular brain receptor for dopamine dont develop a liking for cocaine, which humans/mice find addictive Mouse modified to lack D1 receptor dont self-administer cocaine when given the chance Normal mice will keep returning for more Reinforces the claim that dopamine has key role in addiction

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GENES- DOPAMINE

Maintenance:
y y y y

Chronic exposure downregulaton. Drugs must be taken to avoid withdrawal Chronic exposure results in reduction of activity of these positive reward circuits (associated with dopamine)- dowregulation. This generates chronic stress situation withdrawal symptoms, sadness, anxiety Negative state becomes dominant in driving force, so user no longer takes drug to obtain pleasurable experience (+ve reinforcement) but to avoid unpleasurable state (-ve reinforcement) Drug levels needed to trigger brain reward system increase

GENES- DOPAMINE

Relapse:
y y y y

Lasting memories cause addict to expect reward + lower self-control Drug becomes more important than other desires Although brain doesnt give much pleasure, brain recieves signals of imminent reward forcing addict to take drug again. Addicts have lasting memories of drug, and have learned to expect a reward from drug. Cues are reminders of the drug that cause release of dopamine and therefore predict a reward. This happens even when addict knows there will not be a reward because their self-control is weakened. The frontal cortex has becomes less effective at making decisions/judging consequences. Increases risk of relapse.

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EVALUATION OF MAINTENANCE/RELAPSE

Research support:
Researchers gave Ritalin, (which increases dopamine levels) to ppts Some liked it some hated it They produced brain scans and found those who liked it had fewer dopamine receptors that those who hated it y Concluded some people are particularly vulnerable to the rush of dopamine-enhancing drugs, but others have dopamine circuitry that cant take additional stimulation y Explains why some develop addiction, others dont
y y y

Reductionism:
Reduces a complex behaviour down to a simple explanation, imbalance of brain chemicals. Ignores other explanations like social context. y However this offers possibilities for medical treatment- regarding addiction as disease of brain creates possibility it may be treated by pharmalogical methods y More progressive than those that treat addicts as delinquents to be punished
y

Determinism:
If biochemical factors cause addictive behaviour, this is deterministic, with little room for free will, and no cognitive componenent is involved y This evokes moral questions as it suggests people should be held less accountable for their actions- perhaps punishment to be reduced, because not their fault? y Learning, cognitive and social approaches allow more free will
y

MODELS OF ADDICTION
Cognitive model of addiction, including explanations for initiation, maintenance, and relapse

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SELF-MEDICATION MODEL

Initiation:
Individuals intentionally use drugs to treat psychological symptoms they suffer from Specific drug selected b/c its perceived as helping with particular problem, so depends on specific effect desired. y The drug doesnt help but needs only to be percieved as doing so to become an addiction
y y

Maintenance and Relapse:

Individual maintains addictive behaviour because it has desired effects Individuals with addictive behaviour only appreciate acute effects, not chronic, so keep taking the substance because it has desired effects. y Smoking:
y y

Initial rush of nicotine provides stress relief, but chronic stress effect that prevents relapse Many smokers say they persist smoking because of stress, but smokers have higher stress levels, and their stress levels decrease when they stop smoking. When they relapse, stress rises again. This is explained because each cigarette has acute effect on stress, because it relieves the withdrawal symptoms that arise when smoker cant smoke. However there is chronic effect from smoking that increases stress. Suggested people are able to consider present and future consequences, but attach too much weight on immediate rewards E.g. at moment of smoking, unable to appreciate LT benefits of refusing Preference for immediate gratification over future benefits- cognitive myopia. So they make choice based on immediate reward- acute relief from psychologcial symptoms

Research support: Ainslie:

EVALUATION OF SELF-MEDICATION MODEL

Research support:
y

Central feature of model is that substance-abuse disorders are associated with failures of ego control. Ego control represents the ability to control impulses to self-medicate through drugs and alcohol Meta analysis of 10 studies found that addicts showed significant failure in ego control compared to control group.

Problems of Cause and Effect:

y y y

Model suggests that psychological distress must precede drug use, as former necessitates the latter It is difficult to establish a causal relationship, as the psychological distress may be caused by drug abuse H/e research support: sexually abused women were more likely to turn to alcohol and drugs to remove sexual inhibitions than non-abused women However cant explain addiction in absence of psychological problems

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RATIONAL CHOICE THEORY- (BECKER AND MURPHY)

Initiation:
y y

Economic model of addiction- addiction as rational choice Uses concept of utility- measure of relative satisfaction resulting from consumption of particular good. To calculate utility individuals must weigh up costs incurred against benefits they are likely to receive. Addiction is experiences as an increase in the consumption of goods, because the individuals have made a rational choice concerning current and future utility of it.

Maintenance and Relapse:

y y

Addicts are rational consumers who look ahead and behave in way that maximises the preferences they hold They believe cost of giving up activity, (withdrawal, alienation), are too high, and satisfaction good enough to continue the behaviour

EVALUATION OF RATIONAL CHOICE THEORY

Research support (Griffiths):

y y y y

Exception should be gambling, as RCT would predict that gamblers (particularly those that lose) shouldnt continue Griffiths offers explanation for this, based on the cognitive bias that distorts reasoning of gamblers Compared 30 regular and 30 non-regular gamblers in terms of verbalizations as they played on slot machine Regular gamblers:

Thought they were more skilful than they actually were More likely to make irrational verbalizations while playing + Treated machine as person Explained losses by seeing near misses, not near wins- so they werent constantly losing, but constantly nearly winning which justified continuation.

Explaining restraint:
y y

Explains why some addicts can simply stop If any activity measured in terms of utility, they may reach point where life is so unpleasant, and prospect of better life without addictive behaviour so strong, they decide to stop. E.g. pice of cigarettes may outweigh pleasure gained

Implications for treatment:

y y y

Addictive substances can be treated in same way as any other consumer behaviour- changing utility E.g. maing more expensive, harder to get, or illegal Cost of continuation outweighs benefits

Determinism:
y y y

Cognitive approach suggests addictive behaviour is based on false beliefs By changing these beliefs, people can excecise free will and remove addictive behaviour Approach moves emphasis on behaviour that is determined to behaviour that is the product of free will

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MODELS OF ADDICTION
Learning model of addiction, including explanations for initiation, maintenance, and relapse

INITIATION- SOCIAL LEARNING THEORY

Learning takes place through observation, arousing different outcome expectations and motivations We do not need to experience directly the consequence of behaviour. Individual learns consequence by observing and communicating with others Any positive consequence observed in role model (e.g. approval from friends, physiological effects) will result in repeated drug use, acting as positive reinforcement. (Vicarious reinforcement). Individuals come to recognize that different types of drugs have different effects and therefore arouse different outcome expectations, triggering motivation to use particular type of substance

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EVALUATION OF SLT

SLT and internet addiction research:

SLT proposes addictive behaviour can be explained by outcome expectancy- the expectancy that engaging in a behaviour will have positive or negative outcomes. y Second factor is self-efficacy- belief they can refuse to engage in a behaviour y Lin et al tested these factors for internet addiction on sample of 4450 college students in Taiwan. y Found positive outcome expectancy significantly predicted the level of internet addiction, although this was mediated by the second factor, refusal self-efficacy (measured by the Refusal Self-efficacy of Internet Use Questionnaire). This was significantly and negatively correlated with level of internet addiction.
y

Research support for group influence:

Group influences have been found to be the primary influence for adolescents who smoke or use drugs y Smokers likely to associate with other adolescents who also smoked- shows influence of peer group y This tendency to conform to the norms of reference group and imitate behaviour of admired peers has led to development of treatment programmes that aim to teach adolescents skills to resist influence.
y

Implications of self-efficacy for relapse:

Concept related to SLT explanation is self-efficacy: persons belief in their ability to succeed in a particular situation y Adults: those who smoke more frequently have less confidence in their ability to abstain y Adolescents: self-efficacy predicts the onset of smoking, and progression from experimental use to regular use
y

MAINTENANCE- OPERANT CONDITIONING

After repeated exposure to addictive substance, withdrawal symptoms appear if drug is discontinued. (Withdrawal symptoms are compensatory reactions that are opposite of effects of drugs) Withdrawal symptoms reduced by engaging in behaviour again (maintenance/relapse) Because unpleasant, reduction in effects is negative reinforcement- the reinforcement of behaviour that terminates aversive stimulus

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OPERANT CONDITIONING EVALUATION

Weaknesses:
y y y

Many people take addictive drugs. Not all become addicted. Psychological factors must be involved limited

Strengths:
y

Process of developing addiction doesnt require conscious thought. This can explain why addicts experience conflict between conscious desire to abstain and the motivational forces impelling them to continue

Evolutionary significance of occasional reinforcement:

y y

Explains addiction as due to desired consequence. However in real life this positive consequence is likely to be occasional, not consistent, as sometimes the addictive substance wont have positive outcome The evolutionary advantage of learning from occasional reinforcement is: as the world is an unpredictable place, organisms need to be able to learn adaptive behaviours that work to their advantage on average Therefore if substance provides occasional positive outcome, pattern of drug-taking becomes established and maintained

RELAPSE- CLASSICAL CONDITIONING

Addiction maintained by threat of withdrawal symptoms, produced by cues as CR Wikler found patients treated for drug addiction experienced withdrawal symptoms if they returned to place associated with former drug use. Explanation:
y y y y

Withdrawal symptoms are unavoidable physiological response in drug takers who do not get regular fix Addict reacts by seeking out next dose. This exposes them to environmental cues- coming in contact with cues means higher risk of relapse after period of abstinence. These cues become a conditioned stimulus which produces conditioned response of withdrawal symptoms in anticipation of effects of drug- positive outcome expectations They relapse b/c motivated to take drug to alleviate symptoms

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MODELS OF ADDICTION
Explnations for specific addictions: SMOKING

Psychosocial motives- Image:

y y y y y y y

SOCIAL FACTORS
Smoking usually begins in adolescent years. Driven by psychosocial motives; conveys message of toughness and adulthood Message conveyed in peer group is that smoking promotes popularity Jarvis suggests children who favour this view come from deprived backgrounds that approve of smoking or where smoking common So child starts smoking to obtain positive reinforcement of peer approval. However first experience of smoking usually unpleasant- cant explain why children persist despite punishment Jarvis suggests desired image conveyed is sufficient for smoker to tolerate initial unpleasantness. After this they tolerate and crave nicotine. Children imitate behaviour of role models Role models exercise influence if they are of same age/sex/ethnic background. Higher status = stronger influence Children observe role models smoking and finding it rewarding. Although children originally find smoking unpleasant, they persist b/c observation leads them to expect future enjoyment Parents: Children 2x as likely to smoke if parents are smokers. If parental attitudes are firmly against smoking, child is 7x less likely to start.

SLT:
y y y y y

Gender bias in smoking research:

y y y

Researchers argue there is an inherent gender bias in much research relating to smoking addiction- so cant be applied to both The onset of smoking, and development of smoking addiction follows different pattern in men and woen Researchers found women start smoking later than men, and that there are gender-related differences in relation to both stages and context Research supports claim smoking in adolescence is associated with peer popularity Found positive predictive relationship between smoking (for boys only) at 16, and popularity 2 years later So smoking is motivated by reward of peer approval and the image associated with it Researchers suggest an increased awareness of smoking among older children would make smoking seem less mature, and decrease incidence.

Evaluation: Research support (Mayeux et al):

y y y y

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PHYSICAL AND PSYCHOLOGICAL EFFECTS

OF NICOTINE

Nicotine affects brain chemistry activates nicotinic acetylcholine receptors in brain, which activate dopamine in the nucleus accumbens Causes temporary pleasure Smokers experience impariment of mood/concentration soon after Alleviated by smoking another cigarette The withdrawal creates a cycle of maintenance throughout day, where smoker repeats cycle many times to avoid withdrawal symptoms experienced when not smoking Evaluation: Research support:
y y y y

Study supports claim LT smoking has adverse effect on mood because it alters brain chemistry Found incidence of depression was highest in current smokers and lowest in those who had never smoked Among smokers prevalence of depression highest in those trying to quit Suggests people smoke because of the adverse effect on mood which is alleviated temporarily by cigarettes

SOCIOECONOMIC STATUS AND NICOTINE

ADDICTION

Smoking addiction strongly associated with social/economic disadvantage Poorer smokers have higher levels of nicotine intake This is why deprived smokers find it harder to stop smoking Evaluation: Research support
y

Specific types of neighborhood + poor housing conditions, correlated with socioeconomic status, found to be significantly correlated with smoking addiction Concluded interventions that dont specifically target smoking but instead contribute to improving poor smokers living conditions are necessary to decrease smoking

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MODELS OF ADDICTION
Explanations for specific addictions: GAMBLING

BIOLOGICAL FACTORS: GENES

Twin study (Shah) found evidence of genetic transmission of gambling in men Black et al found first degree relatives of pathological gamblers were more likely to suffer from pathological gambling than more distant relatives- genetic link Comings et al suggested the genetic process involves the genes controlling activity of brain NTs dopamine/serotonin/noradrenaline b/c:
y y y

Motivating factor for gamblers is the high they experience when they seem close to winning Certain NTs rise after winning streak Raised levels of dopamine and noradrenaline have been found in people after episodes of gambling, and in pathological gamblers before gambling

Evaluation: What is inherited?

y y

Genetic predisposition for gambling may work indirectly through trait of impulsivity Studies have supported this, demonstrating impulsivity is a significant predictor for development of pathological gambling

Evaluation: Disentangling genes and environment:

y y y

In Shah study, it wasnt possible to discern whether familal similarity for pathological gambling was due to genetic or environmental factors However in analysis of relative influence of these factors, researchers found that 64% of variation in risk for pathological gambling could be accounted for by genetic factors alone Familiar environmental factors were less significant

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SENSATION-SEEKING AND BOREDOM AVOIDANCE

Sensation seeking:
y y y y y

Individual differences in the need for optimal amounts of stimulation Pathological gamblers are high sensation seekers and need intense stimulation and excitement Sensation seekers look for varied + novel experiences High sensation seekers have lower appreciation of risk and anticipate arousal as more positive 2 reinforcers in gambling:

+ve reinforcement produced by states of high arousal during periods of uncertainty +ve arousal produced by winning

Boredom avoidance Poor tolerance for boredom contributes to repetitive gambling behaviour Pathological gamblers had significantly hgiher boredom proneness scores than control group of non-gamblers. But no differences between different types of gambling Evaluation: Lack of research support
y y

Claim gamblers are higher sensation seekers has received little support Researchers found that those who exclusively betted on horse racing in off-course betting shop were lower on sensation seeking than non-gamblers

Evaluation: Are there differences between different types of gambling

y y

Researchers found casino gamblers were higher sensation seekers than general population Researchers looked at 1 group that gambled in cafes and 1 group who betted on horses in racetrack. Pathological gamblers who bet on racetrack had significantly higher scores on sensation seeing. This led researchers to conclude 2 clinically distinct subgroups of gambler:

Gamblers who play active games, and who gamble for arousal produced by game- racetrack gamblers Gamblers who play passive games and who gamble to avoid unpleasant emotional states- caf gamblers

Findings support view gambling cant be seen as homogenous activity

WITHDRAWAL
Stopping gambling causes same withdrawal symptoms as stopping drugs 60% of pathological gamblers reported physical side-effects during withdrawal, including loss of appetite, insomnia These were sometimes more severe than those reported by comparison group during withdrawal of drugs

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FACTORS AFFECTING ADDICTIVE

BEHAVIOUR
Vulnerability to addiction, including self-esteem, attributions, social context

SELF-ESTEEM

Low self-esteem associated with dependency behaviours As low self-esteem results from falling short of ideal self, it may be individuals with low self-esteem are more vulnerable to dependency disorders to escape reality Baumeister: low self-esteem causes people to behave in selfdefeating ways to escape self-awareness Research: Taylor et al:
y y

Sample of 872 boys, info collected over 9y Those with low self-esteem at 11y at higher risk for addiction (esp drug dependency) at 20y People with low self-esteem scored higher on Mobile Phone Problem Usage Scale Lower self-esteem predicted problem use of mobile phones People with low self-esteem have greater tendency to seek reassurance from peers, so more likely to use phones inappropriately Internet addiction was more common in people with lower levels of selfesteem Self-esteem was good predictor of internet addiction and time spent online

Research: Bianchi and Phillips:

y y y

Research: Armstrong et al:

y y

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EVALUATION OF SELF-ESTEEM

Cause or consequence?
y y y y y

Difficult to establish causal relationship between addictions and low self-esteem. Low self-esteem may cause increased usage But addiction may cause people to become more socially isolated, leading to lower levels of self-esteem Needs to be addressed in longitudinal studies E.g. phone study:
Heavier mobile phone usage leads to poor self-esteem by generating problems associated with inappropriate use (high phone bills) Poor self esteem leads to higher usage and greater likelihood of inappropriate use

ATTRIBUTIONS

The explanations people give for their own and others behaviour Addicts see their dependency as due to external/situational factors + others dependency as due to internal/dispositional factors. This is the attributional error- makes addicts vulnerable Attribution explains why addicts relapse, as they will explain attrutions as due to external factors, (e.g. stress), which they see as beyond their control. So someone with external attributional style more vulnerable Researh: Eiser
y

Smokers attempted to resolve discomfort experienced from conflicting cognitions about their behaviour by attributing their smoking to forces outside of their control Being addicted to nicotine gave explanation of why they still smoked despite health risks Smokers who were labelled as heavy smokers shifted their attributions from internal to more external, to become more consistent with addiction To explain their now diagnoses status as heavy smokers, they produced explanations to justify behaviour, absolving of responsibility

Research: Davies
y y

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EVALUATION OF ATTRIBUTIONS

Detrimental nature of attributions of addiction:

y y

Eiser suggested if smokers saw selves as addicted this would be major obstacle to behvaiour change By endorsing users adopting of the addictive label, agencies may create self-fulfilling prophecy whereby addicted smokers perceive they arent in control of (and so not responsible for) behaviour causing failure to chnage

Gender bias:
y

Hatgis found men and women attributed more personal responsibility for drug and alcohol related problems to men than women Thus men more susceptible to making judgements biased by gender with male drug and alcohol users being held more personally responsible

SOCIAL CONTEXT

Socicultural background:
y y

Predicts substance misuse Hall et al found people who:

Are from lower socioeconomic backgrounds Grow up in areas with high crime rates Have completed fewer years of education + performed poorly in school

are more likely to develop problem substance use and have greater vulnerability

Social identity theory

y y y

Group members adopt norms and behaviours central to the social identity of their group In peer-group, where status as smoker/non-smoker is essential to identity of group, individuals are likely to be similar in their smoking habits Research:Smokers befriend smokers, and v.v.

SLT:
y y y y y y

Behaviours learned through the observation of others and modeling of this behaviour Young people most likely to imitate people that they have most social contact with Once they have started smoking, experiences with it determines whether they persist Parents with permissive attitudes towards drug use have children who are more likely to start taking drugs Older brothers drug use and attitudes towards drug use has been shown to influence younger brothers drug use Adolescent problem gambling has been shown to be strongly related to parental attitudes. Youth problem gamblers are more likely to have parent with gambling problems and many parents of young gamblers unconcerned about childrens gambling

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EVALUATION OF SOCIAL CONTEXT

Age difference in influence:

y y y

Influence of peers on smoking/drugs wanes in later adolescence, decreasing with age Influence of close friends + romantic partners on health-related behaviours becomes increasingly important with age Thus social crowd has greater impact on younger adolescents, but best friend/romantic partner more important later

SLT research support:

y y

Research supports claim that exposure to peer models increases likelihood that teenagers will begin smoking There is support for the claim that percieved rewards, like social status and popularity, are part of the explanation of why adolescents begin smoking and why they continue to smoke

SIT- extent of influence:

y

Although there is evidence that adolescents are motivated to begin smoking by stereotypes they hold of specific social crowds, little is known about the extent to which these groups influence their members to smoker Little known about whether adolescents are impervious to the demands of their social group when these conflict with concerns to maintain healthy lifestyle

GENERAL:

Ethical issues in addiction research:

y y

y y

Lee suggests that research in sensitive areas creates particular ethical issues Threat of sanction- involves possibility that research may reveal information thats stigmatizing/incriminating E.g. interviewing people with drug addiction who may reveal illegal behaviours in interview When designing study must way up potential benefits, (e.g. possibilities for intervention), against potential risks, (e.g. further discrimination)

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FACTORS AFFECTING ADDICTIVE

BEHAVIOUR
The role of the media in addictive behaviour

RESEARCH INTO FILM REPRESENTATIONS OF ADDICTION

Sulkunen:
y y y

Analysed 61 scenes from films Films about drug-users like American Beauty presented scenes of drug competence, and enjoyment of the effects. This enjoyment was contrasted with dullness of ordinary life. The competent use of drugs was also presented as alleviating a particular problem

Gunaskera:
y

Reviewed 87 of most popular films of last 20 years for portrayal of drug usage:

Films in cannabis (8%) less common than those portraying alcohol intoxiction (32%) and tobacco use (68%), but tended to portray the use of drugs positively, without showing negative consequences The study found that only of films was free from negative health behaviours like smoking

Support: Roberts et al looked at pop videos. Drugs were rare, but when they appeared they were portrayed neutrally

Evaluation
y

Research support:

Few studies have documented whether representations in media have effect Researcher tested whether adolescent exposure to smoking in the movies influenced initiation into smoking Surveyed over 4000 adolescents, 11y-15y, who were re-surveyed 1y later In those individuals who had not smoked when first surveyed, exposure to movie smoking the intervening year was strong predictor of whether they began to smoke when re-surveyed 1 year later Boyd argues films dont portray addiction in positive glamorized way, and that they do represent the negative consequences of alcohol/drug dependence E.g. illegal drug use and addiction are depicted by: Physical deterioration (e.g. unkempt bodies) Sexual degradation (e.g. rape) Violence/crime Moral decline (e.g. stealing from loved ones)

Alternative perspective:

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ROLE OF MEDIA IN CHANGING ADDICTIVE BEHAVIOUR

Television support for problem drinking:

y

TV series called Psstthe really useful guide to alcohol was evaluated:

Viewers compared with matched controls who didnt watch Although results showed improved alcohol related knowledge, it didnt show change in alcohol consumption Found intervention group was more successful than control group in achieving lower risk problem drinking, a difference maintained 3m later when followed up

TV series called Drinking less? Do it yourself was evaluated (Kramer):

Anti-drug campaigns:
y y y

Anti-drug campaign by US congress put in place. It revealed no overall effects It had unintended effects in favour of cannabis- individuals who had been uninterested in the drug reported intention to use it Why?

Anti-drug advertising contains implicit message that drug use is commonplace. Those who saw the campaign ads interpreted that their peers were using marjuana, so more likely to use it themselves.

Evaluation:
y

Methodological problems with Kramer study:

Study involved intervention group that watched the series and control group that remained on waiting list for same treatment. Problems with this: Intervention group received weekly visits from the researchers, so this may have had positive outcome Waiting list group was aware it would receive treatment soon, so may have postponed behavioural change This would have inflated magnitude of difference between groups

Causality:

Most evidence about media effects on addictive behaviour is correlational. So we cant assume that there is a causal relationship, as a 3rd intervening variable, common to the other 2, may cause the relationship.

EFFECT OF ADVERTISING

3rd person effect:

y y y y y

People believe that media messages have greater impact on other people on themselves-3rd person effect Researchers used 194 adults in place where gambling was legal They did survey on gambling behaviour/attitudes Evidence found for 3rd person effect Percieved effect of adverts predicted the desire to censor adverts

Children:
y

Charleton found that viewing cigarette ads made children associate smoking with looking grown-up and having confidence Well-established support for the idea that media influences young children they dont question credibility

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REDUCING ADDICTIVE
BEHAVIOUR
Models of prevention, including theories of reasoned action and theory of planned behaviour

THEORY OF REASONED ACTION

Looks at factors involved in how people decide action. Uses beliefs to predict behaviour. If we can predict behaviour, we may be able to change it Persons voluntary behaviour predicted by an interaction between the individuals attitude towards that behaviour and how they think others will view it:
y

Attitude: The individuals attitude towards the behaviour (i.e. how desirable it seems to be). This is based on beliefs about the consequences of behaviour, and appraisal of value of consequences, (good or bad?) Subjective norm: the individuals subjective awareness of social norms relating to that particular behaviour. Subjective norms are beliefs about what we think significant others feel is the right thing to do (injunctive norm) as well as perceptions of what people are actually doing, (descriptive norm)

Attitudes and norms arent always equally weighted- depends on individuals personality and on situational factors- e.g. if someone doesnt care what others think, less likely to attach much weight to social norms Gambling:
y y y

TRA holds behaviour is rational, and that gambling activities can be explained in terms of gambling attitudes and subjective norms Moore et al found in sample of adolescents and adults that TRA predicted gambling frequency and problem gambling Subjective norms and attitudes predicted intentions to gamble, and intentions to gamble predicted actual behaviour.

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THEORY OF REASONED ACTIONEVALUATION

Problems of determining intention:

y y

Attitudes/intentions that are assessed by questionnaires may be poor representations of the attitudes/intentions that take place in behavioural situations, so poor behavioural predictors E.g. smoker may develop negative attitude toward cigarette based on threat to health, and intend to quit. However intention and behaviour may differ when they find themselves with heavy smokers

Intention and expectation:

y

y y

It has been argued a distinction should be made between behavioural intention (which refers to persons plans for future behaviour, and behavioural expectation, (which refers to the percieved likelihood of performing a particular behaviour) E.g. a smoker may think it likely they have given up in 5 years (expectation) without definite plan to give up (intention) Although intention may have a causal effect on behaviour, a behavioural expectation alone is less likely to do so

Influence of alcohol and drugs:

y y y y

Influence of alcohol and drugs can produce disrepancy between measured intention and actual behaviour Attitudes measured when sober, when risky behaviours like gambling take place under influence of drugs/alcohol This is cognitive myopia: tendency for alcohol to decrease cognitive capacity so that only the most obvious characteristics of a situation are attended to McDonald et al found alcohol intoxication increased measured intention to engage in these behaviours

Culture bias and the TRA:

y y

Bagozxi et al: The TRA was developed in the US, an individualist culture, emphasizing variables that focus on internal states, such as attitudes. They suggest that b/c of this it might be expected to apply more to Western cultures

THEORY OF PLANNED BEHAVIOUR

Emphasizes belief that behaviour is under conscious control of the individual TRA was extended by Azjen to include percieved behavioural control, similar to self efficacy- belief individual can carry out the behaviour to achieve a desired outcome Behavioural intentions outcomes of following beliefs:
Attitude: this can be positive or negative evaluation of the behaviour combined with outcome (e.g. giving up smoking is a challenge and will improve health) y Subjective norm: perception of social norms to perform the behaviour, and an evaluation of whether the individual is motivated to comply with this pressure (e.g. my friends will approve) y Percieved behavioural control: belief individual can carry out a particular behaviour based on a consideration of the internal control factors, (e.g. skills), and external control factors, (e.g. obstacles). These weighed up in light of past behaviour.
y

These 3 factors interact to form behavioural intention which leads to actual behaviour. Percieved behavioural control is assumed to act either on the intention to behave in a particular way, or directly on the behaviour because:
The more control people believe they have over the behaviour, the stronger their intention to perform the behaviour will be y An individual with higher perceived behavioural control is likely to try harder and longer than someone with low percieved behavioural control
y

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EVALUATION- THEORY OF PLANNED BEHAVIOUR

Research support:
y y y

Many studies have shown intentions can be predicted from the 3 components of TPB Meta-analysis (Armitage et al) found PBC added extra 6% of the variance of intention compared to the assessment of attitude and subjective norm alone Questionnaire given to gamblers on their gambling, social norms, attitudes, PBC, and behavioural intention. There was +ve correlation between attitudes and behavioural intentions and actual behaviour Interviews were taken to assess whether TPB can explain gambling behaviour. Attitudes and norms were seen as important. PBC wasnt important predictive factor

Predicts intention instead of behavioural change:

y y y

Armitage et als meta-analysis predicted intention to change, not actual behavioural change This pattern of results is typically found in prediction of health behaviours (like quitting smoking) that requires difficult behavioral change This suggests TPB is primarily an account of intention formation, rather than specifying the process involved in translating intention action

Too rational:
y y y

Both theories criticized for being too rational, failing to take emotions/compulsions/other irrational determinants of behaviour into account When filling out questionnaire on attitudes and intention people may find it impossible to anticipate strong desires that compel their behaviour in real life Presence of strong emotions can also explain why people sometimes act irrationally by failing to carry out intended behaviour (e.g. quit smoking) even when its in their best interest to do so.

REDUCING ADDICTIVE
BEHAVIOUR
Types of intervention, including biological, psychological, and public health interventions and legislations, and their effectiveness

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BIOLOGICAL

Aims for complete abstinence must manage withdrawal symptoms Smoking:

y

Nicotine replacement therapy:

Nicotine medications mimic/replace effects of nicotine. Relieve withdrawal symptoms. Provide +ve reinforcement b/c of their arousal and stress-relieving effects They desensitize nicotine receptors in the brain. This means if person relapses and smokes cigarette while on nicotine replacement therapy, cigarette will be less satisfying. Antidepressant that increases levels of dopamine and noradrenaline, simulating the effects of nicotine in these NTs It blocks nicotine receptor, reducing positive reinforcement from cigarette

Buproprion:

Heroin:
y y y

Methadone mimics effect of heroin, but is less addictive Produces feelings of euphoria, but to lesser degree Initially addict is prescribed slowly increasing amounts to increase tolerance. This dose is then slowly increased till heroin/methadone not needed any more.

EVALUATION-BIOLOGICAL THERAPY

Problems with nicotine:

y

Currently available NRTs (e.g. parches) deliver nicotine into blood more slowly than cigarettes. For most smokers, not as satisfying, and some will give up therapy and relapse. Harmfulness of nicotine:

Increases heart rate + BP, aggravates diabetes, tumour promoter Can have adverse effects on fetuses, and its not desirable to use nicotine during pregnancy However if the althrnative is cigarettes, nicotine is less harmful.

Problems with methadone treatment:

y y y

Some drug addicts become as reliant on methadone as they were on heroin, constituting 1 addiction for another Methadone 300 deaths in 2007 For majority of addicts, methadone consumption unsupervised created a black market in methadone, with addicts selling doses for 2.

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CBT:
y y y y y

PSYCHOLOGICAL

Based on idea addictive behaviours are maintained by persons thoughts about these behaviours Goal is to change the way people think about their addiction (challenge faulty thinking patterns) and learn new ways of coping more effectively with circumstances that led to addiction (e.g. peer pressure). E.g: in gambling addiction, cognitive errors like the belief individual can control and predict outcomes maintains gambling. CBT corrects these errors, reducing urge to gamble. Because relapse associated with marital problems (esp alcoholics), CBT programmes include alcoholics spouse, and this helps them improve communication/problem-solving skills Shown to be reasonably effective, but most effective when used in combination with medication. In study of alcohol-abusers, 14% abstention in CBT group, compared with 38% in group that received both.

Reinforcement:
y y y y y

Giving people rewards for not engaging in the behaviour Sindelar et al investigated whether monetary rewards better patient outcomes for people on methadone treatment programmes Ppts randomly allocated to reward/no-reward condition and both groups received usual care Ppts in rewards condition drew prizes of various monetary value each time they tsted negatively for drugs Drug use dropped: negative urine samples 60% higher

Aversion therapy:
y y

Based on idea of punishment Rapid smoking:

person sits in closed room and puffs cigarette every 6 seconds Nausea. Smoker associates unpleasant feelings with smoking, so develops aversion to cigarettes Evidence to suggest this helps, esp when used in multi-component programme. However results havent been consistent across studies Risk associated with people w/ cardiopulmonary disorders Given drug antabuse that makes them sick when alcohol consumed, establishing link/association between alcohol and vomiting. But requires person to take drugs in first place, and they may be unwilling

Antabuse:

EVALUATION- PSYCHOLOGICAL THERAPY

Reinforcement interventions dont address underlying problem:

y

y y

Although research has shown effectiveness of reinforcement therapies, such interventions dont address problem that led to addiction- Treats symptoms not cause So although specific behaviour reduced, benefits may be short-lived, or individual may engage in different addictive behaviour instead E.g. drug addict compulsive spender

86%

Research support for CBT (Ladoucer):

y y y y y

Randomly allocated 66 pathological gamblers to CBT group or control waiting group Of those who completed treatment, 86% no longer fulfilled DSM criteria for pathological gambling After treatment, gamblers had better perception of control over their gambling problem, and increased self-efficacy Maintained at 1y follow-up Support: Sylvain evaluated effectiveness in sample of male pathological gamblers. Treatment included cognitive therapy, skills training, relapse prevention. Found significant improvements after treatment, maintained at 1y follow-up

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NIDA study:
y y y y y y

PUBLIC HEALTH LEGISLATION

Gvt sponsored study, designed to intervene in cycle of social problems associated with drug use In this study, provision of a combination of group and individual drug counseling significantly reduced cocaine use. Study enrolled 487 patients who were randomly assigned to 4 treatment groups All treatment decreased days of drug use in previous month from 10 days at start to 3 days a year later. Individual drug counselling combined with group drug therapy worked best, at 6m mark only 39% reported using cocaine in previous month So study significantly reduced cocaine use Increasing taxes to increase the cost There seems to be relationship between cost of cigarettes and alcohol and the amount that is bought Increasing cost will encourage people to stop, and will prevent children from starting in first place Cognitive: may be powerful factor when weighing up perceived costs against perceived benefits However political reasons makes this difficult

Increasing the cost:

y y y y y

Restricting/banning advertising:
y y y y y

Advertising promotes idea smoking/drinking are sophisticated- SLT Ban would remove this source of learning In 2003 cigarette advertising was banned Ban on adverts that would have strong appeal to those under 18- cannot portray role models that would have particular relevance for young people, or associate drinking with youth culture American study of people 15-26 years found strong correlation between number of adverts for alcohol they watched and the amount of alcohol consumed Ban on smoking in public buildings Evidence suggests smokers have found the law has created more supportive environment for them to quit smoking Ban would reduce likelihood of cues to smoking (e.g. pubs) becoming associated with smoking Statistics show 250,000 people quit smoking with help of NHS services April-December 2007

Anti-smoking legislation: Smoking ban July 2007

y y y y

EVALUATION- PUBLIC HEALTH LEGISLATION

Advertising- methodological issues: (causal relationship)

y y y y

Difficult to conduct controlled studies on effects of restrictions- difficult to isolate effect Results have often been confounded by other variables- e.g. increased health legislation, tighter restrictions on sales to young people However study comparing cigarette consumption before and after total bans on advertising in Finland suggests there is a significant reduction that cannot be attributed to other measures However restrictions on alcohol advertising have less of an effect. It may be that there is less public sympathy for such restrictions because alcohol still seen as socially acceptable

Effectiveness of smoking ban:

y y y y

West shows that although there was a decline in the % of people who smoked prior to smoking ban, this was followed by rebound effect Attempts to quit were higher in 9m before ban than 17m later People may just compensate by drinking/smoking more at home Ban may encourage group solidarity- feeling of shared wickedness for smokers who smoke outside pubs, making smoking seem more attractive

General methodological issues: intervention bias:

y y y

Cohen and Cohen: clinicians illusion Many clinicians believe alcoholism/drug addiction is more difficult to treat than it actually is Lack of routine screening for these addictions means clinicians only come across addicts when condition is well-advanced and too severe to effectively respond to treatment, causing it to seem incurable This is strengthened by biased media reports which rarely comment on celebrities that used to have addiction problem but now doing well

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GENERAL CONCLUSIONS ABOUT

TREATMENT Research hasnt shown that 1 type of psychological treatment is superior to any other. This implies that relationship factors between therapist and client are more important than the specific characterstics of the therapy. Psychological therapies appear more effective when combined with a pharmological treatment, and this approach may improve treatment as more effective medications become available

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