A2 Psychology - Addictive Behaviour

1. A2 Psychology - Addictive Behaviour Learning objectives: What does it mean to be addicted? How have psychologists explained addictive behaviour? Are certain people vulnerable to addictions? How do we reduce/help those with addictions?

2. The psychology of addictive behaviour • Models of addictive behaviour • Biological, cognitive and learning models of addiction, including • Explanations for initiation, maintenance and relapse • Explanations for specific addictions, including smoking and gambling • Factors affecting addictive behaviour • Vulnerability to addiction including self-esteem, attributions for addiction and social context of addiction • The role of media in addictive behaviour • Reducing addictive behaviour • Models of prevention, including theory of reasoned action and theory of • planned behaviour • Types of intervention, including biological, psychological, public health interventions and legislation, and their effectiveness

3. What does it mean to be addicted? 1.Write a basic definition 2.What kinds of things can people be addicted to? 3. What do you think causes a person to become addicted?

4. Defining addiction • ‘Addiction is a state of periodic or chronic intoxication produced by repeated consumption of a drug’ (WHO, 1957) Definitions now include other behaviours, not just drugs, e.g. sex, exercise, playing computer games, gambling, overeating

5. Defining addiction ‘a repetitive habit pattern that increases the risk of disease and/or associated personal and social problems. Addictive behaviours are often experienced subjectively as ‘loss of control’; behaviour still occurs despite efforts to stop it. Attempts to stop are often are marked with a high relapse rate’ Marlatt et al (88)

6. Shared attributes of addictions All addictions seem to be characterised by self-indulgent behaviour with short term gratification at the cost of long term damage Addictions lead to a powerful and rapid change of mood and sensation

7. Celebrity addictions –do you know what they suffer from?

8. Classifications of addictions • DSM-IV and ICD-10 include disabling addictions • WHO- prefers the term ‘dependence’ to addiction • Dependence = characterised by intermittent craving for substance to avoid a dysphoric state (state of mind characterised by depression and guilt) • Dependence is differentiated- abuse and harmful abuse

9. Differences in classifications for addictions • Smoking- substance related disorder • Gambling- habit and impulse disorder

10. Explaining common addictions • In groups- explain your groups addictions using psychology theory/common sense Chris and Farah – alcoholism Ellie and Lucy- food addiction Emily, Naeemah and Andy- gambling addictions • http://www.youtube.com/watch?v=pHDYk15V6hE

11. Explaining addictions Biological/medical/disease model • Addiction is a specific diagnosis • Addiction is an illness • The problem lies in the individual • The addiction is irreversible • There is an emphasis on treatment

12. Genes and addictions • Addiction reflects an underlying physiological abnormality • Genetics may play a role • It is unlikely that a single gene is responsible for addictive behaviour • Very likely- multiple genes are involved and different genes underlie different addictions • E.g. link between tobacco smoking and genes involved in dopamine regulation (Lerman et al, 99)

13. Genetic vulnerability • Most research in this area focuses on alcohol addiction • Family studies and twin studies are used Merikangas et al (98) 36% of the relatives of individuals with an alcohol disorder had also been diagnosed with an alcohol-use disorder Difficult to separate genetics from the environment Adoption studies do however show a link Twin studies; 60-70% concordance for nicotine dependence (Kendler et al, 99); 34-60% for alcohol abuse (Heath and Martin, 93)

14. Genetic predisposition for addictions • Whether this exists or not, you still need to be exposed to a large amount of whatever to become addicted • Likely it is more complicated than genetics

15. Biochemistry How the brain metabolises various addictive substances 2 key areas: -the dopamine reward system -the endogenous opioid system Dopamine (neurotransmitter) has a vital role in the regulation of mood and emotion and in motivation and reward processes Alcohol and nicotine affect the nervous system, increasing levels of dopamine (Altman et al, 96) It is possible those that are susceptible to addictions might have inherited a more sensitive mesolimbic dopamine pathway (Liebman and Cooper, 89)

16. Controlling our behaviour • People have the ability to exercise choice over whether we engage in behaviours and we mostly maintain a balance so we don’t become addicted • Over indulgences are temporary for most • We can do this because we have the ability to balance 2 competing neurochemical systems- reward reinforcement system and control system

17. Serotonin • Serotonin – plays an important role in control • Serotonin- lower levels found in impulsive people • Oldham, Hallander and Skodal (90) –patients who attempt compulsive suicides, impulsive homicidal behaviour, early onset alcoholism and bulimia –all have lower levels of serotonin • Obsessive –patients have high metabolic rates in the frontal areas of the brain and have high levels of serotonin

18. The brain’s Opioid system • Believed to be linked to addiction • Opioid neurotransmitters include enkephalin and the endorphins • The opioid systems are activated in states of pleasure and can be directly stimulated by addictive drugs e.g. heroin, alcohol and nicotine • Naltrexone- used to treat alcohol addiction, blocks opioid receptors in the brain, preventing the rewarding effects of alcohol

19. Neuroadaptation Drug dependence- based on the idea of neuroadaptation (Koob and LeMoal, 97) Changes occur in the brain as result of the taking of psychoactive drugs Tolerance quickly happens and so doses need to increase to have the same effect Withdrawal symptoms- if drug taking stops These symptoms will make people want to start taking the substance again

20. Summary- Biological models • Alcohol, nicotine, opiate drugs- change brain mechanisms (these act on the central nervous system) • Gambling and other addictions where no chemical substance is involved also change brain mechanisms • Evidence –correlational only

21. Sum up the biological model . Provide 1 pro and 1 con

22. Learning (behavioural models) 1970s onwards Addictive behaviours – not seen as illnesses Seen as part of an individual’s repertoire of behaviour Addictive behaviours- Acquired habits which are learned according to the principles of SLT Things that can be unlearned Not all or nothing categories No different from any other behaviours

23. Classical conditioning Unconditional stimulus spontaneously produces an unconditional response If the US is frequently associated with a conditional stimulus this CS will come to produce the conditional response e.g. sitting with friends (US)= relaxed feeling (UR) Smoking with friends, leads to smoking alone becoming the CS= relaxed feeling (CR) US-UR; CS-CR US- can be either internal/external Wikler (48) first applied this to people who were addicted to opiate drugs. He noted withdrawal symptoms following the stopping of consumption of a drug. An addict deals with these feelings by hunting another dose, exposing them to a range of cues which become associated to the withdrawal. Cue exposure theory (Heather and Greeley, 90) could explain why people suffer such intense cravings once they have been weaned off their addictive substance.

24. Operant conditioning • Depends on the consequences of actions • Behaviours are likely to be repeated if they are rewarded in some way Positive reinforcement – reward is a desirable consequence, e.g. feeling relaxed Negative reinforcement- the reward is a removal of an unpleasant consequence, e.g. the relief from withdrawal symptoms if smoking/drug taking continues What is a reward varies- depending on the individual, their past/experiences/ their own needs etc

25. SLT • This is SLT developed, going beyond simple observation to account for some of the more complex perceptual and reasoning skills of humans. • We learn through observing and hearing what others do/say • Significant people – make smoking etc attractive and rewarding • Also includes aspects of Cog Beh models – labelling and outcome expectancy model

26. Cog Beh models • Cognitive labelling models – an emotional experience that is the result of an interaction between physiological arousal and its cognitive interpretation (the label). Cues to emotional arousal are very powerful, e.g. someone who is addicted to alcohol may smell it near a club and want alcohol more • Outcome expectancy model-cues set off expectations about an addictive substance, e.g. adverts of people drinking may trigger the thought ‘I really want/need a drink’

27. Sum up the behavioural model Provide one pro and one con

28. Usefulness of Behavioural approaches • Links to cognitive make it more able to give a solid explanation • Does stress the role of the media (advertising for cigarettes/alcohol etc) • However the theories of cognitive labelling and outcome expectancy are simplistic (Tiffany, 99) • Avoids the idea that humans are creative thinkers

29. Cognitive models • Emphasis on the processes that control mental functions such as communication, learning, problem-solving, planning • Self-regulation- weighing up the relative importance of social and physical factors as well as one’s own personal goals when planning behaviour • Addictive behaviour- more common in people who place excessive reliance on external structures to maintain a balance between their physical and psychological needs • Impaired control over actions lead to addictive behaviour • Rational people can behave like this if they have faulty ways of thinking when exploring the consequences of their actions • Ainslie (92) all people can perfectly predict present and future consequences but they attach different weightings to them, mostly attaching greater weight to the present • Immediate reward over future benefit – called cognitive myopia (Hernstein and Prelec, 92)

30. Beck et al (93) • Addictive beliefs play an important part in the development of addictive behaviours • At first the individual thinks it would be fun/exciting to drink/take drugs etc and then gradually they become reliant on the substance • These individuals often have very negative views of themselves and may suffer depression/anxiety

31. The cognitive processing model • Behaviours if repeated enough become automatic • Tiffany (90) argues that addictive behaviours are regulated by automatic processing • Drinking etc if repeated and repeated become automatic, thus it is difficult to stop automatic behaviour • We are continuously faced with situations that trigger automatic responses • This could be possible if everything else in an individual’s life is good, however if there are stresses etc it becomes more difficult

32. Sum up the cognitive model Provide one pro and one con

33. Evaluations of cognitive theories • Useful for explaining the thinking processes of people who become addicted to certain behaviours • Provides helpful treatments • Also provides explanations for why relapses occur • Does not explain why such addictions start in the first place

34. Use one of the models to explain the following: • Russel Brand’s sex addiction • Pete Doherty’s drug addictions • Michael Jackson’s prescribed drugs • David Hasselhoff’s alcohol addiction

35. Explaining specific addictions • SMOKING 1.1 billion people are estimated to be smokers across the world (WHO) 4 million people are estimated to die from smoke related illnesses (WHO) Evidence links smoking to: -high blood pressure; coronary heart disease; lung disease; cancer and strokes -pregnant women who smoke are more likely to have premature babies -smoke increases stress levels (Parrott, 00)

36. Why do people smoke cigarettes in the face of the side effects? .

37. Smoking • There are 3000 chemical components in cigarette smoke- but nicotine is the active and addictive component • Hilts (94) compared nicotine to 5 other psychoactive drugs-heroin, cocaine, alcohol, caffeine and marijuana. He ranked nicotine lowest for intoxication but highest in terms of dependence • Relapse rates- 70% in the first 3 months of trying to give up. Individuals who give up experience quite nasty withdrawal effects

38. Smoking • It is classed as a psychoactive drug as it directly affects the brain but it’s effects as more subtle than most drugs • Nicotine affects the central nervous system, its estimated that nicotine once smoked takes less than 25 secs to reach the brain • Nicotine has – stimulant and depressant effect on the brain- increases the amount of noradrenaline and adrenaline in the body • It activates the MESOLIMBIC PATHWAY- producing positive effects-smokers explain it has a relaxing yet arousing effect

39. Explaining smoking • Biological factors Genetic factors – Shields (42) looked at 42 twin pairs who had been reared apart Only 9 pairs were discordant for smoking behaviour

40. Explaining smoking Social factors Most people start smoking in childhood Traditional learning theory is able to explain smoking behaviour quite well- using the principles of operant conditioning It is extremely common that the first experience is unpleasant, difficult to explain why children persist

41. SLT • Children continue to smoke to imitate role models • Role models are more influential if the are the same sex, age or ethnic background as the observer • Those with a higher status have more influence (such as a celebrity) –Winnett et al, 89 • The observation of others enjoying the experience leads to them persisting to expect future enjoyment

42. The role of parents in their children’s smoking behaviour • A key influence on smoking behaviour is parents’ attitudes to smoking • Children are twice as likely to smoke if their parents are smokers (Lader and Matheson, 91) • If parents’ attitudes are firmly against smoking, the child is 7 times less likely to smoke (Murray et al, 84)

43. Peer pressure • Believed to be very important, exerting pressures on those that do not smoke to start .e.g. bullying • Michell and West (96) adolescents are considerably less susceptible to this kind of pressure. They explain that some here show a ‘readiness’ for smoking • Those not wanting to smoke, tend to adopt strategies to avoid situations where smoking is likely to be offered • What are the implications here are for health campaigns?

44. Individual differences • Research in the US links smoking to certain other traits such as poor performance at school, low self-esteem, evidence of risk taking behaviour (e.g drinking alcohol) –Mosbach and Lenethal, 88

45. Cognitive factors • TRA and TPB • Conner et al (06)- role of planned behaviour in smoking initiation in 11-12 year olds. 675 non-smoking adolescents were tested for baseline measures including tpb 9 months later they checked if any of these adolescents had taken up smoking They used carbon monoxide poisoning instead of subjective measures Results- behavioural intentions were usually a good predictor of smoking behaviour In China childhood smoking is a big problem, Guo et al (07) studied more than 14000 children with tra and tpb and found they were useful predictors of smoking behaviour

46. Problem gambling • Explain what is meant by the above • What causes such problems?

47. Problem gambling Pathological gambling- term used to describe those at the most extreme end of the gambling behaviour spectrum Problem gambling- gambling that is of a mild to moderate problem for the sufferer Difficulties- no clear cut definition of what gambling is General consensus- an activity where 2 / more people agree to take part – usually the operator and the person/persons who wish to gamble, the stake is paid by the winner

48. DSM-IV – to be a problem gambler you must have 5 or more: Preoccupation with gambling Need to gamble with increasing amounts Repeated unsuccessful efforts to control or cut down gambling Restlessness/irritability when trying to cut down Return to gambling even after losing huge amounts of money Jeopardising or losing relationships due to the gambling Committing illegal acts such as forgery to conceal the gambling

49. Problem gambling • Usually starts in adolescence for men • Later in women • Typically gradual- starting with social to more frequent • Gambling is common- millions report doing it each year (National Centre for Social Research), however gambling does not always lead to addictions, e.g in Canada 0.6% of the population are addicted to gambling

50. Explanations of gambling behaviour • Biological accounts Genetic vulnerability (Eisen, Lin and Lyons, 99) Comings et al (01) argues the genetic vulnerability could be explained in terms of genes controlling the activity of DOPAMINE, SEROTONIN AND NOREPINEPHRINE Gamblers often report enjoying a high/buzz from the game/winning, problem gamblers have high levels of dopamine and norepinephrine in the anticipatory stage before non-problem gamblers Meyers et al (04) compared 2 groups of problem gamblers- one playing cards not for money; the other gambling for money. Gamblers- raised heart rate and secreted more cortisol (both are linked to acute stress) Rosenthal and Lesieur (92) problem gamblers who stop gambling, report withdrawal effects similar to drug addicts who stop taking drugs There is evidence to link dysfunction of the prefrontal lobe to problem gambling (Cavendini et al, 02), high rates of EEG abnormalities have been found (Regard et al, 03)