Biological theories of addictions

Smoking

Initiation – If a person has the DRD2 gene, they will have a predisposition to having a higher chance of having a general addiction such as smoking (Jang). More specifically, if you have the smoking gene SLC6A3-9, you are at more risk of initiating smoking and will find it harder to quit.

Maintenance – People are likely to maintain smoking addictions because their body adjusts to the level of nicotine entering the body. Smokers tend to keep smoking to maintain nicotine levels to prevent withdrawal symptoms (nicotine regulation theory, Shachter) and they have learnt the dopamine release is pleasurable and don’t want to lose it. Since nicotine doesn’t last long, dopamine fades away and cravings increase. Nicotine enhances the reward value of other stimuli (what you do whilst smoking), so the addiction is maintained because it makes other behaviours you have associated with smoking seem more enjoyable (reward system, Lerman).

Relapse –When nicotine is in the body, it creates a physical dependency and increases tolerance every time a person smokes. Repeated exposure to nicotine produces long term changes in the nervous system which is called neuro-adaptation. Once the body has been altered by repeatedly smoking, the absence of nicotine produces a persistent discomfort (withdrawal symptoms such as irritability, headaches) that wants to be relieved. The best way to relieve symptoms would be to smoke (relapse). These factors are enhanced if you have the SLC6A3-9 gene since the nicotine will hit the dopamine receptors harder, causing withdrawal symptoms to be worse.

A02 – A strength of the biological approach is that Shachter tested his theory. He gave 1/2 the Pps high nicotine level cigarettes and the other half were given low-level nicotine cigarettes. As a result, the Pps given the low level cigarettes were craving more cigarettes. This supports the theory that the body regulates and causes smokers to want to smoke more to avoid withdrawal symptoms.

A02 - A criticism of the biological approach is that since SLC6A3-9 only has a 40% inheritability rate, this must mean that biological explanations to why people start smoking is not purely to do with biology. 60% influence is from learnt experiences and cognitive explanations. There is a lot of strong evidence that we learn/copy role models with regards to addictions. Therefore, the biological explanations is too reductionist and simplistic for such a complex behaviour.

Gambling

Initiation – If a person has the DRD2 gene, they will have a predisposition to have a general addiction such as gambling (Jang). Since the SAM pathway is linked to having increased blood pressure, heart rate, excitement etc., this increases the possibility of the release of dopamine and the DRD2 gene makes the ‘buzz higher’ for those who have it. There is also the risk of having pathological gambling run in the family, however we cannot distinguish between SLT and purely biological factors impacting initiation of gambling.

Maintenance – To avoid withdrawal symptoms of gambling, gamblers keep gambling. They realise how much time they have spare once they stop because it usually takes up most of their time. Brain activity and blood flow in the brain is different in gamblers, this is why they stay biologically competent to be encouraged to seek out and gamble.

Relapse – Relapse occurs due to gamblers experiencing withdrawal symptoms. Pathological gamblers are seen as needing intense stimulation and excitement from the lights and interactions

when playing. Stopping gambling can lead to extreme boredom since they realise how much spare time they have because it usually takes up most of their time.

A02 – A criticism of the biological approach to explain initiation of gambling is that it says that it could be due to genetic predispositions. However, bigger factors such as learning to gamble (SLT) by watching role models can be much more powerful than biology. It if runs in the family, children learn that it’s a weekly/daily activity to gamble. Therefore, we cannot prove causality between SLT and biology impacting the initiation of gambling.

A02 – It is also deterministic because it purely blames our biology for our addictions. Some people choose to have free will over if they initiate an addictive behaviour, even if they have predispositions. Bad thing because it doesn’t allow free will.

Behavioural theories of addictions

Smoking

Initiation – Social learning theory proposes that people may initiate smoking through vicarious learning and the observation of role models who may be seen being rewarded for their addictive behaviour through the attention they receive when smoking. People learn the positive effects of smoking through this (vicarious reinforcement) and then engage in the behaviour themselves believing they will have similar positive effects. They may also learn smoking behaviour from peers or even media role models. If parents smoke – 2x more likely, if close friend smokes – 8x more likely.

Maintenance – According to Cue Reactivity Theory, cravings are paired with the presence of items (e.g. coffee, friends, seeing someone smoking) associated with smoking. So the items trigger cravings and the urge to have nicotine (linked to higher order conditioning). (E.g. smelling coffee, a friend, its break time = wanting a cigarette). The more triggers in your environment, the more cravings a person will have. Smoking is maintained as long as we have the positive associations that are experienced regularly.

Relapse – Same as maintenance – Cue Reactivity theory. Since there are lots of associations made to smoking, there will be loads of triggers = more cravings, want to have a cigarette.

Gambling

Initiation – Social learning theory proposes that people may learn gambling behaviour through vicarious learning and the observation of role models who may be seen being rewarded for their addictive behaviour through winning or the praise and attention they receive when gambling. People learn the positive effects of gambling through this (vicarious reinforcement) and then engage in the behaviour themselves believing they will have similar positive effects. They may also learn gambling behaviour from peers or even media role models.

Maintenance – Through variable ratio reinforcement, a person continues to gamble. There is a schedule of reinforcement where a response is reinforced after an unpredictable number of responses. E.g. With slot machines, players have no way of knowing how many times they have to play before winnings. All they know is that eventually, they will get the matching slots. This is why players are often reluctant to quit. There is always the possibility that the next coin they insert will be the winning one.

Relapse – Through cue reactivity theory, if you stop gambling, the more the person will think about it (catch 22). Items/triggers around the gambler would be all around them e.g. pop ups promoting

gambling, scratch cards and lotto, bookies. All these triggers remind and tempt them. They create feelings associated with anticipation and excitement, thus meaning risk of relapse will be high.

A02 – The behaviourist approach is environmentally deterministic because it claims that factors outside our control is to blame for our addictive behaviours. This is a bad thing because it doesn’t allow for people to have free will over if we develop addictions. It is also reductionist because it ignores other factors such as cognitive influences.

Cognitive theories of addictions

Smoking

Initiation – Smoking may help them feel better if they are stressed, need a confidence booster etc. Smoking may escalate into an addiction if it is perceived as having a positive impact of their lives. E.g. helping them become more sociable with a group of people. They expect smoking to help them feel less left out, more relaxed and less stressed which is an illogical way of thinking. This can lead to the self-fulfilling prophecy, if their schemas think that smoking will help them become distressed/help with confidence, they will smoke.

Maintenance – Beck’s vicious cycle of addiction, people start with a low mood/stressed/bored, this leads to the person smoking, and this provides temporary relief. However there are financial/health consequences for their actions. Negative moods and self-efficacy then come about after the consequences and leads to the maintenance of smoking in order to cope with the negative moods because they feel as though they are unable to cope.

Relapse – Marlatt’s Relapse Model -

Gambling

Initiation – Winning money is a big incentive to gamble. It is a modern day self-medication for depression because it gives them excitement/buzz, distracts their sad thoughts and alleviates depression in the short term. People may initiate gambling if they are having financial troubles and they believe they have a chance of winning and have good self-efficacy to stop gambling when they need to.

Maintenance - Becks vicious cycle - people start with a low mood/stressed/bored, this leads to the person gambling, and this provides temporary relief. However there are financial consequences for their actions. Negative moods and self-efficacy then come about after the consequences and leads to the maintenance of gambling in order to cope with the negative moods because they feel as though they are unable to cope.

Griffiths (1994) Gamblers give attribute human characteristics to slot machines (heuristics). This is a cognitive bias/biased schema. He found that gamblers had hind sight bias – gamblers had ‘a feeling’ that they would lose (predicted their losses) after it happened. This is illogical because they justified losing. They has no way of knowing when the machine was going to pay out. Some gamblers had personified the machines e.g. ‘the machine isn’t being fair today, I didn’t play yesterday and she’s angry’’ ‘’I’m going to beat the machine’’.

Relapse – Marlatt’s relapse model ^, life without gambling is dull. Since gamblers spend a lot of time at the bookies, once they stopped, they would feel really bored because they weren’t getting the excitement from the bright lights and sounds. They would also realise that they have a lot of time on their hands. This would lead to relapse when the person can’t handle the boredom.

A02 – Griffiths ideas are from recorded and analysed sources, this is good because of inter-rater reliability. The researchers could analyse the videos of the gamblers, this reduces bias from primary researchers. This also increases our knowledge and understanding of gambling.

A02 – A strength of the cognitive theories for gambling is that they help us better understand individual differences which other explanations don’t explain. Therefore, it is not deterministic unlike biological explanations, they take into account people’s illogical thought processes that can occur.

A02 – The cognitive theories help explain individual differences better than biological explanations as they can account for individual differences and free will and why not everyone becomes addicted to smoking and gambling. They also see people as being able to thing for themselves. This is a good thing because it isn’t reductionist by reducing such a complex behaviour of smoking and gambling to simple ideas such as illogical thoughts. It provides a holistic approach.

A02 – A weakness of the cognitive approach is that it is difficult to establish cause and effect to see if it is actually faulty thinking that leads to smoking addiction or whether this is symptoms of gambling and smoking itself. This is a bad thing because we cannot prove causality. It may be that biological vulnerability factors such as genetic predispositions cause people initiate and maintain addictive behaviours.

Factors affecting addictive behaviours

Personal Vulnerability -

Peers – People of the same age group are influential in the initiation of substance use and behavioural addictions such as gaming and gambling.

Through SLT, peers serve as powerful role models for addictive behaviours and may provide opportunities for vicarious reinforcement (seeing others being rewarded for their addictive behaviour).

Finn – Best friend who engages in an addictive behaviour makes you 8x more likely to initiate.

Morgan and Grube (1991) – Research into the role of best friends and peers. They were found to both be significant in the initiation of smoking, drugs and alcohol. Best friends are more influential in the maintenance of addictions.

A02 – Morgan and Grube – A strength of this finding is that it has face validity, it makes sense that best friends are very influential because there is a strong bond between friends. If a person doesn’t want to lose that friendship, they are probably going to get involved in the same behaviour as them to be accepted. SLT plays an important role because through vicarious reinforcement, seeing best friends become popular because they smoke will cause people to want to identify with them. If they don’t, the group has the power to reject them.

A02 – All research into peer influence uses non experimental surveys. This is a bad thing as they tend to unreliable due to factors such as Pp reactivity and social desirability. There is usually over reporting of desirable data and under reporting of undesirable behaviour which can impact the results looking into peer influence for addictions. Another problem is that it is asking Pps to think back to the past (retrospective data), this is a bad thing because memory is only made up of reconstructed memories, therefore there is the risk of data being perception biased, only based on false memories. Doesn’t give a true representation of peer influence over addictions.

A02 - Eiser et al – found support for peers influencing individuals to engage in addictive behaviours though social learning explanations for perceived rewards. Adolescents reported valuing rewards such as social status (normative influence), acceptance and popularity which appeared to be a key motivator for many to initiate smoking but also why they continued to maintain it.

Age – There is a positive correlation between age at first use/exposure and risk of developing later addiction with both alcohol and nicotine. People may be less aware/educated of the long term risks. More likely to initiate addictive behaviours in teenage years and less influenced by peers after adolescence.

A02 – Research is retrospective, there is an issue of using surveys to find out about addictive behaviour vulnerability statistics. This means that they would be asking questions such as ‘At what age did you start smoking?’ This is asking the Pp to think back, and since memories are reconstructed, this this a bad thing as it relies on accuracy of people’s recall of evens in the past (recall bias).

A02 – A criticism of both social learning and social identity explanations is that much of the information is based on correlational data, therefore this is a bad thing because causality cannot be established between peer groups directly contributing as risk factors to addictions. It may be that those prone to addiction due to personality factors tend to befriend people who have similar behaviour patterns (e.g. smokers befriend smokers). It may also be that peer influence is stronger at a younger age, therefore it could be more age than peer influence.

Personality Traits – Risk seeking personality types are more at risk because they want to try new things and are easily bored. Those who are sensitive to social situations and to other people’s opinions are also at risk in order to fit in to the in-group.

A02 – Research into personality can generate lots of data – can be generalised more easily BUT it ignores individual differences and ignore that our personality can be very flexible. The extent of our flexibility is due to our situation.

Stress – We will be more stressed if our perceived coping abilities towards addictions are higher than we are used to, this will increase our vulnerability to initiate and relapse. Stress in a person’s life can make people use addictive behaviours as a maladaptive coping strategy to feel better. E.g. excessive drinking because they lost their job/relationship issues.

Having Type A (organised/fast/hostile/neuroticism) and Non-Hardy personalities (hostile to change) can increase vulnerability to initiate addictions because being stressed out easily is linked to having more maladaptive coping strategies to cope with not having your way.

The role of the media in addictions

The media is criticised for glorifying addictions

Role Models – Roberts (2002) found through music video analysis that addictive behaviours were extremely common and were portrayed as normal daily behaviours for the celebrities. Through SLT, people imitate these role models who glorify addictions and reproduce the action to become popular/trendy. E.g. modern day examples – smoking weed, coke, plastic surgery, waist trainers.

Gunasekera (2005) – Meta analysis reviewed 200 most popular films portraying drugs and sex. It was found that the movies tended to portray the use of drugs and addictions in a positive way without showing any consequences. This then creates and shapes our schemas about drugs/addictions. They rarely show the negative effects of addictions.

The media isn’t always increasing vulnerability

Media campaigners – Advertisements that inform the public about the consequences of addictions. E.g. lung mutation pictures on cigarette packets, FRANK, passive smoking adverts. Research has found that media campaigns are more effective when there are real people that we can relate to in the adverts and show support phone numbers/websites which allows people to find out more.

Smoking adverts/on TV – The ban of smoking adverts and people smoking on TV caused a decrease in the number of smokers. (Signorielli 1990)

A02 – There is very little research support that has assessed whether addictions represented in film media actually have an effect on its viewers (adolescents in particular). This is a bad things because we can’t isolate media and other factors such as peers and personality.

A02 – data collected using surveys. Adolescents may not admit to it or they may exaggerate the impact (social desirability/Pp reactivity). Asking people who are underage about addictions can cause bias since people don’t want to get into trouble (confidentiality must be kept).

Reducing addictive behaviour

Theory of Planned Behaviour

Fishbean and Ajzen - Theory of planned behaviour consists of 3 parts – personal attitudes towards an addiction, including expectations about outcomes of the behaviour (e.g. understanding negative effects of smoking); subjective norms, derived from other people’s view on the change in behaviour and how susceptible the individual is to conformity; self-efficacy, how confident the individual is that they can carry out the behaviour successfully (e.g. give up smoking whenever they want. The interaction of these components lead to behavioural intentions about the addiction which may or may not always lead to behaviour change.

A02 – A criticism of the TPB is that it ignores the role of motivation in changing people’s overall behaviours/addictions. It was found that recovery was consistently more successful for individuals who had decided themselves to give up substances rather than because of police orders.

A02 – MacDonald (1996) – people’s intentions are measured when sober, however intentions can change when under the influence. It was found that being drunk can cause people to have different intentions than when they are sober such as unprotected sex, taking drugs and being more aggressive. Therefore TPB isn’t applicable to different mental states, intentions don’t always lead to behaviour change.

A02 - Spiral Theory – Stages of change model (Prochaska 1992) to compare to TPB. It involves having the mind-set that you want to stop your addiction. This then leads to preparation to quit (e.g. planning dates for when things should change). Lastly, the person should take action one step at a time to overcome their addiction. Smokers tend to take 3-4 attempts before succeeding.

Biological interventions

Agonistic maintenance treatment provides people who have an addiction with a safer drug. For example, methadone is used for heroin addicts because it is a synthetic heroin. Methadone mimics the effects of heroin and binds to the receptor cells. Doctors control the dosages by gradually reducing the amount given to wean them off heroin. It is aimed to help prevent severe withdrawal symptoms by taking the edge off the cravings.

A02 – A major weakness of the use of agonistic maintenance treatment, especially methadone, is that it is a highly addictive substance. This questions the overall effectiveness of the intervention because some drug addicts can become addicted to the replacement drug and substitute it for the real addiction. Also, methadone is widely available on the black market. To support this, Trauer et al found that those taking methadone were 10x more likely to have a psychiatric disorder than the general population. This suggests that agonistics such as methadone may not be effective for all patients, especially those who are mentally unstable.

A02 – Another criticism is that there are appropriateness and ethical issues that arise when using biological interventions. Patients may not be in the right state of mind to give consent to biological treatments that alter their bodily chemicals due to their addictions. This raises the issue of informed consent. This is a bad thing because the patient’s expectations on how the treatment will turn out may not be how they expect it. This causes problems with the carrying out of full treatment and causes more drop outs. This might even lead to patients buying methadone elsewhere to cope with withdrawal symptoms. However, whilst on the drugs, patients can get counselling, and therefore have long term effective solution.

Narcotic antagonistic treatment is only given as a treatment when a patient is fully detoxified (gone to rehab, no drugs in system). Drugs such as Naltrexone act as a shield over the dopamine receptors/neurons. This then blocks and reduces the effect of dopamine. When the drug is taken,

the patient will have no good feelings/pleasure when taking the addictive substance. It aims to reduce the good effects that come with drug taking. If there are no good feelings, why continue to take the substance?

A02 – Usually taken as a 3 month implant. Since the implant may not actually last 3 months entirely, a person may test if the implant actually works when the implant has finished. If the patient takes the heroin/alcohol, the person may have a toxic shock because of the sudden intake. They may also have an overdose if they feel nothing because they believe they have a tolerance. Person may die… However, if there are no effects when taking drugs, this may give the patient hope and gives them motivation to keep going with therapy.

A02 – Biological therapies have been scientifically tested, vigorously tested using standardised, objective tests. All drugs that have been put on the market have been tested under stringent conditions. Small margin of error, scientists are more likely to make a type 2 error to be safe than sorry. High credibility.

Psychological Interventions

Behaviourist therapies

Aversion therapy – uses an emetic drug to make people feel sick when they smoke/drink alcohol. When they do, it will make them violently sick through classical conditioning (emetic drug=violently sick, smoking plus drug=violently sick, smoking=violently sick).

A02 – unethical procedure but the patient needs to agree for it to take place. It also depends on whether the patient actually takes the drug. If it makes them sick every time, they may prevent themselves from taking the emetic drug in the first place. And if the addiction is engraved, it may take a few attempts.

In-Vivo desensitisation – therapy aimed at weakening the association made when smoking/drinking. It involves the therapist and patient going to the setting where they normally feel as though they need a drink/smoke most. It teaches the patient to be in a high risk situation and not be tempted and so the patient doesn’t relapse.

A02 – There are practical issues such as the therapist actually taking their time to go to the high risk situation. This is a bad thing because it is inconvenient for the therapist and takes a long time to weaken the associations when the therapist can’t be there. This has consequences on expenses… However in order to overcome this, we use…..

Imaginal Desensitisation – this is exactly what in-vivo desensitisation involves but it’s conducted in a therapist’s room. The therapist asks the client to imagine that they are in their high risk situation and the therapist acts as a guide.

A02 – Lacks external validity, might not work in a real life situation. It also depends on the patients imagination skills. How can the therapist be certain that the client is actually trying and has overcome the addiction? Everyone has different skills, so it may not work. Self-efficacy needs to be strong.

A02 – Reductionist because it’s not as easy as imagining the situation and bam, you’re cured. There are other factors such as family/peer influences that could help enhance the therapy.

Cognitive Therapies

CBT – Mood and emotions influence thoughts and actions> My thoughts and actions influence the quality of my life> The quality of my life influences your emotions and moods (vicious cycle). CBT aims at changing people’s knowledge.

Thought stopping CBT technique – teaching the client to shout STOP or use a rubber band to slap wrists when they feel they are getting thoughts about their addictions. It helps to divert thoughts. The client should think about something else that can make them stop thinking about the addiction. E.g. counting back from 100 in 3s.

A02 – needs consistent motivation, time and effort. The therapist can’t monitor this.

Motivational Interviewing – new technique specifically for addictions. Aims to help people recognise their high risk situation and change thinking to avoid or cope with high risk situation. Involves strategies such as giving advice about creating awareness of the high risk situation, removing mental cognitive barriers, decreasing desirability to do addiction, setting homework and actively helping the client stay focussed.

A02 – motivational interviewing is good for preventing relapse, teaches life skills when in any situation where the client is exposed to addictions. They are also tailored to each individuals needs and what will help them best. It is interlinked with imaginal desensitisation, so it is the most flexible type of therapy. Overall, helps improve self-efficacy for real life situations.

A02 – needs constant monitoring and motivation

Public Health Interventions

Public health interventions are designed by the government and charities to prevent or treat addictions. They are not targeted at individuals but the population as a whole.

Harm Minimisation – Through the use of tertiary funding, intervention techniques such as free condoms, flip flops and needle exchange are provided because the government cannot stop risky behaviour happening, but they can encourage safety. Free condoms are provided at health clinics in order to reduce the spread of unwanted pregnancy, underage sex leading to pregnancy and STDs. Needle exchange programmes allow people to give their dirty needles in for cleaning to prevent the risk of diseases such as AIDS spreading though the blood.

A02 – such programmes have often faced public condemnation and often do very little to stop unwanted behaviours (e.g. needle exchange is seen as encouraging the use of heroin and other injected drugs). People are paying for these services to be provided though taxes. This is bad because it is reinforcing the addictions that people are trying to discourage in the first place.

Peer Based Programmes – using peer groups to identify and relate to other users. E.g. Alcoholics Anonymous. A study by Sussman found that peer led programmes that were conducted by high school students about changing behaviour towards drugs had more of an effect on students than when teachers led the programs.

A02 – not enough time and money to schedule these programs.