Psychology Revision

Addictive Behaviour
Defining addiction
Addiction is often mixed up with excessive enthusiasms.
For example, some people may believe that they are
addicted to something such as tea and feel that they can
not go a day without it. However, in actually fact they
probably could go without it without suffering from
withdrawal symptoms.

Addiction refers to the repetition of an action, such as the

taking of a drug or continually gambling which often
gives the individual a short term “buzz” or “high” but has
long term negative effects on health or social life. The
individual often feels as though they have no control
over the addictive behaviour and suffer withdrawal
symptoms when they try to terminate the behaviour.
Defining addiction
Addiction is often defined with the use of criteria. According to Griffiths
(2002), all of the following elements must be present for something to be
considered an addiction:

• Salience – this is when the addict feels that the behaviour is the most important
thing in life.

• Mood Modification – this is the “buzz” or “high” that addicts report when engaging
in the activity.

• Tolerance – increasing the amount of the activity in order to achieve the same
“high” or “buzz” as when first starting the behaviour.

• Withdrawal symptoms – Unpleasant feelings or physical effects that occur when

the addiction is suddenly discontinued or reduced.

• Conflict – the individual begins to create conflict with those around them, and
sometimes experience inner conflict due to their own feelings of lack of control.

• Relapse – high relapse rate when trying to quit the behaviour.

Explanations to Addiction
Biological: neurological / disease model
Neurological Approach
 This explanation assumes that addiction is caused because
of the pleasure drug, dopamine.
 Some substances increase the release of dopamine or
prevent its reuptake at synapses, causing the addict to feel
pleasure/satisfaction for longer.
 Once the dopamine has been removed from the synapses,
the feeling disappears but the user will want to take more
of the drug in order to achieve the same feeling.
 When the drug is used repeatedly the body becomes used
to higher levels of dopamine and increases the rate at
which it’s broken down or taken up. This means that more
of the substance needs to be taken in order to achieve the
same effect. This is an increase in tolerance.
 When the addict stops taking the drug, their body is still
disposing of dopamine at a high rate, causing the addict to
experience the opposite of the drugs effects; withdrawal
symptoms.
 These are removed by continuing to take the drug.
Neurological Approach
Caine et al (1997)
Conducted a study into the effects of dopamine on addiction.
They took two groups of rats and genetically engineered one
group so that they were missing the dopamine receptor.
He then exposed the two groups to cocaine regularly. After
2 weeks he provided food alongside the cocaine. The
genetically modified rats were not interested in the cocaine
and chose to eat the food instead, whilst the non
genetically modified rats chose wanted the cocaine more
than food.
From this Caine concluded that the normal rats had become
addicted to the cocaine because they were able to feel the
effects of dopamine. However, as the genetically modified
rats were unable to feel the effects of dopamine, they were
unable to become addicted.
Neurological Approach
Bostwick et al
Treated an addict with a dopamine
substitute and found that whilst using the
dopamine antagonist, the compulsion for
the addictive behaviour rapidly declined.
This suggests that the dopamine is the
cause of addictive behaviour.
Neurological Approach
Advantages Disadvantages
 Reductionist –
 Practical implications
– can be used in reduces a complex
medicine for helping idea down to a simple
addicts quit using imbalance.
 Some studies show
drugs.
 Has supporting that not everyone is
research and works addicted to dopamine
 Even high quality
well in practise.
animal research fails
to compare to human
research
Explanations to Addiction
Biological: genetics
Genetic Approach
 According to this explanation, some people have
a variant of a gene (A1) coding for a dopamine
receptor.
 The variant causes fewer dopamine receptors.
 Thisexplanation assumes that people with this
variant are more likely to become addicted to
drugs which cause a large release of dopamine,
thus compensating for their lack of dopamine
receptors.
Genetic Approach
 Nobleet al: found that the A1 variant was
present in 2/3 deceased alcoholics and 1/5
deceased non-alcoholics.
 Volkow et al: gave a group of volunteers a drug
that increased dopamine levels. Some liked it,
some hated it. Those who liked it had fewer
dopamine receptors than those who didn’t.
 Nielson(2008): found remarkable associations
between genotype patterns and heroine
addiction.
 Fowler(2007): found that genes were important
but environmental factors such as peer groups
was also important.
Genetic Approach
Advantages Disadvantages
 Reductionist – reduces a
 Has supporting research.
complex idea down to a
 Takes blame away from
simple imbalance.
the sufferer.  The concordance rate
between identical twins is
not 100%, therefore
genetics can not possibly
be the only factor.
 Doesn’t offer much hope
for those with
schizophrenia as they can
not change their genes.
Explanations to Addiction
Cognitive Approach
Cognitive Model
The cognitive model emphasises the
habitual ways of thinking and interpreting
events which may lead to the initiation
and maintenance of an addiction.
For example, a person might become a
drug addict when they think of gambling
as a coping strategy.
“The Vicious Circle”
 Beck et al(2001) describe addiction as a vicious circle. The
addictive behaviour is used as a coping mechanism to
combat the stresses of life, but then the addictive
behaviour begins to cause problems, prompting the need
for the coping mechanism.
 For example, if a person has financial issues and uses
gambling to solve that issue, they may come to rely on it
every time they need more money. However, this may
cause them to lose more than they gain, causing an
increase in financial problems and prompting the addict to
gamble more.
 A similar thing could be said for smoking, eg, a person
perceives smoking as a “stress relief”. When they are
stressed they use it as a means of de-stressing. However,
financial and health problems could arise from smoking
causing more stress and consequently, more smoking.
Self Medication Model
 The addictive behaviour is initiated because of
their beliefs that the behaviour will enable them
to cope. For example, smokers could use
smoking to relieve stress, gamblers to get out of
gambling problems.
 The addictive behaviour will help to fulfil three
major functions:
Mood regulation
Performance management
Distraction

 The behaviour is maintained and relapse occurs

because the addict feels that they can not
achieve the three functions without the
behaviour.
Expectancy Theory
 This theory suggests that individuals become addicted because of their
expectations about the outcomes of the behaviour.
 Addicts differ to none addicts in terms of their expectations about the
positive and negative effects of the behaviour.
 The addiction is initiated because the individual thinks that the behaviour
has more positive than negative effects.
 Brandon (2004) explains maintenance and relapse of addiction as being
influenced by unconscious expectations, thus explaining the feelings of
lost control that addicts experience.

 As addictive behaviour is thought to be the result of false expectations, we

should be able to manipulate the addict’s expectations to prevent relapse.
 Tate et al(1994) told smokers that they should expect no negative
experiences during a period of abstinence. This led to less somatic effects
(eg. the shakes) and psychological effects (mood disturbances) than in
the control group. Those that were told to expect less somatic effects but
should expect psychological effects reported more psychological effects
when compared with the control group. However, this experiment can be
criticised as being unethical as participants were deceived and some may
have returned to the addiction when they experienced the negative
effects.
Self-Efficacy Theory
 This theory was devised by Bandura(1997) and
refers to the belief in one’s self to organise and
control any actions required to meet particular
goals. (self belief)
 Self-efficacy plays an important part in where or
not a person will start to engage in a particular
behaviour. For example, if they believe that they
can not cope with a certain situation they may
use smoking to help them cope with the
situation.
 It also plays a part in the maintenance and
relapse of a behaviour because of whether they
believe that they can do anything about the
addiction once it has been established. For
example “I’m addicted, I can’t do anything about
it”.
Rational Choice Theory
 Becker and Murphy (1998) concluded that people chose to engage in an
activity as a result of weighing up the pros and cons.
 According to this theory, addicts are rational consumers who look ahead
and behave in a way that is likely to maximise the preferences they hold.
 However, this doesn’t take into account the idea that some people begin
and continue an addiction whilst knowing that it’s inconvenient.

 This idea is present in the activity of gambling. The rational choice theory
would suggest that gambling addicts would not continue their behaviour
after a loss.
 A study by Griffiths(1994) offers an explanation for this based on the
cognitive bias/irrational thinking that distorts the reasoning of addictive
gamblers.

 Langer (1975) and Langer and Roth(1983) found that when people
overestimate the extent to which they can predict whether they will win or
lose, they tend to lose track of how much money they have won or lost.
 Griffiths(1994) states that the amount of control and skill involved in
gambling is overestimated, aiding in the irrational thinking of the
gambling addicts. He also found that addicts tended to explain their losses
as “near wins”, something which justified their continuation.
Explanations to Addiction
Behavioural Approach
Behavioural Approach
 The behavioural approach assumes that addictive behaviour is a result of
maladaptive learning through operant or classical conditioning.

 In operant conditioning, the behaviour stimulates a reward. For

example, smoking triggers the is seen as negative reinforcement; they are
not performing the behaviour and therefore do not receive the reward.
 West states that “the process of maintenance of addictive behaviour is
unconscious, therefore it can explain the conflict between he conscious
want to stop and the motivational forces that impel addicts to continue.”

Advantages Disadvantages
 Reductionist - reduces the act
 Offers hope for those who of addiction down to simple
want to quit – they can just reinforcements.
relearn behaviour.  Does not explain initiation well.
 Is supported by studies.  Winefield et al noted that more
gamblers lose than win,
therefore there is little
reinforcement.
 It doesn’t take individual
differences into account.
Behavioural Approach
 In Classical Conditioning the individual associates a stimulus with a
conditioned response (eg pavlov’s dogs). The conditioned stimulus acts
like a secondary reinforcer.
 For example, when a smoker comes closer to something they associate
with smoking, eg smoke/stress, their body may start the biological
process for dealing with the excess dopamine it expects to receive. This
makes the addict feel withdrawal effects and cravings as their body
becomes low in dopamine.
 Glutier et al found that alcohol related stimuli often produced the same
physiological responses as the alcohol itself
 Siegel et al (1982) argued that tolerance to heroine can be conditioned to
the environment in which the drug is usually consumed. A change in
environment can cause an overdose. This explains the high number of
overdoses in unfamiliar places.
 Robsins et al found that veterans who had become addicted to heroine
whilst in Vietnam were much less likely to relapse when they returned
home.
Advantages Disadvantages
 Offers hope for those who
 Reductionist - reduces the act
want to quit – they can just of addiction down to simple
relearn behaviour. reinforcements.
 Is supported by studies.
Behavioural Approach
 The social learning theory brings together both classical and operant
conditioning and extends them to looking at observation and
communication.
 The addiction starts with operant conditioning where the individual
receives an initial award for the behaviour or witnesses someone else
receive a reward (vicarious reinforcement). Some people witness negative
effects and have a decreased likelihood of becoming addicted.
 Through classical conditioning, secondary reinforcers are associated with
the behaviour.
 George et al found that the presence of multiple cues raises the “positive
percieved expectations” and therefore increase the motivation to use the
drug again.

Advantages
 Explains initiation better than the others.
 Takes into account peer group influences.
 Takes into account their own expectations.
Vulnerability to Addiction
Intra and Extra
Intrapersonal factors refer to factors that
are due to the individual, whilst extra
personal factors are factors which are
beyond the control of the individual.

Intrapersonal factors are things like

characteristics, genetics, personality traits
and expectancies.

Extra personal factors include things such

as economic situation, availability of
drugs, culture and social influences.
Intra and Extra
Intra Personal Extra Personal
 Eysenck (1985) identified  Davidson et al (2004)
a wide personality type found that peers and
that causes people be family provide a model for
become predispositioned the learning of an
to addiction. addictive behaviour.
 Sussman and Ames  Sussman and ames found
(2001) found that drugs that culture effects “life
relieve moods such as habits”.
anger and bordem.  Lower economic status
 Hedonistic people has been associated with
experience a lot of drug use and lower self
pleasure from natural esteem.
stimuli and therefore are  Availability of drugs has
at less risk to addiction. an impact on whether a
user can use them.
Self-esteem
 Selfesteem is thought to have an effect on the likehood of
developing an addiction
 Taylor conducted a 9 year study of 872 boys and found
that those with low self esteem were at a higher risk of
becoming addicted at the age of 20.
 Philips et al found that adolescents with lower self esteem
had excessive phone use, using phones as a way of
escaping unpleasant situation. This is thought to be able to
be generalised to the use of drugs.
 Armstrong found that pathological internet use (internet
addiction) was linked to low self esteem

However
 Hull et al found that there was no diffence in levels of self
esteem of adolescence and substance abuse
 Mcmurran found that the most important factors are
culture, family, lifestyle and social group. Feelings and self
esteem were the least important factors.
Attribution theory
 This theory relates to the concept of control. Things beyond our
control are called external attributions, we can not be held
responsible for these because we can not control it. Internal
attributions are within our control, allowing us to take blame for
our own actions.
 Kelly(1967) asked people why they started smoking. He found
that those with an external locus of control answered with
external attributions, whilst those with internal loci of control
answered with internal attributions.
 Sereviratne and Saunders(2000) looked at relapse in alcoholics
and their reasons, and their perceived reasons for other people’s
relapse. They found that alcoholics tended to give external
attributes for themselves, eg “life is so stressful, I had no support
from others” but gave internal attributes for others, such as “they
have a weak personality”. From this it can be concluded that no
one likes to accept blame for their actions so blame addiction on
things beyond our control
 Eiser et al found that if smokers perceived themselves as being
“addicted” they felt that it was beyond their control and do not try
to control or stop their addiction. The label “addict” prompted the
self-fulfilling prophecy.
Social Context of Addiction
 Godard(1990) found that if parents smoke, the children are much
more likely to smoke.
 Murray et al(1984) concluded that a parent’s attitude towards
smoking was very important. If children perceived parents as
being anti-smoking, they were seven times less likely to smoke.
 Turner et al(2002) found that gambling addiction could be
associated with ADHD in early life.
 Those who come from higher income families are less likely to
become gambling addicts than those who come from low income
families.
 Environmental cues may trigger the addiction and cause relapse,
for example, if a smoker is surrounded by ashtrays it may prompt
them to begin smoking again.
 Studies into peer pressure and peer groups have shown that
people are more likely to smoke if their friends also smoke.
The role of the media in
addiction
Media enforcement
 “Celebrity endorsement” of certain lifestyles is
particularly important in influencing addictive
behaviour amongst young people who are most
vulnerable to the cult of perceived celeb glamour.
 Bandura’s social learning theory indicates that
we model our behaviour on someone we respect
or would like to be like. The media offers many
celebrities as models.
 The International Narcotics Control Board (INCB)
highlighted the issue that teenagers, in
particular, are very quick to pick up on stories
about a celebrity’s drug habits that go
unpunished. They often respond to the perceived
leniency in dealing with such offenders by
engaging in the activity themselves.
Media enforcement - Negative
 Strasburger(1995) found that despite tobacco advertising
being banned in the US in 1971, it remained to be the
most purchased product until the early 1990s. He found
that this was because it was often associated with popular
brands of clothes and sports cars.
 Sargent et al(2007) found that being exposed to smoking
through characters in movies and music videos increased
the risk of the observer becoming an established smoker.
 Korn and Reynolds(2008) reported the impacts of
commercial gambling advertising as being influential. They
used a sample of adolescents in Canada to do a
questionnaire on gambling advertisements. Every
participant was able to identify atleast one gambling
campaign which they described to be “funny”, “showed
cool people” and indicated possibilities of financial gain. All
of which are likely be attractive to young people.
Media enforcement - Positive
 Since the 1950s, the portrayal of smoking on TV has
steadily decreased. Signorielli (1990) reports that US TV
characters were 9 times more likely to smoke in 1964 than
in 1982, and at the same time the incidence of smoking in
society has decreased.

 Friend and Levy(2002) reviewed the impact of antismoking

campaigns and found that such campaigns targeted at
youth and adults seemed to be successful, whilst
campaigns targeted solely at youths tended to be mixed in
results.

 Klein et al (2005) found that anti smoking campaigns with

telephone help lines were successful in informing the public
of the dangers of smoking and aided in the changing of
behaviour.
Prevention
Prevention
“Prevention is cheaper than the cure”
The two most common approaches for
prevention are:
o Education
o Introducing social change. Eg, increasing the
price/punishment/age requirement.
The Health Belief Model
 The HBM was developed by Becker in 1974.
 It assumes that the likelihood of individuals
engaging in health damaging behaviour (such as
smoking or drinking) depends on :
How susceptible to the addiction they think they are.
How susceptible to the diseases associated with the
behaviour they think they are.
How severe the consequences of the associated disease
are
Advantages Disadvantages
Takes personal characteristics There is conflicting evidence.
into account. It overestimates people’s own
There is supporting evidence, rationality.
particularly in relation to things The reinforcing effects of
such as safe sex and HIV. addictive behaviour are not
It has real life implications. taken into account.
Intervention
Theory of Reasoned Action
 Thisis used to examine predictions of
behaviours. If we know what makes a behaviour
more likely, we can try to prevent it.

 TRA assumes that the behaviour is the product of

intentions to perform that behaviour, therefore,
it is a cognitive model.

 It is determined by:
Subjective norms/ the desirability of behaviour by
culture or social group.
Attitudes towards the outcome or expected outcome.
Theory of Reasoned Action
Beliefs about the
outcome of the
behaviour. Eg, “if
I stop smoking, I
will be healthier” Attitude to
specific
Evaluations of
behaviour
outcome. Eg “I
want to be Behavioural
healthier” intention Behaviour
(intend to quit) (Quitting)
Normative Beliefs
about the behaviour. Eg
“my friends think i should
stop smoking” Subjective
Norms
Motivation to comply
Eg “I want to be liked by
my friends, so I’ll do what
they want”
Theory of Reasoned Action
Advantages Disadvantages
 It has been  Fails to take past
successfully used in behaviour into account
predicting behaviour even though past
such as blood behaviour is often a
donation and good predictor of
smoking. future behaviour.
 It takes personal  Doesn’t take irrational
characteristics into or involuntary
account. behaviour into
account.
 Not all intention turns
into actual behaviour.
Theory of Planned Behaviour
 This theory is about the link between attitudes and
behaviour. It was proposed by Icek Ajzen as an extension
on the theory of reasoned action and is one of the most
predictive persuasion theories.

 Thismodel includes an extra step, this is the control beliefs

and perceived behaviour control.

 Control beliefs refers to the perceived presence of factors

that might help or stop the behaviour. For example, if they
believe that they will be forced to continue smoking.

 Perceived behavioural control refers to the extent to which

the individual can believes they can control the behaviour.
For example, if they believe that they do have the will
power to stop smoking
Theory of Planned Behaviour
Attitude
towards
behaviour

Subjective
Intention Behaviour
norms

Control
beliefs
Theory of Planned Behaviour
Advantages Disadvantages
 It has been  Fails to take past
successfully used in behaviour into account
predicting behaviour even though past
such as blood behaviour is often a
donation and good predictor of
smoking. future behaviour.
 It takes personal  Doesn’t take irrational
characteristics into or involuntary
account. behaviour into
 Takes into account account.
the perceptions of the  Not all intention turns
individual. into actual behaviour.
Interventions
 There are lots of different reasons why people become addicted to
behaviours, therefore no single intervention will work for every
person.
 The success of all interventions have been shown to be
dependant on the willingness of the individual to give up.
 Prochaska and Diclemente(1983) made a model which details the
stages addicts go through when trying to quit their addiction:
 Pre-contemplation (not thinking about quitting)
 Contemplation (beginning to think about quitting)
 Preparation (thinking practically about quitting, making plans to see
advisors etc.)
 Action (actually attempting to quit)
 Maintenance (maintaining it)

 They found that if an addict made it to the preparation stage,

they were much more likely to give up the addiction.
Biological Interventions
Nicotine Replacement Therapy is devices
such as gum or patches that relieve the
withdrawal symptoms by giving a small fix
of nicotine whilst relieving stress.
Watts(2002) found Bupropion successful
in treating smoking addicts as it increases
dopamine levels whilst reducing the
number of nicotine receptors.
Evaluations
Advantages Disadvantages

Are successful in helping people The addict could believe it’s

quit. going to help them, rather than it
Takes blame away from addict being the drug that allows them
There is evidence to suggest to quit.
that it is the drug that actually Drugs can lead to side effects
helps the addict quit. (studies and further addiction
with placebos). Not good for addictions such as
gambling
Reductionist
Behavioural Interventions
 Cue exposure (classical conditioning) aims to stop the addict from associating
certain environmental cues with the behaviour. For example, if an addict always
smokes when sitting in one room in a house, this therapy aims to make the addict
learn to do something else in the room (eg, play a video game), eventually the
learnt behaviour of having to smoke in that room with fade out. This has been found
be more successful than just avoiding cues.

 Aversion therapy (operant conditioning) can also be used to make the addict
associate the behaviour with punishment. Antabuse is a drug taken by alcoholics
which forces them to be sick if they have alcohol. Whilst Lang and Martlatt (1962)
found this to be effective, they noted that it doesn’t address the problems that
started the addiction.

 Imaginal Desensitization is where addicts are taught to relax so that when they are
exposed to an environment which triggers the cravings for the behaviour, they can
relax and resist.

 Self management techniques are where the addict makes a diary of when they do
the behaviour, therefore they can expect their cravings. Hall et al (1990) found this
to be unsuccessful on its own, but when combined with other therapies it aided in
the reduction of the behaviour.
Evaluations
Advantages Disadvantages
Are successful in helping people Doesn’t address the problems of
quit. why the person began the
Often used together in a multi- addictive behaviour in the first
component programme where place.
other interventions are also used. Aversion therapy poses health
risks.
Aversion therapy is unsuccessful
in non-chemical addictions
because the punishing effect (eg
electric shock) does not last
outside the clinical setting.
Don’t tend to work for gambling
addiction.
Cognitive Interventions
 Cognitive psychologists have identified 3 stages of change which are relevant to stopping
smoking with the aid of a therapist:
 Contemplation and commitment
 Action
 Maintenance
 Currey (1993) found that many smokers can get through the stages themselves and
successfully quit smoking.

 Cognitive Behaviour Therapy involves training the addict in social skills and developing
strategies with them to prevent relapse. It also challenges any ideas they have such as
“I’m not strong enough to give up smoking”, “gambling will get me out of debt”. CBT has
been proven effective, however Feeney(2002) found that it is much more effective when
used in conjunction with drug therapies.

 Motivational interviewing involves trying to help addicts find the motivation to quit. This is
done by helping them weigh up the pros and cons of the addiction. Deroo and Rivara
(2001) found it was effective in helping those with substance abuse issues. They also found
that it encourages them to try more intense methods such as drug therapy.

 Rational Emotive Behaviour Therapy consists of the A B C D model in which A is the

activating event, B is the beliefs about the event, C is the consequences. Through REBT the
individual begins to understand their illogical beliefs and start to D – dipute and challenge
those beliefs.
Evaluations
Advantages Disadvantages
Are successful in helping people Isn’t as successful as drug
quit. therapies.
Often used together in a multi- Isn’t always easy to change
component programme where someone’s way of thinking.
other interventions are also used. Blames the addict for their
Addresses the reasons that addiction.
people become addicted.
Psychodynamic Interventions
 Psychoanalysts believe that even the most self-destructive of behaviours
are defensive or adaptive. This perspective suggests that gambling and
smoking addiction is an expression of underlying psychological conditions.

 Freud speculated that someone who gambles actually gambles to lose. He

believed that this was an expression of self-punishment because of
feelings of guilt or inadequacy.

 Hypnotherapy, free association and talk therapy are all used to un-cover
issues that the addict is experiencing. These have not been proven
entirely successful through research, but this approach is used in
conjunction with others especially in the case of pathological gambling.
Evaluations
Advantages Disadvantages
Often used together in a multi- Isn’t as successful as drug
component programme where therapies.
other interventions are also used. Isn’t always easy to change
Addresses the reasons that someone’s way of thinking.
people become addicted. There is no evidence relating to
the psychodynamic approach.
Public Health
 Doctors are seen as being credible sources of information. Sources have shown
that 70% of smokers will visit the doctors at some point and doctors can be
successful in promoting cessation in smoking.
 Russel found that when doctors gave advices to stop smoking, a leaflet on stopping
smoking and a follow up appointment, smokers were more likely to quit.

 Worksites have been forced to adopt no smoking policies. This makes it more
inconvenient for smokers.
 Ogden found that whilst there was a reduced level of smoking in the workplace, the
smoking outside of work compensated for the less. When he surveyed workers who
smoked, they did see the benefits of not smoking but only 2% actually quit.
 The smoking ban for public places has also shown an decrease in the amount of
smokers.

 Community based programmes aim to give people motivation and social support.
 The swiss national research programme saw a 8% reduction in smoking 3 years
after the campaign started.
 In Australia, there was a 15% reduction within 3 years of the start of their
government community quit programmes.