ADDICTION REVISION Biological Models of Addictive Behaviour Initiation Genes AO1 Individuals with DRD2 gene are more

likely to become addicted to substances such as drugs and alcohol. This is because DRD2 gene decreases the amount of dopamine receptors in the pleasure centres of the brain. And individual with the DRD2 gene may use addictive substances, such as certain drugs, to increase dopamine levels in the pleasure centres of the brain in order to increase feelings of pleasure. McGue et al (1992): Alcoholic Twins AO2 Procedure: Interviewed MZ and DZ twins about their alcohol use. Findings: 77% concordance rate among the MZ twins and a 54% concordance rate amongst the DZ twins. Conclusion: As MZ twins share 100% of their genes and DZ twins share just 50% of their genes, a 23% higher concordance rate in alcohol use for MZ twins suggests that genes are a significant factor in alcohol addiction. Methodological Issues AO3 Gender Bias study conducted on male twins only; in a study with females, there were concordance rates of 39% in MZ twins and 42% in DZ twins. Correlational Data not necessarily a causal relationship between genes and alcohol addiction; may be extraneous variables such as friendship groups MZ twins more likely to have the same friends, especially if they are the same gender. Maintenance Neurochemistry AO1 Increased exposure to addictive substance decreases, or down-regulates, the activity of the dopamine receptors in the pleasure centres of the brain. Therefore the body always needs more of the substance to achieve the same effect as before.

If the individual stops taking the substance, they experience physical withdrawal symptoms such as shaking this causes them to maintain, and even increase, their addiction. Cunningham-Williams (1998): Anti Social Gamblers AO2 Procedure: Interviewed 3000 adults from a variety of ages and backgrounds about their gambling habits. Findings: 46% of participants gambled recreationally, 9.2% were problem gamblers and 0.9% were pathological gamblers. Participants categorised as problem gamblers were six times more likely to display symptoms of AntiSocial Personality Disorder which is characterised by low dopamine levels. Conclusion: Supports the theory that low dopamine levels are a cause of addiction. Relapse Neuroanatomy AO1 Chronic exposure to a substance causes the frontal cortex to become less effective at judging consequences of actions. This means the individual will not focus on the negative effects of taking the addictive substance, increasing the likelihood of relapse. Add study Reductionist AO3 Reduces addiction to alterations in neurochemistry or neuroanatomy and ignores other factors. For example, the behavioural model suggests that an individual may begin smoking because they observe their peers smoking and gaining respect. Therefore, even if the person if biologically predisposed to addiction, they will only develop the addiction if they are exposed to the addictive behaviour. This suggests that the biological theories cannot provide a complete explanation of addiction. Cognitive Models of Addictive Behaviour Rational Choice Theory (Becker and Murphy, 1988) Initiation AO1

Individuals initiate an addictive behaviour because the benefits of the behaviour outweigh the costs. For example, an individual may believe the benefit of reduced anxiety, as a result of smoking, is more important than the long term health effects. Maintenance & Relapse AO1 Individuals believe the costs of stopping the addictive behaviour are outweighed by the benefits of maintaining or relapsing the addiction. For example, an individual may believe, or have found, the withdrawal symptoms (e.g. anxiety) of quitting smoking to be worse than the long term health effects. Ainslie (1992): Short Term Smokers AO2 People but put far more emphasis on immediate rewards of a behaviour For example, smokers focus on the pleasure they receive from smoking and not the long term health effects of smoking. This is known as cognitive myopia, a form of faulty thinking. This supports the theory that the initiation / maintenance / relapse of addiction is a rational choice, as the addict puts emphasis on the short term benefits and views the long term costs as less important. However, research by Griffiths suggests that addictive behaviour is not a rational choice. Griffiths (1994): Near Wins or Losses? AO2 Procedure: Investigated thought patterns of regular gamblers (RG) vs. nonregular gamblers (NRG). 30 participants in each group played fruitskill (slot machine) and verbalised thoughts which were recorded. Findings: The RG has more irrational thoughts such as asking the machine to be nice to them and classifying losses as near wins (unlike NRG who recognised them as losses). Conclusion: Suggests addictive gambling is not a rational choice, undermining the rational choice theory of addictive behaviour. Legislation AO3 Rational choice theory has implications for the legislation of addictive substances.

For example, in Australia, researchers found a negative correlation between teenage smoking and cigarette prices. This suggests that increasing the costs of addictive behaviour decreases the initiation / maintenance / relapse of the behaviour. Another cognitive model of addiction is Self-Medication Model Initiation AO1 Individuals initiate an addictive behaviour to medicate a psychological symptom, e.g. stress. The addictive behaviour is chosen for the individuals specific symptoms, e.g. smoking to relieve stress, gambling to relieve depression. Individuals with addictions only think of acute effects (immediate) rather than chronic effects (smoking increases stress in long term). Maintenance & Relapse AO1 Individuals maintain addictive behaviour because it has desired effects. Stopping the addictive behaviour causes original psychological symptoms (e.g. stress), leading the individual to relapse. Gottdiener et al (2008): Ego Control AO2 Procedure: Meta-analysis of 10 studies of people with substance abuse disorders.to test the idea that people with substance abuse disorders only think about the short term effects of their addiction. Findings: People with substance abuse disorders had less ego control than a control group, meaning they were less able to consider the long term effects of their addiction Conclusion: Supports the self medication theory, that people initiate / maintain an addictive behaviour in order to medicate current problems, rather than as a long term solution. However Psychological Distress AO2 The Self Medication Model could be argued to be limited as it argues that addiction must be preceded by psychological distress.

Supported by Sanjuan et al (2009) who found that sexually abused women were more likely to turn to alcohol and other drugs to remove sexual inhibitions than non-abused women. However, cannot explain the many cases of addiction where there are no major psychological problems to overcome. Furthermore Limited / Choice AO3 The Self Medication and Rational Choice models of addiction suggest that an addict chooses to initiate / maintain / relapse an addictive behaviour. However, research into the biological model of addiction suggests that some people are genetically predisposed to addiction. Therefore cognitive models of addiction may not provide a complete explanation of addictive behaviour. Behavioural Models of Addictive Behaviour Initiation Social Learning Theory AO1 SLT, in relation to the initiation of smoking, involves four components: attention, retention, reproduction and motivation. Attention refers to the observation of others smoking and being rewarded (e.g. respect from peers). This leads to retention, where the individual forms a mental representation of smoking, meaning they associate smoking with gaining respect from peers. This leads to the reproduction of the smoking behaviour, which if rewarded directly, leads the individual to develop self efficacy in regard to smoking, leading to the initiation of smoking addiction. This leads to motivation, where the smoker develops self-efficacy (confidence in smoking Mayeux et al (2008): Popular Smokers Procedure: Studied a group of boys from the age of 16 to 18. Findings: Found a positive predicative relationship between smoking at age 16 and popularity two years later.

Conclusion: Suggests that smoking is associated with popularity, leading many teenage boys to initiate the behaviour. Therefore supports the SLT of smoking addiction in young people. Maintenance Operant Conditioning AO1 Involves direct reward / reinforcement for smoking. For example, an individual becomes more popular as as a result of smoking. This encourages the individual to maintain their smoking addiction so that they continue to be rewarded (remain popular). Add study. Relapse The Cue-Reactivity Theory (Carter and Tiffany, 1999) - Classical Conditioning AO1 Addicts react to stimuli associated with their addiction in a similar way to the actual addiction. This is explained through classical conditioning: 1) An individual takes heroin (unconditional stimulus) and feels high (unconditioned response). 2) The individual initially has no response to a hypodermic needle (neutral stimulus). 3) The individual repeatedly takes heroin with a hypodermic needle. 4) This causes the individual to associate the hypodermic needle (which becomes the conditioned stimulus) with feeling high (conditioned response). 5) Therefore when a heroin addict sees a hypodermic needle, they recall the sensation of feeling high. The temporary sensation of feeling high when seeing the conditioned stimulus can lead the addict to wish to maintain this sensation, consequently leading to relapse of the actual addiction. Conditioned stimuli for smoking may include matches, lighters, cigarette boxes and ash trays whereas for gambling they may include betting slips / shops and gambling odds in the newspaper. Add study. Limited AO3

Cannot explain why two people in a peer group may not both develop smoking addictions, despite being exposed to similar stimuli. This suggests that there are other factors involved in smoking addiction; Griffiths stated that addiction must be explained from a bio-psycho-social approach as no single approach can provide a sufficient explanation. Factors Affecting Vulnerability to Addiction learn two of the following Self Esteem Self Esteem AO1 Self esteem refers to an individuals self worth. Low self esteem is related to dependency behaviours and depression, with addicts often possessing a negative disposition. Addictive behaviours may allow people with low self esteem to escape negative thoughts of themselves. Bianchi and Phillips (2005): Timid Texters AO2 Procedure: Studied the relationship between mobile phone addiction and self esteem in 198 participants with an average of 36. Findings: Participants with low self esteem scored highly on the Mobile Phone Problem Usage Scale (MPPUS). Conclusion: People with low self esteem seek reassurance from peers so need more regular contact; supports the theory that low self esteem increases vulnerability to addiction. Social Context Social Context AO1 Social context includes: Family background, e.g. support from parents and peers when trying to quit an addictive behaviour individuals without support are more vulnerable to relapses of addictive behaviour Environmental factors, e.g. homeless people more vulnerable to addiction in order to cope with difficult living situation Social status, e.g. divorcees have been identified as more vulnerable to addiction Social attitudes, e.g. students in schools where smoking is the norm are more vulnerable to smoking addiction than students in schools where smoking is considered unacceptable.

Wider social attitudes, e.g. women have become more vulnerable to smoking addiction in recent years as it has become socially acceptable for women to smoke

Eiser et al (1991): Smoking Friends AO2 Findings: Smokers tend to befriend smokers and non-smokers tend to befriend non-smokers. Conclusion: Suggests that peer influence is a significant factor in vulnerability to smoking addiction. Brown et al (1997): Year Group Influence AO2 Findings: Young adolescents influenced by wider peer groups while older adolescents influenced by their close friends and romantic partners. Conclusion: Suggests that wider social contexts as well as close peer influences affect vulnerability to addiction. Attribution Theory Attribution Theory AO1 Attribution concerns the explanations that individuals give for their own and others behaviour. This often involves the fundamental attribution error. This is when: - A person perceives their own behaviour as due to situational attributions (external factors) - But perceives others behaviour as due to dispositional factors (internal behaviour) - E.g. addicts attribute their dependence as due to external factors (I have to take drugs to get the respect of my peers) - But addicts attribute others behaviour to internal factors (shes an addict because she has no self respect) This may explain relapse of addictions as addicts believe external factors cause them to relapse. Eiser (1982) Findings: Smokers experienced conflicting cognitions about their behaviour. They resolved these by attributing smoking to external factors, i.e. their body needs nicotine which is why they continue to smoke. Conclusion: Supports the theory that addicts attribute their addictive behaviour to external factors. McAllister and Davies (1992)

Procedure: Smokers were asked to explain their smoking habits. Findings: Initially smokers said they chose (internal) to smoke. When the interviewer suggested the smoker was an addict, the smokers shifted attributions from internal to become more external. Conclusion: Suggests that labelling a smoker as an addict causes external attribution which is a major obstacle to behavioural change. Biological Vulnerability AO3 However research also suggests that some individuals could be biologically predisposed to addiction, making them more vulnerable to developing an addiction. For example, research has found that individuals with low dopamine levels are more likely to develop addictive behaviours. This suggests that low self esteem / social context / attribution theory are not the only factors involved in vulnerability to addiction. The Role of the Media in Addiction Double Role of the Media AO1 There is a double role of the media in addiction: promoting of addictive behaviour and promotion of health education. The portrayal of smoking and gambling in the media are controversial as research suggests that they have implications for the initiation, maintenance and relapse of these addictive behaviours. Films Films AO1 as research is illustrating, not supporting theory The effect of films on addictive behaviour is illustrated by research by Gunakesera et al (2005). Procedure: Analysed the portrayal of addictive behaviours over the last 20 years (excluding cartoons). Findings: There was cannabis use in 8% of the films, non-injected drugs (excluding cannabis) in 7% of the films, alcohol abuse in 32% of the films and tobacco use in 68% of the films. All the portrayals were positive and showed no negative behaviour to the behaviour. Conclusion: Concerning as social learning theory shows that people replicate behaviour if it is shown to have a positive outcome. Therefore, by showing

addictive behaviours such as smoking in a positive light, the media may increase rates of addictions to these substances. Media Responsibility AO2 Authorities in the media argue that the media reflects reality and this includes the portrayal of addictive behaviours. From this point of view, the media is an effect, rather than a cause, of behaviours such as smoking and gambling. Furthermore it can be argued that the media does not have a moral responsibility for the wellbeing of society and therefore to censor the portrayal of these behaviours. Smoking in Films > Smoking in Teenagers: Dalton et al (2003) A02 Findings: The more adolescents are exposed to films with smoking, the more likely they are to start smoking themselves. Conclusion: Suggests that the media can affect the initiation of smoking among adolescents, which may lead some to argue that the media does have a social responsibility to censor these behaviours. Advertising Advertising Ban: Changes Over Time AO1 In 1993, the British Psychological Society called for a ban on all advertising for cigarettes as well as on smoking in adverts. This is because of the significant amount of research into social learning theory that shows a positive portrayal of addictive behaviours encourages replication of these behaviours. The Secretary of State for Health rejected these proposals because: - The government wanted to put forward popular policies, which at the time did not included the censoring of smoking in the media (political). - The tax revenues gained from the sales of cigarettes was, and still is, beneficial for the government. However, in 2005, the government implemented a ban on all advertising of smoking as well as launching several anti-smoking campaigns. This shows how attitudes to addictive behaviours change over time and the role that the media plays in promoting or condemning these behaviours. However, research shows that people dont believe advertising affects whether they partake in an addictive behaviour

Third Person Effect: Youn et al (2000) AO2 Procedure: 194 adults, from US state where gambling is legal, were surveyed about - their gambling behaviour - their attitudes about the effect of gambling on themselves and others - their attitude to the censorship of gambling adverts. Findings: People believed adverts had a more adverse effect on others than themselves, known as the third person effect. Conclusion: Suggests that the belief that the media encourages addictive behaviours may be too limited as people do not believe they are affected by the media. Not Enough Research AO3 Limited research into the effect of advertising on addictive behaviours. This is because a lot of the research is conducted by the companies that promote the behaviours, e.g. cigarette companies, in order to find out the most effective way of advertising their product. These studies are not released to the public as the companies want to protect this information from competitors. Therefore the role of the media in addiction is not well supported by research, meaning there is little reliable and valid evidence to show its significance. Models of Prevention Theory of Reasoned Action TRA AO1 Asssumes that an individuals behavioural intention and therefore addictive behaviour is affected by a persons attitude their beliefs about the behaviour and the subjective norm whether the behaviour will be viewed as normal by other people. ( i.e. attitude + subjective norm > behavioural intention > behaviour) For example, if an individual believes smoking will make them feel more relaxed, and most of their friends smoke, it is likely that they will have the behavioural intention to smoke and consequently begin smoking. However, an individuals attitude and the subjective are not equally balanced. For example if the subjective norm is to smoke but the individual has a relative who died of a smoking related disease, the strength of their anti-smoking attitude could outweigh the subjective norm.

The theory tries to predict whether an individual will initiate an addictive behaviour based on their attitude, the subjective norm and their behavioural intention. Research into TRA AO2 Meta-analysis found the TRA has strong predictive value (Shepard et al, 1988) Questionnaire that assessed adolescents gambling behaviour found attitudes to be a good predictor of behaviour, supporting TRA. (Wood and Griffith, 2004) Self reports from 2074 students showed that attitude to drugs and subjective norms were more useful in predicting drug and alcohol consumption than levels of self esteem. Theory of Planned Behaviour TPB AO1 Similar to TRA assumes that attitude and subjective norms affect behavioural intention. However, whether this behavioural intention (for example, the intention to quit smoking) leads to the behaviour (quitting smoking) depends on the perceived behavioural control. This is whether the person believes they can control their behaviour, i.e. have the willpower to quit smoking. Research into TPB A02 Questionnaire given to gamblers about previous gambling, social norms, attitudes, perceived behavioural control and behavioural intentions and found a positive correlation between attitudes, behavioural intentions and actual behaviour (Oh and Hsu, 2001) Interviews conducted to assess whether TPB can explain gambling behaviour and found that attitudes and norms were seen as important but perceived control (specific to TPB) was not on important predictive factor (Walker et al, 2000). General Evaluation of TRA & TPB A02 Model assumes behaviours are conscious, reasoned and planned (i.e. behaviour may not be rational because of social / chemical [alcohol, drugs] influences). Evidence to support TRA and TPB based on self-report, problems with social desirability bias. Theories can be used to target interventions through addressing: Attitudes education (e.g. campaigns about health effects) Subjective norms e.g. negative portrayal of addictive behaviour in media

Biological Interventions Smoking Nicotine Replacement Therapy NRT AO1 Involves releasing nicotine into the bloodstream in order to relieve the withdrawal symptoms from smoking. Desensitises nicotine receptors in brain so if a person does smoke, it is less satisfying. Releases nicotine into blood more slowly than cigarettes meaning NRT is less satisfying, encouraging relapse. Harmful? AO2 Nicotine causes cigarette addiction but cigarettes contain other harmful substances NRT prevents the person from ingesting these harmful substances. Therefore it is logical to reduce nicotine to eliminate consumption of harmful substances. However nicotine itself does have harmful effects, e.g.: - Increases heart rate and blood pressure, leading to heart disease - Aggravates diabetes - Increases tumour growth - Affects development of foetuses Even so, it is still less harmful than smoking. Drug Therapy & Vaccines use as alternative therapies to NRT but focus predominantly on NRT Varenicline AO1 Drug that causes the release of dopamine. Found to blocks the effect of nicotine. More effective than other drugs. Research AO2 Research shows that varenicline reduces risk of relapse after 12 weeks (short term).

However there is limited research into the effectiveness of the drug in the long term. Furthermore, even if the drug is effective, it will only work if the person is consistent in taking the drug. A potential treatment that does rely on self medication is Vaccinations AO2 Clinical trials underway. Aims to block the effect of nicotine. New treatment limited research. Gambling Serotonin Drugs SSRIs AO1 Evidence of serotonin dysfunction/fluctuation in pathological gamblers (George and Murali, 2005). SSRIs regulate serotonin levels, which could reduce the urge to partake in addictive behaviours. Research into SSRIs AO2 Hollander et al (2000) found that gamblers treated with SSRIs to increase serotonin levels showed significant improvement compared to a control group. However serotonin may not be the only neurotransmitter involved in addiction Dopamine Drugs Neltrexone AO1 Inhibits the release of dopamine that results from gambling. Research into Neltrexone AO2 Supported by research by Kim and Grant (2001) who found a decrease in gambling thoughts and behaviour after 6 weeks. Research with 10 participants over 16 weeks showed neltrexone reduced urge to gamble (Hollander et al, 2000).

However these studies only looked at short term effectiveness limited research into the long term effectiveness of the drug. Evaluation of all Biological Interventions AO3 Easy to use. Need to be taken to work. Reductionist approach; interventions do not address other factors involved in addictions, such as: - Cognitive factors - Social context - Self esteem - Media - Conditioning Suggests that biological interventions should be used in conjunction with psychological interventions in order to provide most effective treatment. Psychological Interventions Behavioural Aversion Therapy for Smoking: Rapid Smoking AO1 Based on classical conditioning. Aims to teach negative associations for addictive behaviour. Person trying to quit smoking put in a small, closed room (no windows or ventilation) and told to smoke every six seconds. This causes the person to feel nausea and discomfort as a result of the amount of nicotine in the body. This leads to the association between smoking and feeling ill. Also other types of aversion therapy for smoking Smith (1988): Electric Smokers AO2 Procedure: Participants were given a wristband with which they were told to administer themselves with electric shocks when they touched a cigarette packet, lit a match or placed the cigarette in their mouth. Findings: 52% of participants abstained from smoking for 12 months.

Conclusion: Suggests aversion therapy is an effective treatment for smoking addiction. General Evaluation AO2 However overlooks what led to addiction. Could be considered unethical as the person has to endure the negative effects of the treatment (i.e. nausea / electric shocks) Original positive associations (e.g. smoking reduces anxiety) can be re-learnt. Most effective as part of a multi-component programme (which uses biological and other psychological interventions). Cognitive Cognitive Behavioural Therapy (CBT) AO1 Based on the idea that addictive behaviours are maintained by the persons faulty thinking about these behaviours. Main goal is to help people change the way they think about their addiction. Also teaches strategies to prevent relapse, such as coping with peer pressure. Research into CBT: Landoueer et al (2001) AO2 Procedure: 66 pathological gamblers were randomly allocated to CBT or waiting list control group (to make sure everyone has the same level of addiction). Findings: Of those who completed treatment, 86% were no longer pathological gamblers (according to DSM criteria). They also had increased self efficacy (more confidence that they could stop their addictive behaviour). Conclusion: Suggests CBT is an effective treatment for gambling addiction. General Evaluation AO2 Research shows CBT is effective for behavioural addictions but less effective for substance addiction as substances often prevent rational thoughts. Most effective when combined with drugs. Feeney et al (2002) found that 14% of alcohol addicts gave up after CBT but 33% gave up after CBT and medication. Evaluation of all Psychological Therapies AO3

Person has to want to change, as it requires greater participation than biological therapies. Theoretical weaknesses overlooks biological factors so are limited explanations of addiction, therefore will never fully treat addiction. Public Health Interventions and Legislation Smoking Ban UK Smoking Ban in Public Places (2007) AO1 Places smoking was banned: - Work - Airport - Restaurants - Public transport - Vehicles used for work Aims to protect non-smoking public from passive smoking. West (2009): Rebound Effect AO2 Research shows people who wanted to quit smoking found there was more social support after the ban and therefore was easier to quit. Findings: found that more people quit smoking in the 9 months before the ban than in the 17 months after the ban (known as the rebound effect). Conclusion: This shows that people who wanted to quit stopped before the ban whereas people who didnt found ways around the ban. Gomel et al (1993): Smoking Ban in New South Wales AO2 Procedure: Implemented a smoking ban at work for New South Wales ambulance staff. 6 weeks later, smokers were given a questionnaire and a blood test. Findings: Staff reported less smoking at work and home (though problems with self report). However blood tests showed increased smoking outside work hours. Conclusion: Showed that ban didnt decrease smoking, just changed smoking behaviour.

Doctors Advice

Doctors Advice AO1 70% of smokers in the UK consult their GP each year. Therefore doctors advice in regard to smoking is likely to affect smoking rates. Degrees of Assistance AO2 A study carried out across give London GP practices compared results where patients were given varying degrees of assistance: Given follow-up only: 0.3% had given up smoking at 12 months. Filled in a questionnaire about their smoking habits and then given a follow-up: 1.6% had given up smoking at 12 months. Advised by the doctor to give up smoking, filled in a questionnaire on their habits and given follow up: 3.3% had given up smoking at 12 months. Advised by the doctor to give up, given a leaflet with tips for giving up and given follow up: 5.1% had given up smoking at 12 months.

These look like very small changes, but if all GPs advised their smoker patients to give up and provided them with some tips on how to do this, it would produce half a million ex-smokers within a year in the UK (Ogden, 2007). Other Legislation AO3 As well as the smoking ban and doctors advice, there has also been other legislation to try and decrease addictive behaviour, e.g: Restrictions or a ban on advertising Increasing the cost Controls on sales Reducing the harmful components in cigarettes or drinks

Public legislation can be effective though results are not the same for all groups. General Evaluation: Social Context AO3 In order to improve the effectiveness of public health interventions, social context should be recognised. In 1971, smokers and non-smokers mixed equally. In 2000, smokers were marginalised and clustered together. Within clusters, the closer the relationships, the high the influence. E.g. friend quit: decreased smoking in others by 36%. Partner quit: decreased smoking by 67%.

Therefore aiming campaigns at specific groups of smokers, such as teenage smokers, is likely to be more effective.