Models of addictive behaviour

Models of addictive behaviour

1. The Biological approach

   • Gambling
     • Initiation - pathological gambling runs in families
       • Shah et al - evidence of genetic transmission in men
       • Biologically predisposed
       • Pleasurable behaviour - reward pathway releases dopamine
         • Prefrontal cortex - plans to create pleasure again
       • Black et al - first degree relatives of pathological gamblers more at risk than distant relatives
       • Noble et al - A1 variant on DRD2 gene of 2/3 deceased alcoholics, only on 1/5 non alcoholics - gene for addiction
       • Able to explain how people with the same experiences don't all develop addiction. More vulnerable to initiation/more resistant to treatment
       • Ignores factors such as peer pressure in initiation. Combined with diathesis stress more appropriate
       • Breen & Zimmerman - unable to explain why different types of gambling are more addictive. Horse racing more addictive, three years later video gambling more addictive
     • Maintenance - underactive pituitary adrenal response - stressful situations
       • Paris et al - pathological gamblers have no cortisol increase to gambling stimuli
         • Hormone associated with stress
       • Individual differences in optimal stimulation
         • Zuckerman - high sensation seekers have lower appreciation of risk. Anticipate arousal more positively than low sensation seekers - more likely to gamble
       • Bonnaire et al - gamblers at race tracks higher sensation seekers than card players in cafes
     • Relapse - vulnerability to boredom can lead to gambling
       • Blaszczynski et al - gamblers had higher boredom proneness scores than control
         • No significant difference between types of gambling
   • Smoking
     • Initiation - genetics play a role
       • Vink et el - individual differences in initiation 44% genetics, 56% environment
       • Boardman - DZ twins 42% heritability for smoking
       • Thorgeirsson et al - variant on chromosome 15 that influences number of cigarettes smoked, nicotine dependence & risk of related diseases
         • Not only determines initiation, also affects dependence
       • Individuals could be screened for genetic vulnerability to decrease chances of starting smoking behaviour
         • Gartner et al - only weak association between genes & smoking - screening unlikely to be successful
     • Maintenance - individual differences in nicotine metabolism
       • Vink et al - nicotine cases dopamine release, behaviour must be repeated to avoid withdrawal symptoms
       • Buka et al - mothers who smoked during pregnancy doubled child's risk of smoking addiction if they started smoking
     • Relapse
       • Xian et al - 54% risk for quit failure inherited
       • Lerman et al - ASP40 variant made smokers with high dosage of NRT x2 more likely to quit than lower NRT levels
         • Effect not found in those without variant - genetic testing allows choice of most appropriate treatment
     • Ignores social context of behviour

2. The learning approach

   • Gambling
     • Initation - operant conditioning - addiction comes from rewards received. psychological - near miss, social - peer praise
       • Generally don't win, greater weight on experience of winning
       • Individual differences in types of gambling not explained, scratch cards - short time period little skill, sport betting - long time period increased skill
       • Nower et al - behaviourally conditioned gamblers (peers & role models) least severe addiction & are more willing to receive treatment
         • Emotionally vulnerable gamblers underlying anxiety/depression, poor coping skills. More resistant to treatment
     • Maintenance - intermittent reinforcement means gamblers become used to long time without payout
       • Lambos et al - social reinforcement also provides reinforcement
       • Only a partial explanation - unable to explain why though most people will sometimes gamble, few become addicts
     • Relapse - addicts associate stimuli with their addiction, providing conditional cues
       • Exposure to conditional cues increase chance of relapse
       • Fulfilment of gambling needs dependent on ability to control arousal & need for reinforcement
       • Adaptive behaviours learnt to calculate advantage on average
   • Smoking
     • Initation - social learning - role models influence the likelihood of addictive behaviour
       • People begin smoking because their peers do, positive social expectations
       • Mayeux - 16 year old males, relationship between smoking & popularity 2 years later
       • Diblasio & Benda - smokers more likely to hang out with other smokers
       • Karcher & Finn - parents smoking doubled likelihood of smoking, peers smoking x8 likelihood
       • NIDA - 90% American smokers started in teens, mainly from observing peers
         • Winett et al - role models with higher social status more likely to influence those of lower social status
           • Brynner - media images of smoking made it appear more attractive & tough
     • Relapse - conditioned cues, such as smell of cigarette smoke increase likelihood of relapse
       • Lawrance & Rubinson - frequent smokers have less self confidence in abstinence & more likely to relapse
       • Lopez et al - there is gender bias in research as addiction development is different in men & women
     • Maintenance - classical conditioning - repetition leads to conditioned association with sensory aspects of smoking & reinforcing properties of nicotine
       • Conditioned stimuli activate same part of the brain as nicotine, making quitting hard
       • Thewissen et al - placed smokers in rooms either with/without smoking cues. Cues produced greater urge to smoke
       • Drummond et al - producing cues without nicotine reinforcement can create stimulus discrimination, association extinguished

3. The cognitive approach

   • Smoking
     • Initiation - expectancy theory - expectations of outcomes of behaviour contribute to excessive use
       • Able to explain loss of control
       • Kassel et al - teens think smoking when they're in a bad mood
         • Brandon & Baker - they expect smoking will improve mood
       • Not seen as a loss of control, only an excessive behaviour
         • Addiction often involves loss of control, cannot be explained how expectancies affect this
         • Rational choice theory - addictive behaviour occurs after weighing up pros & cons
           • Gambling the exception as monies lost should cause offset
             • Pleasure received may offset this
     • Maintenance - automatic processing - as addiction develops, conscious thoughts less important
       • Explains the loss of control & difficulty abstaining
       • Tate et al - expectancies can be manipulated to prevent relapse
       • NRT treatment effectiveness not always consistent
         • Moolchan et al - NRT only effective when combined with CBT to change expectancies of smoking
     • Relapse - expectations of cost benefit will affect likelihood of quitting
       • Individuals who see many benefits in smoking more likely to relapse after quitting
       • Juliano & Brandon - smokers have greater expectancies of smoking improving mood & cutting craving. More positive effect on weight control - expantancies not generalised to NRT explain poor success rate
   • Gambling
     • Initation - gambling behaviour used for self medicaiton
       • Gelkopf et al - individuals use pathological behaviour to treat psychological symptoms
         • Behaviour perceived to help with issue
           • Mood regulation
           • Performance management
           • Distraction
       • Brandon - addictive behavior influenced more by unconscious expectations
       • Li et al - pathological gamblers who gambled to escape more likely to have other addictions
         • Self medication states one behaviour must precede the other
           • Becona et al - comorbidity of depression & gambling
             • Correlation does not show causality, depression may be due to financial difficulties
     • Maintenance - irrational beliefs - overestimate how much they think they can alter outcome
       • Gamblers fallacy - cognitive distortion probability changes based on recent events
       • Illusions of control
         • Langer - gamblers overestimate skill in chance situations
       • Exaggerated self confidence in beating the system & success due to skill not chance
       • Griffiths - regular gamblers made more irrational verbalisations such as 'only putting in a pound fools the machine' & 'this fruity is not in a good mood'
         • Described losses as near misses
       • Benhasin & Ladoucer - no difference in cognitive distortions of students in/not in statistics
         • Delfabbro et al - irrational cognitions in gamblers but just as accurate in calculating odds as non gamblers
     • Relapse
       • Blanco et al - gamblers remember & overestimate wins, rationalise losses
       • String of losses not a negative, gamblers feel they will eventually be rewarded - just world hypothesis, they deserve to win
       • Treatment should involve targeting underlying issue & motivation
   • Beck's vicious circle - Low mood - substance abuse - financial/medical/social problems