Addiction

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toricazaly
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Addiction
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2014-04-29 12:32:45
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  1. Why do self-report methods are not the best way to measure addiction?
    • Social desirability bias - they dont want to tell people they are addicted because of the social stigma
    • In denial about it - might not realise they're addicted
    • Unable to operationalise addiction - might be difficult to find people who fit their definition
    • The targeted group might be unwilling to complete questionaires or return them - lack of reliable date.
  2. Approaches explaining initiation, maintence and relapse
    • Behaviourist
    • Biological
    • Cognitive
  3. Behaviourist approach
    • Initiation: Various reinforcement - see people enjoying gambling and copy them doing it
    • Maintance: Operant conditioning continuously being rewarded with money from gambling which makes you want to continue to win even more money
    • Relapse: Vicarious reinforcement - seeing someone gamble which reminds you of the sense of reward
  4. Delfallbra and Winefield 1999: Schedulas of reinforcement - Maintence
    • Fixed ratio 1: Rewards every trial when stopped being rewarded you quickly stop responding
    • Fixed ration 10: rewarded every 10th trial. Takes loner to stop
    • Variable ratio 10: on average every 10th - really hard to stop. 'Could be the next one'.
  5. Classical conditioning
    • Context --> Gamble
    • Gambling context:
    • Casino; alcohol; football; supermarket till
    • Context --> Smoke
    • Smoking context:
    • Alcohol; people; smell; stress
    • The context causes the craving
    • Robinson, Helzines and Davis 1975
  6. Robinson, Helzines and Davis 1975
    • Vietnam soldiers got addicted to heroin due to the environment they were living in and due to stress. But when they came back to America there was no addiction because the context had changed.
    • This strongly suggests when you go back to the same context you relapse.
  7. Relapse: Operant conditioning
    • Behaviour --> outcome
    • Stop smoking --> withdrawal symptoms
    • Cranky; hungry; cravings etc (punishment)
    • Stop gambling --> withdrawal symptoms
    • frustration; bored; stress
    • The reward is negative reinforcement - taking away something that's bad
  8. Behaviourist approach evaluation:
    • The vast majority of behavioural approach is done with rats (95% experiment done with animals) these have different brain structures to humans. Therefore we cannot generalise the findings.
    • Scientific approach - objective research; falsifiable; replicable; no subjective bias. - We are likely to believe the finding are true.
  9. Biological approach Biochemstry
    • Nicotine mimics acetycholine leading to a rush using the dopamine reward pathway
    • Orginally takes 3 cigarettes to get the rush  but now takes 5 to get the same effect 
    • This is because once used to it, it takes more nicotine to give the rush, leading to brain activity increasing.
    • Therefore receptors desensitised to lower the brain activity meaning they need more nicotine to get the same effect as they have became tolerant also you continue to smoke because you have became dependent and need to feel normal . This explains maintance.
    • So when trying to quit, you have to smoke to feel normal because the brain has became under stimulated so it uses negative reinforcement because smoking gets rid of the withdrawal symptoms. This explains relapse.
    • HOWEVER it doesn't explain initiation because it cant explain why you pick up the cigarette
  10. Biological approach Genetic
    Also can consider genetics because it can run in families - genetically more likely to be more sensitive to become dependent
  11. Biological approach - gambling
    • The biological approach doesn't explain why you gamble. When you first gamble you get initiated because you get a buzz
    • Maintenance: Then you become torelant to it so the gambling has to get more and more riskier so bets get bigger and bigger - you have to get the dopamine rush to feel normal
    • Relapse: need the dopamine to feel normal - the body feel under stimulated so get withdrawn symptoms.
  12. Biological approach Olds and Milner 1954
    • Found that rats woud press a lever for reward of mild electrical stimulation in particular areas of the brain (pleasure centers).
    • The rats would continue to press this in preference to other possible rewards such as food drink and sexual activity.
    • Supports the biological approach as if you stimulate these parts of the brain then you can get addicted.
    • These parts of the brain can be stimulated by smoking or gambling -supports it
  13. Evaluation biological approach
    • Incomplete theory because its very narrow
    • Nicotine patches work so must be biological as nicotine is a chemical that affects the brain.
  14. Cognitive approach smoking
    • Its irrational thoughts that make you think you are less likely to get ill from smoking or disregard any evidence of getting ill
    • Faulty thinking of consequences
    • Ainslie - Things temporally close as better than things that are temporally distant
  15. Cognitive approach gambling
    • Its irrational thoughts that make us think that you are more likely to win - gambling
    • Cognitive bias
    • Availability bias
    • Illusion of control
    • Absolute frequency
    • Flexibility bias
  16. Cognitive approach initiation; maintenance and relapse. Gambling.
    • Initiation: Availability bias because you see people winning therefore think there is a big chance of you winning
    • Maintenance: Illusions of control because they think there in control of winning therefore gamble more. This is because you think you are more likely to win.
    • Flexible attribution - blame losses on near wins so think that you are better at gambling then you are - so gamble more.
    • Relapse: Absolute frequency - when you used to gamble you think you did a lot better than you did. Focus on the wins not how much money you lost over that time period in gambling.
  17. Illusions of control
    Hensin 1967: showed that craps players rolled the dice softly if they wanted a low number and hard if they wanted a higher number.
  18. Flexibility attributes
    Gilovich 1983: shows how gamblers who bet on football games call their losses near wins. They also showed 'hindsight bias' where they weren't surprised by the outcomes and claim they predicted if after the event happened.
  19. Cognitive approach initiation; maintenance and relapse. Smoking.
    • Initiation: - Attentional bias - focusing on the good parts of smoking and ignore the bad things
    • Maintenance: - cognitive myopia - look at things in the present not whats happening in the future. People who smoke see the short-term benefits but dont focus on the long term consequences
    • Cognitive dissonance - Two thoughts which grind together - don't fit together in the mind. For example you smoke and smoking kills - They stop this happening by saying it wont kill me explaining it wont affect you.
    • Relapse: Over estimation of personal qualities - believe they can stop when they want to.
    • Nordgren et al 2009 - addicts who think they have high control over future impulses were more likely to relapse - over estimate how much control they have over smoking
  20. Cognitive approach evaluation:
    • Not scientific - cant measure thoughts or mind because it has no physical qualities - hard to operationalise.
    • Doesnt fully explain initiation
    • There are many types of gambling that have skill in them - the cognitive approach doesnt say this as it balmes it on irrational thinking
    • Its difficult to differentiate between irrational bias and rational thoughts
    • It doesnt explain smoking/gambling completely there its a narrow approach and incomplete theory - need a complete theory bio-psycho-social.
  21. Stress:
    • Addiction is generally seen as relieving anxiety in its many forms.
    • Everyday Stress: Addiction is simply a method to deal with a build up of daily hassles. - Its a stress relief because it gives you excitement the addiction makes you feel better.
    • NIDA (1999): These stressors could be partially responsible for the initiation, maintenance and relapse of many addictive habits.    
    • Traumatic Stress: People (Especially Children) are especially vulnerable to forming addictions as a coping mechanism for dealing with severe stress.
    • Driessen et al. (2008): 30% of drug addicts and 15% of Alcoholics also suffer from Post Traumatic Stress Disorder. Interestingly, mild trauma was not enough to increase chance of addiction formation.
  22. Evaluate Effects of Stress
    • Hajek et al. (2010): Smoking to reduce stress is common, although many studies have found it actually increases stress.
    • Stress reduction for a smoker could simply be the response to the cigarette reducing their cravings, making smoking the cause and solution to their stress.
    • Cloniger (1987): - Problems with Individual Differences
    • Pointed out there were two types of alcoholics:-
    • Type 1 – Drink to reduce tension. (More likely to be female and prone to anxiety/depression)
    • Type 2 – Drinking to reduce boredom. (More likely to be male, and a risk taker.
  23. Peers
    • Social learning theory: Bandura 1977
    • Imitation
    • Vicarious Reinforcement
    • Social identity theory - normative social influence conform to be liked
    • In order to be part of the group you have to follow their behaviour - gambling on the fruit machine
  24. Evaluation of Effects of Peers
    • Duncan et al. (1995): Exposure to peers that model smoking behaviour will increase the likelihood of adopting this behaviour.
    • Eiser et al. (1989): The perceived rewards of Social status and popularity continue to remain motivators after the individual has taken up the habit, and can become powerful motivators to maintain the habits.
    • Done for social status; popularity; more attraction to opposite sex.
    • Social identity theory: created by Abrams and Hogg (1990)
    • Mitchell (1997): - Some teenagers develop addictions as they feel it is expected, and imitate them to be accepted by the rest of their social group.
  25. Age
    Brown et al. (1997) It would appear that your social crowd has the greater impact on smoking and gambling habits in young adolescence, but best friend and/or romantic partner eventually takes over this role.
  26. Personality
    The concept of addictive personalities is an attractive one, as it could explain why some people become addicted while others don't. It could also explain the wide array of different addictions identified, and how people become addicted to seemingly non-addictive things (Work, games, etc.)
  27. Personality and Eysenck (1967): - The Big Three
    • Addictive personalities are formed through the interaction of 3 personality dimensions:-
    • Extraversion-introversion
    • Extroverts are chronically under stimulated and bored. They seek external stimuli to increase cortical brain activity.
    • Neuroticism: Neurotics commonly experience negative affect (emotions) such as depression and anxiety. Because they worry they drink to relax – if you’re a worrier you’re more likely to get stress therefore more likely to have an addiction.
    • Psychoticism: Psychotics, while often demonstrating hostile behaviour, also are impulsive and react with little consideration for consequences. Don’t think things through so likely to do drugs and get addicted.
    • He argues that by an interaction of some or all of these personality traits, a person could easily become addicted to a wide range of stimuli, both physical and behavioural.
  28. Evaluation of personality
    • Belin et al (2008): When providing rats with a button that administered cocaine, one group of rats showed they were sensation seekers, and immediately took large doses. The other group were identified as impulsive and took smaller doses, but were more likely to form addictions.
    • Weintraub et al (2010): When Parkinson’s sufferers were given L-dopa, which is a drug that increases their levels of Dopamine, they showed a 3.5 times increase in impulse control (impulsive) disorders such as gambling and sex addiction.
  29. Media
    • TV (adverts, programmes), newspaper, films, music videos, billboards/posters, magazines, books, internet, radio, video games, packaging.
    • TV adverts Stoptober, TV adverts new game, alcohol, gambling websites, Bingo. TV lottery winners promoted, betting (back the boys!), Celebrities are role models, so if they smoke, others imitate. Within the programme, if you relate to a character. Eastenders, Skins, Misfits.
  30. Psychological mechanism that causes the media to encourage addiction.
    • Social Learning Theory - Imitation and Vicarious reinforcement
    • More likely  to imitate: - follow celeb; feel is similar to you; likeable people; same gender.
    • Perceived rewards: success; social status; popularity; money=power.
  31. People are influenced by the media:
    • Boon & Lomore (2001): found that 59% of young adults had their beliefs and behaviours affected by celebrity idols.
    • Distefan et al (1999): showed that the likability of actors/actresses that smoke is related to their teenage fans’ likelihood to start smoking.
    • Will et al (2005): suggests that the media project many positive images about drug taking and other addictions.
    • Gunsekera et al. (2005): looked at 200 mainstream films, and found that positive
    • impressions of drugs were frequent; Tobacco in 68% of the films, Alcohol in 32%, cannabis in 8%.
    • Further, Roberts et al. (2002): found a similar pattern in popular music, although tobacco references were much rarer.
    • Dalton et al. (2003): showed a positive correlation between exposure to films involving smoking and smoking behaviour.
    • However, Block (1981) found no relationship between exposure to TV advertising of alcohol and actual drinking habits.
  32. The theory of planned behaviour as a model for addiction prevention evaluation:
    • It doesn't aim to cure you but aims to prevent addiction happening in the first place
    • Subject norm: 'what does everyone else do'. This is a cognitive idea so in order to find out what the intention however when you ask them you have irrational thoughts processes so its not going to give accurate ideas about what they're thinking.
  33. The theory of planned behaviour evaluation studies:
    • Morrison et al. (2002)
    • Wood & Griffiths (2004)
    • Schlegel et al. (1992)
    • Armitage et al. (1999)
    • Godin et al. (2006):
  34. Morrison et al. (2002)
    • Investigated drug use by teenage mothers.
    • Attitudes tended to predict Intentions, and Intentions was related to actual marijuana use 6-months later.
    • If you intend to take marijuana your more likely to take it.
  35. Wood & Griffiths (2004)
    Gave questionnaires to a thousand 11-15 year olds, and found that attitudes predicted (correlated with) lottery and scratchcard use.
  36. Schlegel et al. (1992)
    • Found that drinking becomes less volitional (rationally decided) as the level of alcoholism increases.
    • Opposes the TPB because its the behaviour without any thinking about it (without intention)
  37. Armitage et al. (1999)
    • Says that the theory makes the assumption that a person will make a rational decision based on the perceived facts, but this ignores emotions and other irrational factors.
    • It assumes that your rational but your not.
  38. Godin et al. (2006) - Importance of Will Power.
    • Longitudinal 6 month study showed that while attitudes, subjective norms and perceived control all influenced intentions, only perceived control could really predict the eventual behaviour.
    • Due to this many campaigns focus on increasing willpower.
  39. Biological intervention of addiction:
    • Bupropion
    • Varenidine
    • Nicotine replacement treatment
  40. Bupropion:
    • The zyban brand of bupropion is used to help people stop smoking by reducing craving and other withdrawal effects – course lasts 7-12 weeks
    • Comparable to NRT but somewhat less effective than varenidine
  41. Agnoists:
    • Imitates the bad drug in the neutral receptors e.g. methodrome – heroin – gives you the same buzz
    • Nicotine patches – smoking tobacco
    • Removes harmful toxin and deals with the addictive element
    • Something dangerous to something softer
  42. Antagonists:
    • Blocks the neutral receptors and stops the bad drugs from working
    • e.g. bupropion blocks nicotine from working so smoking is no longer pleasurable and doesn’t satiate withdrawal symptoms
  43. Varenicline:
    • Partial agonist (and antagonists) for nicotine.
    • Begin a week before want to quit and then increase the doses once quitting twice a day.
  44. Effectiveness of Biological Treatments
    • Although you deal with the addiction, you are not solving the underlying issue e.g. depression. This means that new addiction may rise up to take its place.
    • Drugs are palliative not curative this means that its only deals with the symptoms and therefore if you come off the nicotine patches you are likely to relapse unless you slowly wean yourself off them
    • Drugs have side effects such as headaches or insomnia. Therefore people may stop the treatment thus making it less effective
  45. Effectiveness of Biological Treatments Studies
    • Fiore et al. (1994)
    • Hurt et al. (1997)
    • Jorenby et al. (1999)
  46. Fiore et al. (1994)
    • They found that for the first 4-weeks, 27% of those using a Nicotine patches were abstinent vs. 13% in the placebo patches. Placebo = control group to see if the expectation of stopping smoking was enough.
    • For the first 6-months, this dropped to 22% and 9% respectively. 
    • 73% did relapse so not very effective
    • Less effective over time BUT more effective than nothing – twice as likely to quit
    • Agonoist
    • 56% of people still relapse BUT significantly better than placebo group so partially effective.
  47. Hurt et al. (1997)
    • Tested 615 participants with either bupropion or a placebo as an intervention for smoking.
    • After 7 weeks, 44% of the buproprion group had quit compared to 19% in the placebo group.
  48. Jorenby et al. (1999)
    • Tested 893 smokers with either NRT, bupropion, both, or a placebo for 9 weeks.
    • A year later, 16% of the placebo group had abstained, 16% of the NRT, 30% bupropion, 36% for both.
    • But there was a 35% drop-out rate from the exp., partly due to side effects of headaches and insomnia.
    • Drugs aren’t very effective. If you stop using them (dropout rate =high)
    • Suggests NRT isn’t very effective as it has the same effectiveness as the placebo.
    • Bupropion and NRT can be effective for some people but not for everyone 64% relapse.
  49. Behavioural Treatment
    • Aversion Therapy
    • Context- desensitsation
    • Reinforcement Therapy (Higgins 1994)
  50. Aversion Therapy
    • Involves the pairing of an advesive  stimuli(electric shock) or an emetic
    • A drug that makes you feel sick with a specific addiction response or may be randomly interpressed while engaging in the addictive behaviour.
  51. Context desensitisation
    • Vivo; imaginal and systematic desensitisation.
    • Involves pairing cues for addiction with no addictive behaviour and feelings of boredom. Typically taking an addict to the environment where the addiction will typically take place
    • Casino without gambling
    • Bar without drinking
  52. Token economy (Higgins 1994)
    • Giving people rewards for not  smoking/gambling (the addictive behaviour)
    • Higgins tried to change the behaviour of people with a very serious cocaine problem.
    • When they hadn’t taken cocaine they were rewarded with vouchers that started with the value of $2.50 and went up $1.50 each time they were tested negative for cocaine.
    • But went down in value when they weren’t ($?).
    • The best way to cash in on the programme was to stay clear on cocaine for as long as possible.
    • 85% stayed on the program for 12 weeks and 66% stayed on for 6 months.
  53. Cognitive Treatments:
    • CBT – replace irrational thoughts with rational.
    • To train the mind in how to cope with quitting.
    • Motivational interviewing.
  54. Motivational interviewing.
    • An interview session to give you the  motivation and skills to quit (supporting the client)
    • Miller and Rollnick (2002):
    • Giving advice – on how to quit
    • Removing barriers – things that might stop you from quitting – e.g. stress – relaxation techniques
    • Providing choice – giving them a choice of what to do such as when wanting to smoke go to the gym
    • Decreasing desirability
    • Practising empathy – can see the effects of what their addiction is having on people
    • Providing feedback
    • Clarifying goals – cutting cigarettes from 20 a day to 10 within the next week
    • Active helping
  55. Relapse prevention:
    • Identity relapse triggers e.g. going to a betting shop – stress; boredom; tiredness
    • Teach techniques and skills how to deal with these triggers
    • e.g. stress = exercise a walk the dog; boredom = time with family; tiredness = go to bed
    • Develop awareness of own weaknesses and to plan ahead strategies to cope.
  56. Cognitive Treatments:
    • Dijkstra and De Vries 2001
    • Floyd et al. (2006)
    • Williams & Connolly (2006)
    • Feeney et al. (2002)
  57. Dijkstra and De Vries 2001
    • Studied 1500 smokers and split them into 4 groups with different conditions.
    • The conditions were no help (control group), information was given – why to
    • quit, efficacy was given – how to quit or both information and efficacy was given.
    • The only difference is if you tell them how to quit much more likely to quit in 7 day period.
    • Effective: 2.5 times more likely to quit when given the information and how to quit then thoses who didn’t get the information
    • Not that effective 90% relapse rate
    • More effective ways then CBT.
  58. Floyd et al. (2006)
    • Worked with students playing computerised roulette games.
    • One group heard a discussion of irrational beliefs by gamblers + “warning messages” in-play.
    • A second group saw brief warning messages about the beliefs,
    • A third group heard the history of roulette.
    • The warning message groups had less-risky gambling and reported fewer irrational thoughts. This shows how it can be effective.
  59. Williams & Connolly (2006)
    • Informed students about probability theory(either gambling or not).
    • Six months later, those who had learned about gambling were better at calculating odds and had fewer gambling fallacies than the other group.
    • However, the two groups did not differ in the amount of actual gambling that they did.
    • Not very effective because they did the same amount of gambling
  60. Feeney et al. (2002)
    Reported 14% abstinence with CBT, but 38% with CBT + drugs.
  61. Public Health Interventions
    • When the government intervenes
    • Examples: talk to frank
    • smoke-free England
    • drink awareness
    • gamble awareness
  62. Public Health Interventions No Smoking Day
    • National and local organisations
    • Website, posters, leaflets, press articles, “quit packs”
    • 1.2 million people stopped smoking in 2008.
    • 20% of those aware of the event made an attempt to quit.
    • Owen & Youdan (2006) evaluated NSD 2004: 70% smokers heard about the event.
    • 11% of those who attempted to quit were still smoke-free 3-months later (~85,000)
    • The government put these campaigns on to get people to quit.
  63. Public legislation
    • The government doesn’t want to simply outlaw smoking as they gain a lot of money from taxing cigarettes - same for alcohol
    • BUT more long term cost – NHS.
    • Legislation hopes to cut addiction: By adding barriers it makes it inconvenient to smoke as its harder to actually buy them
    • Trying to break social norms so want to make it less popular.
    • Lotrean (2008): reviewed smoking bans in a number of countries, and found that the ban helped to shape the social norms against smoking.
  64. What has the government done to reduce smoking?
    • 1965 Banned TV advertising for cigarettes
    • 1971 first health warnings on packets
    • 1991 All tobacco TV adverts banned
    • 2003 General advertising, promotions, sponsorships.
    • 2007 Banned from smoking in enclosed public spaces.
  65. Effectiveness:
    • Italy banned smoking in PP in 2005 - Gorini et al. (2007).
    • Canadian city Saskatoon banned smoking in PP in 2004 - Lemstra et al. (2008).
    • Spain restricted smoking in some PP in 2005 - Jimenez-Ruiz et al. (2008)
  66. Gorini et al. (2007).
    • Smoke particles in 50 locations (e.g., pub, night club) dropped between 70 and 97 %.
    • The amount of Smoking dropped by 7.3%.
    • Support for the ban increased after it was imposed.
    • Effective because people did stop smoking very effective in passive smoking because there was less smoke particles.
  67. Lemstra et al. (2008) used phone surveys to show:
    • The amount of Smoking dropped from 24.1% to 18.2%.
    • 79% of people supported the ban.
    • Heart attack admissions into hospital dropped from 176.1 to 152.4 per 100,000.
    • Very effective because less health problems
    • Number of smokers dropped
  68. Jimenez-Ruiz et al. (2008) used phone interviews:
    • A year before the ban, 59.8% of the 6533 surveyed smoked; a year after only 35% of a different 3289 were smokers.
    • Environmental smoke was down 58.8% in work places, down 27% in homes, and down  8% in recreational areas.
    • Demonstrates an effectiveness in terms of passive smoking
    • Less people smoke
  69. The problems with measuring the effectiveness:
    • Social desirability bias people may lie especially in questionnaires
    • Self-report methods/interviews – no one wants to take part in them
    • Sampling bias – people that do answer may not be the people needed to take part – not representative of the population
    • Correlation is not causation so there could be extraneous variables why people stop. Smokes has steadily been dropping

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