Download File - JFS Psychology

Revision Notes: Addiction
Info is mainly taken from AQA Nelson and Thornes The independent Learner Series.
Definition of addiction.
“A repetitive pattern that increases the risk of disease and/or associated personal and social
problems. Addictive behaviours are often experienced subjectively as ‘loss of control’-the
behaviour contrives to occur despite volitional attempts to abstain or moderate use. These
habit patterns are typically characterised by immediate gratification (short term reward),
often coupled with delayed deleterious effects (long term costs). Attempts to change an
addictive behaviour (via treatment or self initiation) are typically marked with high relapse
rate”. Martlatt et al 1988 (Page 422, N&T)
Models of Addiction
Biological Model of addiction (initiation maintenance and relapse).
AO1





Some have suggested that genetics play a part in addiction, it is possible that some
may have inherited a more sensitive mesolimbic dopamine pathway.
Dopamine is a type of Neurotransmitter. Neurotransmitters carry info through the
nervous system. Dopamine is related to motivation, rewards and moods, and the
main dopamine pathway is the mesolimbic dopamine system.
Initiation: The taking of addictive drugs including alcohol and nicotine trigger the
release of more dopamine, motivating the brain to ‘do it again’. E.g. Crack cocaine
causes the receptors in the mesolimbic pathway to be rapidly activated. The brain
then remembers to link the drug with a rewarding experience.
Maintenance: ‘down-regulation’, of the system, withdrawal and stress. The brain
adapts to the new drug and more are needed for the reward, so positive
reinforcement turns to negative reinforcement. ‘Neuroadaptation’: This is because
the brain adapts to the new drugs, when they are no longer there, the brain no
longer needs it new adaptations. The brain becomes imbalanced (homeostasis
disrupted). Therefore negative reinforcement takes place again.
Relapse: Downregulation and Neuroadapation lead to withdrawal symptoms which
make relapse likely. Memories of reinforcement are lasting and reminders trigger
dopamine predicting a reward (424-426 N&T)
AO2/3

There are issues with a disease model, such as it has an all or nothing approach. This
means that you are either an addict or not, there are no levels. This could be an
issue in diagnosis as someone may be receiving the same diagnosis as another
when the stage and the severity may be very different.
1






By saying the addiction is an illness and it is the fault of the individual it also has a
stigma attached to it. This can make life difficult for that addict and may lead them
to feel worse, which could perpetuate the addiction, particularly if they are
ostracised from all those who are not addicted therefore are only influenced by
other addicts.
The disease model also states that it is treatable but not reversible. This not only
takes away the free will of the individual, leading them to not only have an excuse
for their behaviour by saying it is determined by their biology, but it also takes away
the addicts sense of self efficacy and feelings of control, which again could
perpetuate the addiction further.
Most research into this approach is correlational, this is because of the ethics
involved in manipulating an IV. This leads to issues in establishing a cause and effect
thereby limiting our understanding of whether or not biological components are
actually causing the addiction, but are perhaps a result of it.
Even if someone has a genetic predisposition to an addiction, they still need to be
exposed heavily sometimes to the addictive substance to become addicted. It is for
this reason that a biological model alone can never fully explain addiction, social
and environmental factors must come into play.
Research is yet to be conducted into the reason why some do not get addicted, but
this itself is support for a genetic element in addiction, as perhaps those who do end
up getting addicted have a genetic vulnerability to it.
There is a further link to the learning model as concepts of reinforcement are used
in a biological approach. For example, the increased dopamine levels are rewarding,
therefore the addiction is repeated- this is positive reinforcement. When the brain
has adapted to the new levels of dopamine, and this is then stopped, people are
motivated to take away the negative experience of the disruption to the brain’s
homeostatis. This is negative reinforcement. (424-426 N&T)
Biological Model of addiction (applied to smoking).
•
•
42 twins reared apart. Only 9 had one smoker and one non-smoking twin, suggesting
genetics Shields (1962).
•
This study is good because we can be sure that being twins they will have the same
genes, and that because they are reared apart the results are not down to similar
environmental circumstances. In other words we can be surer that the results are
down to nature and not nurture.
•
On the other hand this is a small sample size therefore it is difficult to apply the
findings widely.
•
Also there are still 9 who despite having exactly the same genes did not have the
same smoking behaviour, therefore we can assume that there must be other factors
which come into play.
There seems to be a link between tobacco smoking and the genes involved in dopamine
regulation (Lerman et al 1999).
2
•
•
•
This suggests that some may have a genetic vulnerability to experiencing the
rewards of dopamine more than others, therefore would be more likely to be
addicted as the experience would be more rewarding to them.
Heritability of nicotine dependence has been estimated at between 60 and 70 per cent
(Kendler et al 1999).
•
On the other hand we cannot fully rely on these findings as they have not been
scientifically tested, they are just estimations.
•
This also means that there must be 30-40% of people who are dependent on nicotine
but have not inherited it, therefore there must be other causes of addiction.
Nicotine effects the system by increasing dopamine levels (Altman et al 1996).
•
As we know the increased dopamine leads to a reward for the individual, it is likely
that the reward of smoking is causing people to want to maintain that addiction and
makes them likely to relapse. (P426-432)
Biological Model of addiction (applied to gambling).
•
•
•
Serotonin levels are lower in those who are impulsive. (Oldham et al ‘90).
•
As serotonin is a hormone which makes people feel good, it is possible that the
reason that are impulsive is to try to increase their serotonin levels.
•
On the other hand it is unclear as to whether or not the low serotonin has caused
impulsivity or the impulsivity has caused the low serotonin, therefore we cannot
conclude that serotonin could be a cause of gambling addiction.
Dopamine: higher after a winning streak (Shinohara et al 1999).
•
This suggests that although gambling is not like a substance which reacts directly on
the body, there are still biological effects of gambling. If the dopamine is higher in
gamblers when they win, this will be rewarding. They will then be motivated to do it
again (positive reinforcement).
•
This can explain initiation.
Increased HR and cortisol leading to a stress reaction for problem gamblers when gambling
for money, compared to when playing cards but not for money (Meyer et al 2004)
•
•
This suggests that it is the act of gambling itself as opposed to the playing of the
game which has a physiological reaction.
Severe physical withdrawal symptoms, often worse than those in a comparison group who
had been withdrawn from drugs. (60% according to Rosenthal et al 1992).
3
•
If the withdrawal is physical, this suggests that the dependence itself may be for
physiological reasons i.e. increased dopamine levels. The implications of this are that
it is possible that problem gamblers should be treated with biological interventions.
(P434)
Learning Model of addiction (initiation maintenance and relapse).
AO1





Assumptions of the approach
The addiction is acquired habits, not innate functioning
The addiction can be unlearned
There are degrees of the addiction, not all or nothing
They are no different from any other behaviour.
Classical Conditioning
AO1


This is the process where an unconditioned stimulus (eg spending time with friends) leads to
an unconditioned response or reflex (eg feeling happy). If the US is frequently teamed with
another stimulus known as the conditioned stimulus (eg smoking a cigarette), the individual
will learn to associate the conditioned stimulus (smoking) with the Unconditioned Response
(feeling happy) and will therefore feel happy when they smoke, known as the conditioned
response.
This can explain the initiation of the addiction and also the maintenance of the addiction, as
an individual will continue to experience the conditioned response once an association has
been made.
AO2



Wikler (1948) researched classical conditioning and drug addiction and found that it could
explain relapse of an addiction also. He noted that patients who had been treated for a drug
addiction experienced withdrawal symptoms when returning to places they associated
with their drug use.
He said that those who are deprived of the addictive substance will experience a
physiological response in the form of cravings. This can often be activated just by a
memory, and can be the result of the memory leading to increased dopamine levels. He
said this is a reflex, therefore can be seen as the unconditioned response.
They respond to this by seeking out the substance, which exposes them to a range of cues
which they associate with the UR. These cues then become Conditioned Stimuli which lead
to a conditioned response of withdrawal like symptoms when these cues are in place. This of
course makes it harder to quit and increases the likelihood of relapse.
4
Operant Conditioning
AO1




This is based on rewards and reinforcement. If engaging in our addictive substance leads to a
reward we will repeat the behaviour (positive reinforcement). If engaging in it takes away a
bad thing we are motivated again to repeat the behaviour (negative reinforcement).
This takes individual differences into account, in that certain behaviours may be more
rewarding for one person in a certain context may not be rewarding for another.
The trigger to engage in the addictive experience is known as the ‘Discriminative Stimulus’.
This can easily explain initiation and maintenance of an addiction.
Social Learning Theory
AO1

We can learn to be addicted by observing the rewards obtained by others, particularly
significant people in our lives and through vicarious learning, see that some behaviours are
more rewarding than others.
Social Cognitive Learning Theory

The Outcome Expectancy Model is incorporated into Social Learning Theory, and is an
extension of it, emphasising cognitive factors as well such as expectancy, attributions and
imitation. This model says that when confronted with cues for the addictive behaviour, the
addict has specific expectation which lead them to again imitate the behaviour. For
example, when an alcoholic walks past a pub and sees someone drinking they may begin to
expect that they are having fun, and that they themselves will also have fun if they get
involved. This can help us to understand relapse.
AO2/3 (Learning Model as a whole)




Classical conditioning and operant conditioning do offer an explanation for initiation
maintenance and relapse but see humans as too simplistic. Humans are cognitive (thinking)
beings and do not respond in a simple stimulus-response way.
Operant conditioning doesn’t explain why some people continue to smoke, when initially it
is not enjoyable therefore should act as a punishment and a deterrent.
Outcome Expectancy is a better explanation as it takes into account both the learning and
the cognitive paradigms. As it is likely that addictions are caused by a number of different
factors, this explanation is more plausible (likely).
On the other hand this model itself is relatively simplistic and has yet to be well researched
and validated (Tiffany 1999). Therefore it is difficult to trust this as a model for explaining
addiction.
5

On the other hand SLT can explain the reasons why people are influenced by the media and
how this can lead to an addiction. (P426-428)
Learning Model of addiction (applied to smoking)
•
Children are 2x as likely to smoke if parents do (Lader and Matherson 1991)
•
•
If attitudes of parents are against then they are 7x less likely to smoke (Murray et al 1984)
•
•
This could also be due to vicarious learning- parents are often seen as role models.
This shows that the attitudes of parents can have a large impact on children’s
behaviour.
Bauman and Ennett found that the magnitude of peer pressure is overestimated.
•
•
This could be due to vicarious learning- parents are often seen as role models.
This goes against what you would expect from SLT and operant conditioning.
Peer Pressure (negative Reinforcement): A large scale study in Scotland challenges
assumptions about peer pressure, and suggests that adolescents are only susceptible to this
if they have a ‘readiness’ to smoke anyway, and if not they adopt strategies to avoid it in
social contexts (Mitchell and West 1996).
•
•
The question remains why do some have a readiness smoke..? (P426-432 and
booklet)
Learning Model of addiction (applied to gambling)
•
Cultural: higher gambling where it is more available (Ladouceur et al ’99)
•
•
Whilst this may seem like a common sense finding, it does suggest that our
upbringing and society can increase the likelihood of us being exposed to the
possibility to develop an addiction. (P 435)
Family:
•
477 children aged 9-14 completed a questionnaire asking about gambling activities
including how they feel about gambling and when and where it occurs. 86% who
gamble regularly do so with family. (Gupta and Deverensky 1997). (IL p.153)
6
Cognitive Model of addiction (initiation maintenance and relapse).
AO1

Self Regulation: weighing up the relative importance of social and physical factors
including one’s own personal goals when planning behaviour. Those who regulate
behaviour with external structures are more likely to show addictive behaviour.

Cognitive Myopia: short-sighted way of thinking which leads people to attach more
weight to immediate gratifications than future benefits. This leads them to believe that
they cannot quit or that is not favourable to do so.

Needs and Wants: people begin feeling like they want something, but as reliance kicks in
they begin to (in error) feel as though they need it.

Automatic Processing: (Tiffany ‘90) These errors in thinking are not actively processed
but occur automatically. There are so many cues in the environment that the cognitive
processes are difficult to avoid, thus the addiction is maintained. This also explains why
the relapse rate in addiction is high, as even when CBT is underway, the automatic
thoughts are harder to avoid in stressful circumstances.
AO2






Useful in explaining the processes of how an addicted person thinks.
It has also provided the basis for helpful therapies which often work. The fact that they work
suggests that the model on which they are based is true.
The thoughts offer a good explanation of how relapse occurs, particularly through
automatic thought processing which are hard to avoid.
On the other hand it does not offer a very useful explanation for how initiation happens, as
it only explain the though patterns of someone who is already addicted.
It does not take any biological or learning factors into account. The problem with this is
that if these factors are the cause, but are ignored and therefore not treated, the person
may be likely to relapse.
The model suggests that people have control over their behaviour. This is a good thing
because by feeling as though they can overcome it, individuals will have an increased sense
of self-efficacy and will therefore be more likely to make good attempts at overcoming it.
(P429-430)
Cognitive model of addiction (applied to gambling)
•
ADHD: there is a higher rate of childhood ADHD reported in adult pathological gamblers
than in the general population (Carlton and Manowicz ‘94)
•
ADHD is an impulsivity disorder. Impulsivity is a way of thinking, characterised by
making somewhat irrational decisions which are based on seeking immediate
rewards i.e. gambling.
7
•
•
•
This research suggests that the way in which we think can have an effect on our
addictive behaviour and makes a suggestion about initiation.
•
This research could also link to a biological model of addiction as it could be
questioned how they became impulsive thinkers in the first place. Some have
suggested that this could be due to low levels of serotonin. (Oldham et al ‘90)
Impulsive thinking: Those with high impulsivity scores showed higher HR during gambling
(+tive correlation) (Schedlowski and Meyer ‘05)
•
This suggests that impulsivity (a faulty thinking pattern) is linked to how addicted to
gambling someone is or how their body is responding to the gambling.
•
This could again link to a biological model as the cognitions could trigger the release
of more dopamine leading to greater enjoyment of the gambling.
•
On the other hand as this research is correlational, we are unable to establish
whether the impulsivity caused the increased heart rate, for all we know it could
have been the other way around.
Irrational Gambling thoughts: 75% irrational (Delfabbro and Winefield 1999)
•
This suggests that there is a link between faulty thinking and gambling addiction.
(P435-436)
Cognitive model of addiction (applied to smoking)

Theory of Planned Behaviour: suggests that personal attitudes to smoking, perceived social
norms and perceived behavioural control will determine the smoking behaviour.
•
Connor et al (2006) tested 675 non-smoking 11-12 year olds for a measure of TPB. 9
months later they tested to see if they were smokers and used a carbon monoxide
monitor to prove it, and found that the behavioural intention measured using the 3
aspects of the theory of planned behaviour were a good predictor of later smoking
behaviour. (P 433)
Conclusions for models for models of addictive behaviour.
Depending on which model is accepted, it will have implications for intervention programmes.
Therefore if some factors are ignored, it will mean that the individual may not receive the
appropriate treatment.
No one model can every fully explain an addiction as humans are so complex and there are so many
individual differences between different people an their addictions so there also will not be a one
size fits all model.
There are models that now exist known as BioPsychoSocial models, which incorporate all three
models to explain the initiation maintenance and relapse of an addiction.
An example is the BioPsychoSocial by Sharpe (2002)- see P. 436.
8
Risk Factors in the development of an addiction (including Age Peers Stress and Personality)
Note: if the exam question does not specifically ask for the four above (which they could so you must
learn them!) you are able to write about others i.e. parents, genetics etc. from the previous section,
as long as they are discussed in the context of them being a risk factor.
Stress as a risk factor (pages in booklet)
AO1



Addicts who cope badly with stress may be more prone to relapse than those who deal with
stress better.
This could be because those who are not dealing with their stress are more likely to turn to
the addictive substance again as a form of self medication.
In comparison those who are able to deal with stress effectively are less likely to need to use
the addiction to help them to deal with the difficulty.
AO2

This is supported by research by Cleveland and Harris (2010) who found that in a study of 55
college students, those who avoided their stress were subject to double the drug craving
when under stress than those who dealt with the problems.
• This suggests that having stress that is not dealt with makes an individual more
vulnerable to relapse.
• On the other hand this research only tells us about relapse, it doesn’t tell us
whether or not stress can be a risk factor in terms of initiation, therefore leaving us
with a limited understanding of stress as a risk factor.
• It also has low population validity as was only carried out on a small sample of 55
and all college students. Therefore our understanding of how stress can impact the
general population remains limited, it is likely that the type of stress experienced by
college students is very different to that experienced by others.
• We also cannot rule out the impact that the age may have had on these findings
(see below).
Age as a risk factor (pages in booklet)
AO1
•
•
•
Some have suggested that the age in which you are exposed to an addictive substance may
make you more at risk of developing an addiction.
It has been suggested that those who are exposed to drugs and smoking at an early age have
a higher risk of developing an addiction later on.
This could be for many reasons including the development of their brains in comparison to
those who are older, or their susceptibility to peer influence.
AO2
9


Research is limited into fully understanding the reasons why there may be a vulnerability to
addiction at a younger age, as the exact mechanism is as yet unclear.
A literature review by Chambers et al (2003) has found that adolescent neurodevelopment
occurs in brain regions associated with addiction. This could leave them vulnerable to the
addictive role of drugs.
• On the other hand as this is a literature review, there is no clear scientific evidence and
assumptions are still being made about the link between age and neurodevelopment,.
Therefore we still cannot be sure the true mechanism involved in the age vulnerability
to addiction.
Peers as a risk factor (pages in booklet)
AO1



Through classical conditioning one can learn so associate the enjoyment of spending time
with friends with an addictive substance if engaged in regularly with friends. Therefore
spending time with those who advocate smoking, drinking, taking drugs etc. Could be a risk
factor in making this association therefore becoming addicted.
Through operant conditioning if peers smoke/gamble/drink alcohol etc. One may receive
positive reinforcement from being included, negative reinforcement may take place if one
is teased or ostracised for not being involved, thereby reinforcing the need to engage also in
order to take away this negative outcome. Therefore the peers one spends time with may be
a risk factor, as rewards and reinforcement are likely to come from being involved in the
addictive substance or activity. This can explain initiation maintenance and relapse.
Through the process of social learning theory and one can become addicted through
observing peers being rewarded for engaging in the addictive substance/activity. If one sees
their peers appearing to enjoy what they are doing or gaining acceptance, they may be
motivated to join in. Therefore if the peers are those who are involved in addictive
behaviour, this could also be a risk factor.
AO2
•
On the other hand research by Bauman and Ennett (2006) found that the magnitude of peer
pressure is overestimated.
•
•
This goes against what you would expect from SLT and operant conditioning.
A large scale study in Scotland also challenges assumptions about peer pressure, and
suggests that adolescents are only susceptible to this if they have a ‘readiness’ to smoke
anyway, and if not they adopt strategies to avoid it in social contexts (Mitchell and West
1996).
•
This also suggests that peer influence may be overestimated, and raises the question
of what may cause a readiness to smoke? Perhaps this could be better explained by
genetic age vulnerability.
10
Personality as a risk factor in addiction (pages in booklet and P438-439 ).
AO1



Research has shown that those with a neurotic personality (on Eysenck’s personality scale)
which is characterised by irritability and anxiety are more likely to experience anxiety or
depression. This could lead them to use drugs alcohol tobacco etc. As a form of selfmedication. Therefore this personality trait is a risk factor in addiction.
This can also be seen in those with the dominant personality trait psychoticism
characterised by aggression and impulsivity. As we have seen impulsivity particularly seems
to be linked with gambling addiction, as people are more likely to look for immediate
rewards.
Certain mental disorders such as personality disorder which is characterised by maladaptive
personality traits has also been linked to personality disorder. This is because they may often
be seen to make non-beneficial personal choices.
AO2



There is a link between Neuroticism and Psychoticism and dependence on alcohol,
benzodiazepines and heroin (Francis 1996)
Rounsaville et al (1998) found that there is a link between alcoholism and the personality
disorder sociopathy.
• On the other hand as this research is correlational we are unable to establish cause
and effect, it may be that taking drugs etc. Leads to adapting these personality traits
or disorder.
If this is the case there are implications for treatment, as treatment should be tailored not
at the outcome (as NRT and Aversion therapy would) but at addressing the underlying cause
which is the personality traits, characteristic or disorders. Unless we do this, people will be
likely to relapse at the personality will remain after treatment.
Vulnerability to addiction and the role of the media
AO1



The media portrays many addictive substance and activities through a range of mediums
including TV, movies, newspapers, magazines and the internet.
Examples of these are smoking in gangster films which make the habit appear rewarding or
desirable to some, or game shows such as Who wants to be a Millionaire? Which portray
gambling as harmless and enjoyable. This can be explained by social learning theory as we
are seeing others get a reward and also outcome expectancy model are we are led to expect
that we too would be rewarded for being involved.
Advertising in the media can be used to show the positive side of a potentially harmful
activity whilst failing to highlight the negative side. An example of this is the widely
advertised national lottery slogan “it could be you” which emphasises the rewards of
winning without the punishment of continually losing. Another example is the Barcardi
11

adverts which show attractive people having fun, with the slogan “librarian by day...” also
suggesting that drinking Barcardi will have a positive outcome and ignores the negative
outcome of alcohol consumption.
Previously smoking adverts used similar tactics such as attractive role models such as Vice
Presidents to sell cigarettes, although research has led to a ban on cigarette advertising in
order to reduce additive behaviour and alcohol advertising has been restricted.
AO2

Chapman and Fitzgerald (1982) found that underage smokers reported a preference for
heavily advertised brands.
• This suggests that advertising leads to preferential treatment of products.

Sargent and Hanewinkel (2009) surveyed over 4000 adolescents, then surveyed them a year
later after watching movies with people smoking. It was found that watching the movies
was a strong predictor of smoking initiation a year later.
•


On the other hand surveys are always subject to demand characteristics and social
desirability effects, therefore the adolescents may have been smokers already and
not wanted to admit it, or may have guessed the nature o the research and
answered the questions accordingly.
Akin et al (1984) also found that 12-17 year olds who had been exposed to higher levels of
advertising were more likely to approve of underage drunkenness
• This suggests that advertising can affect peoples attitudes.
• On the other hand both pieces of research are low in population validity as they only
focus on the effects of advertising on teenagers. Therefore they limit our
understanding of the effect of the media on adults. It is possible that young people
have less rigid attitudes than adults therefore would be more vulnerable to these
effects of advertising.
This research has implications for legislation on advertising. (P440-441)
Reducing addictive behaviour
Theory of Planned Behaviour (TPB) (Azjen 1985) (P 443-444)
AO1




It is a model of addiction prevention.
Explains the link between health beliefs and health behaviours.
It suggests that the combination of 3 belief factors (Attitude, Subjective Norm and
Perceived Behavioural Control) will lead to a behavioural intention.
The attitude is how a person feels about the behaviour. This can be their belief about the
behaviour and how positive it is, combined with their belief about the outcome. E.g. if they
are considering quitting, they may believe that it will save them money but that they will put
on weight. Theses beliefs are weighted in terms of importance.
12



The subjective norm is the perception of how others feel about the behaviour. For example
if considering starting an addiction they may believe that their parents will dislike it, but that
they will be more accepted in their friendship group. These will also be weighted.
Finally the perceived behavioural control relates to how successfully they believe that they
can carry out the behaviour to achieve the desired outcome. This is similar to self efficacy.
This is weighted by considering a combination of internal and external factors. For example
if planning to quit smoking they will consider their level of control in terms of the skills and
info they have (internal) as well as the obstacles and opportunities they will have
(external). These perceptions will be based on past behaviour for example if they have tried
to quit in the past but faced the obstacle of being ostracised for quitting, or not having the
willpower to do so they may perceive they do not have enough control to quit.
These three factors interact to lead to behavioural intention, which leads to the actual
behaviour.
AO2





This theory is good as it helps us to understand how people decide on their actions be it
starting or stopping an addiction. If we can understand behaviour, it can allow us to prevent
it. For example education and advertising can be used to manipulate negative health beliefs
to healthy ones.
There are other factors which play a part which are not measured in this model, for example
the number of choices available to a person in any given situation, and feelings and
emotions. These would be needed to be studied in order to get a fuller picture of how
behaviour can be explained and therefore changed.
Research by Connor et al (2006) tested 675 non-smoking 11-12 year olds for a measure of
TPB. 9 months later they tested to see if they were smokers and used a carbon monoxide
monitor to prove it, and found that the behavioural intention measured using the 3 aspects
of the theory of planned behaviour were a good predictor of later smoking behaviour. (P
433). This further reinforces the idea that if health beliefs can be changed, so can health
behaviours.
Some have argued that this model is too rational to be applied to addictive behaviour.
o This is because addictions are not rational, but are based on emotions and impulses
which cannot be explained or predicted through rational thought processes.
o In support of this idea, research by Armitage and Conner (01) found that the model
is a better predictor of Behavioural Intention as opposed to behavioural change.
o It is possible that this is linked to the research method used to assess the
behavioural intention- questionnaire. When completing this it is impossible to
anticipate the strength of emotions which drive behaviour in the moment. This
could explain the seemingly irrational behaviour and the findings above.
The ONDCP have used this approach to attempt to change the attitudes of teenagers
towards Mariguana in their Above the Influence campaign.
o This is a good thing as they have found that teenagers behaviour is better predicted,
and therefore changed by their attitudes as the theory predicts.
o This appears to be because teenagers do not respond as well to education on the
risks of behaviours, as they are not risk averse.
13

Wilson and Kolander '03 suggest that Anti-smoking campaigns should be based on actual
stats to show those in smoking peer groups the real picture
o This is based on the subjective norm aspect of this theory as most young people do
not smoke, therefore if they are part of a smoking peer group the subjective norm
may appear to be one which would encourage smoking, a campaign showing actual
stats would change this by showing them that the norm is that all people their age
do not smoke.
o Therefore the behaviour can be seen to be predicted, and prevented by the
assumptions laid down by this theory.
Biological Interventions (P 449-451)
AO1



They are based on the idea that addiction is a disease therefore usually uses medication.
The medication often needs to be taken independently by the client.
They aim for complete abstinence by managing the physical withdrawal symptoms.
AO2





All 3 have been shown through controlled clinical trials to be more effective than placebos.
This suggests that they have a level of real success.
On the other hand they all involve compliance from the client which can often not be relied
upon. If the client is not getting the level of reward that they get from their addiction they
are likely to stop taking the medication and relapse.
They also could become addictive themselves. Therefore rather than increasing self-efficacy
(sense of control) leading to abstention, they may just substitute the addiction for a new one
the medication. This could be a problem because this can be expensive and potentially
harmful.
Categorising the addiction as a disease and treating it as one can be seen to be taking
responsibility from the individual. This is a bad thing because it can leave them feeling a
stigma attached to their behaviour which is not helpful for them in dealing with any
underlying psychological causes.
They ignore the influence of social or cognitive factors and only treat the physiological
dependency. This is a problem because it is likely that there are various factors which
contribute to an addiction, therefore if some causes i.e. stress or cognitions are left
untreated it is likely that relapse will occur particularly if the medication ceases.
Nicotine Replacement Therapy (NRT) (P 449)
AO1



One type of biological intervention is nicotine replacement therapy (NRT).
They come in the form of gum patches nasal sprays and inhalers.
They provide positive reinforcement by self administering small doses of nicotine when
cravings occur.
14


Nasal sprays offer the most rapid delivery of nicotine therefore offer the most positive
reinforcement as opposed to patches which deliver nicotine slowly throughout the day
resulting in sustained nicotine levels throughout the day.
They also appear to desensitise nicotine receptors in the brain, therefore if relapse does
occur it is likely to lead to less of a reward as the cigarette will appear less satisfying.
AO2




As the delivery of nicotine is much slower than for cigarettes, they are not as satisfying to
smokers therefore many will be likely to give up the therapy and relapse.
Meta-analyses have provided support for the view that it is the nicotine in cigarettes which
underlies the addiction, therefore it is sensible to assume that maintaining nicotine levels
should be a suitable alternative for smokers struggling to quit. This is good because the
other harmful components in cigarettes such as tar will be avoided.
On the other hand nicotine itself has been linked to reproductive disorders cancer and
delayed wound healing. It is also dangerous for foetuses, and increases blood pressure
which could lead to further illnesses such as heart disorders. Therefore the individual may
still be at risk of illness even during this therapy. This being said it is still less harmful than
smoking cigarettes.
The benefits appear to outweigh the risks therefore it is a recommend therapy for those
with a strong dependency to nicotine.
Varenicline (Champix) (P 450)
AO1:



This drug also causes dopamine release in the brain (association with rewards).
Therefore the drug should also simulate the positive reinforcement from the release of
nicotine offered by a cigarette.
It also works by blocking the effects of any nicotine added to the system.
AO2:



Clinical trials have shown that it is superior to buproprion in helping people to stop smoking.
Therefore this drug should lead to less chances of relapse.
It has also been found to reduce relapse in smokers who have been abstinent for 12 weeks.
• This could be due to the blocking of the effects of any nicotine added to the system
after therapy has commenced.
Some have experienced irritability, the urge to smoke and depression after stopping taking
the drug.
• It is likely this is due to the reduction in dopamine levels.
• This is a problem because it may be that the client has transferred the addiction from
one substance to another.
• Therefore they will need to be weaned off slowly in order that they experience
minimal side effects.
• If they remain addicted to the drug this would be very costly for the NHS and could
potentially be dangerous for the client.
15


More than one in ten people experience headache, difficulty sleeping, abnormal dreams
and nausea whilst on the drug.
More than one in one hundred may experience the same including digestion issues, and
increased appetite or even a change in the way things taste.
• With these side effects it is likely that this therapy will be less effective than others,
as the client may wish to cease treatment as a form of negative reinforcement
(taking away the side effects) and therefore will relapse.
Psychological Interventions (P 446-449)
AO2

These therapies treat any underlying causes as opposed to just dealing with a biological
outcome.
• This is a good thing as it means that when used as part of a multi-component
programme people will be less likely to become dependent on their biological
intervention as a way to avoid cravings, but will have either learned to deal with the
cravings themselves or will have unlearnt the desire to engage in the addiction itself.
CBT (P 448)
AO1





This therapy is based on a ‘stages of change’ model:
Contemplation and commitment (deciding that they are addicted and wanting to do
something about it), Action (creating a plan i.e. biological interventions, avoiding certain
people ad getting support from others), and Maintenance (developing self monitoring
strategies to avoid relapsing and finding ways of dealing with this).
This model need not be followed through with a therapist but can be used as part of a self
help programme.
If used with a therapist the client will be trained in social skills, relapse prevention
strategies and how to challenge faulty thinking patterns (i.e. they only want, do not need
the substance, they should be looking for long-term as opposed to only short term rewards).
They may involve a spouse in order to gain a support structure for the client.
AO2

This therapy can be fairly successful as a self-help programme and therefore does not need
a therapist for everyone (Curry 1993).
• This is a strength as it will save money for the NHS, which will allow funds to be
released for perhaps more serious cases.
• It also means that it is more accessible to those who have limited time availability, or
whose condition does not qualify for therapy but cannot afford this therapy
privately.
16
•



There can often be a stigma attached to having therapy therefore being able to
successfully complete a self help problem avoids this discomfort for the addict.
When conducted with a therapist, CBT is seen to be most effective when used with
medication.
• This is shown through research by Feeney et al (2002) who found that when CBT
alone was used for those with alcohol abuse problems, the abstinence rate was 14%
and when it was combined with medication it rose to 38%.
• This means that it is important to use a multi-component programme, as there may
be many reasons for the cause of addiction, therefore there may be many ways to
address the issue.
Due to the non-invasive method of CBT it is relatively ethical, and there tends not to be
issues of compliance if sessions are with a therapist, although it is important for clients to
use skills and training given to them outside of the sessions.
This therapy is good as it looks to an underlying cause (faulty thinking) as opposed to a
biological outcome (dependence on a drug) to solve the issue.
• This rules out the possibility of transferring the addiction to a new substance (i.e. the
medication)
• It is also likely that there would be less likelihood of relapse after the therapy ceases.
Aversion Therapy (P 446-447)
AO1






Based on the idea that addiction is learned therefore can be unlearnt.
Based on punishment as opposed to reward.
Early programmes used mild electric shocks every time the client sipped alcohol or took a
puff of a cigarette.
Since then alcoholics are given the drug Antabuse which cases sickness when combined with
alcohol. The client should therefore be motivated to quit through negative reinforcement
(they learn that not drinking takes away the negative sickness experience).
Smokers can be offered a therapy known as rapid smoking, where they are placed in
enclosed room where they take a puff on a cigarette every 6 seconds (much faster than the
average rate).
This leads to nausea and the same process as above applies.
AO2



Electric shock therapy has been unsuccessful as clients associate the unpleasantness with
the clinic, therefore continue to smoke/drink outside of this setting.
Antabuse for alcoholics on the other hand has been shown to be effective (Lang and
Martlatt (1982).
The problem associated with this is compliance
17
•




Because it is a drug, clients are expected to take it outside of the clinic. Due to the
unpleasant reaction, it is possible that they will not comply and therefore relapse.
It also ignores the reason that people are alcoholics and only treats using a basic learning
approach.
• This is a problem because the addiction could stem from a personality trait (Eysenk),
lack of dealing with stress (Cleveland and Harris 2010) or a number of other factors.
• Therefore in order to achieve the most success this therapy may be most effective if
used with a therapy such as CBT which deals with these underlying issues.
There is evidence to suggest that rapid smoking can be successful, particularly as part of a
multi-component programme for the same reasons as stated above.
• This may be due to the fact that unlike Antabuse this is only conducted in a clinical
setting therefore compliance is not an issue.
• On the other hand results have been inconsistent across studies suggesting that it
may be suitable for some and not others. This could be related to the underlying
cause. If the cause of the addiction is not learning, this therapy will not be successful.
There is also a slight ethical issue, in that this therapy can be risky for those with
cardiopulmonary disorder.
Again the act of smoking, and not the underlying cause is the focus of this therapy.
• Therefore due to the many factors often involved in addiction it would be beneficial
to use as part of a multi-component programme which offers therapies such as CBT
to target underlying issues related to the addiction.
Public Health Interventions (LEGISLATION IS NO LONGER ON THE SPEC.) (P 451)
AO1:





Public health interventions involve steps taken by public health authorities prevent and
treat physical and mental health conditions through the promotion of healthy behaviours.
Examples include Promoting handwashing, breastfeeding, delivery of vaccinations,
distribution of condoms.
In the context of addiction doctors advice has been offered to smokers as a public health
intervention. This would include services such as listening, offering a follow up appointment,
filling in a questionnaire about smoking habits, advising individuals on quitting and giving out
literature which both educates and advises.
In addition to this the NHS now offers ‘Quit Kits’ and a ‘Quitline’ which are offered free of
charge to anyone thinking of quitting smoking. These involve materials designed to assist
people in all areas of the quitting process.
Examples of items in the kit are pictures of those will smoking related illness to aim to
encourage smokers to consider long term effects, literature to encourage peers to be
involved in the quitting process and information leaflets to educate people about the
financial and health drawbacks of a smoking addiction.
AO2:
18





Doctors are seen as a good place to start in the intervention process as it is estimated that
approx. 70% of UK smokers consult their GP each year.
• Therefore is GPs could intervene at this times it may mean less requirement for
other therapies such as drugs and CBT.
• This would be beneficial for the economy and both safer and less stressful than
many other therapies.
Research conducted across 5 London GP practices found that the highest rate of quitting
after 12 months following doctors advice was when they were offered a leaflet of tips, a
follow up appointment and were advised to give up (5.1%). In comparison those who were
offered a follow-up only had a quitting rate of only 0.3% after 12 months.
• This suggests that doctors can have a part to play in intervention, but that they help
they offer can largely impact the likelihood of someone quitting
• The implications of this are that doctors should be fully trained in the most effective
intervention strategy, in order to assist the greatest amount of smoking addicts.
• On the other hand 5.1% remains a relatively low statistic, therefore it may still be
necessary for doctors to offer other therapies.
It has also been estimated that of all GPs advised smokers to quit and offered tips, that there
would be 0.5m less smokers per year (Ogden 2007)
• On the other hand this is just an estimate as opposed to a figure obtained through
scientific means, therefore remains relatively unreliable.
A meta-analysis conducted by Stead et al (2006) of over 18,000 ps. Found that those who
received repeated phone calls from a counsellor had increased odds of 50% compared to
smokers who only received self help materials and brief counselling. Therefore it can be
concluded that multiple call back increases the likelihood of smoking cessation for those
who contact Quit line services.
• It also suggests that this is more effective than receiving quit kits alone.
• On the other hand this research has been difficult to conduct in a rigorous manner
as researcher’s are reluctant to undertake trials that would require callers who
sought help to be refused support, as this would be considered unethical.
• This being said without doing this, it is not really possible to be sure that those who
do not receive this level of support will have less of a chance of prolonged smoking
cessation.
In terms of alcohol dependency, research has shown that due to a GPs knowledge of a family
circumstances, they are well placed to intervene early to suggest cutting down on alcohol
before it becomes an issue in need to abstention therapy (Room et al 2005)
• This is a good thing because prevention as opposed to intervention is not only more
economically cost effective but is also less harmful to the individual as they have not
entered into full scale addiction and will not have to partake in any costly time
consuming or potentially harmful therapies
19
20