Addiction Flashcards
(114 cards)
1
Q
4 key Terms for addiction
A
- Physical dependency
- Psychological dependency
- Tolerance
- Withdrawal syndrome
2
Q
Physical dependency
A
The result of long term use of a drug. Withdrawal symptoms without substance. Everyday life becomes reliant on substance
3
Q
Psychological dependency
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Condition existing when a person must continue to take a drug to satisfy mental and emotional craving for drug. Individual thinks they cant cope without the drug.
Absence of rug causes anxiety or depression
4
Q
Tolerance
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Diminishing effect with regular use of same dose, requiring user to take larger and larger doses to get the same effect
5
Q
3 ways of tolerance
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1 Metabolic tolerance
2. Neuroadaptation
3. Learned tolerance
6
Q
Metabolic tolerance
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Where enzymes responsible for breaking down the drug become more effective reducing its effect
7
Q
Neuroadaptation
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Where changes at the synapse occur. eg down regulation making receptors less sensitive
8
Q
Learned tolerance
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Result of practice as the person has learned to function normally whilst under the influence of drugs
9
Q
Withdrawal syndrome
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Unpleasant physical or pscyhological effects following discontinuing a drug.
EG - Shakes, tremors, vomitting
Often leads to relapse
10
Q
2 types of withdrawals
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- Acute withdrawal - within hours stops within weeks
- Post acute withdrawal - brain slowly reorganises and balances takes months/ years
11
Q
5 Risk factors for addiction
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- Stress
- Personality
- Family influences
- Peer influences
- Genetics
12
Q
Genetics
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Specific addiction cannot be inherited, but vulnerability to the drug dependence is inherited.
13
Q
Cumings et al 1996 A1DR02
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A1DR02 gene reduces number of dopamine receptors in the brain meaning they need to achieve extra stimulation via drugs or alcohol
14
Q
Shields et al (1962)
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Examined concordance between 42 twin pairs.
Found that 9 pairs were discordant showing how genetic similarity is major factor in starting to smoke
15
Q
Black et al (2006)
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Found that 1st degree relatives of gambling addicts were much more likely to suffer the same fate as more distant relatives
16
Q
Stress
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Stressful events can be triggers for addiction
17
Q
Driessen et al
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Found traumatic events exposed individuals to addictions.
- 30% of drug addicts and 15% of alcoholics had early trauma in their lives
18
Q
Stress - tension - reduction hypothesis
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Suggests that ppl engage in addictive behaviours to relieve stress/ anxiety . EG drinking after long day at work
19
Q
Tavolacci’ (2003)
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Found that that perceived stress was associated with known risks such as alcohol misuse and also new risks such as eating disorders
20
Q
Hardiness
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The ability to endure difficult conditions helps battle stress
21
Q
Kobasa (1979) 3C’s
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- Commitment - strong sense of purpose
- Control (internal LOC)
- Challenge - Individuals see addictions as challenges to beat
22
Q
Personality
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Anti social personality disorder strongly linked to addiction due to impulsivity issue.
23
Q
Eyesenck three key supertraits
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- Extraversion - extraverts need to stimulate themselves
- Neuroticism - low emotional stability
- Psychoticism - Antisocial and impulsive people
24
Q
Family influences
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If your parents have an addiction it is likely you will be influenced to have that addiction
25
Livingston (2010)
Found high school students that were allowed to drink at home by parents become addicted in first year at college
26
Exposure
If addiction is an everyday feature of the family it will likely be continued by the offspring
27
Social learning theory for family influence
1. Imitation - copying role models behaviour
2. modelling - models teach us vicariously how to engage addictave behaviour
3. Vicarious reinforcement - we see them happy drunk positive state but we dont see downsides
28
Peer influences
Very powerful at age of 18 these are when we are influenced to do things to fit in with our peers
29
O' connel 2009 three major features of drinking and peer pressurre
1. At risk adolescents attitudes about drinking are influenced by associating with peers
2. Experienced peers provide more opportunity for at risk person to drink
3. The at risk individual overestimates how much their experienced peers are drinking and overdrinks to catch up
30
Social learning theory applied to peer influences
Our peers are our role models around the age of 18, therefore we are likely to imitate them or suffer from vicarious reinforcement
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Normative social influence applied to peer influence
We will do things to try and fit in with our peers and gain approval from group eg drinking
32
Dopamine explanation for addiction
Smoking of nicotine can produce dopamine activity to increase through the reward system pathway of the brain
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The ventral tegmental area (VTA)
Area of the brain filled with dopamine-specialist neurons.
This area is associated with feelings of euphoria and can be triggered through smoking cigarettes
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Nucleus accumbens
A primary reward centre in the brain and with increased activity dopamine rises causing users to evaluate smoking as pleasurable
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Acetycholine
Nicotine stimulates acetylcholine receptors increasing alertness memory function and learning
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Stimulating endorphins that reduce GABA
Nucleus accumbens is encouraged to release more dopamine as nicotine also stimulates endorphins reducing gaba activity.
This decrease correlates with further rises in dopamine.
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Dopamine amplification
Cigarette smoke contains substances blocking monoamine oxidase, which is responsible for breaking down dopamine.
If it is blocked dopamine will stay higher for longer
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Dsouza and Markou research support on rats
Blocking transmission of glutamate resulted in a decrease in nicotine intake and nicotine seeking.
Both of these also decreased when GABA was enhanced suggesting increasing GABA does reduce nicotine
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Social learning theory for nicotine addiciton
Attention - to role model with cigarette
Retention - remember how to smoke it
Replication - can you physically copy behaviour
Motivation - do you want to copy the role model
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Ennett et al 2010
Found that the family and peer contexts were primarily implicated in the onset of smoking
Suggesting a strong link between social learning and nicotine consumption
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Behaviourism and nicotine addiction
Negative reinforcement - not being able to smoke
Positiive reinforcement - Pleasurable for them to smoke
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Social learning theory - Cue reactivity
Making association through classical conditioning such as holding a pint in one hand and cigarette in the other.
Will lead to you wanting a cigarette every time you hold a pint
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Cue reactivity causing relapse
The person associates specific moods, situations or environemntal factors with the rewarding effects of nicotine triggering a relapse
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Calvert 2009
Showed cigarette packets to smokers who showed strong reactions in their ventral striatum, but it also suggests cue reactivity as people reacting to environmental stimuli
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Gambling disorder
Disorder where someone feels they have lost control and continue to gamble despite negative consequences. Gambling becomes most important to them
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Problem gambling
Problem gambling is the only addiction classified as a behavioural addiction
It is a repeated pattern of gambling behaviour where someone feels:
They have lost control
Sees gambling more important than any other activity
Continues to gamble despite negative consequences.
47
Drug therapy aim
To slowly wean people off their addicted substances at a controlled pace
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Three types of drug therapy
1. Aversives
2. Antagonists
3. Agonists
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Aversives
Aim to produce unpleasant sensations such as vomiting when the drug is taken.
- Usually the aversive drug is taken alongside the addicted drug to purposely encourage the individual to vomit and pair vomiting with the drug and make them want to stop.
50
Antagonists
These bind to receptor sites and block them so the drug cannot be as effective. Since it is not being passed on to the next neuron.
This works on the concept of preventing the addicted drug from having the desired effect.
E.G. bupropion reduces the dopamine hit that follows nicotine consumption
51
Agonists
These are drug substitutes, e.g. methadone.
They bind to neuron receptors and activate them, much like the addicted drug.
However the key difference is that the agonists are safer, more regulated and not contaminated.
Slowly under supervision of clinics, users can wean themselves off the substance
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Smoking Drug treatments
- Nicotine Replacement Therapy - aims to deliver the drug without the other harmful chemicals found in cigarettes.
- This is done through Gum, Inhalers or patches.
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Inhalers (Smoking drug treatments)
Generally seen as the most effective as they also allow you to hold and inhale, which would still be habitual to the user.
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Nicotine patches (Smoking drug treatments)
Deliver nicotine and result in dopamine increases in the VTA and Nucleus Accumbens.
- With the patches being much healthier, users can manage their withdrawal at their own pace.
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Nicotine Replacement Therapy (NRT)
- Works by releasing a clean and controlled dose of nicotine into the bloodstream.
- The nicotine binds to the nicotinic acetylcholine receptors in the mesolimbic pathway, stimulating the release of dopamine
- Using the NRTs means that the amount of nicotine can be gradually reduced over time without the constant inhalation of other dangerous chemicals in cigarettes
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Bupropion - Mode of Action
- Bupropion is an antagonist at nicotinic receptors
- It works by blocking nicotine effects so there is no rise in dopamine levels when you smoke a cigarette.
- Bupropion is also a weak inhibitor of dopamine and noradrenaline reuptake, which leads to an overall increase in dopamine whilst taking the drug, relieving withdrawal symptoms.
- Treatment generally lasts 7-12 weeks
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SDRI
A Serotonin-Dopamine Reuptake Inhibitor
e.g. Bupropion
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Evaluation of drug therapy
- Result in side effects, such as dizziness, sleep disturbance and headaches
- Removal of criminal stigma as finding drugs that treat addictions backs up the argument that addiction should be treated as illness and not something to be punished
- Require less effort from the individual than cognitive therapies. As NRTS can simply be taken at the users own pace.
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Aversion Therapy
Works on the principle of "what can be learnt can also be unlearnt".
This is done through counterconditioning
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Counterconditioning (Aversion Therapy)
Instead of the drug being associated with a pleasant feeling, it is slowly conditioned to be associated with a universally unpleasant sensation
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Antabuse drug
Alcohol user takes this drug, which results in the user immediately being sick upon the ingestion of alcohol.
It adapts the way alcohol is broken down in the body.
This instant punishment improves the contiguity of the treatment, giving an immediate hangover.
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Evaluation of Aversion Therapy
- Ethical issues with forcing patients to be sick repeatedly
- Aversion therapy tackles the behaviour, but not the underlying problem as it fails to tackle the cognitions that contribute to the root of the behaviour.
63
Howard (2001)
Found that by paring alcohol with vomit through the use of Antabuse, ppts recordings of positive alcohol experiences dropped significantly.
64
Alcohol addiction stat
Alcohol addiction was responsible for 232 million lost working days in a year.
65
Covert Sensitisation
Replaced aversion therapy
Clients are tasked with imagining how a certain environment would feel when paired with their addiction.
It requires the client to be effective in using their imagination and the therapist needs to be skilled in getting the client to picture all elements of the imagined environment they are in.
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4 ways imagination could be utilised
1. Olfactory
2. Tactile
3. Visual
4. Auditory
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Phobias (Covert Sensitisation)
Phobias are often incorporated to elicit the necessary reactions.
For example a gambling addict could be asked to imagine playing a slot machine that is covered in spiders or snakes.
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Evaluations of Covert Sensitisation
- It is more ethical than in vivo aversion therapy
- Using phobias means it is quite flexible and can be effectively used in a number of addictions
- Based on behaviourism so only addresses the behaviour and not the root of the cause or cognitions
- Requires a very motivated client and a very skilled therapist which are not always present.
69
CBT in addiction
CBT is mainly used to identify and challenge the irrational thoughts of an individual.
The client is taught to be self-sufficient in tackling these irrationalities
Coping strategies are employed to train the individual to deal with sudden temptations to relapse into addictive behaviours again.
70
Functional analysis (CBT)
With addictions the main focus is on understanding the thought process when clients find themselves in high-risk situations.
The therapist tries to understand where thoughts can be challenged so the client is able to rescue themselves from the situations.
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Cognitive restructuring (CBT)
This is when the therapist may teach the client about addictions, how they work, how they can be overcome and specific things about the clients addictions.
E.g. Teaching about the nature of chance in gambling
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CBT (cognitive aspects)
CBT focuses specifically on the cognitive aspects of addiction.
For example the cognitive biases in gambling, such as
- Gamblers fallacy
- Cognitive myopia
- Illusions of control
- Availability and hindsight biases
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CBT Relapse Prevention
The therapy would focus on situations of high risk for relapse which are identified in the sessions.
Such as
- Intrapersonal factors
- Interpersonal factors
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Intrapersonal factors
Factors within the person
- Stress or negative emotions that might trigger a desire to return to the addiction.
This is training the client to deal with the stressors in their life
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Interpersonal factors
Factors between people
- Social pressures such as being in a pub or with certain friends.
Therapist would role play in these situations
76
Self sufficiency (Relapse Prevention)
Most of relapse prevention is focused around teaching the clients ways to self sufficiently cope with temptation. These are done in 2 ways
- Positive self- statmenets
- Distraction techniques
77
Petry (2006)
Found that Gamblers Anonymous with CBT was much more effective in treating gambling addiction than solely Gamblers Anonymous on its own
78
Cowlishaw et al (2012)
Found that whilst CBT worked in the short term in treating gambling, its long term effects were found to be negligible.
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Operant conditioning for gambling addiction
Winning a bet or seeing the money fall out the fruit machine acts as reinforcement to carry out the behaviour again.
The pleasurable feeling of winning a bet acts as positive reinforcement
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Punishment in gambling
However the punishment is losing the behaviour.
However a constant state of losing does not extinguish the behaviour due to cognitive biases
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Contiguity
The concept of being reinforced for a behaviour at the same time as the behaviour.
E.g. we get the reinforcement for winning straight away, but it takes a build up of losing
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Partial reinforcement in gambling
Much more effective in producing persistent behaviour.
As bets are not always rewarded and the unpredictable nature will keep the gamblers interested even in the face of absent rewards.
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Reinforcement Schedules
1. Fixed interval
2. Fixed ratio
3. Variable interval
4. Variable ratio
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Fixed interval
The first response after a given interval of time is reinforced.
- e.g. rewards may be given after every 5 mins of play on a fruit machine
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Fixed ratio
Every nth response may be reinforced.
- e.g. on a fruit machine every 25th play may be reinforced
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Variable interval
On average, the first response after a given interval of time is reinforced, but this time interval varies
- e.g. could be a 5min interval one day but then 25 mins the next day
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Variable ratio
Every nth number is reinforced but the actual gap between reinforcement varies and can be quite large.
- e.g. A fruit machine that pays out 25% of the time. However these wins may all occur in a small space of time, followed by a long winless streak.
This is the most powerful
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Size of reward/punishment
When betting, you typically stand to win more than you lose though you will lose more often than you win.
This gives a sense of small but frequent losses being tolerable.
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Evaluations of learning theory of gambling
- Doesn't explain all types of gambling. Skill plays important role in poker rather than chance.
- Environmentally reductionist as it tries to explain multi- faceted behaviour of addictions through stimulus- response
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4 cognitive distortions for gamblers
1. Skill and judgement
2. Personal characteristics and rituals
3. Faulty perceptions
4. Self-medication
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Skill and judgement
- Gamblers tend to overestimate the amount of control they have.
- Illusion of control is more likely with fruit machines which give the gambler a feeling of control even though little skill is involved
- Gamblers do tend to overestimate control even with purely random forms of gambling, such as the lottery as they look for patterns.
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Personal characteristics and rituals
- Gamblers believe they are naturally lucky or they engage in ritualistic behaviours prior to or during gambling that they believe will influence the odds
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Selective recall
The tendency to overestimate wins and underestimate losses and to see big losses as totally inexplicable
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Faulty perceptions of gamblers
Gamblers fallacy - Idea that random events equal themselves out over time
Availability bias - The notion that because something has happened in the past it will occur again in the future.
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Cognitive biases
Hindsight bias - Gambler looks back at big wins and big losses and say they expected it giving them irrational sense of control.
Flexible attribution - When they win, it is down to their skill.
When they lose it s down to external factors
The Near miss bias - Sufferers will often think a near win means their chances of winning next are improved.
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Cognitive explanations of gambling
Self - Medication - This approach assumes there are reasons for the persons choice of addiction
For example alcohol is the drug of choice rather than cigarettes due to the person feeling overly anxious or lacking in confidence.
In the case of gambling it may be the perception that gambling will help them overcome poverty or the boredom of everyday life.
97
Rogers (2003)
Examined cognitive bias in lottery ticket buyers.
- Found people believed in their personal luck and had illusions of control with their chances of winning and had gambler fallacy.
- Demonstrating cognitions can affect gambling behaviour
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Evaluations of cognitive biases
- Focus on self-report methodologies in this field and cognitive biases are difficult to falsify and really personal to the individual.
- Cause and effect between distorted cognitive biases and gambling problems cannot be established.
- Research support from Rogers (2003)
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Azjen and Fishbeins Theory of Planned behaviour
Suggests there are 3 processes that suggest whether or not we will successfully change our behaviour.
1. Attitude towards the behaviour
2. Subjective norms about behaviour
3. Perceived behavioural control over changing behaviour
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Attitude towards behaviour
If the addict recognises the behaviour is a negative one, this increases the chances of recovery.
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Raising Awareness of the addictions
A practical application of making people realise their problems is that it increases the importance of awareness campaigns
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Subjective Norms about behaviour
Refers to the belief of the group that the addict belongs to.
- If an addict is surrounded by fellow addicts, there is a big chance that the group as a whole will not realise their issue.
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Perceived behavioural control
This refers to the extent to which an individual feels they have the control to beat the addiction.
If an addict has an external locus of control, they will feel their attempts will be useless and they could never beat the addiction
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Evaluations of Theory of planned behaviour
- It has face validity
- Overuse of self-report methodologies as in order to ascertain someone's personal attitudes, questionnaires or interviews must be used.
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Prochaska's six-stage model
It recognises 6 key factors in addictions
1. Precontemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance
6. Termination
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Precontemplation stage
Addicts are not thinking of changing their behaviour within the next 6 months.
Denial may be the reason or they may not consider it a problem and they believe they cant beat the addiction
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Contemplation stage
The addict is thinking of changing their behaviour within the next 6 months.
However they have not made any plans to change they are just starting to recognise that action is probably needed.
People stay in this stage for a long time so it is key to instil a sense of urgency
108
Preparation stage
This presents more immediate behaviour and the addict will see the benefits of changing outweigh the costs.
Plans are made to change within the next month
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Action stage
People in this stage have made an attempt to change their behaviour in the last 6 months.
At this stage CBT IS very effective
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Maintenance stage
The change in behaviour has been maintained for atleast 6 months.
Relapse is still posbile and even in some cases likely.
So avoidance of addiction is still required. However confidence starts to blossom in the individual that the addiciton can be beaten.
111
Termination stage
Abstinence becomes automatic and addicts are no longer tempted by the addiction.
However it is theorised that his stage may not even be possible for some of the more severe addictions. e.g. heroin
112
Evaluations of Prochaska's 6 stage model
- Gives client a clear idea of where they are in their recovery as well as milestones to hit
- Recognises relapse is normal part of recovery process
- Argued to be too rational as it neglects emotional factors of recover
- Suffers from beta bias as does month consider any differences in successful recovery.
- Mechanically reductionist
113
First 4 steps for biological explanation for nicotine addiction
1. Nicotine stimulates specific acetylcholine receptors increasing alertness memory function and learning
2. This causes a rise in dopamine activity in the ventral tegmental area a critical area in the brains reward circuitry which is highly populated with acetylcholine
3. The vta activity caused by nicotine is projected to the nucleus accumbens a producer of dopamine
4. The nucleus accumbens is a primary reward centre in the brain with increased activity dopamine rises causing users to evaluate smoking as pleasurable making them want more
114
Last 3 steps for biological explanations for nicotine addiction
5. At the same time the nucleus accumbens is encouraged to release more dopamine as nicotine also stimulates endorphins reducing gaba activity. Reducing gaba correlates with further rises in dopamine
6. Cigarette smoke contains substances blocking monoamine oxidase which is responsible for breaking down of dopamine so if its blocked dopamine will stay at higher levels for longer
7. Additionally nicotine causes glutamate to speed up dopamine release and prevents gaba from slowing the brain down so it stays at a heightened level of activity for longer
