PSY389 Lecture 5: Loss of Control and Craving

WHAT IS CRAVING?

Strong desires OR urges to engage in a given behaviour (e.g., appetitive behaviour or other activities)

Is subjective, behavioural, physiological and neurochemical in nature

Some characteristics:

• recurrent and persistent thoughts (about substance), and struggle to control these drives;

• urgent and irresistible desires;

• Impulsive behaviour;

Some characteristics of craving:

1. withdrawal symptoms,

2. a strong desire to alleviate withdrawal symptoms;

3. Increase in autonomic responses (faster heart rate, increased blood pressure, salivation);

4. anticipation of positive outcome;

5. anticipation of relief from negative affect;

6. intent to consume;

7. lack of control over use.

Loss of control / impaired control

Refers to difficulty sticking to a planned limit or cutting down or stopping substance use, despite intending to do so.

Alcohol Dependence Syndrome (ADS)

Proponents of the Alcohol Dependence Syndrome viewed alcoholism as a disease, argued that impaired control was:

• A core feature of alcohol dependence

• Characteristic of “true” alcoholics

• Reflective of being powerless to stop drinking

• A consequence of an underlying physical abnormality

• Indicative of physiological dependence

Evidence supports that alcoholism as an underlying disease or biological problem

Evidence against dependence being underlying disease or biological problem

1. craving and loss of control it is NOT a physical abnormality that separates ‘alcoholics’ from other drinkers,

2. a function of conditioning (i.e. learned behaviours) AND other psychological processes (e.g., expectancies, experience, cognitions)

3. Thus, control of appetites is central to understanding dependence and a complex mixture of biology and psychology

Cues and Appetitive behaviours

• Humans do not easily forget cues that have become associated with appetitive behaviours.

• There are many potential cues associated with appetites, including advertising, media, shops, social situations, and people around us.

• The longer we engage in a particular appetitive behaviour, the more cues we are likely to learn and associate with it.

• Can we identify all the cues that have become associated with our appetitive behaviours?

• These cues can be external (e.g., people, places, objects, or situations) or internal (e.g., thoughts, emotions, memories, or physical sensations).

• We are constantly surrounded by cues in our environment, making it difficult to avoid external triggers associated with substance use.

• Internal cues can be equally difficult to avoid, such as feelings of comfort, relief from stress or tension, or the temporary reduction of negative moods.

• The reward from substance use is often immediate, whereas the negative consequences—such as poorer health or other difficulties—may be delayed.

• Delaying gratification is difficult and requires ongoing selfmonitoring and self-control. We will explore these cognitive processes further in Lecture 11: Cognitive Processes.

Studies involving asking people the question:

“do you ever find that when you are drinking you can’t stop?”

• 11.5% of normal drinkers said yes (Edwards et al. and Clarke et al.) compared to 25% of alcohol dependent individuals (Room et al.)

• Findings suggest impaired control is more significant for dependent drinkers than normal drinkers

IS LOSS OF CONTROL LINKED TO EXPECTANCY?

• Engle & Willliams (1976) divided 40 alcoholics in 4 groups in a balanced placebo design study

• Assessed level of craving

Findings:

• G1 (expect alcohol/get alcohol) had the highest craving score

• G2 (did not expect alcohol/get alcohol) had the lowest craving score

Findings suggest:

• Evidence suggests that expectancy influenced craving

Marlatt et al. (1973) used 2 groups of alcoholics and social drinkers, told them it was a “taste discrimination test”

Findings:

• Alcoholics drank more

• Those told that they would receive alcohol drank more (regardless of whether they given alcohol or not)

Evidence suggest:

• This indicates that expectancy effect is linked to loss of control

Method issue:

• individual differences in expectancies would have influenced the findings

Hodgson, Rankin & Stockwell (1970s & 1980s)

Recruited severely and moderately dependent drinkers

Participants were told the condition they were allocated to (low, medium or high alcohol)

Used different strength priming alcohol doses (low, medium, high)

• Severely dependent reported a greater desire, consumed more and drank faster (irrespective of dose)

• Those in ‘high dose’ condition had higher pulse rate

• Severely dependent individuals drank faster in the high dose condition

What do these finding suggest?

• This suggests a link between loss of control and past use of alcohol

Stockwell used balanced placebo design to control for expectancy, and found that:

Severely dependent participants

• drank faster,

• had greater difficulty resisting alcohol • rated alcohol more positively

• Drank faster when told they were ‘given alcohol’ irrespective of expectancy

• Low dependent participants drank faster if they expected alcohol but did not get it

What do these findings suggest?

• severely dependent drinkers were more sensitive to alcohol (physiology) while low dependent drinkers were affected more by expectancy

Based on evidence on impaired control:

• A stronger support for psychological basis for impaired control (e.g., expectancy)

• Weaker support for physiological basis for impaired control

• An interaction between psychology and physiology?

• More research is needed

Treatment implications - for loss of control/craving/impaired control evidence

1. Need to better identify cues for use & prevent them

2. Need to better understand physiological mechanisms behind impaired control of appetite

3. Need to understand individual’s expectancy and past use and how these influence their impaired control

4. Address the problem of immediate vs. delayed benefits & costs of use

5. Explore alternatives to “time out” via other means (e.g., sport, family activities, hobbies)

6. Explore alternatives for suppressing negative mood (e.g., yoga, mindfulness, relaxation)

7. Consider treatment using Motivational Enhancement and Cognitive Behavioural therapy

Effect of behavioural therapy - loss of control/craving

• Maudsley: former alcohol dependent individuals could return to normal life & social drinking when they received behavioural therapy

• Rand Report examined 2339 dependent individuals and reported that most could drink moderately without relapse at 6 & 18 months after behavioural therapy

• Sobell & Sobell found behavioural therapy was effective in maintaining abstinence and general adjustments in social life at 2 & 4 years after treatment

• Impaired control can be overcome with behavioural therapy