3.1: Addictive behaviours

Salience

Salience

One of the 6 characteristics of addictive behaviours, when the activity becomes the most important thing in a person’s life, dominating thinking, feelings and behaviour. Characteristics.

Reverse salience

Under the salience characteristic, where an addictive activity becomes the most important thing in a person’s life when they are prevented from engaging in that activity. Characteristics.

Mood modification

One of the 6 characteristics of addictive behaviours, when a change in behaviour is caused after engagement in addictive behaviour. Could be a high or numbing, and addicts use this to self-medicate. Characteristics.

Expectation effects

When what you expect can alter actual events. With addicts, mood modification can change based on what they expect, such as causing highs in the morning and calming in the night. Characteristics.

Tolerance

One of the 6 characteristics of addictive behaviours, where more amounts of the activity or drug are required for the same effects. For activity addictions, this can be stronger activities (more money/risk) or more time spent on activities. Characteristics.

Withdrawal

One of the 6 characteristics of addictive behaviours, symptoms that occur when addictive behaviours stop. Can include physical effects, such as sweating and insomnia, and psychological effects, such as irritability and depression. Characteristics.

Rosenthal and Lesieur

Found that 65% of pathological gamblers experience one physical side effect during withdrawal, which can be seen as psychological withdrawal. Characteristics.

Conflict

One of the 6 characteristics of addictive behaviours, can occur intrapersonally or intrapsychically. Occurs as addicts choose the activity without consideration for long term consequences. Characteristics.

Intrapsychic

Type of conflict within an addict. Usually experienced when an addict finds themselves unable to stop or cut down a behaviour, and is unable to do so. Characteristics.

Relapse

One of the 6 characteristics of addictive behaviours, where the addict repeatedly returns to the addictive behaviour after years of non-engagement. They often return back to extreme patterns quickly. Characteristics.

Social learning

Theory by Bandura which states behaviours, such as addiction, are learned from watching those around you. Based on his famous Bobo doll experiments. Peer influences and media.

Attention, retention, reproduction, motivation

The four key processes of SLT, which begin with watching a role model. Peer influences and media.

Vicarious reinforcement

Reinforcement of behaviour after watching another person be rewarded for a behaviour, often socially, such as having more friends. Peer influences and media.

Vicarious punishment

Stopping a behaviour after watching another person be punished for it, such as a punishment from a teacher. Peer influences and media.

Social norms

The rules of behaviour within certain groups, which can vary across cultures and subcultures. Peer influences.

Descriptive norms

Identified by Bosari and Carey as an individual’s perception of how much others engage in a behaviour. Peer influences.

Injunctive norms

Identified by Bosari and Carey as an individual’s perception of the social approval of a behaviour. Peer influences.

Simon-Morton and Farhat

Peer review into 40 prospective studies, finding 38 found a correlation between peers and smoking, and that parental attitudes had a large effect; either providing a protective effect both direct and indirectly, or increasing smoking chances via smoking themselves. Peer influences.

Ennett and Bauman

Found that non-smoking individuals are more likely to start smoking if they have smoking friends (peer influence), but also that social groups altered alongside smoking or non-smoking behaviour (peer selection). Peer influences.

Lyons et al

Found that alcohol usage is seen in 86% of movies and 40% of TV programmes. Media.

Pechmann and Shih

Used experimental method that showed groups two different clips, one with smoking and one without, and found that the one with smoking caused increased positive smoking attitudes and increased intention to smoke. They also found that these effects were negated by showing an anti-smoking advert beforehand. Media.

Eysneck

Developed 3 dimensions of personality, and developed a resource model of addiction, where it develops to fulfill a need of the personality profile. Personality.

Madhuri

Found addicts had higher levels of psychoticism and neuroticism compared to non drug addicts. They also found addicts had lower extraversion. Personality.

Kubicka et al

Conducted a 24 year study which found that extraversion, neuroticism and low conscientiousness were quite stable, and good predictors of drinking and smoking. He also found smoking was predicted by IQ and gender. Personality.

Kahneman and Tversky

Proposed humans have particular methods of quick decision making known as heuristics; such as the availability and representativeness. Cognitive biases.

Representativeness

Heuristic that stems from comparisons to mental representations, such as stereotypes. Attributed to gambler’s fallacy one. Cognitive biases.

Availability

Heuristic that stems from how easy it is to think of an example. This can be winning the lottery. Gambling machines are designed to emphasise this by playing loud noises and bright lights when winning. Cognitive biases.

Keren and Lewis

Identified two key gambler’s fallacy, one where mental representations of long term odds are applied to the short term, and two where a person will believe a randomised system has a pattern. Cognitive biases.

One

A gambler’s fallacy where an individual uses mental representations of long term odds on a short term event, such as a coin flip having landed 10x on heads meaning tails is ‘due‘ or next. Supported by the representative heuristic. Cognitive biases.

Two

Gambler’s fallacy where a truly random system is believed to be biased and have a pattern. An individual will underestimate the amount of observations necessary to detect this bias, and bet accordingly. Cognitive biases.

Griffiths

Compared the verbalisations of 30 gamblers to 30 non-regular gamblers and found gamblers had more irrational verbalisation by 11.5%. He found these verbalisations supported heuristics and cognitive biases. Played these back to some of the gamblers in a separate study, finding they were shocked by what they said. Cognitive biases.

Bosari and Carey

Defined two types of norms, descriptive - how much individuals engage in a behaviour, and injunctive - how approved this behaviour is. These make up social norms. Peer influences.

Ventral tegmental

Where dopamine is said to be released during drug consumption, leading to pleasure in the nucleus accumbens. Part of the mesolimbic pathway. Dopamine.

Nucleus accumbens

Where a sense of pleasure occurs after dopamine is released in the ventral tegmental area of the brain. Part of the mesolimbic pathway. Dopamine.

Mesolimbic

Name of the reward pathway, which is triggered in response to addictive substances. Contains the ventral tegmental area and nucleus accumbens. Dopamine.

Joutsa et al

Found dopamine levels were raised in participants performing a gambling task, whether they won or lost. Dopamine.

Volkow

Suggests that addictions alter the functioning of the frontal cortex, causing maintenance and relapse, as it causes the brain to pay too much attention to the addictive behaviour and it's cues, known as attentional bias. This damage is potentially permanent. They then found abnormalities in cocaine addicts frontal cortices. Dopamine.

Yoder et al

Found no consistent increase in dopamine levels in participants who consumed alcohol. Dopamine.

Comings et al

Found that 48.7% of smokers and ex-smokers carried the A1 variant of the D2D2 gene, and 50.9% of gamblers, compared to 25.9% of non-addicts. Genes.

D2D2

AKA the D2 dopamine receptor gene. The A1 variant causes fewer dopamine receptors in the mesolimbic pathway, which may lead individuals to compensate via drug intake. Genes.

ADH

Gene that controls the alcohol dehydrogenase enzyme, which controls the metabolism of alcohol into acetaldehyde. Lower activity of this enzyme could cause people to drink more, and be more likely to develop alcoholism. Genes.

Higuchi et al

Found that lower activity variants of ADH genes are associated with an increased risk of alcohol dependence in oriental cultures. Genes.

Diathesis-stress

A model that suggests disorders, such as addiction, are developed when genetic predispositions combine with environmental stressors. This could suggest a reason why only some drug users become addicts. Genes.

Stoess

Found that across a range of addictive behaviours, there was not a common pattern or personality, showing that this cannot be generalised across all addictions. Personality.

Aversion

A type of therapy which uses classical conditioning, with an unconditioned stimulus (antabuse) which causes an unconditioned response (nausea), which is then paired with an addictive behaviour (alcohol) which creates a conditioned response with the addictive behaviour as the conditioned stimulus. Aversion.

Disulfiram

Reaction caused by combining antabuse and alcohol. Stops aldehyde dehydrogenase from breaking down acetaldehyde, which causes it to build up in the bloodstream and causes nausea. Due to its long half-life, this occurs up to a week after intake and within 10 minutes of consumption. Aversion.

Antabuse

Drug given for alcohol aversion therapy. Causes side effects such as diarrhea, and nausea with the disulfiram reaction. Advised to be given after withdrawal at 200 mgs by NICE, and to be given under fortnightly supervision for 2 months, then monthly for 4 months. Aversion.

Aldehyde dehydrogenase

Stopped functioning by the disulfiram reaction - the combination of alcohol and antabuse. Causes acetaldehyde to build up in the bloodstream and cause negative side effects. Aversion.

Rapid smoking

Method of aversion therapy where a cigarette is puffed every 6 seconds, causing intense feelings of nausea. Less used than antabuse. Aversion.

Jorgensen et al

Found those who took antabuse had more days until relapse and fewer drinking days. Aversion.

McRobbie

Conducted study on 100 smokers - one group watching a video on quitting smoking, and one group performing rapid smoking. Found for a day and a week they had a decrease in urge to smoke, but this did not continue to 4 weeks, showing it to only have a short term effect. Aversion.

No Quick fix

Report by the Centre for Social Justice that stated that alcoholism costs £21 billion a year, due to unemployment benefits, NHS related costs, crime, homelessness, debt, etc. Could be seen as worth money spent on treatments. Aversion.

Kraft

Suggested covert sensitisation as a quicker, more effective and more ethical technique. Involves imagining nausea when an individual has the urge to drink. Aversion.

Methadone

An agonist which activates dopamine receptors to reduce heroin withdrawal symptoms, without producing a high. It is given orally to avoid heroin associations, and is closely monitored for 3 months to avoid selling on or overdose. NICE recommends it given alongside psychosocial support. A+A usage.

Maintainance

The term for the initial dose of methadone, as advised by NICE. Starts at 10-40 mgs, and then increases by 10 mgs until withdrawal symptoms are eliminated, reaching a dose of around 60-120 mgs. After withdrawal symptoms stop, detoxification may occur. A+A usage.

Naltrexone

An antagonist which blocks dopamine receptors, therefore preventing the pleasurable effects of opioids. Advised for those highly motivated, and who have stopped taking opioids. Usually given orally, but also available as a depot injection or implant. Can also be offered for alcohol. A+A usage.

National Institute for Health and Care Excellence (NICE)

Reviewed 17 studies on naltrexone use in heroin addiction, and found many randomised control trials found no difference in treatment retention compared to a placebo. However, once pooled they found naltrexone is associated with lower relapse rates in patients who were highly motivated, or monitored and offered extra support. A+A usage.

Buprenorphine

An alternative to methadone and naltrexone, with both antagonist and agonist properties. It has a ceiling effect, meaning no effect is produced after intake is increased above a certain amount. However, it is less used in the UK due to lower treatment retention rates compared to methadone. A+A usage.

Marteau et al

Analysed data over 15 years and found that buprenorphine is 6x safer than methadone. A+A usage.

Gyngell

Wrote an article for the Centre for Policy studies, claiming methadone was an expensive failure due to medication cost, addicts on benefits and the fact that drug reoffending is increasing. Argues that rehabilitation units would be more effective, which could undermine free will. A+A usage.

48.7, 50.9, 25.9

From Comings et al., the percentage of smokers, gamblers and the control population with the A1 variant of the D2D2 gene, which has been found to cause less receptos and compensation via drugs. Genes.

Kendler and Prescott

Interviewed 3,516 male twins on alcohol abuse and dependence, finding that MZ twins have a higher concordance rate than DZ, and that around 48-58% of addiction variance is genetic. However, they found environmental factors influenced initiation, and maintenance was genetically based. Genes.

48-58

The percentage Kendler and Prescott believe addiction variance is genetic. Found via their interviews with twins, with MZ having a higher concordance than DZ. Genes.

Kaufmann et al

Found that the serotonin transporter gene (SHTT) only has implications in addiction when it interacts with environmental factors, such as childhood neglect. Supports the diathesis-stress model. Genes.

Gowings et al

Found that methadone programmes are very effective at reducing social and physical harms associated with drug abuse, and this effectiveness increases alongside time in treatment, alongside a lower chance of relapse. A+A usage.

14 and 2.5

The level of irrational verbalisations shown by gamblers and non-regular gamblers respectively, as shown by Griffiths. These verbalisations supported the existence of heuristics and cognitive biases. Cognitive biases.

86 and 40

The percentage of alcohol usage seen in movies and TV programmes respectively, as shown by Lyons et al. Media.

Marco

Analysed a programme in El Cajon, California, where drunk drivers were offered a year in jail vs a year of antabuse treatment. Found that this constitutes cruel and unusual punishment, as participants were coerced and unaware of the side effects of antabuse. Aversion.

10.4 and 13.1

Amount of billions the government is predicted to earn from tobacco and alcohol taxes respectively, according to the Office for Budget Security. Aversion.

Regier et al

Found addiction is often comorbid with mental disorders. Makes the treatments less effective, and explanations less valid.

Buckhoitz

Measured levels of impulsivity in non-addicts before using amphetamines, and found those with higher impulsivity had a higher dopamine release and lower receptivity. This suggests people with ‘addictive personalities‘ may simply respond better to drugs. Personality.

Fortune and Goodie

Conducted a review of CBT treatment for addiction, finding some programmes focused on specific beliefs while some incorporated the idea of cognitive biases. They were both found to be successful treatments. Cognitive biases.

Ibanez et al

Investigated gender differences in gambling. Found women started later but evolved faster and were more likely to have emotional disorders and a history of abuse while men were more likely to have comorbid alcohol abuse and ASPD. Suggests cognitive biases vary drastically. Cognitive biases.

640

Amount of people who died from drug poisoning while taking methadone in 2022. A+A usage.

Brecht et al

Found that patients coerced performed equally well in methadone treatment as those who volunteered, suggesting that ethical concerns may outweigh societal benefits. A+A usage.

3.3 and 20

Millions of pounds that the NHS spent on methadone in 2022, and the billions that drug abuse is estimated to cost the UK. A+A usage.

21

Billions that the no quick fix report by the Centre for Social Justice estimated that alcoholism costs a year. Aversion.

Acetaldehyde

Product of alcohol that is broken down by the alcohol dehydrogenase enzyme. This is stopped by the disulfiram reaction, causing harmful side effects. Aversion.

1.5

Amount, in millions, antabuse cost in the NHS in 2023. Antabuse.

Devevensky et al

Found that teenagers who are already gambling were more likely to be influenced by gambling advertisements. Peer influences.

MSCTWR

Acronym for the 6 characteristics of addictive behaviour.