PSY215 LECTURES 1, 3, 4, 6, 8, 9, 10 ONLY (EXAM COPY)

Psychology of Addictions

**What is addiction?**

Addiction is not limited to drug ingestion → many behaviours can be addictive

* such as: gambling, overeating, exercise, internet use, work, etc

**Addictive behaviours include (2):**

substance and non-substance behaviours

**Characteristics of addictive behaviours (4)**

1. **Repetitive pattern** that increases risk of disease + personal and social problems

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2. **Feeling of “loss of control”** over the behaviour → unable to achieve abstinence or moderate use despite wanting to

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3. **Short term reward with long term cost** → immediate gratification (short term reward) + delayed damaging effects (long term cost)

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4. **Attempt to change behaviour** **results in high relapse rates**

**Two different viewpoints of addiction**

1. **Black and white manner**
2. **Spectrum of severity**

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**Advantage of “spectrum of severity” viewpoint**

Advantage: may reduce stigmatization attached to the word “addiction”

* Some suggest the use of the word (prolonged) **“heavy use”** instead of **“substance use disorder”**
* By putting moderate and heavy users on the same spectrum, it may overtime reduce stigmatization
* Alcohol use disorders = most stigmatized mental disorders followed by illegal drug use disorders

**Is it possible to use drugs and not misuse them?**

Yes

**Is it possible to use drugs and not become addicted to them?**

* Yes
* But we do not know ahead of time who will develop dependence

**DSM-5**

* **Diagnostic and Statistical Manual of Mental Disorders, 5th Edition**
* American Psychiatric Association (APA), 2013
* Widely accepted system for diagnosing and describing mental disorders
* Sets standard for making diagnoses of psychological disorders

**Substance-related & addictive disorders**

* **Range of problems associated with the use + abuse of drugs that alter the way one thinks + feels + behaves**

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* Many addicts use substances or engage in addictive behaviours to modify mood + self-medicate

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* Include separate classes of drugs
* although pharmacological mechanisms by which each class of drugs produces reward is different, they all directly activate the brain reward system + produce feelings of pleasure (arousing “high” or de-stressing “numbing” or __**both**__)
* __**both**__ **= psychology overrides physiology** due to expectation effects
* eg. smoker smokes first thing in the morning to become aroused and ready for the day (physiology), and later after work to destress (psychology)

**Non-substance related disorders**

* Gambling disorder
* Gambling behaviours → similar to drugs, activate the brain reward system + produce comparable behavioural symptoms
* other behavioural addictions (ie. internet gaming addiction) not included due to insufficient research to identify them as mental disorders

**Substances-related disorders include:**

**Substance use disorders: problematic use of a substance**

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AND

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**Substance-induced disorders: specific conditions resulting from use**

* depressive, anxiety, psychotic, or manic symptoms that occur as a physiological consequence of the use of substances of abuse


* may occur during active use, intoxication or withdrawal

**Substance**

Chemical compounds that alter mood/behaviour

**Substance use**

The ingestion of substances in moderate amounts that **do not** interfere with **functioning**

**Substance intoxication**

Physiological reaction to ingested substances

* eg. getting high

**Substance use disorder**

Defined in terms of how significantly substance use interferes with one’s life (rather than the amount of substance ingested)

* described as __**addiction**__

**Physiological dependence includes:**

* **Tolerance:** using increasingly greater amounts of the drug(s) to experience the same effect
* **Withdrawal:** experiencing a negative physical response when the substance is no longer ingested

**Tolerance**

The need for increased amounts of a substance to achieve desired effects, or a diminished effect with continued use of the same amount

* the degree to which tolerance develops varies across individuals and substances

**Withdrawal**

Experiencing negative physiological reactions to the removal of a substance which can be reduced or diminished by the use of the same or a similar substance

* Withdrawal symptoms vary across different classes of substances → separate criteria sets are provided in DSM-5

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Not all substances are physically addictive + result in physical withdrawal (ie. LSD)

**Tolerance and Withdrawal are:**

**BOTH** __**physiological**__ **reactions** to the substance being used

**Withdrawal from Alcohol**

**Alcohol withdrawal delirium** or **DTs (delirium tremens)**

* hallucinations and body tremors
* other alcohol withdrawal symptoms: vomiting, nausea, insomnia, etc.

**Withdrawal from Cocaine**

* anxiety
* sleep changes
* lack of motivation
* boredom

**Withdrawal from Cannabis**

* irritability
* nervousness
* appetite change
* sleep disturbance

**Psychological dependence**

**Behavioural** reactions to drugs

* drug-seeking behaviours (ie. stealing money to buy more drugs, standing in the cold to smoke, etc.)

**DSM-5 diagnostic criteria for substance use disorders**

In order to meet the criteria for a **substance use disorder**, at least 2 DSM-5 symptoms must be met in the last year __which has resulted in clinically significant impairment or distress__ (ie. has interfered with functioning)

* Must specify severity:
* **Mild →** presence of 2-3 symptoms
* **Moderate →** presence of 4-5 symptoms
* **Severe →** presence of 6 or more symptoms

**Problematic pattern of substance use leading to clinically significant impairment/distress, as shown by** __**at least 2**__ **of the following (within the** __**last year**__**):**

1. Substance is taken in larger amounts or over a longer period than was originally intended

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2. There is persistent desire, or unsuccessful efforts, to cut down or control use

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3. A great deal of time is spent in activities necessary to obtain the substance, use of the substance, or recovery from its effects

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4. Craving or strong desire to use the substance

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— — — — — 1 - 4 = **“Impaired control”** symptoms — — — — —

Recurrent substance use resulting in a failure to fulfill major role obligations at work, school or home

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5. Continued use despite having recurrent social or interpersonal problems caused by the effects of the substance

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6. Important social, occupational or recreational activities are given up or reduced because of use

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 – — – – – – 5 - 7 = **“Social impairment”** symptoms — – – – – –

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8. Recurrent use in situations in which it is physically hazardous

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9. Use is continued despite knowledge of having a recurrent physical or psychological problem that is likely to have been caused by the substance

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– — – – – – – – 8 - 9 = **“Risky use”** symptoms — – – – – – – – –

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10. **Tolerance – defined as either or both of the following:**

* A need for markedly increased amounts of substance to achieve intoxication or desired effect
* A markedly diminished effect with continued use of the same amount of substance

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11. **Withdrawal, as manifested by either of the following:**

* The characteristic withdrawal symptoms of the substance
* The substance – or a similar substance – taken to relieve or avoid withdrawal symptoms

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– — – 10 - 11 = **“Pharmacological criteria”** symptoms — – – –

**“Impaired control”** symptoms (4)

1. Substance is taken in larger amounts or over a longer period than was originally intended

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2. There is persistent desire, or unsuccessful efforts, to cut down or control use

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3. A great deal of time is spent in activities necessary to obtain the substance, use of the substance, or recovery from its effects

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4. Craving or strong desire to use the substance

**“Social impairment”** symptoms (3)

5. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school or home

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6. Continued use despite having recurrent social or interpersonal problems caused by the effects of the substance

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7. Important social, occupational or recreational activities are given up or reduced because of use

**“Risky use”** symptoms (2)

8. Recurrent use in situations in which it is physically hazardous

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9. Use is continued despite knowledge of having a recurrent physical or psychological problem that is likely to have been caused by the substance

**“Pharmacological criteria”** symptoms (2)

10. **Tolerance – defined as either or both of the following:**

* A need for markedly increased amounts of substance to achieve intoxication or desired effect
* A markedly diminished effect with continued use of the same amount of substance

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11. **Withdrawal, as manifested by either of the following:**

* The characteristic withdrawal symptoms of the substance
* The substance – or a similar substance – taken to relieve or avoid withdrawal symptoms

**4 groupings of the 11 symptoms of the problematic pattern of substance use**

1. **Impaired control**
2. **Social impairment**
3. **Risky use**
4. **Pharmacological criteria**

**Some minor variations in symptoms across different substances:**

* Some symptoms are less salient (prominent, noticible) for some substances
* Some symptoms do not apply to some substances (ie. withdrawal symptoms are not specified for inhalant use disorders)

**What is a psychological disorder?**

A psychological dysfunction within an individual that is associated with \[1\] __***distress***__ *and* \[2\] __***impairment in functioning***__ & \[3\] __***a response that is not typical or culturally expected***__

* \[1\] and \[2\] and \[3\] must be present for a psychological disorder diagnosis to be met

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Atypical or not culturally expected

* Atypical behaviour which violates social norms in a culture
* Important to consider cultural difference in psychological disorders

**Addiction is an interconnected process involving interplay between 3 factors:**

1. **Individual factors →** personal vulnerability factors

* biological or genetic predispositions
* psychological factors (ie. personality, unconscious motivations, attitudes, beliefs, etc.)

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2. **Situational factors →** social environment (ie. culture, family, friends, etc.)

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3. **Structural factors →** nature of the substance or addictive behaviour (not hypothetically possible to become addicted to anything ie. gardening)

**Biopsychosocial approach to addiction**

Biopsychosocial approach to addiction due to combination of **individual + situational + structural factors**

**Genetic factors of addiction**

Genetic factors contribute to the risk of addiction making some individuals more/less vulnerable

**Drug addiction**

A chronic disorder in which drug-seeking & drug-taking behaviour persists despite serious negative consequences

* addiction substances induce pleasant states (ie. euphoria) + relieve stress

**Continued drug use induces:**

Adaptive changes in the **central nervous system (CNS)** which lead to:

* tolerance
* physical dependence
* sensitization
* craving
* relapse

**Groups of substances (4)**

1. **Depressants**
2. **Stimulants**
3. **Opioids**
4. **Hallucinogens**

**Depressants**

* Result in behavioural **sedation + relaxation**
* include:
* **alcohol**
* **sedative** (calming)
* **hypnotic** (sleep-inducing)
* **anxiolytic** (anxiety-reducing) drugs
* decrease CNS activity + reduce levels of physiological arousal
* among the most likely to produce symptoms of tolerance and withdrawal

**Alcohol-related disorders**

* Cognitive, behavioural, biological + social problems associated with alcohol use + abuse
* The most commonly used substance in the group of depressants
* Apparent stimulation is the initial effect of alcohol (although a depressant)
* Initially → feel more outgoing
* Then gradually → reaction time slows, judgment becomes poor, motor coordination is impaired, etc.

**Effects of alcohol on the body**

* Affects many body parts & neurotransmitters 
* Path traveled throughout the body after ingestion:
* Stomach – small amounts absorbed
* Small intestine – absorbed into the bloodstream
* Circulatory system distributes alcohol throughout the body


* Contacts major organs: heart, lungs (vaporizes, is exhaled), and liver
* ie. breathalyzer tests

**Effects of alcohol on the brain (GABA, glutamate system, serotonin system, dopamine reward system)**

**GABA:** inhibitory neurotransmitter (reduces the activity across the synapse)

* inhibits anxiety → may explain anti-anxiety properties of alcohol

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**Glutamate system:** may explain blackouts/loss of memory period of intoxication

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**Serotonin system:** affects mood, sleeping + eating behaviour

* may explain alcoholic cravings

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**Dopamine reward system:** may explain pleasurable feelings during alcohol consumption

**Consequences of excessive drinking**

**Liver disease + cardiovascular disorders**

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**Dementia:** deterioration of brain functioning

* can be a direct result of neurotoxicity or poisoning of the brain by excessive amounts of alcohol

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**Wernicke-korsakoff syndrome:** results in confusion + loss of muscle coordination

* caused by a deficiency in thiamine (vitamin metabolized poorly by heavy drinkers)

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**Fetal alcohol syndrome (FAS):** pattern of problems including learning difficulties, behaviour deficits + characteristic physical flaws

* alcohol does not permanently kill neurons

**Prevalence of alcoholism**

Men are more likely to drink + do so more heavily

Heavy drinking:

* Men: 5+ drinks on one occasion at least once a month in the past year
* Women: 4+ drinks

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Higher rates of alcohol use disorders in European (Hungary + Russia) and American (USA) regions

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Rate of alcohol use varies across countries:

* different attitudes toward drinking
* availability of alcohol
* social norms
* physiological reactions

**Predictors of later abuse (alcohol)**

* Drinking at an early age (ie. between 11-14 years old is predictive of developing later alcohol-related disorders
* Lacking (or experiencing milder) physiological response to the sedative effects of alcohol may increase the likelihood of later abuse
* mixing alcohol with highly caffeinated energy drinks may be problematic

**Stimulants**

* Enhance alertness + activity + elevate mood, arousal, concentration
* Include:
* amphetamines
* cocaine
* nicotine
* caffeine


* The most commonly consumed drugs in Canada

**Caffeine**

* Most commonly used stimulant in North America


* A gentle stimulant → less harmful than other addictive drugs (but still problematic)

**Caffeine use disorder**

Cognitive, biological, behavioural and social problems associated with the use + abuse of caffeine

**Caffeine effects**

* In small doses: elevates mood + reduces fatigue
* In larger doses: causes insomnia
* Regular use results in: tolerance, dependence, intoxication, withdrawal
* withdrawal example: headache if you don’t have your morning coffee

**Tobacco-related disorders**

Cognitive, biological, behavioural + social problems associated with the use + abuse of nicotine

* smoking prevalence higher in men

**Nicotine**

A psychoactive substance in tobacco that produces patterns of dependence, tolerance + withdrawal

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Nicotine is inhaled into the lungs → enters the bloodstream

* After 7-19 seconds reaches the brain

**Tobacco withdrawal symptoms**

* depressed mood
* insomnia
* irritability
* anxiety
* difficulty concentrating
* increased appetite
* weight gain

**Tobacco effects**

In small doses → can relieve stress + improve mood

* can also cause high blood pressure + increase risks of heart disease + cancer


* bi-directional relationship between smoking + depression
* simultaneous smoking may make drinking alcohol more rewarding in terms of the effects on the dopamine reward system

**Amphetamines + cocaine**

* Increase blood pressure + pulse rate
* Induce the release of corticotropin-releasing factor + cortisol
* Long-term use → irritability, aggressive, stereotyped behaviour, paranoid-like psychosis
* Mild signs of withdrawal → insomnia, depression, lack of energy, intense cravings

**Opioids**

Family of addictive psychoactive substances that include:

* natural opiates, synthetic variations & comparable substances that occur naturally in the brain (ie. endorphins) -- which cause euphoria and reduce pain


* Include:
* heroin
* opium
* codeine
* morphine

**Opiate**

Natural chemicals in the opium poppy that have a narcotic effect

**Opioid-related disorders**

* **Opioid-related disorders** → cognitive, biological, behavioural & social problems associated with the use & abuse of opiates & their synthetic variants 
* Clinicians must be aware of the potential for abuse & minimize inappropriate prescription
* Canada is currently experiencing an opioid crisis (prescription AND illegal use)

Opioid effects

* euphoria
* drowsiness
* slowed breathing
* death
* reduces pain and thus is sometimes given to patients before/after surgery (ie. morphine)

**Opioid withdrawal**

Very unpleasant which leads to continued use despite desire to stop

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**Symptoms include:**

* excessive yawning
* nausea
* vomiting
* chills
* muscle aches
* diarrhea
* insomnia

**Consequences of opioid use**

* Mortality rates are 6 to 20 times more than the general population
* Relapse is common
* Many replace opioids with alcohol or other drugs
* Only 30% experience stable abstinence
* Increased risk of HIV infection (due to intravenous use)
* The high or rush experienced by opioid users → activation of the body’s natural opioid system (ie. endorphins) by the opioids taken (ie. heroin, opium, morphine, etc.)

**Hallucinogens**

* Alter sensory perception & produce delusions paranoia + hallucinations
* Cannabis, LSD, ketamine, PCP, ecstasy
* Physical symptoms → blurred vision, rapid heart rate
* Most hallucinogens do not have withdrawal symptoms but pose the possibility of psychotic reactions and “bad trips”

**LSD**

* Produced synthetically in laboratories
* Sometimes referred to as “acid”
* “trips” and “bad trips”
* Tolerance develops quickly

**Cannabis**

* Can have effects that fall in 3 categories: **depressant, stimulant + hallucinogen**
* Most widely used illegal substance (but legal in Canada)
* Use for medical purposes is controversial

**Marijuana**

Name given to the dried parts of the cannabis or hemp plant

**Common reactions to cannabis**

* Can produce very different reactions in people


* Altered perceptions, mood swings, heightened sensory experiences
* In large doses → paranoia, hallucinations, dizziness
* Overdose can induce panic attacks & psychosis
* Some experience tolerance, others experience reverse tolerance (more and more pleasure after repeated use)

**Cannabis frequent long-term use effects**

* Impaired memory + concentration + motivation


* Cannabis use disorder

**Synthetic marijuana**

* Known as fake weed, K2, spice
* Effects: hallucinations, seizures or heart rhythm problems

**Cannabis withdrawal symptoms**

Are subtle + appear in heavy consumers

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Include:

* restlessness
* irritability
* insomnia

**Dopamine pathways (dopamine reward system)**

* **Ventral tegmental area** (VTA; midbrain, brainstem) → high concentration of dopamine

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* **Mesolimbic pathway** → spans from the **VTA** to the **nucleus accumbens** (striatum) & other limbic regions
* Activation is necessary for experiencing reward and reinforcement
* Each drug increases the amount of dopamine released in this pathway differently

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* Both natural rewards (ie. food) & addictive drugs stimulate the release of dopamine from neurons of the presynaptic VTA into the nucleus accumbens (brain’s ‘pleasure centre’) → causing euphoria & reinforcement of that behaviour

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* During withdrawal there is substantial decrease in dopamine levels in the nucleus accumbens

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* Dopamine transporter → removes dopamine from the synaptic cleft (space between 2 neurons)

**Effects of drugs on dopamine**

All classes of drugs increase dopamine levels in the brain, but in different ways:

* Some (ie. alcohol + nicotine) indirectly excite dopamine-producing neurons in the VTA so they generate more action potentials

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* Others (ie. cocaine) act at the nerve terminal → bind to dopamine-transporter + block the reuptake of dopamine
* **Reuptake** → process that allows neurotransmitters to be taken back into the presynaptic neuron

Substance-related + addictive disorders chapter in DSM-5:

**Substance-related disorders** → separate classes of drugs

* Depressants, stimulants, opioids, hallucinogens
* Although the pharmacological mechanism by which each class of drugs produces reward is different, **they all directly activate the brain reward system** (mesolimbic pathway) and **produce feelings of pleasure** (by increasing the amount of dopamine in the nucleus accumbens – brains ‘pleasure center’)

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**Non-substance related disorders** → Gambling disorder also activates the brain's reward system

**Incentive Salience**

As addiction develops, the addict develops an increase in “wanting” the drug, despite a decrease (or static) “liking”

**Incentive sensitization theory**

As addiction develops, the addict develops an increase in “wanting” the drug, despite a decrease (or static) “liking”

* Different brain mechanisms mediate “liking” & “wanting”
* Cues associated with the reinforcer (ie. drug) also motivate drug-seeking behaviours (operant & classical conditioning) & activate the reward system
* Cues predict that pleasure is about to happen, therefore the user begins to respond positively to cues as well (cues become valuable in themselves even in absence of the drug)
* Eg. person addicted to cocaine stops using but then they encounter a straw that they used to use to snort) → may result in relapse as it motivates drug-seeking behaviours + activates the reward system
* “Wanting” may grow over time independently of “liking” as an individual becomes an addict
* Dopamine hyper reactivity produces intense reward “wanting” rather than “liking”

**Relapse**

Long-term use of addictive drugs produce alterations in the brain that increase vulnerability to relapse & facilitate craving following successful detoxifications

**Factors involved in relapse & craving**

* Re-exposure to the drug
* Exposure to environmental stimuli previously paired with drug use
* Exposure to environmental stressors

**Brain disease model of addiction**

* When fundamental biological processes are disrupted (ie. those involved in decision-making ability + emotional balance) → they can alter voluntary behavioural control & lead to self-regulation disorders (ie. drug addiction or behaviour addictions)
* Research supports that addiction is a disease of the brain

**Criticisms of brain disease model of addiction**

* Challenges values about self-determination & personal responsibilities which frame drug use as a voluntary act
* May excuse personal irresponsibility + criminal acts
* Fails to identify genetic aberrations or brain atypicalities that consistently apply to all individuals

**Operant Conditioning (B.F Skinner)**

Type of learning that is controlled by the ***consequences*** of one’s behaviours

* reinforcement + positive reinforcement

**Reinforcement**

Any consequence that makes a behaviour **more** likely to occur (strengthens the probability of the behaviour)

**Positive Reinforcement**

Presenting a **pleasant** stimulus (ie. the ‘high’ feeling) following a behaviour we want to **strengthen**

**Classical Conditioning (Pavlov)**

Form of learning in which one responds to a previously neutral that has been **paired with** another stimulus which elicits an automatic response

* Learning takes place with association between two stimuli

***Before*** **learning:**

**Unconditioned Stimulus (UCS)** → elicits an automatic response without prior conditioning (ie. cocaine)

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**Unconditioned Response (UCR)** → automatic response to a stimulus that does not need to be learned

***After*** **learning:**

**Conditioned Stimulus (CS)** → initially neutral stimulus (ie. straw) that comes to elicit a response due to association with an **UCS** (ie. cocaine)

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**Conditioned Response (CR)** → response previously associated with a non neutral stimulus that is elicited by a (previously) neutral stimulus through conditioning (ie. the ‘high’ feeling)

**Biopsychosocial approach to addiction**

Addiction is an interconnected process between **THREE** different factors:


1. **Individual factors**
2. **Situational factors**
3. **Structural factors**

**Individual factors**

Personal vulnerability factors

* biological or genetic predispositions
* psychological factors (ie. personality, unconscious motivations, attitudes, beliefs, etc.)

**Situational factors**

Social environment

* culture
* family
* friends

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**Structural factors**

Nature of the substance or addictive behaviour

* not hypothetically possible to become addicted to anything → i.e. gardening

**Developmental theory**

Impact of addictive behaviours on life course development & development of SUD:

* prenatal/fetal developmental period marks the peak sensitivity for being negatively affected as a result of exposure to alcohol & other substances
* first use of a substance (tobacco, alcohol, cannabis) during an earlier age (ie. adolescence) is associated with increases in the risk of developing a SUD

**Developmental trajectories of addictive behaviours**

Addictive behaviours can result in different trajectories

* a person can achieve abstinence, a person can achieve controlled use, another person may engage in risky use, and someone else may have an addiction based on DSM-5

**Multi-directional relationship between trajectories**

It's possible for an individual to move back and forth between different trajectories

**The probability of different trajectories is affected by:**

* Individual characteristics, “addictive potential” of substances, attempts to change behaviour in the past
* There is no single “natural” trajectory to recovery either

**Learning Theory**

* Presents **classical & operant conditioning** processes as explanation of how addictive behaviour patterns may develop, be maintained & become extinguished
* Explains why environmental stimuli or bodily sensations trigger craving

**Classical Conditioning (CS)**

* Form of learning in which one responds to a previously neutral stimulus that has been paired with another stimulus which elicits an automatic response
* The craving stimulus from the environment may involve any of the five senses
* Or craving may be triggered by familiar internal states (ie. anxiety which was previously reduced by use of a drug)

**Before Classical Conditioning**

__**Before learning:**__

* **Unconditioned stimulus (UCS) →** elicits an **automatic** **response** without prior conditioning (ie. cocaine)
* **Unconditioned response (UCR) →** **automatic** **response** to a stimulus that does not need to be learned (ie. the ‘high’ feeling)

**After Classical Conditioning**

__**After learning:**__

* **Conditioned stimulus (CS) →** initially neutral stimulus (i.e., straw) that comes to elicit a response due to association with an UCS (ie. cocaine)
* **Conditioned response (CR) →** response previously associated with a non neutral stimulus that is elicited by a (previously) neutral stimulus through conditioning (ie. the ‘high’ feeling)

**Environmental Cues → Craving Triggers Through Classical Conditioning**

* Principles help explain how environmental cues may trigger craving to engage in addictive behaviour which was previously experienced positively
* An individual may develop a CR to stimuli that are repeatedly associated with an addictive substance/activity
* ie. craving alcohol upon seeing a cold glass of beer or getting triggered to gamble when holding poker chips
* If someone is an alcoholic and they see an advertisement of a glass of cold beer
* Environmental cues can become craving triggers through classical conditioning
* Exposure to those triggering cues increasing the risk of relapse → **cue-induced response**
* Craving cues trigger strong desire to engage in addictive behaviours

**One goal in CBT (cognitive behaviour therapy)**

To help patients identify personal triggers & develop strategies for managing situations where encountered

* Craving cues are person-specific

**Cue-exposure treatment**

Patients are repeatedly exposed to environmental cues (CS) without experiencing the UCR

* ***Relearning*** rather than unlearning the association
* Not effective on its own as sole treatment, must be used in alongside other things

**Operant conditioning**

Type of learning that is controlled by the consequences of one’s behaviours

* positive and negative reinforcement
* positive and negative punishment

**Reinforcement**

Any consequence that makes a behaviour ***more*** **likely to occur** (strengthens the probability of the behaviour)