A2 Addictive Behaviour – Critical Questions

Is Dopamine Just A Pleasure Chemical?

Neurological explanations of pleasure have focused on the mesolimbic pathway. This is a series of connected neurons in the brain which enable us to feel pleasure. Substances such as nicotine are supposed to be addictive because they raise the levels of the neurotransmitter dopamine in this pathway, making feelings of pleasure more intense. Some people are supposed to be more easily addicted to behaviours such as gambling because of abnormalities in the mesolimbic pathway and in the dopamine system. However, this account of dopamine has been challenged by more recent research. These two articles are good starting points.

http://www.guardian.co.uk/science/2013/feb/03/dopamine-the-unsexy-truth

http://www.slate.com/articles/health_and_science/science/2013/07/what_is_dopamine_love_lust_sex_addiction_gambling_motivation_reward.html

Use these as a basis for doing some more searching in order to answer the question of whether dopamine is just a pleasure chemical. Ask yourself what implications your answers might have for our understanding and treatment of addiction.

How Does Online Gaming Teach People How To Gamble?

The cognitive approach to explaining addiction to gambling focuses on how we think. One of the reasons why there is concern about the proliferation of online gaming is that it teaches people how to gamble. Even though no money changes hands, some online games teach people about taking risks and accumulating rewards. There are clear links between the ways in which gaming and gambling websites work. One of the leading researchers in this area is Mark Griffiths at Nottingham Trent University. You can read more about his research at these two links.

http://www.psychologytoday.com/blog/in-excess/201312/level-headed

http://www.theguardian.com/society/2014/jan/11/candy-crush-children-gambling

You can listen to an interview with him here.

http://www.knpr.org/son/archive/detail2.cfm?SegmentID=10909

If the link does not work, please click here for the download.

Use the tabs for gambling and video games to find out more about Mark Griffiths’ work and other research in this area. The links on this blog are not exhaustive: use a search engine to see what else you can find on the link between video games and gambling.

Ask yourself how clear the link is and what the implications are for preventing addiction to gambling.

Can The Learning Approach, Or Any Other Approach, Offer A Sufficient Explanation Of Addiction To Smoking Or Gambling?

In the history of Psychology, different approaches to explaining problems have been dominant at different times. Each has claimed a monopoly of wisdom. The Learning Approach had its period of dominance in the middle of the twentieth century and clearly still had some validity. Increasingly in Psychology, we recognise that we cannot use one approach or set of ideas to explain behaviour. We bring together a number of approaches. The questions we might ask here are what the limitations of the Learning Approach are and how we might connect different approaches to create a valid and balanced picture of addiction. Use what you have learnt in this topic already. Use the Addictive Behaviour category at the bottom of the page. Use the comments button to post your point of view.

Is There An Addictive Personality? What Implications Does This Have For The Treatment Of Addiction?

The idea of an addictive personality has almost become part of our culture. Think of the way in which the lives of celebrities are reported: Russell Brand, Amy Winehouse, Paul Gascoigne. It is however an idea which psychologists think is controversial. Here are some links which discuss this idea.

http://www.thementalelf.net/mental-health-conditions/substance-misuse/illicit-drug-use-personality-and-poverty/

http://drmarkgriffiths.wordpress.com/2014/01/02/within-you-without-you-where-does-addiction-reside/

http://drmarkgriffiths.wordpress.com/2012/02/14/is-there-a-gambling-personality/

A particularly interesting piece of research in this area comes from Karen Ersche at Cambridge University. You can read about her research here:

http://www.mrc.ac.uk/Newspublications/News/MRC008461

You can also watch a news report about her work here.

http://www.bbc.co.uk/news/health-16854593

Use these links and anything else you can find on personality and addiction to decide whether there is such a thing as an addictive personality. Ask yourself what your answer to this question tells you about how we should treat and indeed view addictive behaviour.

Interventions For Addiction – What Works? What Are The Issues In Judging The Effectiveness Of An Intervention?

Treating addiction has the potential to bring huge social benefits. The range of interventions is now considerable but there is controversy about what works. Part of this controversy is about the evidence that these interventions are effective, part of it is about the appropriateness of these interventions. You will have covered core information about interventions and their effectiveness in class from your resources booklet. Here is some extension material to get you reading, listening, watching and thinking.

Drug treatments

You have already seen how Varenicline and Bupropion have been used as drug treatments for addiction to smoking. You have also seen evidence about their effectiveness. This evidence is interesting because it looks at what happens when the two drug treatments are combined.

http://www.thementalelf.net/mental-health-conditions/substance-misuse/combination-of-treatments-may-improve-smoking-cessation/

Naltrexone has been used to treat gambling addiction. You can read about it in these three sources.

http://www.abc.net.au/am/content/2011/s3372620.htm

http://www.medicalobserver.com.au/news/naltrexone-for-problem-gambling–gets-support-in-new-guidelines

http://abcnews.go.com/Health/story?id=117563

You can watch a piece of video about it here.

http://www.sbs.com.au/news/article/1721299/Anti-gambling-pill-goes-to-trial

You can see some evidence about its effectiveness here.

http://www.ncbi.nlm.nih.gov/pubmed/21150845

Cognitive Behavioural Therapy and Motivational Interviewing

There are general issues about the effectiveness of CBT which can be applied to its use as an intervention for addiction. Look back to the posts about depression on this blog from earlier in the year to remind yourself what those issues are. Here are two recent articles about CBT being used specifically in the context of addiction.

http://livuniaddictiongroup.blogspot.co.uk/2013/06/preventing-alcohol-misuse-in-teens-with.html

and

http://livuniaddictiongroup.blogspot.co.uk/2013/04/treatment-of-excessive-alcohol-use-in.html

Use these to consider further how effective CBT is in treating addiction and what the issues with its use might be.

The interventions described here are based on some elements of CBT and MI.

http://www.thementalelf.net/mental-health-conditions/substance-misuse/new-cochrane-review-examines-the-effectiveness-of-smoking-cessation-strategies-in-young-people/

Finally, we will have started this section by looking at the Hello Sunday Morning website. Hello Sunday Morning uses some of the ideas of CBT and MI but, as with some of the other examples we have looked at in relation to depression, does not use a clinical setting to get its message across but instead uses the internet.

 

Public Health Interventions

Here is a story from the BMA website about its campaign to have plain tobacco packaging in the UK.

http://bma.org.uk/news-views-analysis/news/2013/november/call-for-plain-tobacco-packaging-without-delay

You will see a reference to a similar piece of legislation in Australia at the bottom of the article. You can find out more about the Australian experience here.

http://www.who.int/features/2013/australia_tobacco_packaging/en/

Use a search engine to find out what the latest news is about the effectiveness of this legislation is in Australia. This has just appeared on the BBC website: http://www.bbc.co.uk/news/uk-politics-26865693.

We will have looked at the public health intervention based on screening via the resources booklet in the lesson. Here’s the link to the article.

http://www.thementalelf.net/mental-health-conditions/substance-misuse/primary-care-interventions-for-alcohol-misuse-us-preventative-services-task-force-recommendations/

This might give you some ideas about the issues in judging the effectiveness of an intervention.

So in your view and based on the evidence here, what works? What issues emerge in judging the effectiveness of an intervention? Post a comment or contribute to the discussion in class.

 

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10 comments

  1. 13D already have an insight into dopamine as a pleasure chemical. We understood fairly quickly to think of a chemical as a process, “dopamine is pleasure” is fundamentally wrong. Dopamine enables signals to be passed to between brain cells. When this happens, we feel pleasure. Dopamine is a chemical, not pleasure itself. Secondly, dopamine is involved in lots of processes: it is not simply related to pleasure but to lots of other experiences. We need here to explain what we mean by “involved in” oir “related to”. We mean that when people have a particular experience or engage in a particular process, areas known to be rich in dopamine are active in the brain. What that chemical actually does to make these things happen is a mystery. Dopamine is likely to be involved in a huge range of processes and to work in a huge variety of ways. I pointed out in the lesson that the diagram on the board of the mesolimbic pathway is a gross over-simplification of a highly complex process. This should make us realise that addiction is a highly complex process with multiple pathways and changes in the brain. If we reduce addiction to being all about too much dopamine in the mesolimbic pathway, we are in danger of missing the point, coming up with trivial solutions and underestimating the scope of the problem.

  2. Gambling and gaming. 13D used the cognitive approach to understand the link between gambling and gaming. Gaming itself can be explained by the theory of planned behaviour. Attitude is the starting point: people think that these online games are OK if you play a little bit. Subjective norm comes into it: everyone else is doing it. People think they will be able to play a little bit and stop: that’s about perceived behavioural control. Beyond this model, the cognitive approach explains behaviour in terms of automatic processing. Behaviours become part of our routine. We stick to them without questioning them. So a strength of the cognitive approach is that we can apply it to an issue like online gaming behaviour fairly easily.

    The next move we can make within the cognitive approach is that we can make a link between gambling and gaming. Gaming teaches people the principles of gambling. You pay and you take risks in order to win. Gambling, like gaming, can be instantly accessible and becomes part of a routine which people do not question. It becomes automatic and not subject to conscious processing. The people who design gambling websites make them easily accessible and the pace at which you can play appeals to people. So this makes the cognitive approach a powerful tool for understanding why people gamble and offers useful insights into how to prevent problem gaming turning into problem gambling.

    It can’t be the whole story though. The point about both gaming and gambling is that they rely on variable reinforcement. It is well established from conditioning studies of animals that operant conditioning based on unpredictable rewards is hard to extinguish. So a rat in a Skinner Box will keep pressing a lever for longer without getting a reward if it is used to variable as opposed to regular rewards. That is why Mark Griffiths talks about people being behaviourally conditioned to game and then to gamble. So we hit a standard issue in Psychology that the behavioural and the cognitive approaches are quite hard to pull apart.

    We might also think that the biological approach plays a part. Just by thinking about thought processes, we cannot explain why some people get addicted to gaming and gambling while others don’t. We might want to think about what is different about the brains of people who game and gamble to get a grip on this. That is why I like the research of Blaszczynski and Nower (2002). They emphasise three different routes into gambling which derive from different approaches.

  3. Gaming and gambling: here is how 13B saw it. People use games as a way of practising and becoming familiar with gambling without spending real money. Online gaming teaches people about taking risks and accumulating rewards in a way similar to gambling. Games are free to download but 40% of people still pay for add ons. They are therefore learning the techniques from gaming and applying them to gambling for real money. People start to believe that they could gamble with real money and do quite well.

    This link is important because it suggests that policy makers should consider the growing presence of gambling in on line gaming, for example by removing the gambling element for younger users. However, a limitation of the cognitive approach to explaining the link between gaming and gambling is that there is clearly more to gambling than distorted thinking. We can use, for example the idea of operant conditioning to explain how both gambling and gaming provide an instant reward. This conditions the player to want to repeat the behaviour. The distorted thinking which gamers and gamblers display might therefore be seen as the consequence of this process of conditioning.

    You could add a point at the start about evidence for the cognitive approach coming from Delfabbro and Winefield (1999). You could add a point at the end about Blaszczynski and Nower (2002) proposing three different routes into problem gambling, only one of which is really cognitive. You would then have a really good exam answer.

  4. 13B on addictive personality …… We managed to develop an effective line of argument. We kicked off by looking at how poverty interacts with personality factors in the Mental Elf article. Conscientiousness is a personality factor associated with drug use: conscientious people do not take drugs. However, this only applies to more affluent individuals. People with less money can come out as conscientious on a personality questionnaire and still be using drugs. Presumably, their social environment has an impact even if they want to do the right thing. We also noticed that higher scores on neurotoicism were associated with drug use. However, gender also plays a role in whether openness is associated with drug use. Thank you to Izzi for that point.

    Polly and Darcy noticed something more general. Polly picked out the word “global” to describe these definitions of the addictive personality. There seem to be so many different personality factors covered that it is hard to believe that they are all necessary and sufficient for the development of addiction. The definition of addictive personality is therefore too broad to be useful. If we just concentrate on the idea of personality, we miss too many situational factors. Darcy included a strong point about cause and effect. It is clear that people with addictions display certain personality traits. The difficult thing to work out is whether the addiction causes the traits or the other way round.

    Jenny added some of the work on addicted and non-addicted siblings carried out by Karen Ersche. Ersche’s work suggests that there is an abnormality in the parts of the brain which controls impulsive behaviour which is shared by both addicted and non-addicted siblings. This suggests that acting impulsively may be a personality trait in people with addictions which has a genetic basis. Steph took this a stage further by drawing a distinction between sensation seeking and impulsivity. There may be a genetic basis to the tendency to seek out sensation and take risks. People with this tendency will engage in behaviours which are potentially addictive but only those who cannot control their impulses will become addictive. This takes us back to the issue of initiation and maintenance. Impulsivity may explain why addiction is maintained but we need a different theory to explain why addiction starts.

    Sarah completed the process by raising the issue of anyone becoming addicted. It has been suggested that most people could become addicted in the right, or maybe wrong, circumstances. This means that personality matters less in addiction and environment matters much more. There is a classic study which followed American soldiers during the Vietnam War who became addicted to heroin during their tour of duty there. When they got home, their addiction disappeared. This suggests that addiction lies in the environment rather than the individual and her/his personality. I finished off by suggesting that what was needed was a neural footprint for addiction. If there were factors in an environment which drove some people to addiction, we needed to know what it was inside their brains which made this happen.

    For essay writing, we talk about developing a line of argument and about elaborating on points. This is what we have achieved in this exercise.

  5. Is there such a thing as an addictive personality?

    Although I agree with research, to an extent, that certain personality traits can be linked to addiction e.g. impulsivity is linked to substance misuse; I do not think that an “addictive personality” can be concluded yet. Much of the research is correlational – perhaps the personality traits are a result of the addiction, not what causes the addiction. Moreover, just because you have a particular set of personality traits doesn’t mean you could develop an addiction; there are various other factors such as a genetic basis, poverty, etc. that the addictive personality explanation does not consider, but could be just as important as personality, in the development of addiction.

    How does this affect how we treat and view addictive behaviour?

    – Difficult to treat and prevent addictive behaviour if different traits are linked with different addictions
    – We may view addiction less harshly, perhaps we’ll see the possibility that anyone could develop an addiction = it can’t be helped; it’s who you are!
    -Alternatively, we may view addiction in a stricter way; the idea of an addictive personality suggests addiction is purely due to personality traits, therefore, we may view addictions as something the individual has brought on themselves, i.e., they weren’t born with it, like is suggested in some biological explanations.
    -How do you treat someone’s personality?
    -How do you do deal with variable severities of traits?; Is a little neuroticism okay? Or does any amount make you doomed? (!)
    -This affects our view on addictive behaviour as “addictive personality” does not consider other factors e.g. genes, and so treatment may not be as effective if it doesn’t treat all factors.

    1. So the interesting thing here is what we mean by “personality”. When Eysenck was formulating extraversion/introversion and neuroticism as personality types in the 1950s, his idea was that there was a genetic biological basis to these differences. Genetics and ideas about nature-nurture have moved on a great deal since then. We now understand that personality is a complex interaction of genetic and environmental factors. What’s interesting about Karen Ersche’s research is that it can start to give us a handle on what that interaction might be about. By focusing on abnormalities in the system which inhibits impulsivity, it shows us what the genetic basis is on which addiction builds.

      Molly’s right to ask the questions about how we treat and how we view. If we understand the process which leads one sibling into addiction but the other to stay clear, we can work out where in the process intervention can be most effective. We’ll see next week how intervention can be biological, psychological through CBT and motivational interviewing or at the level of public health intervention. On how we view, it’s important to understand what is in the person’s control and what is beyond their control as they move along the pathway to addiction. Locus of control gets interesting here. We cover it as part of social psychology but it has greater applications in a health psychology context. People dealing with pain and with complex medical problems are encouraged to assume an internal locus of control and deal with them. The same applies to psychological interventions for addiction. So the trick is to get someone to see what they can control and find strategies to deal with it. How we view and how we treat get bound up together.

  6. 13D on how we judge the effectiveness of interventions……. We didn’t even get through the core as a group but even from the work we looked at on media influence and the theory of planned behaviour, a whole load of issues came up which need to be addressed.

    In my mind, there are two fundamental issues. The first is the idea of overall effectiveness. We look at evidence that one intervention works better than another but do not consider individual differences. For an intervention to be effective, it needs to meet the needs of an individual. This is clear in something as simple as NRT. People need to decide whether to use a spray which gives an instant response, or patches which work through the course of a day. A particular question here is the extent to which an individual is in control of the intervention and believes that the intervention will work. This is the message from Hello Sunday Morning. Some people may need to have that control if their intervention is going to work, for others it may be less important. The idea of costs and rewards is also important here. Interventions will affect people negatively in different ways. For some people, those rewards might need to be tangible: the attractiveness of measuring levels of carbon monoxide in someone’s breath is that they can see the results immediately.

    The second fundamental issue is that of how to measure changes as a result of interventions. As we saw with the Gaboury and LaDouceur study, measuring changes in knowledge is easy but measuring changes in behaviour is much more difficult. You can ask people in questionnaires or interviews but they may not tell the truth. You can try observing them in controlled or naturalistic settings or you can ask family and friends about what they have seen. Clearly, issues of confidentiality, social desirability and demand characteristics get in the way. There’s also the problem of defining effectiveness. There needs to be a time limit: six months is often the period used but there seems to be something arbitrary about this. You also need to decide whether someone needs to have abstained totally from the addictive behaviour for the intervention to be counted as a success. Different studies use different measures. There’s an issue of control groups. When an experimental group is compared with a control group to assess the effectiveness of an intervention, the question arises of what this control group is doing and whether the comparison between control and experimental groups is a fair one. In the background, the issue of co-morbidity is lurking.

  7. 13B on how we judge the effectiveness of interventions …. We noted from the last lesson that choice is important. An intervention will be effective if the person for whom it is intended chose it. It will also be effective if the person has control over it. This seems to be the message from Hello Sunday Morning. We also noted that the culture and the peers which surround someone using an intervention are important. Interventions which do not take account of this are less likely to succeed.

    In judging effectiveness, we need to think about long term effects, not just short term effects. We need in particular to consider whether six months is long enough to judge the effectiveness of an intervention. We also thought about the problems of generalising from a small scale laboratory study to a larger sample of people in the real world. Measuring addictive behaviour is much harder than measuring knowledge. Self-report methods may be used but with addiction, participants may not be willing to tell the truth about their behaviour. There is also the problem of working out what the active ingredients are in an intervention. In the case of psychological interventions, it is not clear whether the intervention works because there is a relationship between client and therapist or because of the processes which are central to the therapy. We might ask the same question about biological interventions: what exactly is it about these interventions which makes them work? How much is down to placebo? We might also ask this about public health interventions. What is it about banning advertising which makes it effective? Why might screening someone change their attitude to their behaviour?

  8. A few more thoughts from the last lesson with 13D …….

    The effectiveness of an intervention depends on whether it is appropriately delivered. This is obviously true of psychological interventions but is also true of drugs. Naltrexone is safe and effective as long as it is used appropriately and effectively.

    Judging effectiveness has important implications for the prevention of addictive behaviour. We might have doubts about the validity of an intervention, for example because sample size is small, effects are modest or there is a lack of proper control groups. Tobacco companies then seize on these limitations to suggest that there is no evidence for, for example, rules on plain packaging.

    There is a question about the effectiveness of public health interventions such as bans on advertising and plain packaging. It might be argued that resources would be better spent on helping people who want to quit but have not been able to do so.

    Co-morbidity is an issue. We need to remember that addiction often exists alongside other abnormalities, for example depression. An effective intervention needs to treat the full range of symptoms, not just the addiction. That is why CBT might be seen as effective because it addresses the impulsive thinking which underlies addictive behaviour and which might lead to other conditions.

    Judging effectiveness is to some extent dependent on the view taken of what causes addiction. If you think addictions are a consequence of abnormalities in brain chemistry, you will tend to favour and see as effective interventions which affect these abnormalities. If you think that addictions have a psychological basis, you will tend to favour psychological interventions and see them as effective.

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