PSYCHOLOGY IN ACTION: THE
PSYCHOLOGY OF ADDICTIVE BEHAVIOUR
Learning Objectives
Issues to Consider
Models of addictive behaviour attempt to explain the causes of addiction. We will consider the
various approaches taken by the different models and research into the factors affecting
addictive behaviour. This includes the debate of whether the media glamorises or demonises
addiction. In the final section we will consider ways to reduce addictive behaviour and assess
their effectiveness.
On completion of this topic you should be familiar with the following.
Use this list of learning objectives as a revision checklist. Cross-reference the objectives with the
Specification.
Models of addictive behaviour
Discuss biological, cognitive, and learning models of addiction, including explanations for
initiation, maintenance, and relapse.
Critically consider explanations for specific addictions, including smoking and gambling.
Factors affecting addictive behaviour
Consider the factors affecting vulnerability to addiction including self-esteem, attributions
for addiction, and the social context of addiction.
Discuss the role of media in addictive behaviour.
Reducing addictive behaviour
Outline and evaluate the models of prevention, including theory of reasoned action and
theory of planned behaviour.
Describe and assess the types of intervention, including biological, psychological, public
health interventions and legislation, and their effectiveness.
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Models of Addictive Behaviour
For details, see Eysenck’s A2 Level Psychology (pages 609–618).
Fill in the blanks.
The models of addictive behaviour attempt to explain the ca_________s and thereby offer
insights into how an addiction develops. The assumptions as to the causes of addiction also
affect the approach taken to t_________________t.
Biological model of addictive behaviour
According to this model, the main causes of addictive behaviour are biological factors within
the individual, for example a ne____________________al imbalance or a ge___________c
predisposition towards addictive behaviour. Thus, the vulnerability to develop an addiction
may be in______________d and family studies are used to support this explanation. This
approach assumes that addiction has physical causes and can therefore only be cured
through me_____________e.
Cognitive model of addictive behaviour
This model suggests cognitive dysfunction underpins addiction. The individual is an
information pro__________or and it is a breakdown in co___________e processing that
causes the addiction. Irrational, ob____________ve, and faulty thinking can affect emotion
and behaviour. Thus, according to this model faulty, thinking and errors in de___________n
making are considered to be the causes of addiction.
Learning model of addictive behaviour
This model is based on the principles of learning and the assumption that all behaviour is
learned through as______________n (cl______________l conditioning), re________________t
(o______________t conditioning), or social learning (social learning theory), from
environmental experience. Thus, addiction is the learning of maladaptive and dysfunctional
be_________________r.
FIND OUT FOR YOURSELF: Select one addiction: alcohol, other drugs, over-eating,
smoking, gambling, or sex, and apply the models to explain that particular addiction.
Explanations of Particular Addictive Behaviours
Biological explanations of addictive behaviour
Fill in the blanks.
The biological explanation can explain che_____________l addictions such as nicotine more
easily than addictions such as gambling. Biological explanations of addiction focus on
ne___________________s in the brain, and on genetic differences between people with
addictions and people without addictions.
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RESEARCH EVIDENCE FOR BIOLOGICAL EXPLANATIONS
Summarise the research evidence below.
Ψ Dopamine. How does this play a role in addiction?
Ψ Family and twin studies. What evidence is there for a genetic basis?
Ψ Genetic analysis. What does this involve?
Ψ Brain “pleasure centres”. How might these be involved in addiction?
RESEARCH EVIDENCE AGAINST BIOLOGICAL EXPLANATIONS
Summarise the research evidence below.
Ψ Environment over genetics. Why did Han et al. (1999) come to this conclusion?
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EVALUATION OF BIOLOGICAL EXPLANATIONS FOR ADDICTION
The following evaluation points state the criticisms but do not fully elaborate them. This is a
common weakness of students’ answers in the exams. Work out how these points have been
elaborated by matching them to the correct elaboration that follows and number the points
accordingly. Then consider what you have learned about how to elaborate AO2/AO3 points.
Evaluation points
Ψ Separating out the effects of addiction. Ashton and Golding (1989, see A2 Level
Psychology page 612) show that it is difficult to separate out the effects of addiction. For
example, nicotine can affect a number of systems including learning and memory, the
control of pain, and the relief of anxiety.
Ψ Reductionist—ignores social factors. The biological approach ignores social factors,
which means it is too reductionist as. . .
Ψ Lack of reliability in genetics analysis findings. The problem with studies on genetics
is that the genes identified do not occur in all people with the addictive behaviour and
they do appear in some people without it. For example, a gene referred to as DRD2 has
been found in 42% of people with alcoholism, 50% of pathological gamblers, 45% of
people with Tourette’s syndrome, and 55% of people with autism; it has also been found
in 25% of the general population.
Ψ Determinism. The genetic explanation can be seen as deterministic because it ignores
the individual’s ability to control their own behaviour.
Ψ Nature or nurture. The brain abnormality, to some extent, is due to genetic factors.
Ψ Diathesis–stress. Genes alone do not determine who will develop an addiction—they
only create vulnerability.
Elaborations
1. This suggests that inheriting a certain genetic sequence makes the addiction inevitable, when this is
not the case.
2. This means that DRD2 appears more frequently in people with addictions but it also appears in those
without and so it cannot be the sole explanation for the behaviour (Comings, 1998, see A2 Level
Psychology page 613). Thus, there is a lack of consistency in the nature of the genetic basis across
different research studies, which clouds the exact nature of the genetic basis.
3. Thus, they are not a direct cause as other factors must trigger the disorder. Evidence for this is that the
concordance rates are not 100%, which shows that addiction is due to an interaction of genetic and
other factors.
4. This means that it is difficult to pin down a single response that follows smoking a cigarette and this
makes it more difficult to explain the initiation and maintenance of the disorder.
5. But as biological factors lack reliability then nature must interact with nurture.
6. It reduces everything to biology when there are important social factors such as the escapism associated
with taking drugs.
Ψ What have you learned about how to elaborate out evaluative points?
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Behavioural (learning) explanations of addictive behaviour
Fill in the blanks.
Behavioural (i.e. learning) explanations include cla_________al and op___________t
conditioning. Classical conditioning may explain the as_____________n of the addictive
behaviour with pleasure and/or ex________________t and so accounts for the initiation of
the addictive behaviour. Operant conditioning explains behaviour in terms of re________ds
and pu_______________ts, and, as you will see below, partial reinforcement can be a
powerful factor in the mai_________________e of addictions.
RESEARCH EVIDENCE FOR BEHAVIOURAL EXPLANATIONS
Summarise the research evidence below.
Ψ The schedule of reinforcement. Why is partial more influential than continuous?
Ψ Classical conditioning and gambling. How does classical conditioning explain gambling?
EVALUATION OF BEHAVIOURAL (LEARNING) EXPLANATIONS
Summarise the evaluation points below.
Ψ Applications. What are the applications of classical and operant conditioning?
Ψ Classical conditioning explains initiation not maintenance. Why?
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Ψ Operant conditioning doesn’t explain acquisition or relapse very well but does
explain maintenance. Why is operant conditioning better at explaining maintenance?
Ψ Gamblers lose more than they win. How does this challenge operant conditioning?
Ψ Individual differences. Why do the conditioning explanations lack generalisability?
Ψ Varying explanatory power for different forms of addiction. Why do they explain
some addictions better than others?
Ψ Ignores cognition. Why is this a key weakness?
Cognitive explanations of addictive behaviour
Fill in the blanks.
Cognitive explanations focus on the way that we process in______________n. If we are
making faulty judgements then we might develop addictive behaviours. This explanation is
not nearly as clear-cut as it sounds because faulty thi__________g is what keeps us going.
For example, some research suggests the only reason people don’t become
de______________d is that they have a rose-tinted view of the world and that a
po__________e bias about ourselves allows us to judge ourselves as more competent than
we really are—how depressing!
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RESEARCH EVIDENCE FOR COGNITIVE EXPLANATIONS
Summarise the research evidence below.
Ψ Gamblers’ overestimations. What do they overestimate?
Ψ “Thinking aloud” method. How do studies using this method support a cognitive basis?
Ψ Overconfidence in ability. How do gamblers demonstrate this?
RESEARCH EVIDENCE AGAINST COGNITIVE EXPLANATIONS
Summarise the research evidence below.
Ψ Cognitive biases are a product of the research. What did Dickerson and Baron (2000)
mean by this?
EVALUATION OF COGNITIVE EXPLANATIONS
Summarise the evaluation points below.
Ψ Cause and effect. Why is this an issue?
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Ψ Usefulness of the findings. How might the findings on gambling be applied?
Ψ Context needs to be considered. Why do we need to consider whether the participants
are regular or occasional gamblers?
Ψ How faulty is the cognition? In what ways is it faulty?
Ψ Multi-perspective. Why is a purely cognitive approach too reductionist (simplistic)?
CONCLUSIONS—SO WHAT DOES THIS MEAN?
Answer the following questions in your conclusions:
• Why does biological disposition not fully explain addiction?
• How does a multi-perspective better account for the causes of addiction?
Using this in the exam
Outline and evaluate one or more models of addiction.
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Factors Affecting Addictive
Behaviours
For details, see Eysenck’s A2 Level Psychology (pages 618–628).
Fill in the blanks.
Factors that affect addiction include internal factors such as personal
cha__________________s (e.g. self-e____________m and cognitive
att______________________s) that make people vulnerable to addiction and external
factors such as features of the en___________________nt (e.g. availability, the me______a)
that encourage addictive behaviours.
Personal Explanations of Addictions
Attributions
Fill in the blanks.
Davies (1996) argues that attributions help the individual addict to pr_________t themselves
from acknowledging their own be_______________r. As addiction develops, Davies suggests
five attributional stages through which a person progresses. What are these five stages?
1.
2.
3.
4.
5.
Each stage is marked by a different att_____________n style and can vary.
Explain what the following attributional styles mean:
• Purposiveness:
• Hedonism:
• Contradictoriness:
• Addiction self-ascription:
The five stages outlined by Davies (1996) suggest that pu______________ss and
h_____________m attributions characterise the first stage of addiction but as the addiction
becomes more of a problem in stage 2 the attributions tend to be more co________________ry
because the attributions reflect the ambivalence that emerges during the development of
addiction. In stage 3 there is ac___________e of the addiction but by stage 4 there is
re_____________n of the addiction. In the final stage attributions tend to be either positive or
negative. In the positive version, people might have given up drugs or alcohol and have an
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am_____________nt view of their past addiction as they can see both positive and negative
aspects of the behaviour. In the negative version, the concept of addiction has been replaced
by an att____________n of themselves as “down and out”. Here, their behaviour is
un_______________le and their drug use is negative. The stages therefore chart a gradual
progression; however in real life it may not be so uniform so there can be movement back and
forth between the stages. Although Davies (1996) claimed there is an irreversible transition
from the second to third stage that often occurs when people enter tre____________t and may
persist long after the treatment ends, i.e. the acceptance of the “addict l_________l”.
RESEARCH EVIDENCE FOR ATTRIBUTIONS
Summarise the research evidence below.
Ψ The label “addict”. How might this lead to a self-fulfilling prophecy?
Ψ Attributions. How did Davies and Baker (1987) find heroin users’ attributions varied
depending on who they are talking to?
Ψ Stage models supported by inter-judge reliability. How do Davies’ (1996) interviews
with 20 drug and alcohol users support this?
Ψ Nelson (2004). How does this study support the role of attributions?
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EVALUATION OF ATTRIBUTIONS RESEARCH
Summarise the evaluation points below.
Ψ Reliability. Which research has good reliability?
Ψ Sequence was not considered. How does this limit Davies’ model?
Ψ Contradictory research. How is Davies’ claim about movement between stages
contradicted by Prochaska, Norcross, and DiClemente (1994)?
Ψ Sample size. Why is this a weakness?
Ψ Not clear whether attributions predict or reflect behaviour. How does this limit
attempts to explain addiction?
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Ψ Researches an understudied area. Why is this a strength and what further research is
needed?
Self-esteem
Fill in the blanks.
Self-esteem refers to the individual’s sense of self-w_______h. One might expect low
self-esteem to be the impetus for the initiation of the addiction, however, as we will see,
this is not well-supported by research.
RESEARCH EVIDENCE FOR SELF-ESTEEM AS A CAUSE
Summarise the research evidence below.
• Jessor (1987). How does this study support the role of self-esteem?
RESEARCH EVIDENCE AGAINST SELF-ESTEEM AS A CAUSE
Summarise the research evidence below.
Ψ Van Hasselt et al. (1993). How does this study contradict the role of self-esteem?
Ψ Other risk factors are more important. Which factors did Newcombe, Maddahian,
and Bentler (1986) identify as more important?
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Ψ McMurran (1994). Which factors are identified in this research as more important than
self-esteem?
EVALUATION OF RESEARCH INTO SELF-ESTEEM
Summarise the evaluation points below.
Ψ Lack of research. What does this suggest about the role of self-esteem?
Ψ Multi-factorial. What does this mean in terms of the role of self-esteem?
The Social Context of Addiction
Fill in the blanks.
The social context must be considered in addiction because society ju___________es
different addictions in vastly different ways, for example, some types of addictive behaviour
are socially ac________________le and others attract a moral panic in our society. The
addictions that cause the most concern vary over time, and he___________h, financial,
moral, and po__________al reasons are all contextual factors that can affect the level of
concern.
RESEARCH EVIDENCE FOR THE ROLE OF SOCIAL CONTEXT
Summarise the research evidence below.
Ψ Laudanum. How does the taking of this demonstrate very different attitudes to opiates
(such as heroin) than those held today?
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Ψ “Gin palaces” in the 18th and 19th centuries. How did attitudes to these vary?
Ψ Attitudes to smoking. How have these changed over time?
Ψ Situational factors that encourage gambling. What do you think these factors are?
Ψ Context can greatly affect drug taking. How does soldiers’ use of drugs during the
Vietnam War support this?
Ψ Dance music. Which drug is more likely to be taken in this context?
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Fill in the blanks.
The effects of the social context are illustrated by the structural cha__________________s
that can be important in the development of addictive behaviour. For example, slot
machines have features that are specifically incorporated into the m______________e by the
designers and operators in the gaming industry to keep people gambling once they have
started. Griffiths (1999a; Parke & Griffiths, 2007, see A2 Level Psychology page 626) has
summarised some of the key factors.
What do you think these factors are?
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Fill in the blanks.
For drug addictions, structural characteristic include things such as the d____e amount, the
drug’s toxicity, and the route of ad_________________n.
EVALUATION OF THE ROLE OF SOCIAL CONTEXT
Summarise the evaluation point below.
Ψ Applications. How can understanding of structural characteristics be applied?
Availability
Fill in the blank.
The availability of the addicted substance is a key con_________________l factor.
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RESEARCH EVIDENCE ON AVAILABILITY
Summarise the research evidence below.
Ψ Alcohol and cirrhosis deaths. How do these support the importance of availability?
Ψ The availability factor and cigarettes. How do we know availability influences
smoking?
EVALUATION OF AVAILABILITY
Summarise the evaluation point below.
Ψ Strong support. How well is the influence of availability supported?
FIND OUT FOR YOURSELF: What is the current level of availability of alcohol and
cigarettes? Do you think the government needs to do more to restrict availability or not?
The role of the media in addictive behaviour
Fill in the blanks.
The media (television, radio, newspapers, etc.) can influence addictive behaviours in two
clear ways: it can pr_________te addictive behaviour (as in ad_________________g) and it
can decrease addictive behaviour through the promotion of health e__________________n
(such as promoting abst______________e or moderation) (McMurran, 1994).
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Tobacco advertising illustrates the controversy over the effect of the media on addiction. In
the early 1990s there was a call for a ban on the ad_______________g of tobacco by the
British Psychological Society due to concern about how much advertising increased sales.
However, the British government rejected a ban at this time because they were influenced
by the powerful commercial lobby for to_____________o. This debate highlights how issues
of addictive behaviours cannot be discussed just within the context of health. There are also
p_____________l, ec_______________ic, social, and moral contexts to consider.
Television and film often portray addictions. Examples are that of heroin addiction in the film
Tra_________________ng, marijuana use in the TV show W________s, and gambling addiction
in the TV show Sunshine. Because of this constant portrayal of various addictions, television and
film dramas often create controversy because of claims that they gla______________e addictive
behaviour. The makers of such drama counter this with the argument that presenting such
material reflects the fact that addictions are everywhere in real life.
RESEARCH EVIDENCE FOR THE ROLE OF THE MEDIA IN
ADDICTIVE BEHAVIOUR
Summarise the research evidence below.
Ψ Smoking. How do Dalton et al. (2003) support the effect of the media on smoking?
Ψ The likeability of film actors and actresses. How does this influence addiction?
EVALUATION OF MEDIA RESEARCH
Summarise the evaluation points below.
Ψ Cause and effect. Why is this an issue?
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Ψ Inconclusive. Why are conclusions limited?
Ψ Need for further research. What should further research focus on?
FIND OUT FOR YOURSELF: Research media portrayals of addiction (TV and films, including
factual as well as fictional examples). How is addiction portrayed? (Glamorous? Sordid?)
What type of addictions are portrayed? Prepare a summary of guidelines that could be
issued to TV broadcasters on how addiction should be portrayed.
CONCLUSIONS—SO WHAT DOES THIS MEAN?
Answer the following questions in your conclusions:
• Which factors best account for addiction?
• Why is an idiographic approach needed to fully understand which factors affect different
addicts?
Using this in the exam
Critically consider the factors that influence addictive behaviour (for example,
attributions, self-esteem, the social context, and the effect of the media).
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Reducing Addictive Behaviour
For details, see Eysenck’s A2 Level Psychology (pages 628–646).
Fill in the blanks.
The best solution to addiction is to pr_________t people starting in the first place. There is a
range of prevention measures but it is difficult to assess their effectiveness because it’s
impossible to ascertain how many people would have become ad___________d if these
measures were not in place.
Historically, there are three stages of prevention (Force, 1996): “Primary prevention” refers
to measures employed to pr___________t the onset of a targeted condition. “Secondary
prevention” refers to measures that identify and treat asymptomatic persons who have
already developed r_____k factors or are pre-clinical. “Tertiary prevention” refers to efforts
targeting individuals with identified disease in which the goals involve restoration of
function, including minimising or preventing di____________e-related adverse
consequences. Primary prevention targets the ge____________l population, secondary
prevention targets at-risk or v___________le groups, and tertiary prevention targets
individuals with an identified disorder.
Primary prevention has not been particularly successful; “Just say ‘No!’” is not enough!
Studies dealing with adolescents suggest that simply giving in_________________n is not
enough to create positive effects (Edmundson et al., 1991; Donaldson et al., 1997; Van der
Pligt, 1998).
Models of Prevention
Fill in the blanks.
A logical starting point in the history of treatment was that attitudes need to be changed to
change be_________________r. However, other factors supersede attitudes in their
influence on behaviour so the simple intuitive model of attitudes and behaviour cannot be
used to pr__________t how people will behave.
The theory of reasoned action
Fill in the blanks.
The Theory of Reasoned Action, first proposed by Azjen and Fishbein (1975), attempted to
improve on the intuitive model and to explain why people make their be___________al choices.
Draw a diagram to represent the model.
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The model suggests that our intention to engage in behaviour (which is not the same as
behaviour) is predicted by our at____________s and by subjective norms. In this model, an
at____________e is a collection of beliefs that you have about a particular behaviour. The
su____________ve n_______s are the influences around us, including other people.
This is the essence of the Theory of Reasoned Action. It has been used extensively in a
range of areas, such as h________th and also m________________g, to predict and
thereby try to alter behaviour. Human behaviour, however, is very difficult to predict. To try
to take account of a few more of the variables involved in behaviour choice, the Theory of
R_____________d Action was modified and became The Theory of Planned Behaviour
(Ajzen, 1991).
The theory of planned behaviour
Fill in the blanks.
The Theory of Planned Behaviour adds another factor to the original model. This additional
factor deals with the beliefs we have about the amount of c_________l we have over our
behaviour. This makes it sound all so simple—to overcome the addiction, just stop doing it!
Unfortunately, it is not that easy because we don’t seem to be as in c__________l of our
behaviour as we would like to think.
Draw a diagram to represent the model.
EVALUATION
Summarise the evaluation points below.
Ψ The model can predict behaviour. Why is this important?
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Ψ The predictions are weak. Why is this a limitation of the model?
Ψ Ignores emotions. Why is this an important omission?
The stages of change model
The Stages of Change Model (Prochaska, DiClemente, & Norcross, 1992) has had some
success in changing behaviour. The model consisted of a number of stages.
Explain each of these stages.
Pre-contemplation:
Contemplation:
Preparation:
Action:
Maintenance:
Draw the spiral model of change (see A2 Level Psychology page 633):
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Fill in the blanks.
The model presents change as a spiral because giving up the addiction often takes a
nu___________r of attempts. Prochaska et al. (1992) suggest that smokers commonly make
three or four action attempts before they reach the ma________________ce stage.
To achieve “readiness for action” a range of techniques can be used, including
mo_________________al techniques, behavioural self-training, skills tra__________g, stress
ma_________________nt training, anger management training, rel_______________n
training, aerobic exercise, relapse prevention, and lifestyle modification. The goal of
treatment can be either abs_________________e or simply to cut down.
FIND OUT FOR YOURSELF: Make up a case study to illustrate the “cycle of change”, so
explain how the addict has progressed through the different stages and which ones they
have circled back to, and so forth.
Types of Intervention
Biological (medical) interventions
Fill in the blanks.
The main medical intervention is dr_______s. Certain drugs produce an unpleasant reaction
when used in combination with the drug of dependence, so the positive effects of the drug
are replaced with a neg_____________e reaction. The only aversive agent available is
disulfiram (Antabuse), which, when combined with a____________l, produces
n___________a and possibly vomiting.
A different type of drug used for intervention is known as an agonist. This is a substitute
drug, such as a synthetic opiate (met________________ne), which is given to replace the
real drug. Methadone prevents wit_____________l symptoms, blocks the effects of illicit
opiate use, and decreases cravings. Consequently, addicts are more open to counselling and
other behavioural interventions essential to recovery and rehabilitation.
Yet another treatment is the narcotic antagonist (naltrexone), a long-acting
me________________on with few side effects, which blocks the effects of self-administered
opiates (e.g. euphoria). It is based on the premise that the lack of positive effects will break
the drug h_______t. Addicts often fail to comply with the treatment programme so effective
counselling or psychotherapy is often used alongside the medication. More recently,
ant_______________ts have also been used in other addictions, such as alcoholism and
gambling addiction.
EVALUATION OF BIOLOGICAL (MEDICAL) INTERVENTIONS
Summarise the evaluation points below.
Ψ Treat symptoms not causes. Why is this an issue?
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Ψ Substitution therapies are effective. What evidence is there for this?
Ψ Issue of compliance. Why do addicts often fail to comply?
Psychological Interventions
Behavioural therapies
Fill in the blanks.
These are based on the view that addiction is a learned maladaptive be____________r and
can therefore be “unl_______________d”. A wide range of behavioural techniques has
been applied on this basis in the treatment of addictions.
Aversion therapy is based on cl______________al conditioning as this therapy involves
negative as______________ns being made with the addictive behaviour. Thus, the
Antabuse® given to make alcoholics nauseous draws on the principles of classical
conditioning as the nausea is the unc______________ed stimulus that produces the
automatic response of avo___________ce as we wish to avoid feeling sick. The alcohol
becomes paired with this as the conditioned stimulus so the avoidance of alcohol becomes
a co_________________d response.
Similarly, other stimuli could be associated with the addiction thereby encouraging it. For
this reason therapies may initially focus on the avoidance of relapse tri___________s (like the
sight and s_______l of alcohol/drugs, walking through a neighbourhood where casinos are
abundant, pay day, arguments, pressure). The next stage is to have repeated
ex________________e to relapse triggers in the absence of the addiction, so that the addict
learns to stay addiction free in high-risk situations.
Another behavioural method that draws on the principles of operant conditioning is
re___________________nt, which refers to the shaping of behaviour through the
consequences of the behaviour. This is controversial because it involves the giving of
re____________s (positive reinforcement) for not taking the substance. A programme in the
US (Higgins et al., 1994) tried to change the behaviour of people with a serious
co____________e problem. The participants had their urine tested several times a week for
traces of cocaine, and every time it was clear of any cocaine they were given vouchers. The
vouchers started with a value of $2.50 but every time they were clear of cocaine the value
went up by $1.50. The vouchers were backed up with counselling on how best to spend
the money, for example, sports equipment, or a family meal in a restaurant to help build up
relationships that might have been damaged by the substance use. The voucher-therapy
compares well to other in__________________s as the norm for drug treatment
programmes is a drop-out rate of 70%, whereas 85% stayed in the programme for 12
weeks and around two-thirds stayed in for 6 months.
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EVALUATION OF BEHAVIOURAL THERAPIES
Summarise the evaluation points below.
Ψ Should drug addicts be given money not to take drugs? Give reasons for and
against.
Ψ Longitudinal research is needed. Why is this research needed to establish
effectiveness?
Ψ May treat symptoms not causes. Why might this be the case?
Ψ Symptom substitution. What does this mean?
Ψ Difficult to evaluate effectiveness. Why is it difficult to work out how much the
behavioural treatment has contributed to any improvement?
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Cognitive-behavioural therapy
Fill in the blanks.
A more recent development in the treatment of addictive behaviours is the use of cognitivebehavioural therapies (CBT), which include rational em_________e therapy, motivational
int___________________g, and relapse prevention. Cognitive-behavioural therapy involves
techniques that focus on be________________ur change and changing the person’s
thi_________________g (cognitive change).
Motivational interviewing (MI)
There are five general principles of MI: expressing em___________y, developing discrepancy,
avoiding argumentation, rolling with re_________________e, and supporting selfef_______________y. Miller and Rollnick (2002) suggest that MI is primarily about the
motivational aspects of changing people’s behaviour in the therapeutic setting, which
focuses in on the addict’s am________________ce (the mixed feelings the addict has to their
behaviour), as this is a starting point for change. Miller and Rollnick argue that motivation is
not a pe______________ty problem and that there is little evidence for an “addictive
personality”. The MI highlights incorporate the stages of c_________e model and a
mnemonically structured (A–H) list of eight effective m_____________________al strategies:
• giving A_____________
• removing Ba_______________
• providing C______________
• decreasing D________________
• practising E_______________
• providing F__________________
• clarifying G___________
• active H______________
The therapist supports the addict using a non-conf________________al approach to recognise
the problem and to come to a decision themselves about changing their behaviour and very
importantly avoids la_______________g.
Relapse prevention
Relapse prevention (Marlatt & Gordon, 1985) involves helping the addict to identify situations
that present a risk for re____________e, both intrapersonal (factors within the individual, e.g.
unpleasant em_________________s, physical discomfort, pleasant emotions, testing personal
control) and interpersonal (factors between individuals, e.g. c_____________s and social
pressures). The relapse prevention therapy provides the addict with techniques to learn how
to cope with te____________on (positive self-statements, decision review, and distraction
activities), coupled with the use of covert modelling (i.e. practising c_______g skills in one’s
imagination).
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EVALUATION OF COGNITIVE-BEHAVIOURAL THERAPIES
Summarise the evaluation points below and fill in the blank.
Ψ Research evidence. How well is motivational interviewing supported?
Ψ No more eff_____________e than other approaches.
Ψ Cognitions are difficult to change. Why is this a problem?
Ψ Empowers the individual. Why is this a strength?
Ψ Blames the individual. Why is the individual blamed?
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Psychotherapies
Fill in the blanks.
Psychotherapy includes a broad range of techniques, beginning with Freudian
psychoanalysis and including transactional analysis, dr______a therapy, fa__________y
therapy, and minimalist intervention strategies. Psychotherapy is known as the “talking
cure” and this can be on an individual level, as a couple, as a family, or in a group. The
addictive behaviour is seen as the symptom of un______________g problems, which may
include narcissism, ma______________ve behaviour, gu____t, irrational thinking, and low
ego strength.
EVALUATION OF PSYCHOTHERAPIES
Summarise the evaluation points below.
Ψ Difficult to separate out the effects of psychotherapy from other therapies. Why
is it difficult to assess psychotherapy?
Ψ Lack of evidence for effectiveness. What does the evidence suggest about
effectiveness?
Ψ The lack of evidence can be countered. How can the previous criticism be countered?
Ψ Lengthy and expensive. Why is it lengthy?
Ψ Does try to address underlying causes. Why is this a strength?
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Self-help therapies
Fill in the blanks.
The most popular self-help therapy is the 12-Step Programme of A__________s
An_______________s, Gamblers Anonymous, Narcotics Anonymous, Overeaters
Anonymous, Sexaholics Anonymous, etc. This treatment programme uses a gr_____p
therapy technique and uses only ex-addicts as helpers (Griffiths, 1995). The technique
requires the addict to accept personal res_______________ty and view their behaviour as an
addiction that cannot be cured but merely m_______________d.
For the therapy to work, the 12-Step Programme requires addicts to have reached “rock
bottom”, to attend w__________ly meetings, where they disclose their story, to develop
social networks, to focus on abs_____________e and loss of control, to rely on others for
help, and to develop spiritually. New members are provided with a “sponsor” who they can
turn to whenever they get an urge to engage in the behaviour. The therapy uses mottos,
such as the famous “One d____ at a t_______”, and “Fake it until you make it”. For every
y_______r members go without engaging in the behaviour, they are awarded a pin, which
members consider as important milestones.
EVALUATION OF SELF-HELP THERAPIES
Summarise the evaluation points below.
Ψ Lack of empirical support. Why is there a lack of evidence?
Ψ Sample bias. Why is it impossible to obtain a true sample?
Ψ Criterion for success. What is the criterion for success and is it too rigorous?
Ψ Economical. Is it cost effective?
Ψ Spirituality works for some but repels others. Why is this aspect controversial?
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Public health interventions and legislation
Fill in the blanks.
Harm minimisation
Public health edu_______________n interventions have had little success. The message “Hey
kids, just say ‘No!’” does not work. Similarly, the use of scare tactics, such as pictures of
overdoses, has failed to bring about reductions in drug use.
An alternative approach is to encourage harm min_____________on. This approach accepts
that people will engage in risky behaviour and tries to reduce the health risks by
encouraging users to take the drug sa________y. For example, the provision of needle
exchanges means that addicts do not sh____e injecting equipment; this dramatically
reduces the risk of getting blood infections such as hepatitis or HIV and AIDS.
Another way of reducing the potential harm to intravenous drug users is to provide medically
controlled drugs as a substitute for str___t drugs. Drugs such as me______________ne are
less harmful than street heroin, partly because they are free from impurities.
The most dramatic public health intervention in recent years has been the ban on smoking
in all public places introduced in England in 2007 (following the introduction in Scotland a
year earlier).
EVALUATION OF PUBLIC HEALTH INTERVENTIONS AND LEGISLATION
Summarise the evaluation points below.
Ψ Too early to measure. Why is it difficult to measure the effect of the smoking ban?
Ψ Controversial. Why are harm minimisation programmes controversial?
Peer-based programmes
Fill in the blanks.
The peer-based health education programme is based on the fact that we prefer to take
advice from people like our__________s or from people for whom we have great
re_______ct. Research shows that such programmes are more effective than teacher-led
sessions in reducing drug use. Bachman et al. (1988) looked at a health-pro___________n
programme that asked students to talk about their disapproval of drugs to each other to
create a social n____m that was against drug taking and also give people practice in saying
no. It is claimed that the programme changed att__________s towards drugs and led to a
reduction in cannabis use. A similar programme was reported by Sussman et al. (1995), who
compared the effectiveness of teacher-led lessons with lessons that required student
par_____________on. The study looked at around 1000 students from schools in the US,
and suggested that there were significant changes in attitudes to drugs and intentions to
use drugs in the active participation lessons but not in the teacher-led lessons.
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EVALUATION OF PEER-BASED PROGRAMMES
Summarise the evaluation point below.
Ψ Lack of research evidence. Why does this question effectiveness?
ADDICTION TREATMENT: OVERALL EVALUATION
For treatment to be effective a number of points must be considered.
Decide whether you think these points should be high, medium, or low priority.
PRIORITY
High Medium Low
Ψ Treatment must be readily available.
Ψ No single treatment is appropriate for all individuals.
Ψ Treatment is better than no treatment.
Ψ It does not seem to matter which treatment an addict engages in
as no single treatment has been shown to be demonstrably better
than any other.
Ψ A variety of treatments simultaneously appears to be beneficial to
the addict as these can better treat the multiple needs of the addict.
Ψ Individual needs of the addict have to be met (i.e. the treatment
should be fitted to the addict, including being gender specific and
culture specific). An individual’s treatment plan must be assessed
and updated consistently so that the plan meets the person’s
changing needs.
Ψ Clients with co-existing addiction disorders should receive services
that are integrated.
Ψ Remaining in treatment for an adequate period of time is critical
for treatment effectiveness. There is a direct association between
the length of time spent in treatment and positive outcomes. One
of the challenges is retaining clients in addiction treatment.
Ψ Medications are an important element of treatment for many
patients, especially when combined with counselling and other
behavioural therapies. These could include Antabuse, and
anti-anxiety and anti-depressant medications.
Ψ Recovery from addiction can be a long-term process and
frequently requires multiple episodes of treatment.
Ψ The duration of treatment interventions is determined by individual
needs, and there are no pre-set limits to the duration of treatment.
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Does it matter which therapy is used?
Fill in the blanks.
Orford (2001) argues against the effectiveness of treatment as he states that the excessive
nature of the addiction will wane in time and so people give them up na___________lly.
He uses as evidence the fact that treatments only have limited success and that the
success occurs regardless of the treatment that is used. Consequently, Orford concludes
that people give up excessive appetites (or addictions) without the help of
ex______________ts.
A counter-criticism to Orford is that his argument does not account for the addicts that
don’t re__________er, such as alcoholics who drink themselves to an early gr______e
rather than giving up. Thus, his argument doesn’t account for the fact that the addiction
doesn’t wane naturally for all. Also, his claim is speculative rather than
evi______________e-based as saying that treatments are equally effective does not mean
that it wasn’t the treatment that led to the positive outcome.
FIND OUT FOR YOURSELF: Research cyber therapies. How do you think they compare to
those you have already studied? What advantages and disadvantages do cyber therapies
have over face-to-face therapies?
CONCLUSIONS—SO WHAT DOES THIS MEAN?
Answer the following questions in your conclusions:
• Why is it difficult to draw conclusions about the effectiveness of the different types of
intervention?
• What general issues in therapy that you will have covered in your study of psychopathology
also limit our comparisons of the interventions?
Using this in the exam
Outline two models of intervention.
(a) Outline two types of intervention.
(9 marks)
(b) Discuss the effectiveness of the types of intervention described in (a).
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Example Essay Plan
Outline and evaluate one or more models of addiction. (25 marks)
The marking is broken down into three sets of criteria, AO1, AO2, and AO3, but this is not how
you should write your essay. The essay should include all these criteria in a holistic way, e.g. as
you write about each model you will then write about the research studies supporting and
challenging the model, and therefore be able to comment on the strengths and weaknesses of
the model from various points of view such as methodological (e.g. participant sample size),
ethical, reductionist, and determinist approach, etc.
AO1 (9 marks)
A general but accurate description of two models is probably the safest option. If you just do
one you will need a lot of depth to offset the fact your answer will not have breadth so two
models is a good compromise as this will allow for a good balance of depth and breadth. The
biological and behavioural are good models to contrast as they take opposing views on the
nature/nurture debate.
AO2 (12 marks)
Commentary and evaluation of the models and the research studies need to be integrated into
your essay as advised above. A good focus would be the relative strengths and weaknesses of
the model with the advantages of an integrated or multi-dimensional approach to explaining
addiction.
AO3 (4 marks)
Evaluation and/or interpretation of the research could include the reductionism and determinism
of the models.
So the essay could be structured in the following way.
Give a detailed overview of the model and include some AO2 at the outset
Introduce the fact that biological explanations of addiction focus on neurotransmitters in the
brain, and on genetic differences. Use research evidence on the neurotransmitter dopamine
(Potenza, 2001) to support the theory.
Explain the brain reward pathways
Also how the biological explanation overlaps with the behavioural explanation in terms of
reinforcement, and the reward pathways (Olds & Milner, 1954). Then consider the research
evidence against.
Give evidence for genetics
Include family studies and twin studies (Jang, Vernon, & Livesley, 2000). Genetics analysis looks
for common genes in people with addictive behaviour compared to control groups without such
behaviour.
Consider the evidence against
This supports environmental rather than genetic factors (Han et al., 1999).
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Evaluate the biological model
Include issues such as: separating out the effects of addiction; the reductionism of the model
because it ignores social factors; the lack of reliability in genetics analysis findings, using
Comings’ (1998) research as evidence. Consider why the model can be seen as deterministic.
Introduce the behavioural (i.e. learning) explanation
Include classical and operant conditioning and explain that they take the opposite approach to
the biological explanation in terms of nature–nurture because whilst the biological approach
focuses on internal, physical causes of addiction, the behavioural model focuses on external,
environmental causes. Explain how the processes of operant conditioning and reinforcement
and learned classical conditioning associations can explain addiction.
Evaluate the behavioural model including the positive applications
Make sure that you fully explain and assess the usefulness of the model. Discuss the fact that
classical conditioning doesn’t account well for maintenance, whereas operant conditioning
doesn’t explain acquisition or relapse very well but does explain maintenance.
Consider the limitations in using behavioural explanations to explain gambling
Gamblers lose more than they win and there are individual differences in what is rewarding,
meaning it is difficult to apply the principles of operant conditioning to all forms of addiction.
Thus, behavioural explanations have varying explanatory power for different forms of addiction.
Identify a key weakness of behavioural explanations
Explain fully why this is such an oversight, i.e. the behavioural explanations ignore cognition.
Finally, use the diathesis–stress model
Use this model to evaluate the fact that we need to consider the interaction of nature and
nurture to more fully understand addiction.
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