Addiction and Impulse Control Disorders
Bullet point 1 - Definitions, Types and Characteristics of Addictions
definitions, types and characteristics of addictions
Definitions (e.g. Griffiths, 1995); types e.g. alcoholism; impulse control (e.g. kleptomania, pyromania, compulsive gambling); physical and psychological dependence
Definitions (e.g. Griffiths, 1995); types e.g. alcoholism; impulse control (e.g. kleptomania, pyromania, compulsive gambling); physical and psychological dependence
Definitions of addiction
Addiction is the compulsive, uncontrolled use of habit–forming drugs. (Websters New International Dictionary, 3rd edn.)
An addict is a person addicted to a habit, especially one dependent on a (specified) drug. (Concise Oxford Dictionary). An addict is one who habitually uses and has an uncontrollable craving for an addictive drug. (Websters New International Dictionary, 3rd edn.) These definitions all mention drugs, and traditionally chemicals were thought to be central to addiction. Increasingly, however, psychologists have recognised that we can become addicted to a wider range of stimuli, such as exercise, the internet, or sex. Griffiths (1995) proposed a definition for addictive behaviours that highlighted 6 components: salience, mood modification, tolerance, withdrawal, conflict, and relapse. These components can be applied to both drug abuse AND activities other than drug abuse. |
Assignment 1 - noting the definitionsResearch and make more detailed notes on Griffiths' (1995) six components of addiction
Assignment 2 - other people's definitions of addictionPeople use the term “addiction” in inaccurate ways, such as saying “I am addicted to chocolate”
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Types of addiction
AlcoholismAlcoholism is a disease characterized by the habitual intake of alcohol. In order to classify as an alcoholic the sufferer must display chronic alcohol use to the degree that it interferes with their physical or mental health, or with normal social or work behaviour (it must have a significant impact on their life).
Alcoholism produces both physical and psychological addiction. Chemically, alcohol is a depressant that reduces anxiety, inhibition, and feelings of guilt. It lowers alertness and impairs perception, judgement, and motor coordination. In high doses, it can cause loss of consciousness and even death. Alcohol abuse has been found to cause damage to the brain, liver, heart, and other organs. The brilliant (but upsetting) documentary below charts the horrific physical and psychological effect of alcoholism |
Impulse control disordersThese are disorders where impulses cannot be resisted (hence the name)! Examples include kleptomania (stealing), pyromania (setting of fires) and compulsive gambling.
Again, these conditions must have a significant impact on the life of the sufferer if they are to class as an addiction. These conditions are associated with psychological, but not physical addiction. Impulsivity has five distinct stages of behaviour:
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Physical vs psychological dependence
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It is important to understand that physical and psychological dependence are NOT mutually exclusive. They can occur together (and often do). It doesn't have to be one or the other.
Assignment 3 - Investigating impulse control disorders
KNOW YOUR SPECIFICATION!! You don't need to know all of the ICDs listed - they are just examples. Pick one ICD and make detailed notes on it (enough to be able to write half a side of A4 about it). This blogpsychology page has great information for you to use.
Bullet point 2 - Causes of Addiction and Impulse Control Disorders
• causes of addiction and impulse control disorders
Genetic (alcohol): Schuckit, 1985; Peters and Preedy, 2002; Biochemical: dopamine; behavioural: positive reinforcement; cognitive/personality
Genetic (alcohol): Schuckit, 1985; Peters and Preedy, 2002; Biochemical: dopamine; behavioural: positive reinforcement; cognitive/personality
Genetic explanations for alcohol addiction
Schuckit (1985)Schuckit (1985) investigated the genetic basis of alcoholism. The participants in his study were 400 college men, half of which had alcoholic fathers (alcoholic mothers were excluded so that any pregnancy-related effects could be avoided). This therefore provided two conditions in an independent measures design - alcoholic father and non-alcoholic father. None of the participants in the study were alcoholics themselves.
Schuckit gave the volunteers four or five alcoholic or non-alcoholic beverages (but each drink smelled and tasted the same so participants were blind as to which one they were receiving). The participants' blood alcohol levels were tracked. Despite having the same levels of blood alcohol (as they'd had the same amount of alcohol), the 'sons of alcoholics' group reported feeling less drunk than the 'sons of non-alcoholics' group, and they even performed better in tests of hand-eye coordination! They swayed much less when walking and had fewer obvious changes in their hormones, according to Shuckit. In total 40% of the sons of alcoholics showed a decreased sensitivity to alcohol in terms of drunkenness, performance and hormone levels. This was seen in less than 10% of the sons of non-alcoholics. Schuckit also cited high concordance rates among identical twins as compared with fraternal twins (e.g. Kendler, 1992, found a 54% concordance rate for MZ twins but only a 28% concordance rate for DZ twins) and the fourfold greater risk of alcoholism in children of alcoholics, even in adopted children. |
Peters and Preedy (2002)Peters and Preedy (2002) wrote a chapter in a book entitled Drink, Drugs and Dependence: From Science to Clinical Practice by Woody Caan and J. De Belleroche. The full chapter can be read online here.
Below is a summary of the main points of the chapter: Assignment 4 - Summarising and evaluating genetic findings
Interview with Mark SchuckitHere is the transcript of a very good interview with Mark Schuckit, author of the study above left. He gives a very nice and clear summary of the way that genetics and environmental factors combine in alcoholism (think diathesis-stress model!)
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Biochemical explanations for addiction - dopamine
We've already met the neurotransmitter dopamine in the Schizophrenia section, but dopamine is also implicated in addiction and addictive behaviours. This is because it is a neurotransmitter heavily involved in the activity of brain areas associated with reward. A release of dopamine in certain areas of the brain (called the 'mesolimbic system') is associated with feelings of pleasure and a desire to repeat the action that caused the release.
However, it is not a good idea to repeat behaviours constantly, regardless of how good they make us feel. Starting a fire might be a thrill, but if we feel the need to repeat it again and again then soon it will become a very harmful behaviour. We can become dependent on certain activities (e.g. starting fires, or gambling) for our dopamine high, and once we've had the high we quickly want to do it again.
In addition, many drugs have a chemical shape similar to that of dopamine (cocaine and amphetamine are two examples), so they interact directly with the dopamine system, for example by mimicking dopamine and so causing the pleasure response themselves.
However, it is not a good idea to repeat behaviours constantly, regardless of how good they make us feel. Starting a fire might be a thrill, but if we feel the need to repeat it again and again then soon it will become a very harmful behaviour. We can become dependent on certain activities (e.g. starting fires, or gambling) for our dopamine high, and once we've had the high we quickly want to do it again.
In addition, many drugs have a chemical shape similar to that of dopamine (cocaine and amphetamine are two examples), so they interact directly with the dopamine system, for example by mimicking dopamine and so causing the pleasure response themselves.
Assignment 5 - Tolerance, down regulation and relapseLook up the meaning of the term 'down regulation'. Write in your notes an explanation of how this process leads to an addiction being maintained.
Now look up how the biological approach would explain a relapse, and add that to your notes. |
Assignment 6 - Evaluating biological explanations for addiction and ICDsThere is a good page on the psychteacher site about biological models of addiction, including some very good evaluation points. Many of these you will know already (remember that evaluations of biological explanations tend to be very similar for all conditions), but write down two positive and two negative evaluations for both genetic and neurochemical explanations.
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Behavioural explanations for addiction - positive reinforcement
STOP AND THINK!! You know what the Behaviourist idea of positive reinforcement is. Can you apply this to addiction to help explain addictive behaviour?
Operant conditioning is most effective at describing the maintenance of the addiction (rather than being an explanation of its original cause). The good feeling that the person gets from their action is a reinforcement, and the effect of a reinforcement (according to behaviourists) is to make the person repeat the behaviour more frequently. Positive reinforcement is perhaps less effective at explaining the formation of an addiction initially. For behaviourists, the initial formation of an addiction is perhaps better explained by classical conditioning, where a single event can lead to a sudden association of a certain action with a positive outcome (e.g. winning on your first lottery ticket). |
Reinforcement schedules and addictionMuch of Skinner's famous work using rats and pigeons in his Skinner box concerned the effect of different frequencies and types of rewards and their effect on behaviour.
Skinner found that reinforcement according to a variable ratio schedule was very effective for encouraging repetitive behaviour. Assignment 7 - Variable ratio schedules and addictionResearch and answer the following questions:
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Evaluating behaviourist explanations of addiction
Cognitive explanations of addiction - personality
The phrase 'addictive personality' has entered the language. But what does it really mean? From a cognitive perspective, of course, 'personality' will refer to the style we have of processing information, and the behavioural responses we produce as a result. There may be certain personality characteristics which predispose people to develop addictive behaviours, but which are they, and are they the same for all addictions?
Personality characteristics and alcoholismNathan (1988) reviewed the literature on personality and addiction to see if there were any traits commonly associated with the misuse of alcohol. He found that only two had any sort of reliable link to alcoholism - depression and a history of anti-social behaviour - and of these only anti-social behaviour could usefully be used to predict the likelihood of behaviour.
This seems to suggest that there are not many behaviours which are reliably linked to all cases of alcoholism. However, a history of anti-social behaviour is the best predictor of future alcohol abuse. Assignment 8 - Griffiths (1994) podcastHere is a great podcast (and set of accompanying slides) of a talk given by Griffiths on his 1994 study into cognitive biases.
Listen to the podcast and read this description, whilst making notes to further increase your understanding of the cognitive explanation of addiction. Assignment 9 - What about ICDs?The information here seems useful for interpreting some addictions (e.g. alcohol) and impulse control disorders (e.g. gambling). BUT what about other addictive conditions.
Pick one ICD which has not been mentioned here, and see if you think that the ideas here would make a good explanation for that condition. |
Errors and biases in addicts thinkingA heuristic is a rule or shortcut that we use when we are making a decision. Sometimes these are irrational, and lead to addictive behaviour being continued when it shouldn't be. Therefore, a person more likely to make these cognitive mistakes may be more likely to develop an addiction.
Griffiths (1994) suggests a number of such heuristics: Gambler’s fallacy is the idea that random events equal themselves out over time. For example "it's been heads four times so it's bound to be tails this time" Illusion of control: gamblers tend to over-estimate the amount of control they have. We follow lucky strategies when picking lottery numbers, or get excited at 'nudges' on slot machines. Availability bias: The notion that because something has happened in the past it will occur again in the future. Because we see reports of success stories, but no coverage of all the cases of failure, we overestimate our chances of success. Sunk cost bias: Having put something in initially (e.g. money), we feel obliged to keep going no matter how bad it gets, to try to get back our initial investment. The problem is that it could just keep on getting worse! |
Evaluating cognitive explanations for addictionAS ALWAYS - note how these evaluations overlap with ones from other sections!
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Assignment 10 - Spot the biasWhich irrational errors of thinking or cognitive biases are being shown by the following quotes?
I had a feeling it wasn’t going to pay very much after it had just given me a feature . . . I had a feeling it was going to chew up those tokens fairly rapidly . . . I had a feeling it had paid out earlier because it’s not giving me a chance. I’m only gonna put one quid into start with because psychologically I think it’s very important . . . it bluffs the machine—it’s my own psychology. This machine doesn’t like me . . . ooh it does, it’s given me a number . . . hates me! It’s given me low numbers, I don’t think it wants to pay out at all . . . probably thinks I’m a *******—it’s not wrong!” It’s really ******* me over . . . Am I allowed to change to another machine? . . . I think this machine is not going to pay out happily . . . It stitches me up every time . . . unbelievable. I had a feature held and then it stopped them . . . ******* conned . . . this is where it just takes off your money right at the end ‘cos it’s out of pocket . . . ******* machine. |
Successful explanations for addiction are likely to take BOTH psychological and biological factors into account!
Assignment 11 - Rat Park by Alexander et al (1978), drawn by Stuart McMillen
Rat park is the name of a series of amazing cartoons by Stuart McMillen reporting the results of a series of experiments in the 1970s into addiction using rats (Alexander et al, 1978).
Read the comics, and then write:
This experiment would be a great one to include in an essay on addiction as it argues against a reductionist explanation of addiction!
Read the comics, and then write:
- Half a page summarising the findings of the experiments
- Half a page saying what you think these results contribute to our understanding of addiction
This experiment would be a great one to include in an essay on addiction as it argues against a reductionist explanation of addiction!
Bullet point 3 - Coping with and Reducing Addiction
• coping with and reducing addiction and impulse control disorders
Behavioural e.g. token economy; aversion therapy (for alcoholism). Cognitive behaviour therapy (e.g. Kohn, 2000) for kleptomania
Behavioural e.g. token economy; aversion therapy (for alcoholism). Cognitive behaviour therapy (e.g. Kohn, 2000) for kleptomania
Behavioural strategies for reducing addiction
Token economiesWe've already met the token economy system as a behaviourist treatment for Schizophrenia. You should therefore be able to imagine how you could design a program using a token economy to treat addiction.
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Assignment 12 - Sample Section C questiona) Describe a token economy program (6)
b) Based on your knowledge of token economies, design a program that could be used to treat an addiction or ICD of your choice. (8) |
Aversion Therapy
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Aversion therapy is based on the ideas of classical conditioning. The idea is to create an unpleasant association between the sufferer and the addictive behaviour. This is usually done by giving the sufferer an 'emetic' drug, which a drug which induces vomiting (usually considered a very unpleasant experience!) Just before the vomiting happens, the person performs their addictive action. This could be gambling, or it could be drinking a shot of alcohol. Immediately afterwards, they are sick. This is repeated multiple times until the poor sufferer is thought to have a formed a strong enough association between the unpleasant feeling and the behaviour.
An alternative method is to use electric shocks, zapping the sufferer as they perform the addictive action! The aim is that the addictive behaviour should come to elicit the same feelings of disgust or pain that were initially caused by the emetic drug/electric shock. The video shows this process using food and electric shocks. In reality the process would be a lot less entertaining and a lot more upsetting! The Stanley Kubrick film 'A Clockwork Orange' shows the process in a much darker light. |
Evaluating behavioural strategies for addiction
Because these are a behaviourist treatments, you should already be able to evaluate them in terms of reductionism and determinism. Have a go at creating two PEE points, one for each of those issues.
- Relapse is a major problem for both strategies. Away from the controlled lab environment where the associations are made, it is common for addictions to return. It can be rare for gains made in therapy to last for more than a year.
- However, there is still evidence that it can be effective for some people and for some addictive behaviours. Meyer and Chesser (1970) used aversion therapy to treat alcoholics. After twelve months success rate was put at around 50% (though of course this also means a relapse rate of 50%!)
- Behavioural therapies can be effectively combined with other therapies (e.g. cognitive or biological. It is therefore perhaps unfair to evaluate their effectiveness alone, as they will rarely be used alone these days.
- Behavioural methods can be criticised as they try to change the behaviour but ignore the underlying cause (i.e. the thing that is leading them to addictive behaviour in the first place)
- Aversion therapy has clear ethical problems, most notably in terms of the protection of the participant from harm.
Cognitive-Behaviour Therapy for Kleptomania
You have already seen how CBTs will try to alter both behaviour and cognitions together. Examples of the sorts of tasks that a kleptomaniac might experience in CBT could include covert sensitization, shaping, behavioral chaining, problem-solving, cognitive restructuring and homework
Some of these ideas you have come across before and some may be new to you. Try to work out how each would function as a therapy tool in CBT. Kohn (2002) used all of these in a case study of a 39 year old man called 'Jay', who had shoplifted since he was 6. They reported that symptoms of depression and kleptomania decreased during treatment, and also that they remained low at a follow-up 16 weeks afterwards. Another important aspect of the therapy will be regular self-assessment, for example using self report scales (have a go at the Kleptomania Symptom Assessment Scale 'K-SAS' yourself! CBT for Kleptomania would roughly follow a stepped program like the one below:
Assignment 13 - test your memoryWrite half a page for this section C question from memory:
Describe one strategy for the management or reduction of addictive behaviour (6) |
Evaluating CBT for Kleptomania
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End of section essay writing exercise - Section B
We'll now start looking at the Section B 'evaluate' question. The essay will have two parts, a 'describe' section and an 'evaluate' section.
14 (a) Describe what psychologists have discovered about addiction and impulse control disorders. [8]
(b) “No single explanation of impulse control disorders is adequate.” Evaluate what psychologists have discovered about addiction and impulse control disorders and include a discussion about competing explanations. [12]
First read this document, which covers the skills that we want you to learn when approaching these questions. In summary, you need to try to mention a range of information in question a), so try to mention things from all three bullet points in the specification (so here, something from each of the three approaches). For the question b), try to evaluate using issues and debates (same ones as from AS level). On this page, issues such as reductionism, determinism, ethics, data collection methods, scientific-ness, objectivity and other have been mentioned. Use these in your evaluations! Remember to use a PEE format if you find it helpful.
One final point. Make sure you answer the specific question asked! The b) question will always have a little extra requirement in it, where it will ask you to focus your discussion on one specific area or issue. Here is it 'competing explanations'. At least a paragraph should consequently be devoted to discussing different explanations and models.
Generic mark schemes are given below. Read them carefully before you start writing and make sure your essays fulfill all the requirements. Please submit your essays through the form on the home page.
14 (a) Describe what psychologists have discovered about addiction and impulse control disorders. [8]
(b) “No single explanation of impulse control disorders is adequate.” Evaluate what psychologists have discovered about addiction and impulse control disorders and include a discussion about competing explanations. [12]
First read this document, which covers the skills that we want you to learn when approaching these questions. In summary, you need to try to mention a range of information in question a), so try to mention things from all three bullet points in the specification (so here, something from each of the three approaches). For the question b), try to evaluate using issues and debates (same ones as from AS level). On this page, issues such as reductionism, determinism, ethics, data collection methods, scientific-ness, objectivity and other have been mentioned. Use these in your evaluations! Remember to use a PEE format if you find it helpful.
One final point. Make sure you answer the specific question asked! The b) question will always have a little extra requirement in it, where it will ask you to focus your discussion on one specific area or issue. Here is it 'competing explanations'. At least a paragraph should consequently be devoted to discussing different explanations and models.
Generic mark schemes are given below. Read them carefully before you start writing and make sure your essays fulfill all the requirements. Please submit your essays through the form on the home page.
End of section essay writing exercise - Section C
Section C in your exam always consists of two questions, one 6 mark recall question and one 8 mark application question. There are always two of these types of question, and you need to choose one.
16 You are a parent and recently your seventeen-year-old son has started to behave differently from usual. You have had money taken from your bag and you are concerned that he might be gambling. You are worried that he might become addicted to it.
(a) Describe the characteristics of addiction such as those outlined by Griffiths (1995). [6]
(b) Suggest how the characteristics of addiction apply to your son’s behaviour. [8]
The first question is a straightforward recall question. This is the longest question you will get which could focus on just a single theory. You need to write about half a page, so a simple revision check is to make sure that you can write half a page of description about every idea/theory/study that is specifically mentioned in the specification.
The second question allows you to be creative. There is no single right answer. All you have to do is give practical and specific ideas for how you might implement the theory you have described in the first question into the scenario they give you. About a page should be a good length.
Here you have to apply Griffiths' characteristics to the behaviour given in the question. You therefore need to make sure that you are specifically referring to Griffiths, and to the condition and behaviours given in the question. It takes some getting used to writing this way, but it is an area that, with a little bit of practice, you will be able to do very well on.
Have a go at the questions above. Please submit your essays through the form on the home page.
16 You are a parent and recently your seventeen-year-old son has started to behave differently from usual. You have had money taken from your bag and you are concerned that he might be gambling. You are worried that he might become addicted to it.
(a) Describe the characteristics of addiction such as those outlined by Griffiths (1995). [6]
(b) Suggest how the characteristics of addiction apply to your son’s behaviour. [8]
The first question is a straightforward recall question. This is the longest question you will get which could focus on just a single theory. You need to write about half a page, so a simple revision check is to make sure that you can write half a page of description about every idea/theory/study that is specifically mentioned in the specification.
The second question allows you to be creative. There is no single right answer. All you have to do is give practical and specific ideas for how you might implement the theory you have described in the first question into the scenario they give you. About a page should be a good length.
Here you have to apply Griffiths' characteristics to the behaviour given in the question. You therefore need to make sure that you are specifically referring to Griffiths, and to the condition and behaviours given in the question. It takes some getting used to writing this way, but it is an area that, with a little bit of practice, you will be able to do very well on.
Have a go at the questions above. Please submit your essays through the form on the home page.
RevisionLast year Fairuz made this revision Prezi, which summarises some of the main points you need (though you will need plenty of evaluation ideas too!)
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