Addiction Revision Guide PSYA4

Specification

Definition of addiction:
Addiction is a persistent, compulsive dependence on a behaviour or substance. (ome researchers spea) of two types of addictions: chemical addictions *for example, alcoholism, drug abuse, and smo)ing+, and behavioural addictions *for example, gambling and shopping+.

Key terms
Chemical addiction: Physiological addiction to a mood altering substances, such as nicotine, drugs or alcohol. Behavioural addiction: An addiction to an activity, such as gambling or shopping, which may alter mood, but only as a result of the bodys own chemicals, rather than an external substance. Biochemical: atural chemicals such as neurotransmitters and hormones which control bodily responses, including mood. Dopamine: !opamine is a neurotransmitter that is important for communication in many parts of the brain, including the reward system.

Characteristics of addiction: "riffiths identified the following characteristics of addictive behaviour: 1. Salience: #he behaviour becomes the most important thing to the person and they have it on their minds for much of the time. Alcohol and nicotine addicts tend not to be so obvious in this regard, since they are able to combine their addiction with other behaviours in social settings. $owever, once deprived of their fix, salience becomes far more apparent. 2. Mood modification #he addict gets a rush or bu%% when engaged in the behaviour. #he addict is also able to use their behaviour to bring about a mood change. &nterestingly, the same chemical or behaviour can alter mood in different directions depending on time or setting. icotine can stimulate in the morning or relax before sleep.

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3. Tolerance -sually associated with chemical addiction such as alcohol or heroin, this one can also be applied to behaviours. .asically the addict needs bigger and bigger hits to get the same effect as they did initially with smaller amounts. /is)0ta)ing behaviour, for example, tends to get more extreme over time. . !ithdra"al symptoms 1hanges in mood, sha)es, irritability etc. as a result of cessation. Applies to behavioural as well as chemical addiction. #. Conflict #he pursuit of short term pleasure can cause conflict with other, parents, spouse, friends and can also result in conflict within the person. $. %elapse A tendency to return to the behaviour, months or even years after an apparent cure. Again this is 2ust as common with behavioural addiction as it is with chemical.

&riffiths 'elieves that all si( need to 'e present for a dia)nosis of addiction. *o"ever+ others disa)ree+ 'elievin) that addiction doesn,t al"ays result in undue disruption to a person,s lifestyle and occasionally no "ithdra"al symptoms are e(perienced on cessation.

&eneral overvie" of each model in relation to the three sta)es of addiction: -nitiation Biolo)ical
&enetic predisposition 4 various genes identified for different addictions. &t is believed that some genes may ma)e a person more or less sensitive to the effects of dopamine. #hose who are less sensitive may see) out addictive substances5behaviours to compensate for low levels of dopamine *6 pleasure+, whereas those who are more sensitive do not seem to need the extra stimulation provided by addictions. Social learnin) theory 4 initiation occurs through observations of role models *peers, parents, media, celebrities, etc.+ and imitation of their behaviour.

Maintenance
Biochemical effects 4 the body becomes used to the physiological effects produced by the addiction *increased dopamine, rush of adrenaline+ and tolerance may occur *the person needs more and more of the substance or behaviour to produce the same effects+. #he addiction is maintained to continue receiving the pleasurable feelings originally produced and avoid the negative effects of withdrawal. Classical conditionin) /Cue %eactivity Theory0 4 stimuli related to the addiction *e.g. cigarette lighter, betting shop+ become associated with the positive feelings produced. 1perant conditionin) 4 the addictive behaviour brings rewards such as peer acceptance, physiological bu%%, etc. which ma)es the individual repeat the behaviour. Copin) /self medication0 4 if the individual believes that the addiction does help relieve stress5boredom, etc., they are li)ely to continue. 2(pectancy 4 if the addict believes that giving up will be difficult, they are li)ely to maintain the behaviour to avoid the negative effects of withdrawal. Self efficacy 4 the individual must believe they are capable of giving up. &f they do not, the addiction will be maintained.

%elapse
Biochemical effects 0 relapse occurs as a response to physiological withdrawal due to the loss of increased levels of pleasure producing biochemicals such as dopamine. #he individual returns to the addictive behaviour to avoid the unpleasantness of physical withdrawal.

.earnin)

Co)nitive

Copin) /self medication0 4 initiation occurs because the individual believes that the substance5behaviour helps serves a specific purpose *e.g. mood regulation, performance enhancement, distraction+. 7ften this might be to treat a psychological illness *such as depression+ that has not been diagnosed or ade8uately treated. 2(pectancy 4 initiation occurs if the individual expects the behaviour to have positive outcomes. Self efficacy 0 &t could be that addicts )now that the habit is dangerous and addictive but they believe that they are able to control the behaviour and any problems that may arise from it.

Classical conditionin) /Cue %eactivity Theory0 4 when presented with stimuli related to their addiction, the addict anticipates the associated pleasure. #his produces a physiological response which ma)es them relapse. 1perant conditionin) 4 the person relapses into their addictive behaviour to avoid the unpleasantness of withdrawal *negative reinforcement+. Copin) /self medication0 4 the addict may relapse because the withdrawal symptoms are so unpleasant that they feel they need the addictive substance5behaviour to cope with them. 2(pectancy 4 the addict must expect that abstaining from the addictive behaviour will be more beneficial than returning to it. &f they do not, relapse will occur. Self efficacy 4 if the individual struggles with the withdrawal symptoms after giving up, they may feel unable to continue, and relapse into addiction.

&eneral evaluation for each model of addiction

1an be used for 8uestions such as outline and evaluate the ...... model of addiction. &f used to relate to a specific addiction or stage, you should ma)e sure that you tailor it specifically to that 8uestion e.g. the 'iolo)ical e(planation for the initiation of )am'lin) addiction is reductionist because... Biolo)ical
%eductionist3reduces complex addictions to too simple a level. Deterministic 0 says people have no free will over whether or not they become addicted. -ndividual differences: explains why some people develop addictions and others dont in the same bad environments *those that do have a genetic pre0disposition+. Stron) research support to suggest runs in families .-# this may be better explained by social learning theory0copying parents addictions .ots or research done on animals3 cannot )eneralise to humans . .-#, it would be unethical to carry out this type of research on humans. 2(plains some addictions 'etter than others. #he biological approach offers a good explanation for chemical addictions *e.g. smo)ing+ but is less effective for explaining behavioural addictions such as gambling.

.earnin)
.earnin) theories are reductionist. (timulus response0 humans seen as copying behaviours without thin)ing. Deterministic. :ou are pre destined to become an addict. ;earning theories explain addictive behaviour without involving any conscious evaluation of the costs or benefits of a particular activity. 4either conditionin) e(planation is sufficient on its o"n : 0 1lassical is useful to explain maintenance and relapse, but not initiation 0 7perant 6 useful to explain maintenance and relapse. S.T3'est learnin) theory as uses both operant and classical. .ut wea) at relapse. .i5ely that other models e(plain addiction 'etter0 e.g. cognitive as it sees humans as thin)ing about what they are doing

Co)nitive
*elps e(plain individual differences: e.g. millions of people have gambled but not all get addictive, as not all develop faulty cognitive biases *irrational thin)ing patterns+ .o)ical and lots of supportin) research Some research doesn,t support: "riffiths found gamblers gamble without consciously thin)ing *auto0pilot+ which goes against cognitive theory which says people thin) about what they are doing. (o doesn,t e(plain maintenance. -t sees humans as 'ein) thin5in) 'ein)s so is not deterministic

Doesn,t addictions as it

SM1K-4& 7 B-1.1&-C8. 3 -4-T-8T-14

e(plain chemical /smo5in)0 as "ell e(plains )am'lin).

"< <#&1 =-; </A.&;&#: A71 A7' #he heritability estimates for smo)ing in *0+ 1oncordance rates in twin studies may twin studies have ranged from 9> to be better explained by social learning ?9@, indicating a substantial genetic theory 4 twins share the same component to smo)ing. /esearch has environment so may be influenced by the focused on the role of specific genes, same family members. including: *B+ $owever, research shows higher #hose with the A1 variant of the !/!' concordance rates for smo)ing in CD gene appear to have fewer dopamine twins that in !D, suggesting that genetics receptors in the pleasure centres of the do play a role in explaining the initiation brain, meaning that they are more li)ely of smo)ing addictions. to become addicted to drugs *such as nicotine+ that increase dopamine levels *B+ #he genetic explanation helps to as this compensates for the deficiency explain individual differences in initiation by stimulating what few dopamine 4 not everyone who tries smo)ing becomes receptors they do possess. Comin)s et addicted because they do not have the al /166$0 found that 9A@ of smo)ers gene that ma)es them vulnerable. and ex smo)ers carried the A1 variant of !/!', compared to '>@ of the general *0+ ot everyone with the gene develops population. an addiction, and not all addicts have the gene. #his means that genetics cannot be .erman et al /16660 suggests those the only explanation for the initiation of without the (;1>A30A gene are more smo)ing addiction. #he diathesis stress li)ely to ta)e up smo)ing *the gene explanation could help explain this 4 that seems to have a preventative effect+. some people have a genetic predisposition &t is suggested that individuals carrying to develop a smo)ing addiction but it is the (;1>A30A gene have altered only triggered by a stressful environment dopamine transmission, which reduces and5or events. their need for novelty and reward by external stimuli, including cigarettes. *0+ #his approach can be criticised as deterministic because it suggests that a person does not have free will over whether they develop an addiction 4 their genetic vulnerability will ma)e it very difficult for them to resist.

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SM1K-4& 7 B-1.1&-C8. 3 M8-4T2484C2 .&71$<C&1A; <EE<1#( 4 &17#& < /<"-;A#&7 A71 A7' According to the biological model, the *B+ Schachter /16990 found that smo)ers reason for continued smo)ing is chemical who smo)ed low0nicotine cigarettes addiction to the highly addictive smo)ed 'F@ more cigarettes than those substance, nicotine. who smo)ed high0nicotine content cigarettes. #his supports the theory that Shachter /16990 argues that smo)ers there is an optimum level of nicotine continue to smo)e to maintain nicotine in re8uired to avoid withdrawal symptoms. their body at a level high enough to avoid any negative withdrawal symptoms. #his *0+ .iological explanations of maintenance is )nown as the 4icotine %e)ulation offer a reductionist view 4 it is unli)ely Model. that biochemicals offer a full explanation as there are li)ely to be environmental factors involved *e.g. life stresses+.

.&71$<C&1A; <EE<1#( A71 icotine increases dopamine release, providing a positive, rewarding feeling which leads to maintenance of the addictive behaviour.

A7' *B+ Cori)all and Coen /16610 found that mice would self0administer nicotine into the reward centres of their brain, unless their dopamine release system was inhibited. #his suggests that nicotine addiction is maintained because of the rewarding effects produced from increased dopamine levels. *0+ $owever, because this study was carried out on mice, we cannot be sure that the results would extrapolate to human beings, due to the differences in physiology between species. *0+ .iological explanations do not explain individual differences in the maintenance of smo)ing addiction. &f nicotine is so addictive and rewarding, how is it that G

some people are able to give upH

SM1K-4& 7 B-1.1&-C8. 3 %2.8:S2 .&71$<C&1A; <EE<1#( A71 ;ong0term use of nicotine leads to a high tolerance to it *meaning that the amount of nicotine needed increases+. (topping this use can lead to severe withdrawal symptoms, so to avoid this, the addict relapses.

A7' *0+ .iological explanations for relapse ignore the role of environmental factors. Eor instance, it has been found that many people relapse due to life stress /4-D8+ 16660. *0+ .iological explanations for do not explain individual differences in relapse. Presumably all smo)ers experience withdrawal symptoms, but not all smo)ers relapse. *0+ #his explanation is deterministic because it suggests that smo)ers do not have any control over whether they are able to give up or not.

%emem'er that not all approaches "ill have an e;ual amount of 811 and 812 for each addiction /smo5in) and )am'lin)0. Some approaches may e(plain certain sta)es or addictions more fully+ or more research may have 'een carried out in certain areas.

SM1K-4& 7 .28%4-4& 3 -4-T-8T-14 (71&A; ;<A/ & " #$<7/: A71 According to (ocial ;earning #heory, initiation occurs through the process of vicarious reinforcement: reinforcement received indirectly, by observing another person being reinforced. &n other words, the individual begins to smo)e because they observe others receiving positive rewards *such as popularity+ from the behaviour and they then begin to associate these rewards with the smo)ing behaviour. As smo)ing is most li)ely to begin during adolescence, peers are li)ely to be the most influential role models, although media role models may also be influential.

A7' *B+ Mayeu( et al. /2<<=0 found a correlation between smo)ing and popularity two years later. *0+ $owever, this study is a correlation, so cause and effect cannot be established, it may be that a third variable *such as confidence+ is involved. *0+Also, the sample was only 1> year old males, so we cannot be sure that the results will generalise to other populations. *B+ DiBlasio and Bersha /16630 found that peer group influences were the primary influence for adolescents who start to smo)e. *B+ 4-D8 /2<<<0 reported that AI@ of -( smo)ers too) up the habit as teenagers and most of them attribute this to watching others, such as friends.

SM1K-4& 7 .28%4-4& 3 M8-4T2484C2 1;A((&1A; 17 !&#&7 " *1-< /<A1#&=&#: #$<7/:+ A71 A7' Carter and Tiffany /16660 suggest *B+ Cany studies /e.). Carter and Tiffany+ that addicts start to associate 16660 have supported the theory that certain stimuli with their addictive exposure to smo)ing related cues increases behaviour. #his could be items such the urge to smo)e and produces a range of as cigarette lighters, or situations, physiological effects *such as raised heart such as when in the pub. #hese rate+ which may contribute to the stimuli then act as cues, producing maintenance of smo)ing behaviour. similar feelings to the addictive behaviour itself, thus encouraging *B50+ Saladin et al /2<120 report that women the individual to continue with their are more susceptible to smo)ing related cues addiction. than men, and other studies have shown that this may be particularly true at certain stages in the menstrual cycle, suggesting that response to cues may be at least partly determined by biological factors. 7P</A # 17 !&#&7 & " A71

A7'

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#he addiction is maintained because the pleasurable feelings produced by increased levels of dopamine act as positive reinforcement for the addictive behaviour, whilst the avoidance of withdrawal symptoms also negatively enforces the behaviour. #he addict continues with the behaviour to maintain the pleasurable feelings and avoid the unpleasant symptoms of withdrawal.

*B+ #here is lots of animal research which demonstrates that rats will repeatedly self administering nicotine, due to the pleasurable effects it produces. Eor example, .evin and %ose /2<1<0 gave rats an intravenous dose of nicotine and then offered them the opportunity to drin) from a choice of two bottles, one laced with nicotine, the other with 2ust water. #hey found that they lic)ed the nicotine water significantly more times than the plain water, and that the number of lic)s they gave increased with every subse8uent opportunity they were given. #his supports the role of nicotine as a positive reinforcer being important in the maintenance of smo)ing addiction. *B+ $owever, this was an animal study, so we cant be sure that results will generalise to humans.

SM1K-4& 7 .28%4-4& 3 %2.8:S2 1;A((&1A; 17 !&#&7 & " *1-< /<A1#&=&#: #$<7/:+ A71 A7' #he li)elihood of relapse is increased if *B+ &nterventions for addiction based on the individual is confronted with cues cue avoidance do seem to be effective in that remind them of their addiction. presenting relapse. #hese cues produce similar physiological effects as the behaviour itself, causing *0+ !oes not explain individual the individual to relapse. differences. (ome smo)ing addicts are able to give up, even though they are exposed to cues.

7P</A # 17 !&#&7 & " A71 /elapse can be explained via negative reinforcement. #he individual relapses to avoid the unpleasant feelings produced by withdrawal. 1ommon symptoms of withdrawal from nicotine are weight gain, constipation, anxiety and insomnia, which

A7' *B+ :arrott /16==0 suggests that abstaining from nicotine, even for a brief period, causes increased stress and anxiety in the form of cravings. (mo)ing immediately removes this anxiety and in the very short term reduces the 11

last for an average of three wee)s.

perception of stress. ote that longer term use actually increases stress but this isnt noticed. *0+ either learning explanation accounts for individual differences in the maintenance of smo)ing behaviour. Presumably all addicts are exposed to cues and experience withdrawal symptoms when they try to stop, but this approach does not explain why some relapse and others do not. *0+ #he behaviourist approach is reductionist as it does not consider the role of biology, cognitions or social context in the maintenance of addiction. &t suggests that relapse occurs through simple learning processes, which may not ade8uately account for the complexities of addictive behaviour.

SM1K-4& 7 C1&4-T-?2 3 -4-T-8T-14 17P& " *(<;E C<!&1A#&7 + A71 #his explanation suggests that people purposely choose what they become addicted to. #he individual chooses something that they believe will help them with a problem they have. <.g. someone may feel that smo)ing relieves stress so will initiate the behaviour as a form of stress relief. $elps fulfil 3 ma2or functions 1. Cood regulation '. Performance management *they may believe that smo)ing helps them concentrate+ 3. !istraction *from problems or 2ust boredom+ A7' *B+ *eishman /16660 found that smo)ing does help concentration, with increased attentional focus and enhanced performance of well0learned behaviours. #his why explain why it may be used to self medicate. *0+ $owever, 1ohen and ;ichtenstein *1AAI+ found that smo)ing actually increases stress levels. But it does not matter whether the choice e.g. smo)ing actually helps the person, it only matters that they believe that it does. *B+ #his explanation is supported by the fact that smo)ing is more common in lower socio economic groups />idler et al+ 2<<=0 as they may have more stressful 1'

lives, increasing the need to self medicate. <JP<1#A 1: A71 Khether smo)ing begins or not can be described in terms of expectancy. (mo)ers may expect that smo)ing reduces stress and negative feelings. #hey may believe that it ma)es them loo) cool and attractive to the opposite sex. All of these expectancies may motivate smo)ing behaviour regardless of whether they reflect reality. &t is enough that the smo)er believes that they are true. (<;E <EE&1A1: A71 (elf efficacy may help to explain the initiation of a smo)ing addiction because the individual may believe they are able to smo)e without becoming addicted. A7' *B+ #his is not a deterministic explanation 4 it sees the choice to parta)e in an addictive behaviour as an act of free will on the part of the individual.

A7' *0+ !oes consider individual differences in initiation of smo)ing, as some people may not start to smo)e because they believe they will become addicted.

SM1K-4& 7 C1&4-T-?2 3 M8-4T2484C2 17P& " *(<;E C<!&1A#&7 + A71 #he functions of coping may also explain why people maintain their addictive behaviour. &t may be that people continue to smo)e because the nicotine really does help them to concentrate for longer, or engage in repetitive tas)s without getting unduly bored.

A7' *B+ *eishman /16660 found that smo)ing does help concentration, with increased attentional focus and enhanced performance of well0learned behaviours.

<JP<1#A 1: A71 <xpectancies may influence whether someone continues to smo)er or not. #he smo)er who expects the withdrawal symptoms to be unpleasant is more li)ely to maintain their addiction.

A7' *B+#his explanation for maintenance does ta)e individual differences into account 4 those who expect withdrawal to be difficult are more li)ely to maintain the addiction. 13

*B+ Tate et al. /166 0 found that smo)ers who were told to expect no negative experiences during a period of abstinence experienced fewer physical and psychological effects compared to a control group who were not primed. (<;E <EE&1A1: A71 &t could be that once smo)ing is initiated, the individual feels unable to cope with the withdrawal procedure associated with smo)ing, and so their addiction is maintained.

A7' *B+ $elps to explain individual differences 4 some people maintain their behaviour because they do not feel capable of 8uitting. *0+ !oes not explain why some people have lower self efficacy. #herefore, does not offer a full explanation of why smo)ing addiction is maintained.

SM1K-4& 7 C1&4-T-?2 3 %2.8:S2 17P& " *(<;E C<!&1A#&7 + A71 &n terms of coping, the negative feelings of withdrawal can be relieved almost immediately by smo)ing another cigarette. #he symptoms of withdrawal include attention lapse, and smo)ing provides an immediate route to performance enhancement in this respect.

A7' *B+ *eishman /16660 found that smo)ing does help concentration, with increased attentional focus and enhanced performance of well0learned behaviours.

(<;E <EE&1A1: A71 &t may be that self efficacy can explain why smo)ers relapse. #he may feel that they do not have the necessary willpower or mental capabilities to abstain from their addiction long term.

A7' *B+ #reatment programs which aim to increase self efficacy have been found to be effective in preventing relapse. #his supports the role of self efficacy in explaining why someone relapses. 19

Alternatively, if they have given up before, they may feel that they are able to do so again, so they do not feel that a return to smo)ing will be permanent.

*B+ !oes not explain why some people have higher self efficacy than others so therefore may not provide a full explanation for relapse.

&8MB.-4& 7 B-1.1&-C8. 7 -4-T-8T-14 "< <#&1( A71 Duc)erman *1AGA+ proposed the personality characteristic of sensation see)ing which may be passed on genetically. People with certain genes may be predisposed to see) out stimulating activities, such as gambling, and may therefore have a higher ris) of developing an addiction.

A7' Shah et al. /2<<#+ found evidence of a genetic transmission of gambling behaviour in men, suggesting that there is a biological basis for gambling addiction. *0+ only in men *B+ Blac5 et al. /2<<$0 found that first degree relatives of pathological gamblers were more li)ely to suffer from pathological gambling than more distant relatives. *0+ (ocial learning theory could also explain why addiction to gambling may run in families 4 observation of gambling role models. *0+ !eterministic 4 suggests that some 1F

people may not have free will over the development of an addiction. .&71$<C&1A; <EE<1#( A71 Lim *1AA?+ has found biochemical evidence which suggests that gambling may activate the brains reward system, causing the release of chemicals *such as endorphins+ which create a rush of pleasure. "amblers are li)ely to feel this sensation whenever they place a bet, due to the anticipation of winning *even if they do not eventually win+. #he occasional bet then becomes an addiction because they want to experience these feelings again.

A7' *0+ !oes not explain individual differences in the initiation of gambling 4 most people have gambled occasionally *e.g. the ational lottery, bingo, etc+ but few become addicted.

&8MB.-4& 7 B-1.1&-C8. 7 M8-4T2484C2 .&71$<C&1A; <EE<1#( A71 #he individual continues with the addictive behaviour to maintain the positive effects *the feelings of pleasure+ and avoid the negative conse8uences of withdrawal.

A7' *B+ !ray and Dic5inson /16=10 found that gambling addicts who are stopped from gambling experience symptoms almost li)e withdrawal symptoms from chemical addictions. *B+ #reatments using naltrexone *a drug which bloc)s the rush of endorphins+ have been found to be effective in reducing thoughts about gambling and gambling behaviour itself. #his suggests that at least part of the reason for the maintenance of the addiction is the pleasure received from gambling. *B+ !oes not explain individual differences in gambling 4 if everyone experiences pleasure from gambling and withdrawal 1>

effects when they stop, why do some develop an addiction but others dontH #his is better explained by the genetic explanation for initiation.

1ne of the main evaluation points for 'iolo)ical e(planations for )am'lin) /any sta)e0 is that 'iolo)ical approaches do not e(plain 'ehavioural addictions+ such as )am'lin) as "ell as they e(plain chemical addictions li5e smo5in). This is "hy there is less material for 'iolo)ical )am'lin) e(planations.

&8MB.-4& 7 B-1.1&-C8. 7 %2.8:S2 .&71$<C&1A; <EE<1#( A71 "amblers experience similar withdrawal symptoms to addicts with substance addictions, so it is suggested that gamblers relapse in order to stop the withdrawal symptoms.

A7' *B+ !ray and Dic5inson /16=10 found that gambling addicts who are stopped from gambling experience symptoms almost li)e withdrawal symptoms from chemical addictions. *B+ #his approach can be accused of being deterministic as it suggests that gamblers do not have free will over whether they relapse. *B+ #his explanation for relapse can also be said to be reductionist as it does not consider the complex social and cognitive factors that may contribute to relapse.

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&8MB.-4& 7 .28%4-4& 7 -4-T-8T-14 (71&A; ;<A/ & " #$<7/: A71 According to the behaviourist model, gambling behaviour is initiated through the process of (ocial ;earning #heory 4 the addict sees others being rewarded for their addictive behaviour *winning+.

A7' *B+ &upta /16690 reports that ?>@ of children *aged A019+ who gamble regularly reported gambling with family members. #hey also found that, as childrenMs age increases they tend to gamble more at friendMs homes and at school. #his supports the role of (;# in initiation of gambling as parents and peers are li)ely to be the most important role models. *0+ $owever, this study is a correlation, so cause and effect cannot be established, it may be that a third variable is involved. *0+ #he participants in "uptas study were not assessed for pathological gambling, so they may have only been occasional gamblers rather than addicts. #herefore, 1?

the study may lac) validity.

&8MB.-4& 7 .28%4-4& 7 M8-4T2484C2 7P</A # 17 !&#&7 & " A71 People are said to continue gambling in order to experience the biological bu%% and reward. Although you do not win every time when gambling, intermittent or variable reinforcement has been shown to produce longer lasting ac8uisition of gambling and indeed other behaviours. Coreover, behaviours which are established this way *intermittent or variable reinforcement+ are much more difficult to extinguish.

A7' *B+ !oes explain why some people continue to gamble even when faced with regular losses *variable reinforcement+. *0+ #he behaviourist approach is reductionist as it does not consider the role of biology, cognitions or social context in the maintenance of addiction. &t suggests that maintenance occurs as a result of simple learning processes, which may not ade8uately account for the complexities of addictive behaviour.

1-< /<A1#&=&#: #$<7/: *1;A((&1A; 17 !&#&7 & "+ A71 A71 #he individual may condition to gamble *B+ 2del)ard /2<<60 compared the heart rate because the material associated with of social and pathological gamblers *addicts+ 1A

their habit is presented to them on a day to day basis *e.g. wal)ing past betting shops+.

when presented with pictures of their preferred form of gambling *horse racing or scratchcards+. #hey found that heart rate increased for both groups, but was significantly higher in the pathological group, particularly when exposed to cue for their preferred form of gambling. #his may explain why gambling addicts continue their behaviour 4 because the increased physiological arousal *excitement5pleasure+ experienced when they are exposed to cues reinforces their desire to continue gambling. *0+ !oes not explain why some do manage to give up gambling, whilst others are not. Presumably all gamblers are faced with cues, but not all relapse.

&8MB.-4& 7 .28%4-4& 7 %2.8:S2 1-< /<A1#&=&#: #$<7/: *1;A((&1A; 17 !&#&7 & "+ A71 A7' /eturning to gambling after a period of *B+ !olflin) et al /2<110 found that abstinence can be explained in terms of pathological gamblers showed increased cue0reactivity. #he material associated physiological arousal when presented with with gambling is all around, particularly gambling cues, which also increased with the easy way which people can now cravings to gamble, thus leading to an play the ational ;ottery, and the many increased li)elihood of relapse. scratch cards readily available. "amblers are always surrounded by reminders of *B+ &nterventions for addiction based on their addictive behaviour, causing them cue avoidance do seem to be effective in to relapse. presenting relapse. #his supports the idea that cues are an important factor in explaining why relapse occurs. *0+ !oes not explain why some people are eventually able to abstain long term, whilst others are not. Presumably all gamblers are faced with cues, as betting shops and ational ;ottery products are 'I

everywhere, but not all relapse.

&8MB.-4& 7 C1&4-T-?2 7 -4-T-8T-14 17P& " *(<;E C<!&1A#&7 + A71 "ambling may be seen as an exciting activity which relieves the boredom of everyday life. #he self medication hypothesis was first suggested by !uncan *1AG9+. !rug addicts, in his view, have found a drug which provides them with temporary escape from an ongoing state of emotional distress which might be due to a mental disorder, to psychosocial stress, or to an aversive environment. on0drug addictions, in his opinion, represent similar negatively reinforced behaviour *i.e. the behaviour provides relief from emotional distress+.

A7' *B+ #he self medication model can help to explain why people develop specific addictions. Eor example, those who are bored may be more li)ely to turn to gambling, whilst those with high levels of stress may become addicted to nicotine. *B+ Blas@c@yns5i /2<<$0 found than gamblers are more prone to boredom vs. non0gamblers. #his may explain why they are drawn to an exciting addiction. *B+#his theory is compassionate to people with addictions. &t presents them not as wea)0willed, but as creative problem0 solvers, who are attempting to fill the gap left by limited medical options. *0+ Also, it is difficult to establish cause '1

and effect as it may be that gamblers are so used to the excitement that comes from gambling that they feel especially bored when they are not indulging in their habit *such as when ta)ing part in psychological researchN+ <JP<1#A 1: A71 &f the individual expects that gambling will have positive outcomes they are more li)ely to develop an addiction. #hese expectancies may be increased if they have a win early on. #hey may also expect few negatives of their behaviour, as gambling is seen as a relatively acceptable behaviour *unli)e some other addictions such as heroin+. A7' *B+!alters and Contri /166=0 compared expectancies for gambling amongst a group of male American prisoners. #hey found that those identified as probable pathological gamblers had significantly more positive *e.g. gambling ma)es me feel important5expert5in control+ and arousing *e.g. exciting+ expectancies than non gamblers. *B+ $owever, this was obviously not a representative sample, so results may not be generalisable. &8MB.-4& 7 C1&4-T-?2 3 M8-4T2484C2 17P& " *(<;E C<!&1A#&7 + A71 &f gambling does help to relieve boredom, the individual is li)ely to continue with their addiction. #hey may also )eep gambling to reduce the anxiety associated with losses from gambling.

A7' *B+ A study for the 8ustralian )overnment found that problem gamblers were more than 1? times more li)ely to experience severe psychological distress, and more than twice as li)ely to be depressed as people without a gambling problem. #his would support that the maintenance of gambling is a form of self medication to distract from emotional problems.

*0+ $owever, there is a clear cause and effect problem here, as it is not clear whether the distress5depression came before the gambling or after. <JP<1#A 1: *&//A#&7 A; 17" &#&=< .&A(<(+ A71 A7' /egular gamblers seem to have irrational *B+ van *olst et al /2<120 used C/& ''

expectations of gambling which help to maintain their behaviour. #hey may overestimate the li)elihood of winning and underestimate the potential for losses. #hey may also believe there is a s)ill to winning where there is no s)ill involved *e.g. slot machines+.

scans to measure the brain activities of problem gamblers and a control group when presented with various probabilities of winning or losing different amounts of money. #hey found that the problem group had increased blood supply to the regions of the brain associated with reward expectancy, suggesting that problem gamblers may have over optimistic expectancies of gambling outcomes. #hey also found that the most severe problem gamblers were less li)ely to be ris) aversive *to avoid ris)+. *B+ -sing brain scans is an ob2ective and scientific way to investigate gambling behaviour. *0+ 7ther studies have found that expectancies only predict addiction in males, not females.

&8MB.-4& 7 C1&4-T-?2 7 %2.8:S2 *17P& "+ (<;E C<!&1A#&7 A71 &f someone ta)es up gambling to relieve boredom, they may find that their boredom returns when they try to stop. #hey may even feel more bored because they have experienced the excitement of winning and so return to gambling to cope with these feelings. &n addition, they may now have anxieties associated with their gambling behaviour *money or relationship problems+ which gambling can help distract them from.

A7' *B+ A 8ualitative study by !ood A &riffiths /2<<90 interviewed pathological gamblers on their reasons for relapse. #hey found that escape *from boredom5problems in every day life+ was the main characteristic that facilitated a return to problem gambling. #he authors suggest that those who are able to cope with unwanted emotions and environmental cues were less li)ely to relapse. *B+ Oualitative research offers rich data which may help us understand gamblers thought processes more fully than 8uantitative research. *0+ .ut may not be ob2ective5scientific. '3

(<;E <EE&1A1: A71 #he individual may begin to gamble again because they do not have confidence in their ability to give up permanently. A '10item measure of gambling abstinence self0efficacy *"A((+ was developed by *od)ins et al /2<< 0 to measure gambling addicts beliefs about their ability to give up their habit.

A7' *B+ -sing the "A((, *od)ins et al /2<< 0 found that higher self0efficacy was related to fewer days of gambling over a 1'0month period. #his supports the role of self efficacy in explaining relapse. *B+ #his has implications for the treatment of gambling addictions 4 increasing self efficacy may be a useful way of reducing relapse rates. *0+ $owever, this approach does not explain why some people have lower levels of self efficacy, so may not offer a full explanation for relapse in gambling addiction.

%-SK >8CT1%S -4 T*2 D2?2.1:M24T 1> 8DD-CT-14

%is5 factors often appear as an applied ;uestion+ "here you "ill 'e as5ed to identify ris5 factors in a )iven scenario. >or this type of ;uestions+ evaluation is not necessary as 812 "ill 'e )ained 'y application.

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:oint: :oint: #here is lots of research to suggest young people are influenced by peers. &t is &t is suggested that young people more prone to addiction because they have less thought that peer pressure is a ma2or cause in starting to smo)e. #his lin)s to mature brains. #his means they are more sensitive to positive of drugs (ocial ;earning theory. :oung people are more li)ely to imitateeffects behaviour if they see than older people. #hey also experience effects from drugs that it as rewarding e.g., smo)ing ma)es themfewer seem negative cool. adults, which may help to maintain their addiction. 2vidence: 2vidence: DiBlasio and Bersha /16630 found that peer group influences were the primary A reportinfluence commissioned by the 4*S found that >G@ of regular smo)ers for adolescents who start to smo)e. started before the age offound 1? and ?9@ by age 1A. Sussman A 8mes /2<<10 that friend and peer use of drugs is a strong Shram /2<<=0 found adolescent rats were more sensitive tobeing the predictor of drug usethat among teenagers due to role modelling and rewarding effects of nicotine and less sensitive to the its aversive effects offered drugs by their peer group, demonstrating influence of social compared to adult rats. networ)s in determining levels of individual vulnerability 2valuation: 2valuation: *B+ #his suggests that the younger smo)ing5gambling more li)ely *0+ #here is lots of research which someone supports tries the importance of (;# the in explaining they are to develop an addiction. addiction. *0+ research is based is on animals so the may not be *B+ $owever, $owever, this much of the research correlational so findings cause and effect cannot be generalisableEor to humans. established. example, the study by Sussman and 8mes appears to show that peer groups cause smo)ing, but when it loo)ed at other factors it found the family influence *poor supervision and conflict, parents drug ta)ing behaviour+ had an effect on addiction too. #his shows that several factors may lead to a smo)ing addiction and that peer pressure is 2ust one of these. *0+ &t could also be that people are drawn towards people who en2oy the same things as them, e.g. smo)ing, gambling etc. #herefore, the same addictive behaviours may be similar in peer groups because they have 2oined the group because of these similarities, rather than that they changed their behaviour as a result of peer pressure after 2oining the group.

:22%S 8&2

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:2%S148.-TB :oint: 2ysenc5 /16$90 proposed that there are certain personality types which are more prone to develop an addiction *the so called addictive personality+. $e suggested three components of personality, extroversion *vs introversion+, neuroticism and psychoticism. -sing 8uestionnaires, <ysenc) assessed personality types based on their score on each of these three measures. $e found that those who were scored highly on neuroticism and psychoticism were more at ris) of developing an addiction. 2vidence: >rancis /166$0 found a lin) between addiction and high scores on both neuroticism and psychoticism. Cuc5erman /16=30 suggested that individuals high in sensation see)ing *extraversion+ are more li)ely to see) novel experiences, and this would ma)e them more li)ely to develop an addiction. 2valuation: *0+ Cost research is correlational. 1ertain traits may be present in people with addictions but this may 2ust be coincidence or due to a third factor. Eor example, Teeson /2<<20 said it is difficult to see whether the addiction was caused by the persons personality or the addiction caused a change in personality

'>

ST%2SS :oint: Addiction relieves anxiety *stress+ e.g. smo)ing, drin)ing. #hose who have suffered a very stressful situation or long term daily stress are more vulnerable to addiction, especially children and young people. 2vidence: /esearch has found that everyday stress could contribute to initiation and maintenance and explain why people relapse *because life is stressful again+. * &!A,1AAA+. (mo)ers say they smo)e to relieve stress, but actually smo)ing increases stress levelsN $owever, once in the maintenance stage of smo)ing, self medication is occurring to relieve the stress of not smo)ingN * $a2e) et al 'I1I+ !riesssen et al * 'II?+ found that 3I@ of drug addicts and 1F@ of alcoholics also suffer from post traumatic stress disorder. #herefore this is some evidence for the fact that people that people exposed to severe stress are more vulnerable to addictions. 2valuation: *B+ &ndividual differences: stress can explain why some people are more vulnerable to addiction than others.. *0+ 1orrelational: cause and effect *between stress and addiction+ cannot be established 4 it may be that a third variable is involved. *B+ ;ots of supporting research *B+(eems logical and fits in with cognitive self 4medication model.

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M2D-8 -4>.D24C2S 14 8DD-CT-?2 B2*8?-1D% #he media can influence addictive behaviour in two ways: 1. &t can glamourise addictions *in films, #=, etc+, ma)ing them seem cool and playing down any negative effects, thus possibly leading more people to develop an addiction. '. &t can be used to try and reduce addictive behaviour by means of advertising and public health campaigns. 42&8T-?2 -4>.D24C2S :oint: Eilms such as #rainspotting and $uman #raffic ma)e addictions seem exciting and cool, which could lead to an increase in addictive behaviours. #elevision, especially soap operas, portrays potentially addictive behaviours such as smo)ing and alcohol consumption as a part of everyday life 4 this could also increase the li)elihood of addiction. #his can be explained by (ocial ;earning #heory 4 if we see others being rewarded *or not punished+ for a behaviour we are more li)ely to copy it. 2vidence: (ul)enen *'IIG+ found that, in 19I scenes from 9G films, alcohol, drugs, tobacco, gambling and se were represented. Cany films about drugs presented scenes of drug competence and en2oyment of the effects. "unase)era et al. *'IIF+ found that, in ?G of the most popular films of the last 'I years, only 1 in 9 was free from negative health behaviours such as unprotected sex, cannabis use, smo)ing and alcohol intoxication.

2valuation: *0+ .oyd *'II?+ claimed that not all films displayed addiction in a positive manner, and films do regularly represent the negative conse8uences of addiction. *B+ (argent and $anewin)el *'IIA+ found that adolescents who watched films containing smo)ing behaviour were more li)ely to begin smo)ing in the next year. *0+ #he media may have more influence over children and adolescents *than adults+ so findings may not be generalisable. *0+ #he media may only influence some addictions 4 smo)ing and drin)ing are legal so people may be more li)ely to be influenced to try them, whereas illegal drugs such as cocaine and heroin may carry more negative associations so will not be influenced by the media.

'?

:1ST-?2 -4>.D24C2S #he media can be useful in educating a large section of society about the dangers of addiction, via advertising and public health campaigns. 2ffectiveness: A government stop smo)ing campaign in 'II9, using posters showing cigarettes dripping fat to demonstrate the effect of smo)ing on arteries, was found to be more effective than doctors advice in helping people give up smo)ing. #he #obacco <ducation 1ampaign #rac)ing study, commissioned by the government, shows that advertising campaigns prompted 3'@ of recent attempts to )ic) the habit while "Ps were responsible for 2ust '1@. 2valuation: *0+ .etween 1AA? and 'II9 over P1billion was spend on -( anti drugs campaigns, but research suggests that these campaigns may actually have increased cannabis use. *Qohnston et al 'II'+ says that this may be because the adverts gave the impression that cannabis use was commonplace.

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%2DDC-4& 8DD-CT-?2 B2*8?-1D% The Theory of :lanned Behaviour /T:B0 R R R Proposed by A2%en *1A?A+ &t is a cognitive theory about the factors that lead to persons decision to engage in a particular behaviour. According to #P. an individuals decision to engage in behaviour can be directly predicted by their intention to engage in that behaviour.

:ositive or ne)ative attitude to"ards the 'ehaviour+ com'ined "ith 'eliefs a'out the outcome+ e.). Eif - stop smo5in) my health "ill improve.F

R&ntention is a function of 3 factors:

:ersonal perception of ho" society "ould vie" the 'ehaviour+ and "hether the individual is motivated to conform to these social norms+ e.). Emy friends "ill approve of my attempt to stop smo5in).F

8n individual,s 'elief a'out their a'ility to carry out certain 'ehaviours+ ta5in) into account internal and e(ternal control factors

2valuation of the T:B: 3I

R R

/esearch support 0 /esearch into various areas of health psychology have shown that the #P. can be used to predict intention and behaviour. Eor example, Khite *'II?+ found that attitude+ norms and perceived control were significant predictors of intentions to engage in sun protection, and these intentions were significant predictors of actual sun protection behaviour. /eductionism 0 the #P. is criticised for being too rational, as it does not ta)e into account emotions, compulsions or other irrational determinants. &ntention does not always predict behaviour 0 Miller and *o"ell /2<<#0 found that although attitudes, norms and perceived control can predict intentions, they are not good predictors of actual gambling behaviour by underage teenagers. Cethodological issues 3 1)den /2<< 0 highlights that behaviour in studies using the #P. is usually measured using self0report, and thus may suffer from lac) of ob2ectivity, lac) of accuracy and bias.

Biolo)ical treatments !rugs used to treat addiction fall into one of two basic categories: 8)onist #hese act as a less harmful replacement for the dependent drug, resulting in fewer side effects and allowing gradual and controlled withdrawal from the substance. &deally they should be accompanied by counselling and rehabilitation. 8nta)onist #hese bloc) the effects of the target drug and prevent them from having the desired effect.

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4-C1T-42 %2:.8C2M24T T*2%8:B /# is an agonist substitute. icotine itself, whilst addictive, is much less damaging to the body than the other components of cigarettes *such as carcinogenic tars+. 7ne strategy for reducing smo)ing is therefore to replace the nicotine obtained through smo)ing with a safer nicotine source. icotine replacement therapy is available in a number of forms including patches, gum, nasal spray and inhalers. 2ffectiveness of 4%T: *B+ Sel'y /2<120 found that a '1.9@ who called a helpline to receive a free F wee) course of /# were still non smo)ers after six months, compared to 11.>@ of the control group. *B+ large sample 4 19II *0+ high drop out rate 4 only '>II completed all follow up materials *0+ 1anadian study so may not be generalisable *B+ but studies in other countries have found similar success rates with /# *0+ only follows up for > months so doesnt monitor long term effectiveness 2valuation of 4%T: *0+ (ide effects 4 common side effects of /# include disturbed sleep, upset stomach, di%%iness and headaches. *B+ Availability 4 can be bought freely over the counter or may be available on prescription from the smo)ers "P. *0+ Cay not be effective long term 4 a recent study found that about a third of smo)ers relapse after a period of abstinence. /esearchers found no difference in relapse rates amongst those who used /#. *0+ #he individual may become dependent on the /# *B+ $owever, the ris) of dependence on /# is small, and only a small minority of patients *about F@+ who 8uit successfully continue to use medicinal nicotine regularly in the longer term /Molyneu( 2<< 0. *0+ !oesnt address the cause of addiction 4 research suggests that people may smo)e to relieve life stresses. #his treatment does not treat the underlying causes of addiction, so relapse may be more li)ely than with psychological therapies. *B+ 1an be combined with psychological therapies 4 biological therapies can be combined with psychological treatments such as Cotivational &nterviewing to improve long term effectiveness.

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&242%8. 2?8.D8T-14 1> B-1.1&-C8. T%28TM24TS *0+ .ehavioural or chemical 4 research suggests that biological treatments may be more useful for treating chemical addictions *such as smo)ing+ than for behavioural addictions *e.g. gambling+. *B+ $owever, this may be because the recognition and treatment of behavioural addictions is a more recent development, so there is less research evidence available. *0+ <thical issues 4 there may be ethical issues involved in using treatments which interfere with bodily chemicals, particularly for non chemical addictions. *B+ $owever, the individual does give consent for the treatment to be carried out. *0+ Although it could be argued that their addictions ma)e them unable to give fully informed and reasoned consent.

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48.T%2G142 altrexone is an opium antagonist 4 meaning that it bloc)s the action of opoids and endorphins in the brain, this reducing the rush of pleasure felt by the addict when they indulge in the additive behaviour. #he drug has been used for some time to treat chemical addictions such as alcoholism, but is now also being used to treat behavioural addictions such as gambling, sex and internet porn. "rant and Lim *'II>+ suggest that gamblers experience a rush of excitement a)in to that of heroin users. 2ffectiveness of naltre(one: *B+ Lim and "rant *'II1+ found that naltrexone reduced thoughts about gambling, the urge to gamble and 4 at relatively high does 4 gambling behaviour itself. &n a further study, Lim et al *'II1+ found that, over a 1' wee) period, naltrexone was effective than a placebo in controlling the fre8uency and intensity of urges to gamble, as well as the behaviour. *B+ used a double blind procedure to eliminate demand characteristics and investigator effects *B+ only measures over 1' wee)s, so doesnt monitor long term effectiveness 2valuation of naltre(one: *0+ (ide effects 4 possible side effects include nausea, headaches, constipation and insomnia. *0+ !oesnt address the cause of addiction 4 treatment does not treat the underlying causes of addiction, so relapse may be more li)ely than with psychological therapies. *B+ 1an be combined with psychological therapies 4 biological therapies can be combined with psychological treatments such as Cotivational &nterviewing to improve long term effectiveness.

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:sycholo)ical treatments M1T-?8T-148. -4T2%?-2!-4& Cotivational interviewing is a form of cognitive behavioural therapy *1.#+ which aims to change the way the addict thin)s, so giving them the motivation to change their behaviour. &t draws on the theory of cognitive dissonance 4 the belief that we experience uncomfortable psychological tension when we hold two conflicting thoughts in our mind at the same time. #he therapist aims to ma)e the addict aware of the problems of dependency *e.g. health, cost+ and the benefits of abstinence, thus creating cognitive dissonance between this information and their desire to engage in the addictive behaviour. #he therapist then guides the individual towards channelling this dissonance into change by building the addicts sense of self esteem and self efficacy. 2ffectiveness of M!unn et al *'II1+ carried out a review of 'A studies which investigated the success of C& in reducing a range of negative behaviours, including substance abuse and smo)ing. #hey found that >I@ of studies yielded a significant behaviour change. *0+ found to be most effective for substance abuse, so may not be suitable for all addictions *0+ methodological differences between studies *e.g. procedure and sample used+ ma)e it difficult to establish a clear conclusion on effectiveness 2valuation of M*0+ #raining 0 therapists must be fully trained in C& procedures, so time and cost of training may be an issue. *0+ /elies on the addicts commitment to attending regular sessions, which may be a problem if the individual is still in the midst of their addiction. *B+ 1an be combined with biological treatments to increase effectiveness and reduce relapse. Eor example, #/ may help the addict abstain long enough to commit to C&. *0+ May 'e effective lon) term 4 because this treatment aims to change the way the patient thin)s about the addictive behaviour, it may be more effective than biological interventions in preventing relapse.

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8?2%S-14 T*2%8:B Aversion therapy is based on the principles of classical conditioning. &t aims to create a negative association with the addictive behaviour. #his may be achieved by administering drugs which cause nausea when the substance *e.g. alcohol+ is consumed or by means of painful *but relatively mild+ electric shoc)s when the behaviour is carried out. 2ffectiveness of aversion therapy Smith /16==0 gave 3'G smo)ers a five day course of treatment involving aversion therapy and therapy sessions. #he participants self administered shoc)s though a wristband when ta)ing part in smo)ing behaviour, such as opening a pac) of cigarettes or placing one in the mouth. #hey were as)ed not to inhale any of the smo)e so that there were no positive associations with the behaviour. Participants were given a telephone interview to chec) on progress 13 months after the treatment ended. &t was found that F'@ had abstained from smo)ing for 1' months. *0+ self report method 4 prone to social desirability bias *B+ although this may have been reduced because it was a telephone interview rather than face to face *0+ difficult to separate the effects of the therapy and the aversion therapy 4 may have been that the combination of the two was most effective 2valuation of aversion therapy *0+ <thical issues 4 the patient is being sub2ected to a very unpleasant substance or shoc) 4 this raises issues of psychological harm. *B+ 1onsent 0 $owever, patients do consent to the treatment and drop out rates are low. Cany addicts report that they find aversion therapy less unpleasant than psychological tal)ing therapies. *0+ &nformed consent 4 it could be counter argued that addicts are not psychologically healthy, so are unable to give fully informed consent because they may be so desperate to give up their addiction. *0+ /elapse rates are high 4 aversive therapy wea)ens with time, meaning that the patient may return to their addictive behaviour. *B+ /einforcement sessions 4 (mith and Erawley *1AA3+ found that two reinforcement sessions *involving further shoc) treatments+ significantly reduced relapse rates. *0+ 7ther factors 4 (mith *1A??+ found that relapse was much more li)ely when reformed smo)ers returned to a household where others smo)ed. #his suggests that learning and environmental factors are also important considerations in the success of interventions for addiction. 3>

?1DC*2% T*2%8:B =oucher therapy is a behavioural *learning+ theory based on the principles of operant conditioning. #he basic premise is that the addict is given vouchers when they abstain from their addictive behaviour. #hese vouchers can them be exchanged for cash or a reward of their choice. 2ffectiveness of voucher therapy: $iggins et al *1AA9+ gave '? white male American cocaine addicts a voucher every time their urine test was clear from cocaine. #he reward increased for each consecutive test that was clear, but returned to a lower level if they had a positive result. #he participants also received counselling on how to spend their rewards. #he researchers reported a low drop out rate, with around >F@ of addicts staying on the programme for > months. &n a follow up study using a control group who were on a standard drug treatment plan, 11 out of 13 patients receiving voucher therapy stayed on the programme for 1' wee)s, compared to F out of 1F in the control group. *0+ only cocaine addiction amongst white male Americans so may not be generalisable to other addictions5cultures *0+ small sample, so again it is hard to generalise findings *0+ the scheme also involved counselling and s)ills and employment training, so it is difficult to separate the effects of these techni8ues from the effectiveness of the voucher therapy 2valuation of voucher therapy: *0+ 1ontroversial 4 many people would be opposed to rewarding addicts for good behaviour, when the ma2ority of the population is able to abstain without rewards. #his may be a particular problem in the -L because, if the treatment was offered on the $(, it would be the taxpayer who would foot the bill for the rewards. *0+ /elapse 4 voucher therapy does not teach the individual how to deal with their addiction when the treatment ends, so they may relapse. *B+ 1an be combined with other therapies 4 the rewards offered may convince addicts to abstain long enough to commit to other therapies, such as motivational interviewing. #hese may increase effectiveness and reduce the li)elihood of relapse.

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Public health interventions Public health interventions are aimed at changing the behaviour of a large section of The smo5in) 'an Doctor,s advice (mo)ing in public places was banned in the -L in Quly 'IIG. Although the primary ob2ective of this legislation was to protect wor)ers and the general public from the #his intervention simply consists smo)e, of offering smo)ing cessation from doctors harmful effects of second0hand evidence suggests that advice smo)ers have also found and5or nurses at local surgeries. !octors are seen by many as an authority figure that the law has created a more supportive environment for them to 8uit smo)ing. and )nowledgeable. #hey have a clear role in advising about the dangers of addictions. 2ffectiveness 2ffectiveness of doctor,s advice: *B+ (tatistics show that nearly a 8uarter of million people 8uit smo)ing with the help of local $( (top (mo)ing (ervices between April and !ecember 'IIG. 7gden *'IIG+ ;oo)ed at F ;ondon "P( practices. #hey loo)ed at whether the amount of support given by "P( increased the number of people who beat smo)ing addiction 2valuation *0+ $owever, !est /2<<60 found that although there was a decline in the percentage #hey had 9 different conditions: of people smo)ing in the -L who smo)ed prior to the ban on smo)ing, this was 1) followed Eollow upby only 4 were a effect. smo)erAttempts at the start of the study and then 1' months later a rebound to stop smo)ing were actually greater in the they months recorded whether were or not *so received no doctors advice+. nine before the they ban than insmo)ing the 1G months after. ;ess than 1@ had given up 2) Eilled in this 8uestionnaires about smo)ing habits and to follow 1.>@ had up into *B+ .ut, may have been because people tried give up up 6 before thegiven ban came smo)ing.. place. 3) Advised by doctor to give up smo)ing, filled in the 8uestionnaire and follow up 6 3.3@ had given up smo)ing. 4) Advised by doctor to give up smo)ing, given a leaflet with tips for giving up and follow up at 1' months 6 F.1@ had given up smo)ing. (hows that successful cessation increases with a higher level of advice from the doctor. *0+ ;ondon only 4 may not be generalisable. *B+ studies in different areas have found similar results. *0+ only followed participants for 1' months, so does not give a clear picture of long term effectiveness. 2valuation of doctor,s advice <ffective: #he above @ for group 9 loo)s small, but if all "Ps did this *leaflet and advice+, it would lead to half a million people giving up in a year. 1ause and effect: !ifficult to day that the doctors advice given directly led to giving up smo)ing as correlational research method. Cay not wor) with all addictions e.g., could be used with food addiction and even gambling but may not be suitable for others e.g., severe alcoholism. people.

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%estrictin)H'annin) advertisin) &n the -L cigarette advertising was banned in 'II3 and cannot now be shown in any public form i.e. in maga%ines, newspapers, #= or cinema adverts. &t is still legal to advertise alcohol, but is governed by a combination of legislation and self0regulation to ensure that drin) brands are not promoted as having the power to improve social or sexual success, or ma)ing the drin)er popular and attractive. Cessages must also avoid encouraging irresponsible or dangerous behaviour, such as drin)ing at wor) or when driving. &n the -L, annual expenditure on alcohol advertising rose for S1FI million to S'FI million between 1A?A and 'III. 2ffectiveness (tudies comparing cigarette consumption before and after total bans on advertising suggest that there is a significant reduction that cannot be attributed to other measures e.g. increased health education and tighter restriction on sales to young people. 2valuation *0+ Cay not have the same effect for all addictions 0, restrictions on alcohol advertising appear to have little effect on consumption /Smart 16==0.

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