THEORIES OF ADDICTION

By- Manali Naphade ( MA Psychology Sem III)

 What is Addiction?
 Addiction is an inability to stop using a substance or engaging in a behavior even though it is
causing psychological and physical harm.
 The term addiction does not only refer to dependence on substances such as heroin or cocaine.
Some addictions also involve an inability to stop partaking in activities such as gambling,
eating, or working.
 Addiction is a biopsychosocial disorder characterized by compulsive engagement in rewarding
stimuli despite adverse consequences
 Examples of drug and behavioural addictions include alcoholism, marijuana addiction,
amphetamine addiction, cocaine addiction, nicotine addiction, opioid addiction, food addiction,
chocolate addiction, video game addiction, gambling addiction, and sexual addiction
 Major Theories of Addiction
 1) Neuroscientific Theories
a) The Dopamine reward system b) Endogenous Opioid system

 2) Biological Theories
a) Genetic factors b) Neuroadaptation

 3) Psychological Theories
a) Behavioural theories
b) Cognitive theories
c) Personality theories
d) Rational choice theories

 4) Contextual Theories
 Neuroscientific Theories
 These theories require an understanding of the effects of the drugs on the brain
 Different drugs clearly have different primary actions on the brain

 Major pathways of the primary actions of drugs on the brain are-

a) The Dopamine Reward system

b) Endogenous Opioid system
 The Dopamine Reward System
 The critical pathway of brain reward: The mesolimbic-fronto cortical dopamine system
 Dopamine has been implicated in the reinforcing effects of alcohol, with alcohol use resulting
in the direct stimulation of dopamine and also an indirect increase in dopamine levels
 Research also indicates the connection between the behavioural rewards of nicotine, and also
the basis of nicotine dependence with the release of dopamine in the mesolimbic pathway
 Research on rats: Administration of nicotine leads to increased levels of dopamine
 Research on rats: An active component of Cannabis: tetrahydrocannabinol produces
enhancement of brain stimulation reward and increases levels of dopamine
 Endogenous Opioid System
 Exogenous opiates such as heroin, morphine, and codeine act as opiate receptor agonists and
readily cause tolerance and dependence
 Research: Opioid system may also be involved in the rewarding effects of other psychoactive
substances
 Recent research suggests that long-term tobacco-smoking may cause changes in the
responsivity of the endogenous opioid system, which leads to an increased likelihood of
developing nicotine dependence
 The Dopaminergic System- Associated with incentive, preparatory rewards which are
experienced as thrill, urgency and craving
 The Opioid System- Associated with consummatory rewards like rest, blissfulness and sedation
 Biological Theories
 Biological factors can broadly be categorised into two-

 1) Individual differences in liability to drug dependence because of genetic characteristics

 2) Drug dependence in terms of changes that occur in the brain due to chronic drug
administration
 Genetic Factors
 People may inherit an increased likelihood (vulnerability) of developing dependence on
substances
 1) Family Studies:
 Over one-third (36%) of the relatives of persons with an alcohol use disorder were also
diagnosed with an alcohol use disorder (abuse or dependence), compared to 15% of the
relatives of controls
 The rate of alcohol dependence among siblings: among subjects identified with alcohol
dependence, 50% of male siblings met criteria for alcohol dependence, compared to 20% of
controls’ male siblings; the respective rates for female siblings were 24% and 6%
 Among persons whose predominant problematic drug was cannabis, 13% of relatives also had a
cannabis use disorder, compared to 2.4% of controls’ relatives.
 The comparative rates for opiates were 10% vs. 0.4%
 The comparative rates for cocaine 7.5% vs. 0.8%
 Genetic Factors
 2) Adoption Studies:
 Adoption studies examine rates of disorder among adoptees, given their biological and adoptive
parents’ disorder status. This allows evaluation of the effects of genetic (biological parents’
status) and environmental (adoptive parents‘ status) effects on vulnerability to substance use
disorders
 Research suggests that there is a significant genetic factor that influences adoptees’ vulnerability
to alcohol use disorders
 Genetic Factors
 3) Twin Studies:
 Research with twins suggests that there is a significant genetic component (heritability) that
increases the likelihood of dependence on a range of substances.
 Estimates of the heritability of alcohol dependence ranging from 39 to 60% of the total variance
 The heritability of smoking persistence has been estimated at 53%
 For nicotine dependence between 60 and 70%
 Research examining dependence on other drugs has revealed significant heritability estimates
for cannabis dependence (Kendler & Prescott, 1998b; Tsuang et al., 1998) and dependence on
heroin, sedatives, and stimulants
 Genetic Factors
 A further issue: Do persons have a vulnerability towards one specific drug, or is there a more
general vulnerability to a class of drugs or, indeed, to any psychoactive substance?

 In one discussion of this question, researchers concluded: ”There is no definitive evidence

indicating that individuals who habitually and preferentially use one substance are
fundamentally different from those who use another” (Tarter & Mezzich, 1992)
 A recent study found that among the relatives of persons with substance use disorders, rates of
all substance use disorders were higher than those among the relatives of controls
 Genetic Characteristics: Influences may involve multiple genes or incomplete expression of
several major genes
 Relationship between tobacco-smoking and genes involved in dopamine regulation
 Research examining the gene for the brain’s cannabinoid system (CNR1) found that variants of
the CNR l gene were associated with cannabis, cocaine, and heroin dependence
 Neuroadaptation
 Neuroadaptation refers to changes in the brain that occur to oppose a drug’s acute actions after repeated
drug administration.
 Two types of neuroadaptation-
a) Within system adaptation: the changes occur at the site of the drug’s action
b) Between systems adaptation: changes in different mechanisms that are triggered by the drug’s action

 When drugs are repeatedly administered, changes occur in the chemistry of the brain to oppose the drug’s
effects. When this drug use is discontinued, the adaptations are no longer opposed; the brain’s homeostasis
is disrupted
 Essentially, this hypothesis argues that tolerance to the effects of a drug and withdrawal when drug use
stops are both the result of neuroadaptation (Koob, Caine, Parsons, Markou, & Weiss, 1997).
 Animal models have shown that stressful stimuli activate the dopamine reward system, so vulnerability to
relapse from abstinence is hypothesized to occur. As a result, drug use continues in an attempt to avoid the
symptoms that follow if drug use stops
 Neuroadaptation
 Presence of more negative motivational symptoms; such as dysphoria, depression, irritability,
and anxiety may lead to substance abuse and dependence
 Hypothesis- Negative motivational symptoms and neurobiological changes leads to drug
dependence
 These changes indicate not only “the beginning of the development of dependence, but may
also contribute to vulnerability to relapse and may also have motivational significance”
 Neuroadaptation and the timing of drug use or dependence
 Psychological Theories
 Psychological approaches to the explanation of drug dependence have often been based on concepts that
are common to those of other syndromes of behaviour involving compulsive or impulsive behaviours, such
as obsessive-compulsive disorder or gambling

 In particular, emphasis is given to the fact that there is impaired control over use and continued use despite
usage problems

 There are a variety of psychological approaches to the explanation of drug dependence, including
emphasis on learning and conditioning (behavioural models), cognitive theories, pre-existing behavioural
tendencies (personality theories), and models of rational choice
 Behavioural Theories
 Observational Learning and Modelling
 Operant Conditioning- consequences of consuming alcohol and drugs (positive reinforcement)
 Drugs could generally be reinforcing in two ways:
a) Through the direct effects of drugs on some sort of reinforcement system in the brain
b) Through its effects on other reinforcers (such as social or sexual reinforcers) or
behavioural effects (such as increased attention)

 Using animal research models, it has been possible to control the history of use (learning) and
current environmental conditions of use (cues). As a result, it has been shown that both of these
factors are important in the development of persistent use or abuse of drugs
 Behavioural Theories
 Classical Conditioning – Plays an important role in the development and maintenance of
addictive behaviours
 Cue Exposure Theory: Based on classical conditioning, argues that cues are important in the
development and maintenance of addictive behaviour
 A cue that has previously been present when drugs were administered will be more likely to
elicit a conditioned response (cue reactivity). This is thought to underlie craving, and may
explain why someone who was dependent on a substance but has been abstinent for some time
experiences strong cravings
 Exteroceptive cues occur before the use of a drug, and may include the smell of an alcoholic
drink, the sight of a needle, or may even constitute the time of day when drugs are typically
taken.
 Interoceptive cues include such things as the effects of a drug on the brain's receptors, mood
cues such as depressed affect or cognitions such as beliefs about drug effects
 Behavioural Theories
 Cue Exposure Theory-

 The response to these cues may be autonomic, behavioural, or symbolic-expressive

 Autonomic responses to the cues- changes in heart rate, temperature, and salivation
 Behavioural responses to the cues- an increased likelihood to use drugs
 Symbolic expressive responses to the cues- self-reported drug-craving and urges to use drugs
 Cognitive Theories
 Self-regulation is an important factor in the development of drug use problems
 Self regulation has been described as taking “planful action designed to change the course of
one’s behaviour”
 Self regulation has also been defined as the “executive (i.e. non-automatic) capacity to plan,
guide and monitor one‘s behaviour flexibly, according to changing circumstances”
 Self-regulation involves planning, taking into account social and physical factors as well as
one’s own goals, and acting appropriately
 Addictive behaviours are seen as the result of having an excessive reliance on external
structures in the case of drug dependence
 Addictive behaviours are seen as the result of excessive reliance on substance use - to maintain
a physical and psychological balance
 Personality Theories
 Some theorists argue that certain people are more prone to addiction through a so-called
“addictive personality”
 Psychological resource model by Hans Eysenck- habit of drug-taking is developed because the
drug used fulfils a certain purpose that is related to the individual’s personality profile
 For such people, drug-taking behaviour - or, more specifically, “addiction” - holds benefits even
though there are negative consequences that occur after some time.
 Eysenck’s three major and independent personality dimensions:
1) Psychoticism- an underlying propensity to functional psychosis (coldness, impulsivity,
aggression)
2) Neuroticism- a propensity towards emotional liability (anxiety, moodiness, irritability)
3) Extraversion- a propensity towards being outgoing, adventurous, sociable, lively
 Personality Theories
 Eysenck’s model-
 There has been extensive examination of the relationship between drug dependence and these
personality dimensions
 Researches examining link between Extraversion & drug dependence: 10 studies found a
negative relationship, 2 found a positive correlation, and 12 found no significant relationship
 Researches examining link between Neuroticism, Psychoticism & drug dependence: Persons
with dependence on a range of substances - alcohol, heroin, benzodiazepines, nicotine - have
higher than normal N and P scores
 Furthermore, research examining the genetic contributions to personality suggests that
dimensions such as N may indicate vulnerability to psychopathology in general, not simply a
tendency to have an “addictive personality” per se
 Rational Choice Theories
 Why do people voluntarily engage in self-destructive behaviour?
 One of the central elements of drug dependence is the fact that the individuals have impaired
control over their use of the substance
 This may manifest itself in continued use despite a wish to reduce or stop use of the drug, to use
greater amounts of the drug than intended, or to use the drug for longer periods than intended
 For such theorists, drug-dependent persons have a choice of two options, both of which may be evaluated
in terms of their future consequences. They realize that one option is superior, yet choose the other; for
instance, an individual may have made the decision to stop drinking and yet accept a drink from someone
even though the individual knows, at that particular time, that he or she should not.
 As Elster and Skog (1999) point out, the problem with this approach is that it is difficult to know whether
such a person knew at the time of acceptance that choosing the drink was the less preferred option. The
person may have made this considered decision before the party, and regretted accepting the drink after the
party, but it is difficult to ascertain whether he or she thought so at the time of accepting the drink
 Rational Choice Theories
 In contrast, some theorists argue that drug-dependent persons do make rational choices in their
continued use of drugs.
 The aim of these theories is to explain how rational people can become "knowingly trapped in a
consumption pattern and even when they realise that their current lifestyle is actually
suboptimal (i.e. not the best thing, all things considered), still continue to act the same way“
 A number of attempts to explain this paradox have centred on people's ability to weigh present
and future benefits - in other words, their ability to consider the immediate rewards associated
with drug use, weighed against the longer-term benefits of abstention
 One approach- Cognitive myopia- a limited ability to consider future benefits
 Another approach- while people are able to consider a range of future benefits, present and
future benefits are differentially weighted, with greater weight given to the present
 Contextual Theories
 People with antisocial personality disorder- more likely to develop addiction behaviours
 Adolescents with conduct disorder-more likely to develop addiction behaviours
 Children or young people with anxiety or depressive symptoms are more likely to begin
substance use at an earlier age, and to develop substance use problems
 Peer pressure and peer environments & drug dependence
 Modelling of substance use by parents and other family members
 Parents holding permissive attitudes towards the use of drugs by their children, their children
will be more likely to use drugs
 Family discord, disturbed family relationships & low levels of bonding
 Inconsistent behavioural management techniques by parents
 Socio-economic & socio-cultural background & drug dependence
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