Addiction: A-level Psychology

Addiction is characterized by key features:

• Dependence
• Tolerance
• Withdrawal symptoms

Addiction is included in the Statistical Manual of Mental Disorders (DSM 5) in the category “Substance-related and Addictive Disorders.”

The only behavior included is gambling, as not enough research on other behavior, such as internet use, has been carried out to justify their inclusion.

Dependence (AO1)

Dependence takes two forms:

• Physical dependence: occurs when a person has used a substance so often, and in such amount, that they experience withdrawal symptoms when they stop using it.
• Psychological dependence: an emotional need to use a substance or perform a behavior, with no underlying physical need. People who stop smoking recover physically quickly, but the emotional need for nicotine takes far longer to fade.

Tolerance (AO1)

Tolerance is shown when a person has a diminished response to a drug as a result of repeated use. The individual has to increase the dose of the substance to obtain the same effects as their initial response.

Tolerance is a physical effect of repeated use. It is not necessarily a sign of addiction.

Tolerance can develop to legal drugs, such as benzodiazepines (Valium), and to illegal ones, such as cocaine.

Tolerance varies by effect. To get the euphoric feelings produced by cocaine, an individual might have to increase the dose. The effects on the respiratory system, however, increase with the amount taken. This can lead to respiratory arrest and death.

Withdrawal Syndrome (AO1)

Withdrawal syndrome is the set of unpleasant physical and psychological symptoms that appear when a substance the body has adapted to is stopped or reduced. It occurs in drug and alcohol-addicted individuals who discontinue or reduce use.

The brain has adapted to the drug’s presence. When the level falls, or the drug is absent, the brain seeks the substance to bring the level back up.

This can lead to very unpleasant psychological symptoms, such as depression and anxiety. Physical symptoms include nausea, loss of sleep, and weight loss.

The type and severity of the symptoms depend on the type of drug, the amount used, and the length of time the substance has been used. Fear of withdrawal syndrome often motivates people to carry on using the drug.

AO2 Scenario Question

Marie shows physical dependence on nicotine. She has used it so often, and in such amounts, that she experiences withdrawal symptoms when she does not smoke for a short time. This is why she feels the urge to smoke more often than when she started.

She has also developed tolerance. Her response to nicotine has diminished through repeated use, so cigarettes no longer relax her as much as they used to. She has to increase the dose to obtain her initial response of relaxation.

Risk factors in the development of addiction (AO1)

Genetic vulnerability AO1

Genetic factors play a role in addiction by predisposing individuals to become addicted to some substances. They do so by influencing how a substance is metabolized. This shapes how strongly its effects are felt.

For example, Europeans generally metabolize alcohol quickly, so they do not feel sick. Roughly half of people of East Asian ancestry carry a gene variant that causes marked nausea after even small amounts of alcohol. As a result, they are less likely to become addicted to alcohol.

Genes alone are never enough. There has to be a gene-environment interaction: if the individual is not exposed to the drug, they cannot become addicted.

Evaluation AO3

• There is support for the influence of genetic factors. For example, Kendler et al., 1997 carried out a twin study on a 2516 twin Swedish males sample and found a concordance rate of 33% for MZ twins and 15% for DZ twins. This suggests a significant influence of genetic factors.
• However, it also highlights the importance of environmental factors, as the concordance rate for MZ twins in all the studies was less than 100%. Additionally, the studies make the assumption that twins share exactly the same social environment, but MZ twins are treated more similarly by their social environment than DZ twins.
• Furthermore, the samples are not representative of the general population as their developmental environment is different from non-twins; e.g., before birth, they have to share the mother’s nutrients and oxygen, which is not the case for non-twins. This could have influenced their development.
• Furthermore, Kendler et al., 2012 found that individuals with one addicted parent who were adopted away from their biological parents had a greater risk of becoming addicted, 9%, compared to individuals also adopted away from their biological parents who had no addiction, 4%.
• Verhulst et al. (2015) pooled 12 twin and five adoption studies of alcohol use disorders. Heritability was about 49%, with no difference by study design or sex. Shared environment explained about 10%.
• This type of study is now relatively rare. Still, they are important as they allow us to distinguish the contributions of genetic and environmental factors because biological relatives have only genes in common with the adopted individual. Adoptive relatives have only a shared environment in common with the adopted individual; the relative influence of genetic and shared environmental factors can be estimated by comparing the incidence of a disorder or the similarity of a trait in biological relatives to adoptive relatives.
• However, adopted individuals might still have contact with their biological family. Furthermore, the individual shared the social family environment until adoption and could have been influenced by it, so the influence of the shared environment is not completely eliminated.

Wider limitations of the genetic explanation:

• The vulnerability varies across substances, so it is specific rather than a general susceptibility to getting addicted to any substance.
• This explanation does not take into account social factors such as social norms, peer pressure, and moral values, e.g., some people choose not to take drugs or drink alcohol for moral or religious reasons.
• It is an example of biological reductionism as this explanation suggests that an individual is likely to become addicted to a substance due to their genetic makeup but does not take other factors into account, e.g., social factors such as peer pressure, social norms, and moral values. An interactionist approach combining genetic influence with social factors would be more appropriate and more likely to lead to more effective ways to deal with addiction.
• It is a determinist explanation as it does not recognize free will in whether an individual develops an addiction.
• It is a socially sensitive explanation as it implies that people are not responsible for their condition and the consequences, e.g., stealing to buy drugs.

Stress AO1

High levels of stress make people more vulnerable to addiction. They might turn to substances or behavior that give them temporary relief as a coping mechanism.

However, addiction is less likely in stressful situations if there are mediating factors, such as social support.

The stress could come from the social environment, such as family. It can also come from where people live. There are more people addicted to drugs in cities than in the countryside. This could be because drugs are more easily available in urban environments.

Evaluation AO3

• Stress could also be due to childhood trauma, such as sexual abuse. This is supported by Epstein et al. (1998), who found that women with a history of childhood rape had twice as many Post Traumatic Stress Disorder (PTSD) symptoms as women who had not been raped. They also had significantly more alcohol symptoms.
• Furthermore, childhood rape victims with PTSD symptoms had twice as many alcohol-related symptoms as victims without PTSD symptoms. This suggests that PTSD may be one of the contributing factors to alcohol use. It could be that people experiencing PTSD use alcohol to gain relief from the persistent memories of the abuse.
• Tovalacci et al., 2013 found that highly stressed university students (stress measured by a questionnaire) were more likely to smoke and abuse alcohol and were at higher risk of addiction to the internet. This suggests a link between stress and addiction; however, this was a correlational study, so it did not show a causal relationship between the two factors. Furthermore, the stress was measured using a questionnaire, so social desirability could have influenced the results.

Personality AO1

Eysenck (1997) proposed that some personality types were more prone to addiction. For example, those with high neuroticism (high levels of irritability and anxiety) and those with high psychoticism (aggressive and emotionally detached).

However, this theory is now rejected by most psychologists. The link between personality and addiction is still being investigated, and one factor seems key to addiction, impulsivity.

This is characterized by a lack of planning, risk-taking, and the desire for immediate gratification of desire.

Evaluation AO3

• Ivanov et al. 2008, showed a strong link between impulsivity and drug use. Morein-Zamir et al. 2015 found inhibitory difficulties mediated by frontostriatal circuitry. This suggests that there is a neurological cause for impulsivity which in turn leads to addiction. However, more research is needed on this topic.
• One strength of this explanation is that it could help identify individuals at risk of developing addiction and provide them with help before they do. This would reduce the personal cost to the individual and to society.

Family influences AO1

Social influences on addiction work through the family and through peers. Two key features of family influences are social learning theory and perceived parental approval.

Social Learning Theory or social learning – AO1:

The individual (child or adolescent) observes their parents smoking or drinking, and the results of the behavior. For example, the parents feel more relaxed or seem to experience pleasure.

The individual imitates the behavior to get the same result. Over time and repeated exposures, the individual becomes addicted.

Evaluation AO3

• However, cognitive factors mediate whether the child will smoke or not. He might be influenced by other sources, such as health messages and peers. Furthermore, the influence depends on the age of the individual younger children are more influenced by their families than older ones.
• It also depends on how much he/she identifies with the model of the behavior.

Perceived parental approval- AO1:

The adolescent perceives that their parents hold a positive, or at least permissive, attitude towards a particular drug or addictive behavior, such as gambling. As a result, the adolescent is more likely to develop the habit.

This perception might rest on the parents’ own drug use. It might also rest on a lack of monitoring, for example letting the teenager drink to excess at home.

Evaluation AO3

• Quine and Stephenson 1990 carried out a study on a sample of 2336 10-12 years old Australian children and found that children were significantly more likely than other children to have the intention to drink or to have drunk a glass of alcohol if their parents drank at least weekly.
• Furthermore, Bonomo et al. (2001) found adolescents who had experienced an alcohol-related injury were 1.8 times more likely than other adolescents to have parents who drank alcohol daily.
• However, it is difficult to separate and measure the influence of the family from all other influences, such as peers and the media. Furthermore, these studies are correlational, so they do not show cause and effect.

Peers- AO1:

The influence of peers is greater than the influence of the family, according to Quine and Stephenson 1990.

O’Connell suggests that there are three features of peer influence that lead to addiction to alcohol or other drugs.

• An individual is influenced in his drinking or use of drugs by associating with peers who themselves drink or use drugs.
• These peers provide opportunities (and possibly access) to drink or use drugs.
• The individual overestimates how much their peers drink or use and increase their own consumption to keep up.

Evaluation AO3

• It is difficult to test the influence of peers. It could be the choice of peers to follow the addiction rather than the addiction being the result of the association with a particular group.
• The influence of peers varies in importance depending on the age of the individual. Peers are more important in the teenage years, after which their influence decreases.
• It is impossible to disentangle the influence of peers from other social influences, such as the influence of the family and media.
• This approach does not take into account other possible factors, such as social deprivation, unemployment, and stress.
• The research done is mostly correlational, so it does not show a causal relationship between the factor studied and addiction.
• No factor is by itself causal to addiction. These and other factors combine in various ways to lead to addiction but also to abstention from drugs, alcohol, and gambling. These factors can be social such as social norms and health messages, but also personal experience. For example, an individual who has seen his parents drinking to excess regularly might choose to avoid alcohol and become teetotal others might choose to abstain from drugs and alcohol for moral or religious reasons. So these are risk factors but not causes.
• However, research on this topic is important as it can be the base for preventing and treating addiction. For example, teenagers who don’t use alcohol, cigarettes, and other drugs are less likely to use them as adults. Therefore, targeting prevention health messages to teenagers is an effective way to prevent addiction in adult life.

AO2 Scenario Question

Julie’s addiction could be explained by genetic factors. Her parents drink alcohol. They might have passed on genes that influence how alcohol is metabolized. This could enhance the positive effects of alcohol and decrease the negative ones.

However, it could also be explained by social learning. She has observed family members drinking and showing positive consequences, such as feeling more relaxed (vicarious reinforcement). So she is imitating the behavior to get the same pleasant consequences.

Julie could also have been influenced by her school friends, according to O’Connell. She has associated with friends who drink vodka.

They might have provided opportunities and access to alcohol. She could also have overestimated how much her peers drank and increased her own consumption to keep up.

Another possible reason is her demanding job. It increases her stress, so she might turn to drinking as a coping mechanism because it gives her temporary relief.

Explanations for nicotine addiction

Brain neurochemistry

Brain neurochemistry explains nicotine addiction through two chemicals: acetylcholine and dopamine. Nicotine binds to receptors normally activated by acetylcholine, which triggers dopamine release in the nucleus accumbens, the brain’s reward center. Two accounts follow: the desensitization hypothesis and the nicotine regulation model.

Desensitization hypothesis – AO1:

Acetylcholine (ACh) is a neurotransmitter that, like all neurotransmitters, binds with receptors and activates post-synaptic neurons. One subtype of ACh receptors is called nicotinic receptors. They bind with both nicotine and ACh.

When nicotine binds with nicotinic receptors, the neuron becomes stimulated. Almost immediately, the receptors shut down, and the neuron does not respond to any neurotransmitters (desensitization).

This also releases dopamine in the nucleus accumbens. This generates a pleasurable feeling, increased alertness, and a reduction of anxiety.

Evaluation AO3

• The Desensitisation hypothesis is supported by Domino, 2004 who used fMRI scans that showed a change in the blood flow in the nucleus accumbens, amygdala, and hippocampus immediately after smoking the first cigarette in the morning.
• After smoking the second cigarette, the effects were less than smoking the first. Low-nicotine cigarettes produced fewer changes in blood flow than those after the first average cigarette.
• D’Souza and Markou, 2013 found that by blocking the transmission of glutamates in rats, they reduced their addiction to nicotine.
• These results cannot be extrapolated without caution as animals are physiologically and psychologically different from humans, but it can give rise to research in humans and treatments aiming at blocking the transmission of glutamates to reduce addiction to nicotine.

Nicotine regulation model – AO1:

When the smoker does not take nicotine for a prolonged period, the nicotine is metabolized and excreted. The nicotinic receptors become sensitized again. This causes agitation and anxiety (withdrawal symptoms). These feelings motivate the individual to smoke.

Additionally, the increased ACh transmission is accompanied by a decrease in dopamine activity.

Repeating this cycle creates chronic desensitization of the nicotinic receptors. The intake of nicotine has to increase to produce the same effects (tolerance).

The prolonged use of nicotine also increases the number of nicotinic receptors.

Nicotine stimulates the release of glutamate too. Glutamate speeds up the release of dopamine, increasing the rewarding effects of nicotine.

Evaluation AO3

• The link between the use of nicotine and dopamine is also supported by the study of patients with Parkinson’s disease (this disorder is due to the loss of dopamine-producing cells). Research shows that smokers are less likely to develop Parkinson’s disease than non-smokers.
• This suggests that nicotine has a protective effect against the development of Parkinson’s disease and supports the existence of a link between nicotine and dopamine.
• Cosgrove et al. (2014) compared the brain of men and women while smoking using PET scans and found that the dopamine effect took place in different regions of the brain. This suggests that men and women might smoke for different reasons. This is not taken into account in this explanation.
• This explanation is limited as research shows that there are many more neurotransmitters involved in the addiction to nicotine, such as serotonin and GABA.
• This research is very important as addiction to smoking leads to very serious disorders such as cancer of the lungs, which can be fatal and is very expensive to treat, so the development of treatments based on this research can contribute to individuals’ well-being and to the economy.
• This explanation is reductionist; it focuses only on neurochemical processes and fails to take into account social and psychological factors, so it cannot explain why, as Choi et al. (2003) found the teenagers who were the most likely to get addicted to nicotine were individuals who felt that they were underachieving. It cannot explain either individual differences. For example, some people can be and remain occasional smokers, while others get addicted to nicotine very quickly.

AO2 Scenario Question

Nicotine from the tobacco enters Josh’s bloodstream. It reaches his brain very quickly. There it binds with nicotinic receptors.

The neurons become stimulated. Almost immediately, the receptors shut down, and the neurons stop responding to any neurotransmitters (desensitization).

This also produces dopamine in the nucleus accumbens. Josh feels pleasure, alertness and less anxiety.

Josh does not smoke during the night. The nicotine is metabolized and excreted, and the nicotinic receptors become sensitized again. This gives rise to agitation and anxiety (withdrawal symptoms), so he wakes up craving a cigarette.

The first cigarette of the day is the best. The receptors have been sensitized, so Josh feels the effects of nicotine more than after later cigarettes. During the day, he smokes often enough to avoid the unpleasant effects of abstinence.

Learning Theory

The learning theory explanation of nicotine addiction aims to explain the initiation, maintenance, and relapse of nicotine addiction.

• Initiation: social learning theory (SLT).
• Maintenance: operant conditioning.
• Relapse: cue reactivity, a craving triggered by cues that have become linked to smoking through classical conditioning.

Social Learning Theory (SLT) – AO1:

SLT suggests that people begin to smoke, particularly when they are young, due to learning from their social environment. They observe people, such as peers or parents, smoking. They also observe the consequences: for example, they enjoy it, they look “cool,” and they are popular (vicarious reinforcements).

So they imitate smoking to get the same reinforcements.

Mayeux et al. (2008) carried out a longitudinal study. They found significant positive correlations between smoking at 16 and popularity two years later in boys. In girls, however, smoking at 16 was negatively related to popularity at 18.

This suggests that popularity might act as a vicarious reinforcement, rather than a direct positive reinforcement, for boys but not for girls.

Evaluation AO3

• DiBlasio & Benda (1993) found that adolescents who smoked associated themselves with other smokers and were more likely to conform to the social norm of a smoking group.
• This explanation accounts for the motivation to start smoking but does not explain why smoking continues despite the consequences -punishments-such as the cost, the health warnings, and the health difficulties resulting from smoking.
• This explanation has practical applications in the prevention of smoking. Individuals could be taught the skills necessary to resist social influence (Botvin, 2000).

Operant conditioning – AO1:

Operant conditioning explains why smoking continues after initiation. When an individual smokes, he/she gets positively reinforced by the action of nicotine on the dopamine reward system.

Nicotine leads to a release of dopamine in the nucleus accumbens, and this produces a mild feeling of euphoria, thus rewarding the behavior (smoking).

Not smoking, however, causes agitation and anxiety. This acts as a negative reinforcement. Therefore, the behavior (smoking) is more likely to be repeated to avoid withdrawal symptoms.

Evaluation AO3

• Levin et al., 2010 trained rats to self-administer nicotine by licking one of two waterspouts. The number of licks increases with each training session which suggests that the effects of nicotine (higher dopamine leading to mild euphoria) reinforce the behavior of taking nicotine.
• However, this study was carried out on animals, so we cannot extrapolate to humans without caution as we are different both psychologically and physiologically, so the effects might be different in humans.
• Furthermore, the study used only nicotine, but real cigarettes and other tobacco products contain many other constituents, which might also affect the behavior, so the results might not represent the response to tobacco as a whole.

Cue reactivity- Classical conditioning – AO1:

Cue reactivity is the theory that people associate situations (e.g., meeting with friends) and places (e.g., a pub) with the rewarding effects of nicotine. These cues can then trigger a feeling of craving.

These factors become smoking-related cues. Prolonged use of nicotine creates an association between these factors and smoking.

This is based on classical conditioning. Nicotine is the unconditioned stimulus (UCS), and the pleasure caused by the increase in dopamine is the unconditioned response (UCR).

Following this increase, the brain tries to lower the dopamine back to a normal level. The stimuli that have become associated with nicotine were neutral stimuli (NS) before “learning” took place. With repeated pairings, they became conditioned stimuli (CS).

The conditioned stimuli can produce the conditioned response (CR). If the brain has not received nicotine, the levels of dopamine drop, and the individual experiences withdrawal symptoms. Therefore, the individual is more likely to feel the need to smoke in the presence of these cues.

Evaluation AO3

• This can explain the maintenance of smoking and relapse in individuals who have given up smoking but cannot explain why people start smoking.
• Carter and Tiffany, 1999 support the cue reactivity theory, and they carried out a meta-analysis reviewing 41 cue-reactivity studies that compared responses of alcoholics, cigarette smokers, cocaine addicts, and heroin addicts to drug-related versus neutral stimuli. They found that dependent individuals reacted strongly to the cues presented and reported craving and physiological arousal.
• Calvert,2009 found that when smokers were shown packets of cigarettes, they experienced strong activation in the nucleus accumbens. This supports cue reactivity as the cigarette packets acted as a cue and elicited the same activation pattern as the intake of nicotine produces

Social Learning Theory (SLT) – AO3:

• There are practical applications: some treatments, such as aversion therapy and covert sensitization, are derived from this explanation (see reducing addiction).
• These treatments have been shown to be effective. It does not explain why men and women show some differences. For example, women find giving up smoking more difficult than men and are more likely to relapse than men.
• It does not explain why many people start smoking but do not become addicted. This suggests that other factors are involved which are not considered by this theory.
• Operant conditioning and classical conditioning are deterministic explanations; however, SLT does accept that the individual might decide not to imitate the behavior displayed by the models, so some free will is recognized in this instance.
• This theory does not take into account other negative environmental factors.
• Robins (1973) carried out research on American Vietnam veterans. About 20% of American soldiers were using heroin during the Vietnam war; however, when they returned home, she found that “only 5% of the men who became addicted in Vietnam relapsed within 10 months after return, and only 12% relapsed even briefly within three years”.
• These results are supported by Alexander et al. (1981). They placed rats in a cage in which they could drink from two dispensers. One dispenser contained a morphine solution, and the other plain tap water.
• When the rats were on their own, they drank 19 times more of the morphine solution than they did when they were with other rats.
  These studies suggest that negative environmental factors can lead to drug use and maintain addiction.

AO2 Scenario Question

Pubs and clubs are smoking-related cues for William. He has come to associate them with the rewarding effects of smoking over time.

The cues can produce an increase in dopamine. This brings the related feelings of pleasure and reduced anxiety. Following this increase, the brain tries to lower the dopamine back to a normal level.

But William’s brain no longer receives nicotine, so the levels of dopamine drop. William experiences withdrawal symptoms. This is why he struggles more in the presence of these cues.

He also struggles after a stressful day. He is craving the negative reinforcement (decreased anxiety) that nicotine used to provide when he smoked.

Explanations for gambling addiction

Social Learning Theory (SLT)

SLT suggests that people begin to gamble due to learning from their social environment. They observe people, e.g., peers or parents, gambling and the consequences of the behavior, e.g., they enjoy the excitement, and they win money (vicarious reinforcements). So they imitate the behavior- gambling- to get the same reinforcements.

Operant conditioning

The behavior of gambling is maintained by direct positive and negative reinforcements. A reinforcement is anything that makes a behavior more likely to be repeated.

• Positive reinforcement: anything that rewards the behavior, for example winning money, the excitement of betting, or the social life of casinos and betting shops.
• Negative reinforcement: anything unpleasant that is avoided by performing the behavior. Gambling, for example, can offer an escape from a stressful life and loneliness.

Schedules of Reinforcement: Continuous and Variable Ratio

• Continuous reinforcement: Skinner’s research with rats and pigeons found that behavior reinforced by food every time it was performed (fixed ratio), such as pecking a disc, was repeated. When the rewards stopped, the behavior quickly ceased (extinction).
• Variable ratio reinforcement: a type of partial reinforcement. Only some responses are rewarded, and it is impossible to say when. The behavior takes longer to learn but, once learned, is very resistant to extinction.

Applying the theory to gambling, a fruit machine might be set to give a payout on average every 30 games.

An individual might win at the 5th game and then not until the 47th game (variable ratio). They carry on playing despite the losses, waiting for the reward.

Evaluation (AO3)

• It could be argued that operant conditioning does not explain why people continue gambling when they lose more often than they win, as the loss is punishment. Therefore, it should make gambling less likely.
• However, the magnitude of the losses is less obvious than the magnitude of the wins, e.g., in a fruit machine, the losses are a few pounds at a time, so they are not so obvious, but the win might be £50 at once, so it is more noticeable.
• Furthermore, the loss being relatively small each time does not give rise to a lot of anxiety, but the win gives rise to a feeling of euphoria, so the association between the behavior and the feeling of triumph is greater.
• Parke & Griffiths,2004 found support for the reinforcing role of winning but also of “near-win” (coming very close to winning, e.g., the horse comes second). This means that gambling is rewarded not only by winning but also by nearly winning, which makes it more addictive.
• Operant conditioning cannot explain how people start gambling (see SLT) but can explain how the behavior is maintained.
• Operant conditioning requires contiguity between the behavior and the consequences (short delay between the gambling and the win or loss).
• However, in some gambling activities such as poker or betting on the outcome of a sports game or a horse race, there is a fairly long delay between the two, so the association between the behavior and the consequences should be weaker than for fruit machines, but this does not seem to be the case as both types of gambling seem to be equally addictive.
• This theory cannot explain why many people gamble at some point during their lives and experience reinforcement. Only a relatively small number of people become addicted to gambling.
• This suggests that other factors are involved in the formation of gambling addiction.
• This theory is beta biased (it does not acknowledge the difference between men and women). According to a study of gambling in Victoria, Australia, by Hare, 2009 using a sample of 15 000 adults, 1.3% of men were addicted to gambling but only 0.6% of women.
• They also found that men were more likely than women to gamble for social reasons or for general entertainment, but women were more likely to gamble to relieve stress, loneliness, and boredom. This suggests that there are differences between the genders that the theory cannot explain.
• This theory is reductionist. It does not take into account the physiological rewards experienced by gamblers, such as the adrenaline and dopamine involved in the ‘buzz’ of winning.
• Operant conditioning is deterministic; it does not recognize free will, and the behavior is determined by the consequences, but SLT recognizes that the individual might not want to imitate the gambling behavior observed for moral or religious reasons.
• This explanation has practical applications: some treatments, such as aversion therapy and covert sensitization, are derived from the learning explanation (see reducing addiction). These treatments have been shown to be effective.

AO2 Scenario Question

Operant conditioning could explain Alice’s addiction. According to this theory, gambling is maintained by direct positive reinforcement. In Alice’s case, this was winning on two occasions.

However, the reinforcements are received only intermittently and unpredictably (variable reinforcement). For example, a fruit machine might be set to give a payout on average every 30 games.

An individual might win at the 5th game and then not until the 47th game (variable ratio). They keep playing despite the losses, waiting for the reward.

The behavior takes longer to learn but, once learned, is very resistant to extinction. Parke & Griffiths (2004) also found support for the reinforcing role of winning and of “near-wins” (coming very close to winning, e.g., the horse comes second).

This means gambling is rewarded by nearly winning as well as by winning. Alice has had a few near misses. This makes gambling even more addictive.

Cognitive theory explanation for gambling addiction AO1

The cognitive theory explains gambling in terms of irrational/ maladaptive thought processes. It focuses on the reasons people give for gambling.

According to the cognitive theory, gambling can be explained by cognitive biases.

A Cognitive Bias is a pattern of thinking and processing information about the world that produces distorted perceptions, attention, and memory of people and situations around us.

These biases operate at an automatic, pre-conscious level. They still influence attention and memory linked to the behavior.

Rickwood et al. (2010) identified four main categories of cognitive biases:

1. Skill and Judgement: Gamblers tend to overestimate the amount of control they have over their chances of winning, even with random forms of gambling such as the lottery. They may look back over recent draws and believe they can spot patterns in the winning numbers.
2. Personal characteristics and Rituals: Gamblers sometimes believe themselves to be naturally luckier than other people. They engage in ritualistic behaviors prior to or during gambling which they believe may influence the odds in their favor, e.g., they have a lucky number.
3. Selective Recall: The tendency to overestimate wins and underestimate losses and to see big losses as totally inexplicable.
4. Faulty perceptions: these include Gambler’s fallacy, the idea that random events equal themselves out over time, e.g., “I haven’t won for three weeks, so it should be my turn soon.”

Evaluation (AO3)

• The theory is also supported by Michalczuk et al. (2011), who compared 30 pathological gamblers with 30 healthy controls. The gamblers reported more cognitive distortions on a questionnaire, the Gambling-Related Cognitions Scale.
• The results of these two studies support the cognitive explanation as it shows the presence of cognitive biases expected and irrational beliefs, e.g., attributing personality and moods to a fruit machine in the addicted gamblers.
• However, it could be argued that what the participants uttered whilst using the slot machines did not represent what they really thought, but as these biases operate at a pre-conscious level, it is very difficult to access these beliefs in any other way.
• It is impossible to know if cognitive biases are a cause or the symptoms of gambling addiction. If they come before the addiction, the theory does not explain how these biases occur or why they occur in some people and not others.
• This theory is also beta biased. Hare (2009) found gender differences in gambling addiction and in reasons for gambling (see the operant conditioning evaluation), which the theory cannot explain.
• This explanation is reductionist; it sees the gamblers in isolation from their social environment. For example, if people are struggling financially, it might make sense to buy lottery tickets regularly in the hope of a big win that would solve their problems. Furthermore, it does not take into account the physiological rewards experienced by gamblers, such as the adrenaline and dopamine involved in the ‘buzz’ of winning.
• A more holistic explanation combining cognitive, physiological, and social factors would be more complete.
• The knowledge of how gamblers think has practical applications. For example, cognitive behavioral therapy aims at addressing these biases and irrational beliefs to reduce gambling addiction.

AO2 Scenario Question

Ben shows cognitive biases. Rickwood et al. (2010) identified some of them. One is skill and judgment. He thinks he can identify patterns in the lottery-winning numbers.

This gives him the illusion of control in a game where the results are completely random.

Another bias is his use of rituals, such as using the same pen at the same shop at the same time every week. He believes these rituals may influence the odds in his favor. He thinks betting online would prevent him from winning.

Reducing addiction

The AQA specification names three ways of reducing addiction: drug therapy, behavioral interventions (aversion therapy and covert sensitization), and cognitive behavioral therapy (CBT). Each can be evaluated for appropriateness, such as cost, ethics and practicality, and for effectiveness, meaning the outcome evidence.

Drug Treatments

There are three basic types of drug treatments:

1. Aversives:
   These drugs produce unpleasant consequences, e.g., vomiting and nausea, if taken with specific drugs. For example, if people consume alcohol while taking disulfiram, an antabuse drug, they experience nausea, vomiting, dizziness, blurred vision, and severe headache. They work on the principle of counterconditioning the behavior, replacing pleasant associations with unpleasant ones.
2. Agonists:
   These drugs are, in fact, drug substitutes. They act as a less harmful replacement for the drug on which people are dependent. They have fewer side effects. They bind to the same neuron receptors as the addictive drugs and produce similar effects. They allow a gradual and controlled withdrawal from the substance. One example is methadone for the treatment of heroin addiction.
3. Antagonists:
   These drugs block the neural receptors sites, thus preventing the drug addiction from having its usual effects, such as the feeling of euphoria, for example, naltrexone for the treatment of heroin addiction.

Drug therapy for nicotine addiction – AO1:

Nicotine replacement therapy (NRT) uses patches, gums, and inhalers to deliver nicotine, the psychoactive substance in tobacco, in a less harmful and more controlled way than smoking.

NRT uses “clean” means to release nicotine in the bloodstream. Although it still increases heart rate and blood pressure, it is not being taken with the cocktail of other harmful chemicals that are found in tobacco products such as cigarettes.

Nicotine acts in the same way as tobacco products. It stimulates the nicotinic receptors, releasing dopamine in the nucleus accumbens, thus producing sensations of pleasure and reducing anxiety.

Over time the amount of nicotine is reduced gradually. For example, the patches are reduced in size, so the withdrawal symptoms are managed over a period of two to three months.

Stead et al. (2012) reviewed 150 trials, including 50 000 people.

NRT increased the chances of stopping smoking by 50 to 70%. The comparison groups received a placebo or no treatment.

They found no overall difference in effectiveness between different forms of NRT (patches, spray, or gums). This supports the effectiveness of the treatment but also supports the biological explanation of nicotine addiction.

The evidence has since strengthened. Hartmann-Boyce et al. (2018) pooled 133 trials involving 64,640 smokers who wanted to quit.

Those using any form of NRT were 1.55 times as likely to be abstinent after at least six months as people given a placebo or no NRT.

Gum, patch and lozenges performed similarly (risk ratios 1.49 to 1.64). Inhalers and nasal spray looked stronger. Each rested on only four trials.

Drug treatment for gambling addiction – AO1:

There is no specific drug to treat gambling addiction. However, naltrexone, usually used to treat heroin addiction, is used in the U.S. because gambling addiction resembles substance abuse.

Like nicotine, heroin, and other drugs, gambling leads to the release of dopamine, thus activating the reward system.

Naltrexone, an opiate antagonist, reduces the release of dopamine in the nucleus accumbens. This decreases the feeling of pleasure. It also increases the release of GABA in the mesolimbic system. GABA is a neurotransmitter that decreases cravings.

In the UK, naltrexone is used only for heroin addiction. In the USA, it is becoming more widely used for other addictions.

A significant issue is that naltrexone can have serious side effects. These include anxiety, drowsiness, fatigue, panic attack, and depression.

It could also block pleasure in other areas of life. This can lead to non-compliance, when patients stop taking the drug. The treatment is then less effective.

Kim et al. (2001) carried out a 12-week double-blind, placebo-controlled trial of naltrexone in 45 pathological gamblers. A dose of 188 mg/day reduced the frequency and intensity of gambling urges, as well as the gambling itself, compared to the placebo group.

Another group of drugs, the Selective Serotonin Reuptake Inhibitors (SSRIs), is also used. The serotonin system is associated with impulse control. SSRIs inhibit the reuptake of serotonin, so more of it is available in the synapses. They should therefore increase impulse control and reduce gambling.

Hollander et al. (2000) support this. They found a significant improvement in the experimental group compared with placebo. However, Saiz-Ruiz et al. (2005) found no difference.

Evaluation (AO3)

• Drug treatment is cheaper than other forms of treatment, such as CBT, as it requires only prescription and medical supervision. However, the use of drugs raises ethical issues as there are serious side effects to some of the drugs used.
• This should be clearly discussed with the people treated. Though, some drug addicts might not have the mental capacity to give informed consent because of the damage caused by the drugs.
• This treatment requires people to take their tablets/injections regularly, and this might be difficult for drug addicts who lead a very disorganized life or whose memory has been damaged by the use of drugs such as cannabis, ecstasy, and cocaine.
• Drug treatment might not be effective on its own for example, McLellan et al. (1993) found that a group of drug addicts on methadone receiving also psychological intervention responded better to the treatment than a group treated with methadone but without psychological help.
• By focusing only on the biological problem rather than considering addiction as a choice, this approach removes the stigma of addiction and the blame culture that surrounds it.
• On the other hand, it does not address the difficulties that might have led to addiction in the first place, e.g., stress, loneliness, or other social problems such as unemployment.
• Furthermore, it does not address the issue of cognitive biases, which are involved in some addictions, such as gambling.

AO2 Scenario Question

Nicotine patches are a form of Nicotine Replacement Therapy (NRT). They deliver nicotine, the psychoactive substance in tobacco, in a less harmful and more controlled way than smoking.

NRT uses “clean” means to release nicotine into the bloodstream. It still increases heart rate and blood pressure.

However, the nicotine is not taken with the cocktail of other harmful chemicals found in tobacco products such as cigarettes, so her breathing should improve.

The nicotine acts in the same way as tobacco products. It stimulates the nicotinic receptors, releasing dopamine in the nucleus accumbens. This produces pleasure and reduces anxiety.

Mia does not need to worry about the withdrawal symptoms. She might miss holding a cigarette in her hand. She will not have the symptoms associated with stopping nicotine, such as anxiety and low mood, so she is more likely to succeed in her attempt.

Over time, the amount of nicotine is reduced gradually. For example, the patches are reduced in size, so the withdrawal symptoms are managed over a period of two to three months.

Behavioral interventions

Behavioral interventions use classical conditioning to replace the pleasure linked to an addictive substance or behavior with an unpleasant association. The two main forms are aversion therapy and covert sensitization.

Aversion therapy – AO1:

This is based on classical conditioning. According to the learning theory, two stimuli become associated when they frequently occur together (pairing). In addiction the drug, alcohol, or behavior, in the case of gambling, becomes associated with pleasure and high arousal.

Aversion therapy uses the same principle but changes the association and replaces the pleasure with an unpleasant state (counterconditioning).

Aversion therapy and alcohol addiction

Patients are given an aversive drug which causes vomiting-emetic drug. They start experiencing nausea. At this point, they are given a drink smelling strongly of alcohol, and they start vomiting almost immediately.

The treatment is repeated with a higher dose of the drug.

Another treatment involves the use of disulfiram (e.g., Antabuse). This drug interferes with the metabolism of alcohol. Normally alcohol is broken down into acetaldehyde and then into acetic acid (vinegar).

Disulfiram prevents the second stage from occurring, leading to a very high level of acetaldehyde which is the main component of hangovers. This results in severe throbbing headaches, increased heart rate, palpitations, nausea, and vomiting.

Aversion therapy for gambling addiction

For behavioral addictions such as gambling, electric shocks are used. These are painful but do not cause damage.

The gambler creates cue cards with key phrases they associate with their gambling, and then similar cards for neutral statements. As they read through the statements, they administer a two-second electric shock for each gambling-related statement.

The patient sets the intensity of the shock themselves, aiming to make the shock painful but distressing.

Covert sensitization – AO1:

This is more likely to be used now than aversion therapy. It is also based on the principle of counterconditioning.

Rather than experiencing electric shocks or vomiting, the client is asked to imagine how it would feel to experience these. This is called in vitro conditioning.

The procedure has three steps:

1. Relax: the client is first asked to relax.
2. Imagine an aversive scene: for example, feeling sick, vomiting, or seeing a snake coiled around their drink (if they fear snakes). The therapist encourages detail: color, texture, smell.
3. Link it to the behavior: the client imagines smoking, drinking, or gambling while thinking about the unpleasant consequences, such as smoking cigarettes smeared with feces.

The aim is to make the scene as vivid as possible to create a strong association. It is thought that the more negative the imagined situation, the greater the chance of success.

Evaluation of behavioral interventions as a way to reduce addiction (AO3)

• Meyer & Chesser (1970) found that with aversion therapy, 50% of alcoholics abstained for at least a year and that the treatment was more successful than no treatment. This supports the effectiveness of interventions based on classical conditioning.
• However, Hajek and Stead (2011) reviewed 25 studies on the effectiveness of aversion therapy and found that all but one had significant methodological flaws, which means that their results have to be treated with caution.
• Compliance with the treatment is low due to the unpleasant nature of the stimuli used, e.g., inducing violent vomiting.
• There are ethical issues associated with the use of aversion therapy, such as physical harm (vomiting can lead to electrolyte unbalance) and loss of dignity. For this reason, covert sensitization is now preferred to aversion therapy.
• Ashem et al. (1968) found that 40% of a group of alcohol addicts receiving covert sensitization were still abstaining after six months compared to a control group in which all carried on their normal drinking patterns.
• McConaghy et al. (1983) found that after one year, 90% of gamblers who received covert sensitization had reduced their gambling activities compared with 30% of the participants who had received aversion therapy.
• This suggests that the effect of covert sensitization has a longer-term effect than aversion therapy.
• However, relapse is a problem for both therapies. Away from the controlled environment where the associations between behavior/drug and unpleasant stimuli are formed, it is common for addictions to return.
• Behavioral therapies are mostly used in combination with other therapies [(CBT) or biological (drugs)]. It is, therefore, difficult to evaluate their effectiveness.
• Behavioral interventions focus on the behavior but do not address the underlying cause of addiction, such as biological factors, cognitive biases, or social environment (i.e., the thing that is leading them to addictive behavior in the first place). A more holistic approach might be more effective in achieving lasting improvement.

AO2 Scenario Question

Aversion therapy is based on classical conditioning. Two stimuli become associated when they frequently occur together (pairing).

Melanie’s cigarettes have become associated with pleasure and relaxation. Aversion therapy replaces the pleasure with an unpleasant state (counterconditioning).

Melanie might be given an electric shock every time she sees a picture of a cigarette or reaches for a lighter. After repeated pairings, she should come to associate cigarettes with shocks and stop smoking.

Aversion therapy can be effective for alcohol addiction.

For example, Meyer & Chesser (1970) found that 50% of alcoholics abstained for at least a year with aversion therapy. The treatment was more successful than no treatment.

However, it is an unpleasant treatment. Melanie might struggle to comply. She might give up before the association between cigarettes and the pain of the shocks is strong enough to stop her smoking.

Aversion therapy also has limits. It focuses on the behavior. It does not address the underlying cause of addiction (the thing that leads to addictive behavior in the first place), such as biological factors, cognitive biases, or the social environment.

A more holistic treatment might achieve a lasting improvement. One option is a combination of nicotine replacement therapy and cognitive behavioral therapy.

Cognitive behavioral therapy (CBT)

CBT assumes that behavior and addiction are determined by our ways of thinking. Therefore, the aim of the therapy is to identify and change the way people think about their addiction in a more adaptive way (functional analysis).

The second aim is to help the client to develop strategies to avoid situations that trigger addiction behavior (skills training).

Functional analysis – AO1:

The client and the therapist identify the situations in which he/she is likely to gamble/take drugs or drink alcohol. They explore the thoughts and motivations before, during, and after the event in an attempt to help the patient to identify “faulty thinking,” cognitive distortions, or cognitive biases.

These are challenged by the therapist. Functional analysis is ongoing throughout the treatment to assess the success of the therapy and guide its future direction.

Skills training – AO1:

People who are addicted usually respond to the challenges of everyday life by turning to their addiction. CBT helps by suggesting other strategies.

• Cognitive restructuring: the treatment helps the client modify their irrational beliefs and cognitive biases.
• Specific skills: these enable the client to cope with situations that lead to drinking, gambling or drug use. They vary with the client’s needs and may include assertiveness training, to help an alcoholic firmly but politely refuse a drink at a party.
• Social skills: these help people manage social situations more effectively and avoid those likely to cause a lapse. The therapist explains and models the behavior, and the client imitates it in a role play.

Evaluation of cognitive interventions as a way to reduce addiction (AO3)

• This is also supported by Petry (2006), who compared pathological gamblers attending Gambler’s Anonymous (GA). They either had GA and CBT or just GA. A year later, those from the CBT group were gambling significantly less than the GA group.
• However, Cowlishaw et al. (2012) reviewed 11 studies comparing CBT with controls. Benefits were medium to very large at 0 to 3 months. Only one study followed up at 9 to 12 months, and its smaller effects were not significant.
• CBT is carried out over 10-15 one-hour weekly sessions. Furthermore, one important aspect of this therapy is the “homework,” as, after each session, the client will be asked to practice new skills in real-life situations. This makes CBT time-consuming, and it also requires commitment from the client. This might be a problem for certain types of addicts, such as drug addicts who lead very disorganized life.
• This leads to a high rate of dropout. Cuijpers (2008) found that the drop-out rate is five times greater for CBT than for other types of therapies. So only very motivated clients are likely to benefit from the therapy.
• CBT does not take into account the influence of biological factors. However, it can be used with other treatments, such as drugs, to help with withdrawal symptoms.
• A strength of CBT is that, unlike other therapies, it provides skills to resist social pressure and deal with everyday situations without engaging in drugs or alcohol.
• A further limitation of CBT is that it does not deal with the stressors in the social environment which might have led to the addiction or maintain the addiction, such as demanding jobs, difficult home life, or housing problems. A more effective solution to addiction needs to take a wider approach to address the social environment.
• Furthermore, individuals with a long history of abuse face other difficulties, such as unemployment and homelessness, and drugs/ alcohol are part of their culture and environment. They might not have the skills and resources to change to a new life and require more than CBT to adjust.

Applying theories of behavior change to addictive behavior

Theory of planned behavior (TPB)

TPB is no longer on the AQA specification. The current specification (4.3.10) names only Prochaska’s model of behavior change, so treat this section as background.

This cognitive theory comes from Ajzen (1991), who extended Fishbein and Ajzen’s (1975) theory of reasoned action. It proposes that intention predicts behavior, such as gambling or stopping gambling. Intention is the key variable.

According to the theory of planned behavior, intentions are determined by three variables:

• Personal attitudes: the sum of all our knowledge, attitudes, and prejudices about a behavior. For smoking, these might include that tobacco is relaxing and feels good, but also that it causes a morning cough, costs a lot of money, and smells bad.
• Subjective norms: how we view other people’s ideas about a behavior, such as the attitudes of family, friends, and colleagues toward smoking. It is our perception of their attitudes, not what they actually think.
• Perceived behavioral control: the extent to which we believe we can control our behavior (self-efficacy). It depends on internal factors, such as our ability and determination, and external factors, such as available resources and support.

The theory argues that our perception of behavioral control has two effects:

• It affects our intentions to behave in a certain way, i.e., the more control we think we have over our behavior, the stronger our intention to perform the behavior.
• It also affects our behavior directly; if we perceive that we have a high level of control, we will try harder and longer to succeed.

Evaluation AO3

• TPB is the model most used in health psychology. It has been useful in predicting intentions relating to smoking and drinking, as supported by Hagger et al. (2011). He found that the three components of the model (personal attitudes, subjective norms, and perceived behavioral control) correlated with alcohol addicts’ intentions to limit or stop their drinking. He also found that those intentions were reflected in their behavior and could predict the approximate number of units consumed after 1 and 3 months. However, it did not predict binge drinking.
• Penny (1996) found that smokers were less likely to believe they would quit smoking and therefore were less likely to try the more times they have failed to quit previously. This shows the importance of perceived behavioral control in shaping our intentions, as predicted by TPB.
• However, Webb and Sheeran (2006) carried out a meta-analysis of 47 experimental tests. A medium-to-large change in intention (d = 0.66) led to only a small-to-medium change in behavior (d = 0.36). This suggests a significant gap between intentions and behavior.
• There are methodological problems associated with research on this theory. All the components of the model are assessed using questionnaires or interviews, so the answers are influenced by social desirability. Furthermore, these interviews or questionnaires are done when the participants are not under the influence of drugs/ alcohol but when they are in situations that trigger their addiction behavior (pub, party, etc.), their intentions might soon be forgotten, and the behavior resume.
• A strength of TPB is that it takes into account the influence of peers (subjective norms), which is significant in both the beginning of the behavior and its maintenance (SLT and operant conditioning).
• TPB assumes that all behaviors are conscious, reasoned, and planned; however, it does not consider the role of emotions such as sadness and frustration, which can play an important role in influencing behavior.
• TPB has been used in health education campaigns. Anti-drug campaigns often give data about the percentage of people engaging in risky behavior such as smoking or drug use to change the subjective norm. For example, teenagers who smoke are usually part of a peer group who smoke. Therefore, they might think smoking is the norm; however, most teenagers don’t smoke, so exposure to statistics showing them the true extent of smoking should change their subjective norm.

AO2 Scenario Question

Miguel has a positive personal attitude toward quitting. He realizes that smoking is affecting his health, and he is concerned about the cost of smoking.

He also has a subjective norm that should help him, as his family and colleagues make it clear that they want him to quit. However, he lacks perceived behavioral control (self-efficacy). He does not believe that he can quit smoking.

According to the theory of planned behavior, this is the most important factor in determining whether he would succeed. This makes him unlikely to succeed if he attempts to stop smoking.

Prochaska’s six-stage model of behavior change

Prochaska and DiClemente (1983) noticed that the change from unhealthy behavior (smoking) to healthy behavior (not smoking) is complex and involves a series of stages.

These stages do not happen in a linear order. The process is often cyclical. Some stages may be missed, or the addicts might go back to an earlier stage before progressing again.

The model considers how ready people are to quit the addiction and adapts intervention to the stage the client is at.

The model describes six stages:

1. Precontemplation: people are not considering changing their behavior in the near future. They might be in denial or demotivated by failed attempts. Intervention should help them realize they have a problem.
2. Contemplation: people become increasingly aware that they need to change and weigh the advantages and costs. This stage can last a long time. Intervention should help the client see that the pros outweigh the cons.
3. Preparation: the individual has decided to change but has no plan yet. Intervention should help the client decide which support is needed, such as a GP, a specialized clinic, or a helpline.
4. Action: people change their behavior, for example by getting rid of all tobacco products and lighters. Relapse can happen. Intervention should offer practical help, praise, and rewards to maintain the change.
5. Maintenance: the individual has maintained the change for at least six months and is growing in confidence that it can be permanent. Intervention focuses on strategies to prevent relapse, such as emphasizing the benefits of stopping.
6. Termination: the change is permanent and stable. Abstinence is automatic and there is no relapse. Some people never reach this stage and stay in maintenance for many years, where relapse is still possible.

Evaluation AO3

• The model is flexible and dynamic. It reflects the changing emotions and attitudes that addicts have toward their condition. Sometimes they appear to be in denial, and at other times, they recognize that their addiction is a problem.
• It also offers a different focus of intervention at every stage. This should lead to more individually tailored interventions which are more likely to be successful than a “one size fit all” approach.
• However, research on the model’s effectiveness is inconclusive. Velicer et al. (2007) reviewed five studies and found a 22-26% success rate, which compared well with other interventions.
• Aveyard et al. (2009) found that tailoring the intervention to the stages of change did not increase its effectiveness in individuals trying to stop smoking.
• Similarly, Baumann et al. (2015) randomly allocated alcohol-dependent participants to an experimental or a control group. They found no beneficial effect of a staged intervention.
• The model encourages a more realistic view of relapse, which is seen as an inevitable part of the process rather than a failure on the part of the client. This is a strength as it avoids the low self-confidence and demotivation likely to arise if the client sees relapse as a failure.
• One weakness of the model is that the difference between stages is often “blurry,” e.g., the difference between contemplation and preparedness is vague. So it is questionable whether they are, in fact, two distinct stages.
• A further weakness is that the model neglects the influence of social factors, for example, living conditions and unemployment within this environment. It also fails to recognize the influence of wider social norms as in some societies, and it is expected that when people socialize, they will drink alcohol, so abstaining would be very difficult.

AO2 Scenario Question

Layla is at the contemplation stage, the second stage of the model. She has become aware that she needs to change her smoking habit because it is affecting her health and costing her a lot of money.

She is weighing the advantages against the disadvantages. The advantages are better health and some savings. The disadvantages are losing the enjoyment of her first cigarette of the day and finding another way to deal with the stress at work.

This stage can last for a long time. At this stage, intervention should help Layla to see that the pros outweigh the cons.

How Addiction Is Assessed in AQA A-level Psychology

Addiction is topic 4.3.10 of the AQA A-level Psychology specification (7182). It is a full A-level topic, not an AS one. It is examined in Section D of Paper 3, Issues and Options in Psychology, and is worth 24 marks out of 96.

Specification Areas and Paper 3 Structure

The specification organizes addiction into six named areas. Each one has its own section above.

• Describing addiction: physical and psychological dependence, tolerance and withdrawal syndrome.
• Risk factors: genetic vulnerability, personality and social influences.
• Nicotine addiction: brain neurochemistry, including dopamine, and learning theory, including cue reactivity.
• Gambling addiction: learning theory, including partial and variable reinforcement, and cognitive theory, including cognitive bias.
• Reducing addiction: drug therapy, behavioral interventions (aversion therapy and covert sensitization), and CBT.
• Behavior change: the application of Prochaska’s six-stage model.

Addiction is an optional topic, not a compulsory block. Section D offers three Option 3 topics: Aggression, Forensic Psychology and Addiction. A student studies and is examined on only one of them.

Paper 3 is a 2-hour written exam worth 33.3% of the A-level grade. It has four sections of 24 marks each.

• Section A: issues and debates in Psychology (compulsory).
• Section B: one Option 1 topic: Relationships, Gender, or Cognition and development.
• Section C: one Option 2 topic: Schizophrenia, Eating behavior, or Stress.
• Section D: one Option 3 topic: Aggression, Forensic Psychology, or Addiction.

Assessment Objectives and the Two-Sentence Technique

Questions mix multiple-choice, short-answer and extended-writing formats. They are marked against three assessment objectives.

• AO1: accurate knowledge of a definition, explanation or treatment.
• AO2: applying knowledge to a case-study scenario. This is extremely common in addiction, as the scenarios above show.
• AO3: evaluating an explanation or treatment.

Students must evaluate therapies and treatments in terms of both appropriateness and effectiveness. This covers drug therapy, aversion therapy, covert sensitization and CBT.

Appropriateness means practical and ethical fit: cost, time commitment, client motivation, side effects and informed consent. Effectiveness means the outcome evidence.

For AO2, use the two-sentence technique. State the relevant psychological knowledge in one sentence. Then name the specific detail from the scenario that it explains.

For example, cue reactivity explains relapse through classical conditioning: cues repeatedly paired with nicotine’s rewarding effects become conditioned stimuli that trigger craving on their own (AO1).

William struggles to resist smoking in pubs and clubs because these venues have become conditioned cues through years of association with nicotine’s rewarding effects (AO2).

Further information

• Approaches Revision PowerPoint(1)
• Approaches Revision PowerPoint(2)