by Elisabeth Brookes, updated 2021
WHAT YOU NEED TO KNOW
Describing addiction: physical and psychological dependence, tolerance and withdrawal syndrome Risk factors in the development of addiction, including genetic vulnerability, stress, personality, family influences and peers Explanations for nicotine addiction: brain neurochemistry, including the role of dopamine, and learning theory as applied to smoking behavior, including reference to cue reactivity Explanations for gambling addiction: learning theory as applied to gambling, including reference to partial and variable reinforcement; cognitive theory as applied to gambling, including reference to cognitive bias Reducing addiction: drug therapy; behavioral interventions, including aversion therapy and covert sensitisation; cognitive behavior therapy The application of the following theories of behavior change to addictive behavior; the theory of planned behavior and Prochaska’s six-stage model of behavior changeAddiction is characterised by key features:
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.
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 the substance.
Psychological dependence: this is an emotional need to use a substance or perform a behavior that has no underlying physical need. e.g. when people stop smoking they recover physically in a very short time but their emotional need for nicotine takes a lot longer.
Tolerance is shown when a person has 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 of a drug, not necessarily a sign of addiction. Tolerance can develop to many types of drugs legal such as benzodiazepam (Valium) and illegal such as cocaine.
The level of tolerance is different for different effects of the substance e.g. to get the euphoric feelings produced by cocaine an individual might have to increase the dose but the effects on the respiratory system increase with the amount taken this can lead to respiratory arrest and death.
This occurs in drug and alcohol addicted individuals who discontinue or reduce the use of the drug. This is due to the fact that the brain has adjusted its functioning to the presence of the drug, when the level is reduced, 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 and physical symptoms such as nausea, loss of sleep, weight loss.
The type and severity of the symptoms depends of the type of drug, the amount used and the length of time the substance has been used. Fear of the withdrawal syndrome often motivate people to carry on using the drug.
Marie started smoking a few years ago and used to find smoking relaxing. However, she now finds that despite smoking a lot more than she used to, cigarettes don’t help her relax as much as they did when she first started.
Use your knowledge of the key features of addiction to explain what is happening to Marie.
(4 marks)
Marie smokes a lot more than when she started because she has developed nicotine physical dependence. She has used nicotine so often and in such amount that she experiences withdrawal symptoms when she does not smoke for a short period of time so she feels the urge to smoke a lot more often than when she started. She has also developed tolerance for nicotine, she has a diminished response to nicotine as a result of repeated use this is why she does not find that cigarettes don’t help her relax as much as they used to. She has to increase the dose of the substance to obtain the same effects as her initial response of relaxation.
Genetic factors play a role in addiction by predisposing individuals to become addicted to some substances. They do so by influencing the way various substances are metabolised therefore influencing the response to the substance by enhancing the positive or negative effects of the drug.
For example, generally Europeans metabolise alcohol quickly so they do not feel sick but 50% of Asians metabolise alcohol slowly so they feel very nauseous after drinking even a small amount of alcohol as a result they are unlikely to become addicted to alcohol.
There has to be a gene-environment interaction as obviously if the individual is not exposed to the drug, they are not going to become addicted.
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 be due to the social environment such as family but also where people live. There are more people addicted to drugs in cities than in the countryside however this could be due to the fact that drugs are more easily available in the urban environment. Stress could also be due to childhood trauma such as sexual abuse.
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 investigated and one factor seems key in addiction, impulsivity. This is characterised by a lack of planning, risk-taking and the desire for immediate gratification of desire.
Two key features of family influences: Social Learning Theory and perceived parental approval:
The individual (child or adolescent) observes their parents smoking, drinking or …. and the results of the behavior e.g. the parents feel more relax or seem to experience pleasure, the individual imitate the behavior to get the same result. Over time and repeated exposures, the individual becomes addicted.
The adolescent perceives that their parents have a positive or at least a permissive attitude towards a particular drug or addictive behavior such as gambling. This perception might be based on the fact that their parents take the drug themselves or do not monitor their behavior e.g. let the teenager drink to excess at home.
The influence of peers is greater than the influence of the family according to Quine and Stephenson 1990. O’Connell suggests that there three features of peer influence that lead to addiction to alcohol or other drugs.
Julie comes from a family of drinkers. She began drinking vodka with her school friends at 12. Now in her early twenties, she has tried to stop drinking but finds it difficult, especially now that she has a very busy and demanding job.
Explain risk factors relevant to Julie’s addiction to drinking.
(4 marks)
Julie’s addiction could be explained by genetic factors. Her parents drink alcohol they might have passed on to her genes that influence the way alcohol is metabolised therefore influencing the response to alcohol by enhancing its positive effects and decreasing the negative effects.
However, it could also be explained by social learning, she has observed members of her family drinking and showing positive consequences such as feeling more relaxed (vicarious reinforcements) so she is imitating the behavior she has observed to get the same pleasant consequences.
Furthermore, Julie could have been influenced by her school friends according to O’Connell because she has associated with friends who drunk vodka, they might have provided opportunities and access to alcohol and she could have overestimated how much her peers drank and increased her own consumption to keep up.
Another possible reason is that she has a demanding job which increases her stress, so she might turn to drinking as a coping mechanism because it gives her temporary relief.
Brain neurochemistry
Acetylcholine (ACh) is a neurotransmitter which like all neurotransmitters bind with receptors and activate post-synaptic neurones. 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 become stimulated however almost immediately the receptors shut down and the neuron does not respond to any neurotransmitters (desensitisation).
This also leads to the production of dopamine in the nucleus accumbens. This generates a pleasurable feeling, increased alertness and a reduction of anxiety.
When the smoker does not take nicotine for a prolonged period of time, the nicotine is metabolised and excreted, and the nicotinic receptors become sensitised again giving rise to feelings of agitation and anxiety (withdrawal symptoms) which motivate the individual to smoke.
Additionally, the ACh increased transmission is accompanied by a decrease of dopamine activity. The repetition of this cycle creates a chronic desensitisation of the nicotinic receptors, so the intake of nicotine has to increase to produce the same effects (tolerance).
Furthermore, the prolonged use of nicotine results in an increase of the number of nicotinic receptors. Nicotine also stimulates the releases of glutamates which also increase and speed up the release of dopamine thus increasing the rewarding effects of nicotine.
Josh has been a heavy smoker for many years. He has tried to give up but the urge to smoke is so strong that he has failed every time. He always has a cigarette before he goes to bed and smoking is the first thing he does when he wakes up. He always says that the first cigarette in the morning is the best cigarette of the day.
Use your knowledge of the brain neurochemistry explanation of nicotine addiction to explain Josh’s behavior. (4 marks)
(4 marks)
When Josh smokes a cigarette the nicotine in the tobacco gets absorbed in the bloodstream and very quickly travels to his brain. There it binds with nicotinic receptors and the neurons become stimulated however almost immediately the receptors shut down and the neuron do not respond to any neurotransmitters (desensitisation).
This also leads to the production of dopamine in the nucleus accumbens. This generates a pleasurable feeling, increased alertness and a reduction of anxiety. However, Josh does not smoke during the night so the nicotine is metabolised and excreted, and the nicotinic receptors become sensitised again giving rise to feelings of agitation and anxiety (withdrawal symptoms) and he wakes up with a craving for a cigarette.
The first cigarette of the day is the best because the receptors were sensitised, so he feels the effects of nicotine more than after the other cigarettes he smokes during the day as he smokes often enough to avoid the unpleasant effects of abstinence when he is awake.
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
SLT suggests that people begin to smoke, particularly when they are young, due to learning from their social environment. They observe people e.g. peers or parents smoking and the consequences of the behavior e.g. they enjoy it, they look “cool” and are popular (vicarious reinforcements).
So they imitate the behavior- smoking- to get the same reinforcements. Mayeux et al. (2008) carried out a longitudinal study and found significant positive correlations between smoking at 16 and popularity two years later in boys, however they found a negative relationship in girls between smoking at 16 and popularity at 18.
This suggests that popularity might act as a vicarious reinforcement then a direct positive reinforcement for boys but not for girls.
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, this produces a mild feeling of euphoria thus rewarding the behavior (smoking).
However not smoking gives rise to feelings of agitation and anxiety, this acts as a negative reinforcement therefore the behavior – smoking- is more likely to be repeated to avoid the withdrawal symptoms.
Cue reactivity is the theory that people associate situations (e.g. meeting with friends)/ places (e.g. pub) with the rewarding effects of nicotine, and these cues can trigger a feeling of craving.
These factors become smoking-related cues. Prolonged use of nicotine creates association between these factors and smoking. This is based on classical conditioning. Nicotine is the unconditioned stimulus (UCS) and the pleasure caused by the sudden increase in dopamine levels 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 but they became conditioned stimuli (CS), with repeated pairings.
They can produce the conditioned response (CR). However, if the brain has not received nicotine the levels of dopamine drop, and the individual experiences withdrawal symptoms therefore is more likely to feel the need to smoke in the presence of the cues that have become associated with the use of nicotine.
William is 25 years old, he has been smoking since he was 14 and he has decided to give up because he wants to run a marathon next year. He is really struggling especially on Friday and Saturday nights when he goes out with his friends to pubs and clubs. He also has an overwhelming urge to smoke when he has had a stressful day.
Using your knowledge of the learning theory explanation of nicotine addiction, explain why William is struggling to abstain from cigarettes. (4 marks)
(4 marks)
William has come to associate pubs and clubs with the rewarding effects of smoking over time, so they have become smoking related cues.
They can produce an increase in dopamine with the related feelings of pleasure and reduced anxiety however, following this increase, the brain tries to lower the dopamine back to a normal level.
But, as William’s brain has not received nicotine as he no longer smokes, the levels of dopamine drop, and William experiences withdrawal symptoms. This is why he is struggling more in the presence of these cues.
Furthermore, he is also struggling after a stressful day because he is craving the negative reinforcement (decreased anxiety) that nicotine used to provide when he smoked.
Learning theory explanation for gambling addiction
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, they win money (vicarious reinforcements). So they imitate the behavior- gambling- to get the same reinforcements.
The behavior, 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, e.g. winning money, the excitement of betting, the social life associated with betting e.g. in casinos and betting shops. Negative reinforcement: anything unpleasant that is avoided by performing the behavior e.g. gambling can offer an escape from a stressful life, loneliness.
Continuous reinforcement: Skinner’s research with rats and pigeons showed that when the behavior e.g. pecking a disc was reinforced by food every time it was performed (fixed ratio), the behavior was repeated but when the rewards stopped the behavior quickly ceased (extinction).
Variable ratio reinforcement: When the behavior was only rewarded unpredictably (only now and then and it is impossible to say when the reward will occur) then the behavior took longer to learn but once learnt it was very resistant to extinction.
Variable ratio reinforcement is a type of partial reinforcement. Applying the theory to gambling: A fruit machine might be set to give a pay out on average every 30 games.
However, an individual might win at the 5th game and then not until the 47th game (variable ratio) but the individual will carry on playing despite the losses waiting for the reward.
Alice started going to the casino with her friends and at the start did not really enjoy it but she had two big wins and a few near misses then she found that she started looking forward to going back every weekend. Now she places bets on line when she cannot go to the casino and realised last months that she had spent over half her wages in that way.
Using your knowledge of the learning theory explanation of gambling addiction to explain Alice’s addiction. (4 marks)
(4 marks)
Operant conditioning could explain Alice’s addiction. According to this theory the behavior, gambling is maintained by direct positive reinforcement in Alice’s case 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 pay out on average every 30 games. However, an individual might win at the 5th game and then not until the 47th game (variable ratio) but the individual will carry on playing despite the losses waiting for the reward.
The behavior takes longer to learn but once learnt it is very resistant to extinction. Furthermore, 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 as Alice has done a few times which 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 the behavior- 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 and pre-conscious level but they influence attention and memory linked to the behavior.
Rickwood et al. (2010) identified four main categories of cognitive biases:
Ben plays the lottery every week he could do it on line but he says that he would not win this way. He always goes to the same shop at the same time, always uses his lucky pen and chooses his numbers with care after examining the results of the 12 previous weeks where he identifies patterns.
Using your knowledge of the cognitive approach, explain Ben’s behavior. (4 marks)
(4 marks)
Ben is showing evidence of the use of some of the cognitive biases identified by Rickwood et al. (2010). One of these biases is skill and judgement, he thinks he can identify patterns in the lottery winning numbers, this gives him the illusion that he has a certain amount of control on a game where the results are completely random.
Another cognitive bias demonstrated by Ben is his use of rituals such as using the same pen at the same shop at the same time every week, he believes that these rituals may influence the odds in his favour whereas betting on line would prevent him from winning.
Drug Treatments
There are three basic types of drug treatments:
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.
The nicotine acts in the same way than in 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 and found that chances of stopping smoking were increased by 50 to 70% by the use of NRT compared to the placebo and no treatment groups.
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.
There is no specific drug as to treat gambling addiction however naltrexone, usually used for the treatment of heroin addiction is used in the U.S and because of the similarities between gambling addiction and 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 therefore decreasing the feeling of pleasure and increases the release of GABA in the mesolimbic system which is a neurotransmitter which decreases the cravings.
In the UK naltrexone is used only for the treatment of heroin addiction, however, in the USA it is becoming more widely used for other addictions. A significant issue with the use of naltrexone is that this drug can have serious side-effects such as anxiety, drowsiness, fatigue, panic attack and depression.
Furthermore, this drug could also stop patients feeling pleasure in all other areas of their life which leads to non-compliance (the patients stop taking the drug) this reduces the effectiveness of the treatment.
Kim, 2001 carried out a 12-week double-blind placebo-controlled trial of naltrexone and found that a dose of188mg/day reduced the frequency and intensity of gambling urges, as well as the behavior itself in 45 pathological gamblers 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, by inhibiting the reuptake of serotonin these drugs make more of it available in the synapses therefore should increase impulse control and reduce gambling.
This is supported by Hollander et al. (2000) who found a significant improvement in the experimental group compared with the group given placebo however Saiz-Ruiz et al. (2005) found no difference.
Mia is addicted to cigarettes, she has smoked 20-30 cigarettes a day for over 10 years. She realises that it is bad for her health and costing her a lot of money which she could use for other more enjoyable things like a holiday. She wants to stop smoking but has tried before and has failed, this time she has decided to use nicotine patches but is concerned about the withdrawal symptoms.
Explained to Mia how nicotine patches work and the benefits of using them.
(4 marks)
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 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, so her breathing should improve.
The nicotine acts in the same way than in tobacco products, it stimulates the nicotinic receptors, releasing dopamine in the nucleus accumbens thus producing sensations of pleasure and reducing anxiety.
So Mia does not need to worry about the withdrawal symptoms, she might miss holding a cigarette in her hand but she will not have any of 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.
This is based on classical conditioning. According to the learning theory two stimuli become associated when they occur frequently 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, they start vomiting almost immediately.
The treatment is repeated with 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 very high level of acetaldehyde which is the main component of hangovers. This results in severe throbbing headache, increased heart rate, palpitations, nausea and vomiting. (bad hangover x 10 !!!)
Aversion therapy for gambling addiction For behavioral addiction 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 set the intensity of the shock themselves aiming to make the shock painful but distressing.
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 client is asked first to relax then to imagine an aversive situation, for example feeling sick, vomiting or seeing a snake coiled around their drink if they are afraid of snakes. The therapist encourages the client to go into a lot of detail, mentally picturing the colour, texture, smell….
Then they imagine themselves smoking, drinking or gambling whilst thinking about the unpleasant consequences. These might include smoking cigarettes smeared with faces. The aim is to get 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.
Melanie has been smoking for many years, she has tried to give up smoking many times but has failed even when she used the nicotine patches.
She is getting very concerned by her cough in the morning which she thinks is due to her smoking. Her doctor advised her to consider aversion therapy. She is not sure what it consists of and ask your advice.
Using your knowledge of behavioral interventions to reduce addiction, explain how aversion therapy might help Melanie to stop smoking and whether you would recommend this treatment.
(6 marks)
Aversion therapy is based on classical conditioning. According to the learning theory two stimuli become associated when they occur frequently together (pairing).
In Melanie’s case cigarettes have become associated with pleasure and relaxation. Aversion therapy uses the same principle but changes the association and replaces the pleasure with an unpleasant state (counterconditioning).
In Melanie’s case she 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 electric shocks and stop smoking.
Aversion therapy can be effective for alcohol addiction for example 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.
However, it is an unpleasant treatment and she might find it difficult to comply and give up the treatment before the association between cigarettes and the pain of the electric shocks is strong enough to stop her from smoking.
Furthermore, aversion focuses on the behavior but does 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 treatment such as a combination of nicotine replacement therapy and cognitive behavioral therapy might be more effective to achieve a lasting improvement.
The assumption of CBT is that behavior, addiction, is determined by our ways of thinking. Therefore, the aim of the therapy is to identify and change the way people think about their addiction to 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).
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.
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 in modifying their irrational beliefs and cognitive biases.
Specific skills: The aim is to enable the client to cope with situations that leads to drink/gambling or drug use. The skills taught vary depending on the client’s needs. They may include assertiveness training to help an alcoholic firmly but politely refuse a drink offered at a party.
Social skills: These skills help people avoid situations likely to result in a lapse managing social situations more effectively. The therapist explains and models the behavior then the client imitates the behavior in a role play.
This is a cognitive theory by Azjen and Fishbein (1975) that proposes that an individual’s decision to engage in a specific behavior such as gambling or stopping gambling can be predicated by their intention to engage in that behavior.
According to theory of planned behavior intentions are determined by three variables:
Personal attitudes- This is our personal attitude towards the particular behavior. It is the sum of all our knowledge, attitudes, prejudices …. positive and negative that we think of when we consider the behavior. For example, our individual attitude to smoking might include tobacco is relaxing and makes me feel good but it makes me cough in the morning, costs a lot of money and smells bad.
Subjective norms- This considers how we view the ideas of other people about the specific behavior e.g. smoking. This could be the attitude of family and friends and colleagues to smoking. It is not what other people think but our perception of others’ attitudes.
Perceived behavioral control- This is the extent to which we believe we can control our behavior (self-efficacy). This depends on our perception of internal factors such as our own ability and determination and external factors such as the resources and support available to us.
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.
Miguel smokes about 40 cigarettes a day and is concerned that it is affecting his health negatively, he is also concerned about the cost. His family and his colleagues want him to quit, however he does not feel he has the will power to do so.
Using your knowledge of the theory of planned behavior, explain whether Miguel is likely to succeed quitting smoking. (4 marks)
Miguel has a positive personal attitude to quitting as he realises that smoking is affecting his health and he is concerned about the cost of smoking.
He also has a subjective norm which should help him in his attempt as his family and colleagues make it clear that they want him to quit. However, he does not have the perceived behavioral control (self-efficacy) as he does not believe that he can quit smoking.
According to the theory of planned behavior this is the most important factor is determining whether he would succeed. This makes him unlikely to succeed if he attempts to stop smoking.
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.
Stages of Prochaska’s model of behavior change
1. Precontemplation
At this stage people are not considering changing their behavior in the near future. They might be in denial or feel demotivated by their failure in previous attempts. Intervention at this stage should focus at helping them realise that they have a problem
2. Contemplation
People become increasingly aware that they need to change. They consider the advantages and the cost of changing. This stage can last for a long time. At this stage intervention should help the client see that the pros outweigh the cons.
3. Preparation
At this stage, the individual has decided to change but has not got a plan on how to do it yet. Any intervention should focus on helping the client to decide which support will be needed to achieve the change successfully e.g. contact GP, specialised clinics or helpline.
4. Action
At this stage people change their behavior e.g. they get rid of all tobacco products, lighters …. Relapse can happen. Intervention should focus on supporting the individual by practical help, praise, rewards .. to maintain the change.
5. Maintenance
The individual has maintained the change for at least 6 months and is growing in confidence that the change can be permanent. Intervention at this stage focuses on strategies learnt to prevent relapse e.g. emphasizing the benefits of stopping the addiction…
6. Termination
The change is permanent and stable. Abstinence is now automatic, there is no relapse. Some people do not achieve this stage and remain at the maintenance stage for many years. Relapse for them is still possible.
Layla has been smoking for a few months now but she realises that it is affecting her health and costing her a lot of money. One the other hand she feels that she enjoys her first cigarette in the morning and that cigarettes help her relax when she is stressed at work.
With reference to Prochaska’s model of behavior change explain which stage Layla is at. Justify your answer. (4 marks)
Layla is at the contemplation stage of the model which is the second stage. She has become aware that she needs to change her smoking habit as this is affecting her health and is costing her a lot of money.
She is considering the advantages, in her case better health and some savings and the disadvantages such as the lack of the enjoyment of her first cigarette of the day and having to find 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.
Elisabeth Brookes is an A-level psychology teacher, and author of her own website http://www.psychbug.co.uk/
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