Cognitive Theories of Addiction Dr Tony Moss London South Bank University

Session Outline Tiffany’s Cognitive Model of Drug Urge Franken’s Neurobiological Model of Craving Moss & Albery’s Dual-Process Model of the Alcohol-Behaviour Link Dyer, Moss & Albery’s Dual Systems Theory of Addiction

Tiffany’s (1990) Cognitive Model of Drug Urge and Use Argued that dependence is a form of automatic behaviour Repeated use of drugs leads to the automatisation of drug urges, which in turn increase the future frequency of actual use Therefore, craving is a non-automatic process that does NOT always have to precede drug use

Tiffany’s (1990) Cognitive Model of Drug Urge and Use Tiffany argued that ‘craving’ has two components Automatic: linked to withdrawal etc.; activates schemata linked to use, so possibly nonconscious Controlled: when use is not possible, conscious evaluation of the ‘craving state’ lead to subjective ‘wanting’ experience Tiffany, 1999, Alc. Res. Health

Tiffany’s (1990) Cognitive Model of Drug Urge and Use Importantly, Tiffany sees subjective craving as being the result of interrupting an automatic drug-seeking schemata This may be due to either individual or environmental influences: E.g. having no alcohol available will ‘interrupt’ an automatic ‘drink alcohol’ schema, and induce craving, or; Consciously trying to stop oneself from accepting a drink offered at a party may lead to increased subjective craving

Tiffany’s (1990) Cognitive Model of Drug Urge and Use This model is supported by studies of Attentional Bias in problem drinkers, e.g. Sharma, Albery, & Cook ; Townshend & Duka (2001) These studies show that dependent drinkers are massively distracted by drug-related stimuli, to the extent that performance on an unrelated task becomes impaired E.g. responding to the colour of a word in a stroop, identifying the location of a dot in the dot-probe

Tiffany’s (1990) Cognitive Model of Drug Urge and Use In addition, Sayette et al. (1994), amongst others, have shown that attentional biases are positively related to craving E.g. attentional bias for smoking related words is associated with factors such as subjective craving and time since last cigarette

Tiffany’s (1990) Cognitive Model of Drug Urge and Use Presaging Tiffany’s work, Ludwig (1988), commenting on the automaticity of alcoholism, said: “Others essentially think instinctively, short circuiting both imagery and cognitions, and are inclined to act without knowing why. When alcohol becomes readily available, they drink before they think.”

Franken’s Neuropsychopharmacological Model of Craving and Relapse Franken attempted to integrate evidence from attentional bias research into a wide range of other evidence to explain craving and relapse Essentially a cognitive model: Stimulus – Evaluation/Processing – Response Provided convincing neurological and pharmacological evidence to explain the mechanism of attentional bias

Franken’s Neuropsychopharmacological Model of Craving and Relapse Conditioning of drug stimuli increases dopamine levels This serves to increase AB for drug stimuli (cf. I-S theory) ‘Hypervigilance’ then occurs, increasing craving and decreasing attentional resources for other mental activities

Franken’s Neuropsychopharmacological Model of Craving and Relapse A useful model in that it demonstrates, quite convincingly, that attentional biases have a neuroanatomical underpinning Helps us understand the role of craving in relapse and drug use Perhaps not so clear if the model is ‘new’, or just reinforcing previous theories (esp. I-S and Tiffany) with solid neuropsychopharmacological evidence

A theory of the effects of alcohol on behaviour and cognition Moss & Albery’s (2009) Dual-Process Model of the Alcohol-Behaviour Link A theory of the effects of alcohol on behaviour and cognition Based on dual-process models of cognitive processing The model distinguishes between pre-and post-consumption drinking phases Argues that different effects of alcohol before and after consumption starts are important to understand behavioural change

Based on a theoretical dichotomy between types of cognitive processing Moss & Albery’s (2009) Dual-Process Model of the Alcohol-Behaviour Link Based on a theoretical dichotomy between types of cognitive processing Automatic AKA: System 1, Implicit, Associative… Features: Fast, (often) Unconscious, Parallel, High Capacity, Contextualised, Independent of Intelligence Controlled AKA: System 2, Explicit, Propositional… Features: Slow, Conscious, Serial, Low Capacity, Abstract, Linked to Intelligence

Moss & Albery’s (2009) Dual-Process Model of the Alcohol-Behaviour Link Pre-consumption Phase Involves the activation of mental representations in long term memory relating to alcohol E.g. expectancies, beliefs, action schemata This can lead to changes in behaviour prior to the commencement of drinking These changes in behaviour could manifest in terms of subtle social behaviours (becoming more outgoing, chatty, relaxed), or even serve to moderate drinking behaviour once it begins (ordering high-alcohol content drinks, drinking the first few drinks more quickly)

Moss & Albery’s (2009) Dual-Process Model of the Alcohol-Behaviour Link Consumption Phase Once alcohol enters the bloodstream, it begins to impair cognitive processing Specifically, alcohol reduces the capacity and influence of controlled processing As yet, no evidence has shown impairments in automatic processing Therefore, active mental representations may still influence behaviour via the automatic system as they normally would Goals and actions that are derived in the controlled system will be less ‘effective’

Moss & Albery’s (2009) Dual-Process Model of the Alcohol-Behaviour Link

Dyer, Moss & Albery’s Dual Systems Theory of Addiction An attempt at unifying the diverse evidence and theory in addictions Aims to demonstrate both theoretical coherence and practical utility Based on a Dual-Process model of cognitive processing, and an extension of the previous model in to the field of addiction …And still a work in progress!

Dyer, Moss & Albery’s Dual Systems Theory of Addiction From Moss & Dyer, 2010

Dyer, Moss & Albery’s Dual Systems Theory of Addiction From Moss & Dyer, 2010

Dyer, Moss & Albery’s Dual Systems Theory of Addiction From Moss & Dyer, 2010

Dyer, Moss & Albery’s Dual Systems Theory of Addiction From Moss & Dyer, 2010

Dyer, Moss & Albery’s Dual Systems Theory of Addiction From Moss & Dyer, 2010