1. Cognitive model of addictive behaviour 1 Can I give up ?

2. What is CBT ? Why does it work? Remember …. A= Activating event: The client records the event that led to the disordered thinking (e.g. exam failure) B= Beliefs: the client records the negative thoughts associated with the event (e.g. “I’m useless and stupid”) C= Consequence: client records negative thoughts or behaviour that follows D – Disputes- Therapist strongly disputes these thoughts

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4. Cognitive models Easier in relation to behavioural addictions than chemical addictions. Focus is on faulty thinking and biases. More focus on maintenance and relapse than on initiation. CBT

5. Utilizes ….. CBT Cognitive Behavioural Therapy

6. Cognitive model and initiation – self medication Recent clinical observations and psychiatric diagnostic findings of drug-dependent individuals suggest that they are predisposed to addiction because they suffer with painful emotional states and related psychiatric disorders. The drugs that addicts select are not chosen randomly. Their drug of choice is the result of an interaction between the action of the drug and the dominant painful feelings with which they struggle.

7. Cognitive model and initiation – self medication Narcotic addicts prefer opiates because of their powerful muting action on the disorganizing and threatening affects of rage and aggression. Cocaine has its appeal because of its ability to relieve distress associated with depression, hypomania, and hyperactivity. In other words, cognitions are involved in addiction..

8. The ‘Relapse Prevention’ (RP) Model (Marlatt and Gordon 1985) Although the RP Model concentrates mainly on the factors that will influence success or failure of an addict who trys to become abstinent, there is considerable overlap with processes that may be involved in the initial development of an addiction (initiation) For addicts, there will be a range of discrimiative stimuli (a term borrowed from operant conditioning that refers to stimuli that indicate the appropriateness or ‘rewardingness’ of specific behaviour). For example: one addict may have learned that heroine use is more rewarding when they are ‘down’ rather than we they are ‘happy, while another may have learned that heroin is particularly exciting when they are with other users but less so when they are on their own (Powell 2000) DSs = “Drug Using Friends” (e.g. for heroin use)

9. If after becoming drug free, an addict meets one of these Dss, they will be at high risk of relapse. For example: if a female addict meets one of her drug using friends. However, the addicts ability to survive any threat to abstinence is influenced by various other factors including: The strength of his/her motivation not to use Knowledge of alternative strategies for coping with the situation Self-efficacy A shortfall in any of these factors will increase vulnerability to relapse..

10. 10 The ‘Relapse Prevention’ (RP) Model (Marlatt and Gordon 1985)

11. Activity : Using textbook page 402-3 use this model to explain; why an addict may relapse in a high-risk situation. Lacks coping response Decreases self-efficacy which prevents a positive outcome - reverts to previous expectations of how substance can help Reminder of initial use of substance Stops person from abstaining from use due to perceived effects of substance Result - increased Probability of relapse

12. 12 The role of Cognitive processes (destructive and productive) in the promotion or reduction of addictive behaviour Activity: Use textbook page 402-404-take notes on the following The abstinence violation effect (AVE) Drug use seen as incompatible with previous determination to remain abstinence Cognitive dissonance When two cognitive thoughts are psychologically inconsistent ‘I am a drug addict’ ‘I want to remain abstinent’. Festinger – creates a state of cognitive dissonance Dissonance (personal/internal attribution) Negative drive state ‘psychological discomfort or tension’ motivating person to reduce it by achieving consonance (consistency or balance||) Reduction of dissonance Attitude change a major way of reducing dissonance Involves changing one or more cognitions (things person knows about themselves, their behaviour and their surroundings

13. Maintenance and relapse Smokers report higher levels of stress then non smokers, and levels of stress do go down when they stop smoking. Stress levels rise if they relapse. But smokers say that the cigarettes help with stress. Parrott suggests that each cigarette has an immediate effect on stress because it alleviates the symptoms that smokers feel when they can’t smoke (e.g. in a building). But there is a chronic effect of nicotine that in fact increases stress. Alcohol may be the same (short term gain, long term pain).

14. Maintenance and relapse Expectancy – as the addiction develops, unconscious expectations come into play more. This explains loss of control and likelihood of relapse. Expectations can be manipulated during treatment programmes to prevent relapse – e.g. if you tell addicts that a particular programme won’t result in any negative symptoms then there are fewer somatic and psychological effects.

15. 15 Evaluation of the ‘Relapse Prevention’ model Theoretically rich Ideas common with other theories, i.e. Theory of Reasoned Action (TRA)/Theory of Planned Behaviour TPB) – both have considerable empirical support. RPM and TRA - share the common idea of motivation to comply with other’s expectations. Link with Cognitive Dissonance Theory ( a major theory of attitude change) as it applies to health matters e.g. Smoking and drug taking Substantial evidence in support of the general principles Cummings et al (1980) - alcoholics, smokers, gamblers, overeaters relapse when experienced negative emotional state – addictive behaviour effective in escaping stress Stressful situations risky to recent ‘quitters’ Miller et al (1996) – progress of alcoholics – strongest predictor of relapse - Lack of coping skills Research is flourishing - see journal Addiction (1996) Implications for treatment No single treatment applicable to every client Awareness of different factors influencing attitudes and expectations Therapists - free from assumptions Broad theoretical framework - principles to develop individual treatment

16. Summary Cognitive explanations can be useful in explaining individual differences.Irrationality is very difficult to study as it is hard to find co-variables. May be limited to behavioural addiction, although the self-medication approach would help to explain chemical addictions, too. Helpful in relation to therapies, not so good on initiation as on maintenance and relapse. Needs to be considered as part of a broader explanation.

17. Timed exam question Explain how Classical Conditioning explains addictive behaviour (5 marks) Outline and evaluate two learning models as explanations of initiation and maintenance of smoking addiction in young people (10 marks) Explain two Cognitive processes (one destructive, one productive) involved in the promotion or reduction of addictive behaviour (4 + 5 marks)

18. Other sample exam questions Explain how Classical Conditioning explains addictive behaviour (5 marks) Outline and evaluate two learning models as explanations of initiation and maintenance of smoking addiction in young people (10 marks) Outline and Evaluate the Social Learning Theory of addictive behaviour (10 marks) Explain two Cognitive processes (one destructive, one productive) involved in the promotion or reduction of addictive behaviour (3 + 3 marks) Outline and evaluate a Cognitive Model of Prevention as an explanation of addictive behaviour (10 marks)

19. Possible Question “Outline and evaluate the cognitive model of addiction, including explanations for initiation, maintenance and relapse.” (8+16 marks)

20. Exam question – Monday 4 th March a) Outline and evaluate two learning models as explanations of initiation and maintenance of smoking addiction in young people (10 marks)

21. REVISION OF MODELS OF ADDICTION

22. Now a..

23. 1. Instructions Divide into four groups or sit at 4 tables Look through notes/textbook, etc MODELS OF ADDICTIVE BEHAVIOUR

24. 2. Then … Then make up 5 pub style questions They must be as difficult as possible-but still be able to win. Write an answer sheet for all the questions. When each team has 5 questions the pub quiz begins Group 1-Biological Group 2-Behavioural Group 3-Cognitive Group 4 -All

25. 3. Instructions You will be given a sheet with 1 – 15 on it (answer sheet) Team 1 ask teams 2, 3 and 4 their questions Team 2 then asks teams 1, 3 and 4 their questions etc At the end the tables swap answers for marking and each team reads the answers out. You can take questions from teams about the answers you have in front of you.. Winning team is the team with the most points