Psychology of Addictive Behaviour

Antony C. Moss, Kyle R. Dyer

• Publisher: Bloomsbury Academic
• Year: 2010
• ISBN:
  9781350312425
• Edition: 1
• Topic: Psychology
• Subtopic: Psychopathology
• Index: Psychology

Part of the Palgrave Insights in Psychology series, this highly accessible text presents the main theories, evidence and ideas in psychology, pharmacology and medicine most useful for learning about the psychological and physical experience of addictive behaviours. Unique in their approach, Authors Moss and Dyer employ an innovative explanatory framework for conceptualising the onset of psychopathology, drawing upon not only the biological, but the social and psychological determinants most useful for understanding behaviour. This book undertakes an interdisciplinary analysis of how psychology thinks about the onset and treatment of addictive behaviours such as drug use, drinking alcohol, gambling, internet use and sex. This is an engaging and informative guide to understanding the main approaches to treatment and strategies of prevention for addictive behaviours. This title stands as part of the Insights series edited by Nigel Holt and Rob Lewis, containing versatile, quick guides to the cornerstone theories, main topics and debates of their subjects and are useful for pre-undergraduate students looking to find incisive introductions to subjects that they may be considering for undergraduate study or those looking for helpful preparatory reading for undergraduate modules in the prospective subject.

Chapter 1

What is addictive behaviour?

Introduction

Addictive behaviours are challenging – they can affect anyone, they develop slowly, often without our awareness, they touch all aspects of our lives, and they can be very difficult to treat and prevent. Throughout this book we will present the theories, evidence and ideas, drawn from the fields of psychology, pharmacology, medicine and allied health, that are most useful for understanding addictive behaviours. The purpose of the present chapter is to introduce some of these key ideas, issues and arguments, and provide a foundation for understanding the rest of the book. We use the term addictive behaviours to capture not only drug and alcohol dependence (both physical and psychological), but also to include other behaviours, such as gambling, internet and sex, that people can become dependent upon. While at times there may be a focus on drug dependency in this text, it is important to remember that some key concepts apply to all addictive behaviours, and not just those that involve the administration of a drug.

In this chapter we will examine:

Issues in defining addictive behaviour

The clinical criteria used for diagnosing dependence disorders

The distinction between physical and psychological dependence

The role and implications of the disease concept in addictive behaviour

Pathways out of addictive behaviour

What is addictive behaviour?

It’s as good a way as any to begin a book with a question. However, the question we have chosen to open with – What is addictive behaviour? – does not have a straightforward answer. The problem with defining addictive behaviour is that, while it is a term that most people understand in a broad sense, it covers so many diverse behaviours: alcohol dependence, drug dependence, smoking, and gambling, to name but a few.

At first, trying to pick a definition that is specific enough to be useful, but broad enough to incorporate this diverse range of behaviours that we think of as examples of ‘addictive behaviour’ would seem like a tall challenge. The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) (American Psychiatric Association, 2000), which is used by clinicians to identify and diagnose 297 recognized mental health disorders, does not in fact mention ‘addiction’ at all. This is because the term addiction implies a medical illness and does not adequately incorporate the biological, psychological and social components of this disorder. Instead, the DSM-IV-TR uses the term Substance Dependence (see Box 1.1). The key symptoms identified are tolerance; withdrawal; increased use over time; inability to cut down use despite a desire to; preoccupation with obtaining and using, or recovering from the effects of a drug, and giving up of other interests and activities in favour of use; and continued use despite obvious harms. These criteria are a good starting point for understanding addictive behaviour, so let’s think about each in turn.

Box 1.1: DSM-IV-TR Criteria for diagnosis of Substance Dependence (American Psychiatric Association, 2000)

A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:

(1) Tolerance, as defined by either of the following:

(a) a need for markedly increased amounts of the substance to achieve intoxication or desired effect

(b) markedly diminished effect with continued use of the same amount of the substance

(2) Withdrawal, as manifested by either of the following:

(a) the characteristic withdrawal syndrome for the substance (refer to Criteria A and B of the criteria sets for Withdrawal from the specific substances)

(b) the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms

(3) the substance is often taken in larger amounts or over a longer period than was intended

(4) there is a persistent desire or unsuccessful efforts to cut down or control substance use

(5) a great deal of time is spent in activities necessary to obtain the substance (for example, visiting multiple doctors or driving long distances), use the substance (for example, chain-smoking), or recover from its effects

(6) important social, occupational, or recreational activities are given up or reduced because of substance use

(7) the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example, current cocaine use despite recognition of cocaine-induced depression, or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)

Specify if:

With Physiological Dependence: evidence of tolerance or withdrawal (that is, either Item 1 or 2 is present)

Without Physiological Dependence: no evidence of tolerance or withdrawal (that is, neither Item 1 nor 2 is present)

Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, TextRevision, Fourth Edition (Copyright 2000). American Psychiatric Association.

Tolerance

Have you ever noticed how coffee seems to affect you less if you have been drinking a lot of it lately? Perhaps you have heard someone being referred to as a ‘hardened drinker’? Or perhaps you know of someone who has been taking pain medication for a chronic condition and has remarked, on a particularly bad day, that ‘the tablets just don’t touch the pain any more’?

Each of these examples is an instance of tolerance. Simply put, tolerance to a drug means that, over time and with repeated use, larger doses are required to achieve the initial experience. So you need to drink more coffee to feel as you did when you first started drinking it; you find you can drink more alcohol without becoming as disoriented; or you may need stronger doses of painkillers to relieve your discomfort. So, tolerance is the first key characteristic of drug dependence. The biological basis of tolerance will be explained further in Chapter 2.

Withdrawal

People like sugary foods, some more than others. Those of us who do like sweet treats will know what is meant by the phrase ‘sugar rush’; that heady feeling of overindulgence that accompanies eating an ice cream dessert-for-two by yourself, or downing a packet of sherbet in one. And those of us who have ever had a sugar rush will also know what it is like a short while after the ‘buzz’ has worn off – we feel groggy, lethargic and even a little depressed. Quite the opposite of the effect the sugar had on us in the first instance. This is withdrawal: a negative state that occurs when we cease using a substance. Importantly in the context of addictive behaviour or substance dependence, taking the substance will immediately lead to a reduction in withdrawal symptoms, and this can motivate continued use. Tolerance and withdrawal together represent physical dependence, and the neuroadaptation that occurs in response to a drug (see Chapter 2).

Addictive behaviours develop slowly

Few, if any, problem drinkers ever began their drinking career with two bottles of vodka a day. Instead, alcohol dependence is marked by a progressive increase in consumption over time – until consumption has reached levels that most social drinkers would find quite astonishing. This increase in consumption over time is linked to the two phenomena mentioned above: tolerance and withdrawal. As an individual uses alcohol more and more, they become more tolerant to its effects, and will experience increasing negative effects of withdrawal whenever they are not using.

These two factors of tolerance and withdrawal are important in understanding why drug use can increase to such dramatic levels – with problem drinkers consuming three or four times a social drinker’s weekly average consumption every day, and heroin users administering doses that would have caused an overdose early in their drug use career. Interestingly, the same pattern of recreational use developing into problem use as a function of time can be seen in other addictive behaviours (for example gambling).

Preoccupation with obtaining and using, and giving up other interests

Many people can relate to the feeling of becoming a little obsessive about certain activities; be it the keen amateur footballer who attends Sunday League matches and training come rain or shine (or hail, or snow, or thunderstorms), or the Big Brother obsessive who cannot stand to miss a night’s viewing. When we develop particular interests in life, we often find ourselves restructuring our other daily activities to accommodate our passions, and this is quite normal. In the case of dependence, however, the tendency to value the ‘passion’ over other things may often end up well out of any reasonable proportion, such that personal relationships, employment, and even family commitments may be neglected in favour of obtaining and using a drug, or recovering from its effects.

Neglect of important areas of one’s life to focus upon the addictive behaviour will inevitably lead to problems – our relationships may break down, we may lose our jobs and our health will suffer. These problems are often the most debilitating aspects of an addictive behaviour, and ironically the stress that they cause can actually lead people to turn to further engagement in the behaviour. The problems caused by addictive behaviours in turn become motivators, strengthening the addictive behaviour. Moreover, these problems can be the most difficult to deal with, and have significant effects not just on the individual, but on those close to them and the wider community: addictive behaviours impact upon us all.

Continued use despite obvious harms

So some people love football, others enjoy Big Brother. But surely, if a visit to your GP led to the startling revelation that continued engagement in playing/watching would lead to your untimely death, you would think that you would give up either activity in a heartbeat. You may be remorseful at the loss of a favourite pastime, but then life is more precious to us than any one hobby. However, among users of certain substances, including alcohol, such information – for example that continued drinking will lead to cirrhosis of the liver and premature death – often fails to halt use. Breakdown of marriages, loss of jobs, imprisonment and serious health problems are among the many other negative consequences often associated with substance dependence which seem ineffective in stopping use.

The picture of addictive behaviour that we have painted here looks something like this: a person might be said to be dependent if they demonstrate signs of increased tolerance to a substance, of withdrawal when they are not using, and whose life has become focused on obtaining and using their substance of abuse, despite the obvious fact (to themselves and those around them) that it is causing significant harm to their health and general wellbeing. However, we have been talking mainly about substance dependence disorders so far, and clearly we need a way of understanding non-substance-related dependence disorders, which can be as problematic for the individuals concerned as substance dependence disorders. Instances of dependence that do not involve substances differ from the examples discussed so far in that they do not necessitate tolerance or withdrawal. This brings us on to the final set of terms contained within the DSM-IV-TR diagnostic criteria.

Physical vs. psychological dependence

Under the DSM-IV-TR (APA, 2000) criteria for diag...