Notes · PsychologyUK · A-Levels

Addiction

This optional topic examines addiction as a psychological and physical condition. It covers the features and risk factors of addiction, the explanations of nicotine and gambling addiction through neurochemistry, learning and cognition, the drug, behavioural and cognitive methods of reducing addiction, and the models used to explain and support behaviour change. It is one of the three choices in the third option block of Paper 3.

5 sections~17 min reading time3 competenciesLevel Standard 1 · Advanced 4

T·171717 / 17

Exam profile

AO1 · Describe the features and risk factors of addiction, the explanations of nicotine and gambling addiction, and the methods of reducing addictionAO2 · Apply the explanations and interventions to novel case materialAO3 · Evaluate the explanations of addiction and the effectiveness of the interventions and models of behaviour change

Operators:describeexplainapplyevaluatediscuss

basic level

This is a full A-Level (A2) optional topic, not part of AS; on Paper 3 students study one topic from this option block (Aggression, Forensic psychology or Addiction).

higher level

The full A-Level requires description, application and evaluation of the explanations of nicotine and gambling addiction, the methods of reducing addiction, and the models of behaviour change.

Depth

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Contents · 5 sections

Addiction

Describing addiction and its risk factors#

StandardAQA 7182 3.3.10DfE GCE Psychology - describing addiction

Addiction is a disorder in which a person becomes dependent on a substance (such as nicotine) or a behaviour (such as gambling), and it is described by three key features. Physical dependence is a state in which the body has adapted to the substance so that stopping produces unpleasant physical withdrawal symptoms. Psychological dependence is a compulsion, or strong felt need, to continue using the substance or performing the behaviour because of the reward or relief it brings, even without physical dependence.

Two further features complete the description. Tolerance is the reduction in response to a substance, so that increasing amounts are needed to achieve the same effect the original dose once produced - the body adapts and becomes less sensitive. Withdrawal syndrome is the set of unpleasant physical and psychological symptoms (such as anxiety, irritability and cravings, and physical symptoms specific to the substance) that occur when a dependent person stops or reduces their use; the desire to avoid withdrawal is itself a powerful driver of continued use.

Risk factors are the influences that make a person more likely to develop an addiction. Genetic vulnerability is an inherited predisposition (for example, in the number or sensitivity of certain receptors) that makes some people more susceptible. Stress increases the risk, as people may use a substance or behaviour to cope with stress and negative emotions. Personality is a factor, with traits such as impulsivity and sensation-seeking associated with higher risk.

Family and peers are two more social risk factors. Family influences include being exposed to substance use at home (providing models and availability) and particular parenting styles, while peers influence risk through modelling, peer pressure and the norms of the social group (a person whose friends smoke or gamble is more likely to do so). The risk factors interact - none guarantees addiction - and this interaction is the basis for the biological, learning and cognitive explanations that follow.

Worked example

Identifying features of addiction

A smoker now needs 20 cigarettes a day to feel the effect that 5 once gave, and feels anxious and irritable within hours of their last cigarette. Identify the two features of addiction shown.

The increasing dose
Needing far more cigarettes to achieve the same effect shows tolerance - the body has become less responsive.
The symptoms on stopping
Anxiety and irritability soon after the last cigarette are withdrawal symptoms - a withdrawal syndrome.
Link to maintenance
Tolerance drives increasing use, and the desire to avoid withdrawal drives continued use, so together they maintain the addiction.

Result: The smoker shows tolerance (needing more) and withdrawal (symptoms on stopping), both of which maintain the addiction.

Typical mistakes

Confusing tolerance (needing more for the same effect) with withdrawal (symptoms on stopping).
Treating physical and psychological dependence as the same - a behaviour like gambling can create psychological dependence without physical dependence.

Active revision

Explain the difference between tolerance and withdrawal syndrome, and how each helps to maintain an addiction.

Active recall

Recall the key points — then reveal.

Sources: GCE AS and A level subject content for psychology (Department for Education) · AQA A-level Psychology 7182 specification (AQA)

Explanations for nicotine addiction#

AdvancedAQA 7182 3.3.10DfE GCE Psychology - explanations for nicotine addiction

The neurochemistry of nicotine addiction

Fig. 1Nicotine triggers dopamine reward (positive reinforcement), and relieving withdrawal (negative reinforcement) also maintains the addiction.

The brain-neurochemistry explanation of nicotine addiction centres on dopamine and the brain's reward pathway. When nicotine is inhaled it reaches the brain within seconds and stimulates nicotinic acetylcholine receptors, which causes the release of dopamine in the mesolimbic reward pathway (particularly the nucleus accumbens). Dopamine produces feelings of pleasure and reward, and this is what makes nicotine reinforcing - the desire to repeat the pleasurable dopamine surge drives continued smoking. With repeated use the brain adapts (down-regulating receptors), producing tolerance, so more nicotine is needed and stopping produces withdrawal.

Learning theory explains nicotine addiction through conditioning and provides the sources of reinforcement. Through operant conditioning, smoking is positively reinforced by the pleasurable effects of the dopamine reward, so the behaviour is strengthened. It is also negatively reinforced: once a smoker is dependent, smoking removes the unpleasant withdrawal symptoms, and this relief reinforces smoking too. Both forms of reinforcement therefore act to maintain the habit.

Classical conditioning adds cue reactivity, which helps explain relapse. The many cues that repeatedly accompany smoking (the smell, a cup of coffee, a particular place, finishing a meal) become associated with the nicotine reward, so they become conditioned stimuli that trigger cravings on their own. This is why an ex-smoker can experience a strong craving simply on encountering a smoking-related cue, long after the physical withdrawal has passed.

The explanations of nicotine addiction are evaluated as complementary and well supported. The neurochemical account is supported by strong evidence for the dopamine reward pathway and by the action of nicotine-replacement therapy, but on its own it is reductionist and cannot explain individual and social differences in who becomes addicted. Learning theory explains the maintenance of smoking and the role of cues (with good real-world support and application to treatment), but it has been criticised for relying partly on animal studies and for underplaying the biological and cognitive factors. As with other topics, the fullest account combines the neurochemical, learning and cognitive perspectives.

Worked example

Explaining a relapse from a cue

An ex-smoker who has not smoked for months feels a sudden strong craving when they smell cigarette smoke at a party. Explain this using conditioning.

Identify the conditioning
During years of smoking, the smell of smoke was repeatedly paired with the nicotine reward, so through classical conditioning it became a conditioned stimulus.
Explain cue reactivity
Encountering this cue now triggers a conditioned craving (cue reactivity), even though the physical withdrawal is long over.
Link to relapse
Such conditioned cravings help explain why ex-smokers relapse in situations associated with their former smoking, which is why avoiding cues is part of treatment.

Result: The smell is a conditioned cue that triggers a craving, illustrating the role of cue reactivity in relapse.

Typical mistakes

Saying smoking is only positively reinforced - relieving withdrawal is negative reinforcement, which also maintains it.
Omitting the dopamine reward pathway when explaining the neurochemical basis.

Active revision

Explain how both positive and negative reinforcement contribute to the maintenance of nicotine addiction.

Active recall

Recall the key points — then reveal.

Sources: GCE AS and A level subject content for psychology (Department for Education) · AQA A-level Psychology 7182 specification (AQA)

Explanations for gambling addiction#

AdvancedAQA 7182 3.3.10DfE GCE Psychology - explanations for gambling addiction

Reinforcement schedules and persistence

Fig. 2Variable-ratio (unpredictable) reinforcement produces far greater persistence than a predictable fixed-ratio schedule - why gambling is so hard to stop (illustrative).

Learning theory explains gambling addiction through operant conditioning, and the key idea is the schedule of reinforcement. Gambling is reinforced by winning, but wins do not follow every bet - they occur on a variable-ratio (partial) reinforcement schedule, in which reinforcement is delivered after an unpredictable number of responses. Skinner showed that variable-ratio schedules produce very high, steady rates of responding that are highly resistant to extinction, because the gambler never knows which bet will win, so they keep playing 'just one more time'. This unpredictability is what makes gambling so persistent and hard to give up.

Additional learning factors strengthen the addiction. Big wins can act as especially powerful reinforcers, and 'near misses' (for example, two jackpot symbols and a third just above the line) are experienced almost as wins and can reinforce continued play even though no money is won. Cues associated with gambling (lights, sounds, the venue) become conditioned stimuli that trigger the urge to gamble, just as with nicotine.

The cognitive explanation focuses on the faulty thinking of problem gamblers, centred on cognitive biases - distorted beliefs about gambling and about their chances of winning. These include the illusion of control (believing one can influence a chance outcome, for example by throwing dice a certain way), the gambler's fallacy (believing that a run of losses means a win is 'due'), and biased attributions (attributing wins to one's own skill but losses to bad luck or external factors). Such biases lead the gambler to overestimate their chances and to keep gambling despite losses.

The explanations of gambling addiction are evaluated for support and limitations. The learning explanation is well supported by the demonstrated power of variable-ratio schedules and explains the persistence of gambling, but it may not fully explain why only some people become addicted, and much of its basis is in animal research. The cognitive explanation is supported by evidence that problem gamblers do show these biases (and it underpins cognitive treatments), but it can be criticised for describing the distorted thinking that accompanies problem gambling rather than proving it causes the addiction. Combining the learning and cognitive accounts gives the most complete picture.

Worked example

Identifying a cognitive bias

A gambler who has lost ten times in a row insists their luck 'must change on the next spin' and bets more. Identify the cognitive bias and explain it.

Identify the belief
The gambler believes that a run of losses makes a win more likely on the next, independent spin.
Name the bias
This is the gambler's fallacy - the mistaken belief that past independent outcomes influence future ones.
Explain the effect
The fallacy leads the gambler to overestimate their chance of winning and to keep betting (even more) despite losses, helping to maintain the addiction.

Result: The gambler's fallacy - believing a win is 'due' - drives continued betting despite the losses.

Typical mistakes

Saying gambling is reinforced every time - it is reinforced on a variable-ratio (partial) schedule, which is what makes it persistent.
Confusing the gambler's fallacy (a win is 'due' after losses) with the illusion of control (believing one can influence chance).

Active revision

Explain how the variable-ratio schedule of reinforcement contributes to the persistence of gambling behaviour.

Active recall

Recall the key points — then reveal.

Sources: GCE AS and A level subject content for psychology (Department for Education) · AQA A-level Psychology 7182 specification (AQA)

Reducing addiction: drug, behavioural and cognitive therapies#

AdvancedAQA 7182 3.3.10DfE GCE Psychology - reducing addiction

Methods of reducing addiction

Fig. 3Biological (drug), behavioural (aversion, covert sensitisation) and cognitive (CBT) methods target different parts of addiction and are often combined.

Drug therapy reduces addiction pharmacologically in three broad ways. Aversives make the substance unpleasant (for example, disulfiram makes drinking alcohol cause nausea). Agonists provide a safer substitute that acts on the same receptors and reduces cravings and withdrawal (for example, nicotine-replacement therapy, or methadone for heroin). Antagonists block the receptors so the substance no longer produces its rewarding effect. Drug therapy is quick and requires little effort, but it treats the physical side of addiction rather than its psychological and social causes, can have side effects, and relapse is common when the drug is stopped.

Behavioural interventions apply conditioning to weaken the addiction. Aversion therapy uses classical conditioning to pair the addictive substance or behaviour with an unpleasant stimulus (such as a nausea-inducing drug or a mild electric shock), so that the substance comes to produce an aversive rather than a pleasant response. Covert sensitisation is a gentler version in which the pairing is done in imagination - the person vividly imagines the addictive behaviour together with highly unpleasant consequences - so that the behaviour becomes associated with disgust or aversion. These can reduce the behaviour but are criticised on ethical grounds (aversion therapy in particular) and for effects that may not last outside the clinic.

Cognitive behaviour therapy (CBT) targets the faulty thinking and the behaviour together. It helps the addict identify and challenge the cognitive biases and triggers that maintain their addiction (for example, correcting a gambler's illusion of control), teaches coping and relapse-prevention skills, and helps them practise avoiding or managing high-risk situations. Because it addresses the underlying thinking, CBT aims for lasting change, though it requires motivation and effort.

These methods are evaluated on effectiveness and appropriateness. Drug therapy is effective for the physical dependence and easy to administer but does not address the psychology of addiction; behavioural interventions can reduce the behaviour but raise ethical concerns and problems of durability; CBT tackles the causes and has good evidence but demands engagement. Because addiction has physical, learned and cognitive components, a combination of approaches - for example, nicotine-replacement therapy together with CBT and support - is generally the most effective way to reduce it.

Worked example

Recommending a treatment plan

A person addicted to nicotine has strong physical cravings and also gambles, driven by the belief that they can 'beat the system'. Recommend a plan and justify it.

Address the physical craving
For the nicotine cravings, an agonist such as nicotine-replacement therapy reduces the physical withdrawal, making it easier to stop smoking.
Address the cognition
For the gambling, CBT can challenge the cognitive bias (the illusion of control - 'beating the system') and teach relapse-prevention skills, tackling the psychological driver.
Justify the combination
Because addiction has both physical and cognitive components, combining a drug approach for the physical side with CBT for the thinking is more effective than either alone.

Result: Nicotine-replacement therapy for the physical dependence plus CBT for the gambling cognitions gives a combined, more effective plan.

Typical mistakes

Confusing agonists (substitute that acts on the receptors) with antagonists (block the receptors).
Confusing aversion therapy (real unpleasant stimulus) with covert sensitisation (imagined consequences).

Active revision

Compare aversion therapy and CBT as methods of reducing addiction, referring to effectiveness and ethical issues.

Active recall

Recall the key points — then reveal.

Sources: GCE AS and A level subject content for psychology (Department for Education) · AQA A-level Psychology 7182 specification (AQA)

Models of behaviour change: the theory of planned behaviour and the stages of change#

AdvancedAQA 7182 3.3.10DfE GCE Psychology - models of behaviour change

The theory of planned behaviour

Fig. 4Attitudes, subjective norms and perceived behavioural control shape intention, which drives behaviour; control also affects behaviour directly.

Two models on the specification explain how people change addictive behaviour. The theory of planned behaviour (Ajzen) proposes that the immediate cause of a behaviour is a person's intention to perform it, and that this intention is determined by three factors. Personal attitudes are the person's favourable or unfavourable evaluation of the behaviour (e.g. their beliefs about the costs and benefits of quitting smoking). Subjective norms are the person's perception of whether important others approve of the behaviour and what they do. Perceived behavioural control is how much control the person believes they have over performing the behaviour (their confidence that they can do it), which also influences the behaviour directly.

The theory of planned behaviour predicts that to change an addictive behaviour, interventions should target these three components - improving attitudes towards quitting, using the influence of social norms, and strengthening the person's sense of control - in order to build a strong intention that leads to change. It is evaluated as useful and well applied to health behaviours, but it is criticised because a strong intention does not always translate into behaviour (the 'intention-behaviour gap'), so it may better predict intentions than actual change.

Prochaska's transtheoretical (stages of change) model describes behaviour change as a process that unfolds through six stages rather than an all-or-nothing event. In precontemplation the person is not yet considering change (and may deny a problem); in contemplation they become aware of the problem and think about changing but are ambivalent; in preparation they intend to change soon and make plans; in action they actively change their behaviour; in maintenance they work to sustain the change and prevent relapse; and termination (not always reached) is when the new behaviour is fully established. Importantly, the model treats relapse as a normal part of the cycle from which a person can re-enter at an earlier stage, rather than a failure.

The stages-of-change model is evaluated for its practical value and its limitations. Its strength is that it recognises that people are at different stages of readiness, so that interventions can be matched to the person's stage (which is more effective than a one-size-fits-all approach), and it takes a realistic, non-judgemental view of relapse. Its limitations are that the stages may be somewhat arbitrary and people may not move through them in a neat order, and that categorising a person into a single stage can oversimplify a continuous process. Together the two models show how psychology informs the design of interventions to reduce addiction.

Prochaska's stages of change

Fig. 5The transtheoretical model: change unfolds through stages, and relapse is a normal part of the cycle from which a person can re-enter.

Worked example

Matching an intervention to a stage

A smoker admits smoking is harming their health and is starting to think about quitting but has made no plans. Identify their stage of change and suggest an appropriate intervention.

Identify the stage
Being aware of the problem and thinking about change but ambivalent and without concrete plans places the smoker in the contemplation stage.
Match the intervention
At this stage the aim is to resolve ambivalence, so an intervention that weighs up the costs and benefits of quitting and builds motivation is appropriate - not yet a full action plan.
Justify the stage-matching
Matching the intervention to the contemplation stage is more effective than pushing an action plan on someone not yet ready to act, which the stages-of-change model predicts.

Result: The smoker is in the contemplation stage; a motivation-building intervention that resolves ambivalence best matches it.

Typical mistakes

Confusing subjective norms (perceived approval of others) with perceived behavioural control (belief in one's own ability).
Getting Prochaska's stages out of order or treating relapse as outside the model - it is part of the cycle.

Active revision

Using the theory of planned behaviour, explain how you would design an intervention to help someone stop gambling.

Active recall

Recall the key points — then reveal.

Sources: GCE AS and A level subject content for psychology (Department for Education) · AQA A-level Psychology 7182 specification (AQA)

References & sources

Sources

Department for Education

GCE AS and A level subject content for psychology

AQA

AQA A-level Psychology 7182 specification

Addiction

5 sections~17 min reading time3 competenciesLevel Standard 1 · Advanced 4

Addiction

Key points

Identifying features of addiction

Key points

Explaining a relapse from a cue

Key points

Identifying a cognitive bias

Key points

Recommending a treatment plan

Key points

Matching an intervention to a stage

Sources

Addiction

Key points

Identifying features of addiction

Key points

Explaining a relapse from a cue

Key points

Identifying a cognitive bias

Key points

Recommending a treatment plan

Key points

Matching an intervention to a stage

Sources