Choice and Self Control Theories of Addiction

Dr Bob PattonAddictions Department

In this 1 hour introductory lecture you will learn about psychological theories of addiction

At the end of this session you should:

Understand the relationship between self control and behavior

Be familiar with psychological theories of addiction

Be able to distinguish between rational and irrational models of behavior

All theories of addiction attempt to explain the processes that underpin the onset and maintenance of drug taking behaviors.

When considering the various theories remember that each should be able to:

• Explain the onset of addiction• Account for the maintenance of addictive behaviors• Suggest mechanisms for treatment

There is NO single unified theory of addiction (although attempts are being made to integrate existing ones – refer to ALICE-RAP, 2011 for more details)

Theories of Addiction

Our lives are characterized by the regulation of behaviors by rules and by situation.

We all know how to limit or indeed inhibit our behavior according to circumstances.

We are able to engage in activities that might not have immediate rewards.

Self Control and Behaviour

Behavior is mediated by control process

• Automatic / Regulatory• Conscious / Reflective

These processes are in turn mediated by other factors:

• Psychological• Social• Economic• Biological

The focus of todays lecture is upon psychological components.

Self Control and Behaviour

Baumeister, 2003

Proposes three models of self regulation:

Energy model – control is a mental resource (limited)Cognitive model – control results from thought processesSkills model – control is learnt

The energy model offers the most plausible explanation as self regulation is a limited resource – once expended the individual is open to impulsive and appetitive behaviors.

Addiction is seen as a failure of self-control

Psychological mechanisms and addiction

Addiction is a choice – a decision process (based upon reason) is undertaken and acted upon. For the addict, the benefits of addiction seem to outweigh the costs.

Choice is important otherwise addicts could be viewed as little more than “consumption robots” (Skog, 2000)

Is addiction a rational decision?

Are we rational people…?

Addiction as a choice

Frankfurt (1971) proposes three ‘types’ of addict:

Wanton Addicts simply engage in the addictive behaviourwithout questioning their actions

Unwilling Addicts have thought about their addictivebehaviour, would rather not be engaging in it, but findthemselves unable to stop

Willing Addicts have thought about their addictivebehaviour, are happy with it, and have no intention ordesire to stop

Types of addict

Rationality is about behaving in ways that lead to you achieving your goals

Cognitive scientists distinguish two types of rationality:

Instrumental Rationality You behave in ways to maximise your goals

Epistemic RationalityYou engage in evaluations of your own goals, beliefs and knowledge to ensure that they fit with the way the world is presented to you

So What is Rationality?

So, we know that people do not always behave in completely rational ways

This is largely because we are cognitive economists who avoid expending mental energy whenever possible. But what does this mean for our understanding of addiction?

Let’s think about addition from a rational and an irrational perspective.

Rationality and addiction

Addiction (addictive behaviours) are preferable to any alternate courses of action or endeavour.

The balance of consequences demonstrate that the benefits outweigh the costs.

How are such judgements made?

Rationality and addiction

Expectancies refer to the likelihood of particular outcomes from specific behaviours

These are seen as utilities – which are both positive and negative values associated with rewards

The expectation that drugs are harmful can be mitigated by the view that ‘self harm’ is of little consequence, and thus has low utility, and thus behaviour is therefore likely.

Expectancies, Utilities and Addiction

When considering utilities, think about the risks and rewards of drug taking

These are a few examples:

Risk and Rewards

RewardsEnjoyment and pleasureGroup membershipRelief from stress & anxietyRebellion

RisksLegal consequencesMorbidity & MortalitySocial exclusion

Addicts tend to believe that life is better with drugs than without. (Davies, 1997)

The use of incentives and disincentives can successfully modify addictive behaviors (Lussier, 2006)

HOWEVER

Awareness of the consequences and harms associated with addiction does not predict relapse among those in recovery (Mooney, 1987)

It is a well known fact that EDUCATION is the least effective intervention for substance misuse – often showing no effect whatsoever upon actual behaviors (Flay, 2009)

What is the evidence?

There are many different theories all based on the principals of rationality.

• Theory of Rational Addiction

• Subjective Expected Utility Theory

• Theory of Planned Behavior

• Positive / Negative Expectancy Theory

Examples of ‘Rational’ theories

Becker & Murphy, 1988

Maximisation of consumption over time, increasing (or decreasing) appetite according to exposure.

Explains binge behaviour, and ‘cold turkey’

Drug taking leads to further drug taking. Future behaviour based on the apparent consequences / benefits of the current

HOWEVER

Overly simplistic, difficult to test empirically and fails to account for the differing ‘types’ of addict

Theory of Rational Addiction

Edwards, 1961

Different courses of action will lead to different outcomes.

Decision to engage in specific behaviors are based upon the maximization of utility (the value of rewards)

Decisions are mediated by the likelihood of occurrence (weighted utility)

Subjective expected utility model

Ajzen, 1991

This is based on the earlier Theory of Reasoned Action.

Actions are driven by intention.

Intention is made up of three separate components:~

1. The Subjective Expected Utility2. The individuals perception of control3. The influence of others opinions

Theory of planned behaviour

Jones et al, 2001

The consequences of potential actions are viewed as certainties (no need to account for probability) and are weighted by their positive and negative attributes

Positive & Negative expectancy theory

Perhaps a more robust premise when considering addiction acknowledges that our choices and preferences are unstable – they change over time and in response to cognitive and emotional bias.

In these models addition is seen as a consequence of emotional an other bias upon the processes of decision making.

Are we really rational?

Addicts tend to express thoughts and motivations that promote and support their drug taking. (Field et al, 2008)

HOWEVER

There is limited evidence on the extent to which emotional bias actually affects behavior (Wiers et al, 2010)

Experimental manipulation of bias does not result in long term modifications of behavior. (Field et al, 2009)

What is the evidence?

These are sometimes known as Biased Choice models:

• Decision-Making Deficit Model of Addiction

• Unstable Preference Theory

• Cognitive Bias Model

• Gateway Theory

Examples of ‘Irrational’ theories

Redish, Jensen and Johnson, 2008

The human ‘machinery’ of decision-making is said to be vulnerable to particular kinds of intervention (pharmacological and experiential) which can lead to maladaptive decisions

Addiction is therefore seen as primarily a condition of maladaptive decision making

Decision-Making Deficit Model of Addiction

Skog, 2003

Utilities vary as a function of time and circumstance.

This is a realist approach that acknowledges that people and the situations they find themselves in change, and this is reflected in the variability of how utilities are weighted

Unstable Preference Theory

McCusker, 2001

Behavior is based upon information processing bias that tend to favor addiction. Expressed as positive responses to the behavior leading to an elevated tendency to repeat the experience.

Attentional Bias – Addicts are over-sensitive to cues & stimuli related to addiction and this increases likelihood of engaging in that behavior

Recall Bias – Addicts tend to focus upon and recall positive outcomes

Cognitive bias model

Kandel et al, 1992

Engaging in one behavior will increase the utility of other behaviors, and can lead to an escalation of activity.

Gateway Theory

• Self control is an energy that is expendable.

• Addiction can be viewed as a failure of self control.

• Choices about behavior are based upon rational and irrational cognitive processes.

• Behaviors can change over time and are responses to both cognitive and emotional bias

• There is no one over-arching theory of addiction.

In summary

ALICE RAP Project (2011), ‘Addiction and lifestyles in contemporary Europe reframing addictions project’, online at: https://sites.google.com/site/alicerapproject/home West, R (2013). EMCDDA Insights 14: Models of Addiction, doi: 10.2810/99994

Background reading