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Roger Bloor & Steve Freeman
Keele University Medical School
Email:[email protected]
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Theories of Aetiology
Genetic Research
PsychodynamicT
heories Behavioural & Cognitive Theories
ConditioningSocial Theories
Craving Activation
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Classical vs. Operant
Conditioning Classical Conditioning
Neutral stimulus paired with US
Neutral stimulus becomes CS CS evokes CR automatically
Operant/Instrumental Conditioning
Behavior occurs
Event presented or removed
Behavior strengthened (reinforcement) or weakened (punishment)
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Reinforcement in Addiction Positive Reinforcement
Drug use increased/maintained due to rewarding effects (e.g.
euphoria)
Associated with release of dopamine in nucleus accumbens
Negative Reinforcement
Drug use increased/maintained due to reduction/elimination of
aversive conditions (e.g. relief from withdrawal symptoms,
depression, or anxiety)
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Social LearningT
heory Modelling
Self efficacy
Locus of Control
Cognitive mediation of behaviour
Thoughts
Feelings
Expectations
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Cocaine Study
Cocaine addicts and
controls shown cocaine
cues and neutral cues
Cocaine cues in addicts
elicited craving, brain
activation
Activation correlated with
craving in Dorsolateral
Prefrontal Cortex,
Amygdala, Cerebellum
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Classic Models of AddictionModel Emphasized Causes Example Interventions
Moral Personal responsibility; self-
control
Moral suasion; social/legal
sanctions
Spiritual Spiritual defect Prayer; 12-step faith-basedtreatment (e.g. AA)
Temperance Drugs Control of supply; calls for
abstinence
Educational Ignorance Education
Conditioning Classical/operant
conditioning
Counter conditioning;
extinction
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Classic Models of Addiction continued
Model Emphasized Causes Example Interventions
Biological Heredity; brain physiology;
self-medication
Risk identification; calls for
abstinence; medical treatment
Psycho-dynamic
Personality; defensemechanisms
Psychoanalysis
Family
Dynamics
Family dysfunction Family therapy
SocialLearning
Modeling; expectancies Positive role models; rationalrestructuring of expectancies
Sociocultural Environmental; cultural;
economic
Social policy; social services
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Time for thinking
In small groups spend 10 minutes
Review your notes on the patient story
Which models may describe the aetiology
in this case
Feedback to the main group your
discussions (briefly)
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A Multidimensional Concept
many and varied determinants in the
biological, psychological and socioculturaldomains, and these variables interact in
complex ways dependence is one of the best
examples of the complexity of human kind
Orford 1990
