Theory of Addiction E-Book

Robert West

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: Addiction Press
• Sprache: Englisch

Seitenzahl: 563

Veröffentlichungsjahr: 2013

Beschreibung

The word ‘addiction’ these days is used to refer to a chronic condition where there is an
unhealthily powerful motivation to engage in a particular behaviour. This can be driven by
many different factors – physiological, psychological, environmental and social. If we say that it
is all about X, we miss V, W, Y and Z. So, some people think addicts are using drugs to escape
from unhappy lives, feelings of anxiety and so on; many are. Some people think drugs become
addictive because they alter the brain chemistry to create powerful urges; that is often true.
Others think that drug taking is about seeking after pleasure; often it is. Some take the view that
addiction is a choice – addicts weigh up the pros and cons of doing what they do and decide
the former outweigh the latter. Yet others believe that addicts suffer from poor impulse control;
that is often true… And so it goes on.

When you look at the evidence, you see that all these positions capture important aspects of
the problem – but they are not complete explanations. Neuroscience can help us delve more
deeply into some of these explanations, while the behavioural and social sciences are better at
exploring others. We need a model that puts all this together in a way that can help us decide
what to do in different cases. Should we prescribe a drug, give the person some ‘tender loving
care’, put them in prison or what? Theory of Addiction provides this synthesis.

The first edition was well received:

‘Throughout the book the reader is exposed to a vast number of useful observations...The
theoretical aims are timely, refreshing, ambitious and above all challenging. It opens up a new
way of looking at addiction and has the potential to move the field of addiction a considerable
leap forward. Thus we wholeheartedly would like to recommend the book for students as well
as scholars. Read and learn!’ Nordic Studies on Alcohol and Drugs

‘The book provides a comprehensive review of existing theories - over 30 in all - and this
synthesis of theories constitutes an important contribution in and of itself... West is to be
commended for his synthesis of addiction theories that span neurobiology, psychology and
social science and for his insights into what remains unexplained.’ Addiction

This new edition of Theory of Addiction builds on the first, including additional theories in
the field, a more developed specification of PRIME theory and analysis of the expanding
evidence base.
With this important new information, Theory of Addiction will continue to be essential reading
for all those working in addiction, from student to experienced practitioner – as urged above,
Read and learn! 

Leseprobe

Table of Contents

Cover

Series

Title

Copyright

Preface

Chapter 1: Introduction: journey to the centre of addiction

Preparing for the journey

In the end

What this book does

The synthetic theory of addiction in brief

References

Chapter 2: Definition, theory and observation

Defining addiction (addiction is not an elephant)

Diagnosing and measuring addiction

Theory and supposition

‘Big observations’ in the field of addiction

Recapitulation

References

Chapter 3: Beginning the journey: addiction as choice

Addiction as a reflective choice

Irrational, ill-informed choice and unstable preferences

Addiction as the exercise of choice based on desires

References

Chapter 4: Choice is not enough: the concepts of impulse and self-control

Reports of feelings of compulsion

Powerful motives versus impaired control

Personality and addiction typologies

Self-efficacy

The transition from lapse to relapse

Impulse control

Self-regulation as a broadly based concept

Urges and craving

Addiction as a failure of self-control over desires and urges

References

Chapter 5: Addiction, habit and instrumental learning

Instrumental learning

Mechanisms underpinning instrumental learning

Classical conditioning

More complex learning models

Social learning

Associative learning

References

Chapter 6: Addiction in populations, and comprehensive theories

Addiction in populations

Comprehensive theories of addiction

What is addiction and how can we explain it?

References

Chapter 7: Development of a comprehensive theory

A functional classification of theories of addiction

Addiction as reflective choice

Addiction as irrational choice

Addiction, compulsion and self-control

Addiction, instrumental learning and habit

Addiction, choice, compulsion and habit

References

Chapter 8: A synthetic theory of motivation

Understanding behaviour in context: the COM-B model

Focus on motivational theory

The human motivational system

Structure and function of the human motivational system

The ‘head model’

Momentum and inertia

Adaptation: ways in which experience affects motivational disposition

The ‘representational system’, consciousness and dual process models

Self and self-control

Mental effort and motivational resources

What motivates us

The unstable mind

A summary: key propositions from PRIME theory

References

Chapter 9: A theory of addiction

Addiction is

The pathologies underlying addiction

A return to some ‘big observations’ about addiction

The abnormalities underlying addiction

Effects of interventions

Recommendations and predictions regarding addiction interventions

Testing the theory

First results

Conclusions

References

Index

End User License Agreement

List of Tables

Chapter 2: Definition, theory and observation

Table 2.1 Commonly used definitions of addiction/dependence

Table 2.2 Examples to test a definition of addiction

Table 2.3 Diagnostic criteria for addiction

Table 2.4 Drugs and activities that at least some people have seriously claimed to have addictive potential

Chapter 7: Development of a comprehensive theory

Table 7.1 Categories of theories of addiction together with examples

Table 7.2 Key concepts used in theories of addiction (adapted from West 2013)

List of Illustrations

Chapter 3: Beginning the journey: addiction as choice

Figure 3.1 A simplified view of the Opponent Process Model of addiction. The affective (hedonic or emotional) response to a stimulus (such as a drug) is the underlying a-process, which elicits the opponent b-process. These processes add together to create the pleasant A-state followed by an unpleasant B-state. On first use the pleasant A-state is large, followed by a small B-state (see i). With repeated drug use, the b-process increases in magnitude and duration, leading to an experience dominated by the unpleasant symptoms associated with withdrawal (see ii).

Figure 3.2 Identity Shift Theory (adapted from Kearney and O'Sullivan 2003).

Chapter 5: Addiction, habit and instrumental learning

Figure 5.1 Location of the mesolimbic dopamine pathway (adapted from Tomkins and Sellers 2001).

Figure 5.2 Drug actions of the mesolimbic dopamine pathway (adapted from Tomkins and Sellers 2001).

Figure 5.3 White's Multiple Memory System Theory of addiction (reproduced from White 1996).

Figure 5.4 Changes occurring in development of addiction according the stimulus–response (S–R) Habit Learning Model (top) and the Incentive Sensitisation Theory (bottom). According to the Habit Learning Model, addiction is primarily due to the development of strong S–R habits (indicated by the thick arrow from a drug cue, the conditioned stimulus (CS), to a response). According to the incentive sensitisation view, the primary change is in the ability of drug cues to create a sensitised motivational response of incentive salience which then leads to compulsive drug pursuit (thick arrow) via an unconditioned stimulus (UCS) (Robinson and Berridge [2003]. Modified with permission from Annual Review of Psychology).

Chapter 6: Addiction in populations, and comprehensive theories

Figure 6.1 Consequences of conflict from the Excessive Appetites Model (adapted from Orford 2001).

Figure 6.2 The three pathways to pathological gambling (adapted from Blaszczynski and Nower 2002).

Chapter 7: Development of a comprehensive theory

Figure 7.1 Classification of theories of addiction (West 2013).

Figure 7.2 Addiction as rational choice. Given the opportunity, the individual makes decisions to seek out or enact the behaviour depending on analysis of the costs and benefits. A high frequency or intensity of activity simply reflects the preferences of the individual given current circumstances. Increases in frequency or intensity derive from feedback from the behaviour to the costs and benefits of engaging in it.

Figure 7.3 A Choice Theory of addiction with self-control added.

Figure 7.4 A simplified diagram of a Choice Theory of addiction with self-control, and instrumental learning added.

Chapter 8: A synthetic theory of motivation

Figure 8.1 The COM-B system for analysing behaviour in context.

Figure 8.2 A schematic of the five subsystems that make up the human motivational system.

Figure 8.3 Subsystems and their main paths of influence in the PRIME Theory of motivation.

Figure 8.4 The ‘head’ model of the human motivational system

Figure 8.5 A representation of PRIME theory with the different constructs labelled as either reflective or automatic.

Figure 8.6 Examples of different trajectories in the unstable mind.

Figure 8.7 Example of the epigenetic landscape proposed by Waddington (1977) to represent how genes and environment interact in ontogenesis.

Chapter 9: A theory of addiction

Figure 9.1 The SNAP model of smoking cessation. Transitions occur as result of a combination of tension and triggers. Tension is a feeling of a desire to change (want or need) arising from a combination of dissatisfaction with current situation or hope that change can be achieved. Triggers are events that momentarily either raise the tension (including increasing urgency), reduce barriers, simply put the idea of change in the person's mind or show a pathway by which the change can occur.

Guide

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Table of Contents

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Addiction Press aims to communicate current ideas and evidence in this expanding field, not only to researchers and practising health professionals, but also to policy makers, students and interested non-specialists. These publications are designed to address the significant challenges that addiction presents to modern society.

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Theory of Addiction

Second Edition

Robert West

Jamie Brown

University College London

This edition first published 2013, © 2013 by John Wiley & Sons, Ltd. First edition published 2009 © 2009 Robert West

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Library of Congress Cataloging-in-Publication Data

West, Robert, 1955–  Theory of addiction / Robert West and Jamie Brown. – Second edition.   pages cm  Includes bibliographical references and index.  ISBN 978-0-470-67421-5 (pbk. : alk. paper) 1. Substance abuse. 2. Compulsive behavior. I. Brown, Jamie, 1984– II. Title.  RC564.W47 2014  616.86–dc23 2013013746

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PREFACE

The first edition of Theory of Addiction summarised the major theoretical approaches that attempt to explain the range of phenomena that we call ‘addiction’ and synthesise these into an overarching theory that captured their main core features. It was borne out of a need for a single model that could account for features of addiction that involve conscious choice, powerful desires and impulses, and attempts at, and failure of, self-control. It needed to bring in ideas of pleasure-seeking as well as relief from mental and physical discomfort. It needed to account for individual differences in susceptibility to addiction and explain when and why many addicts ‘recover’ without help but also why some interventions help some addicts. It needed to explain why population-level interventions such as price increases and reductions in availability can influence the prevalence of addiction and why some medicines can help addicts recover without appearing to provide any of the functions provided by the addictive behaviour.

Given that motivation lay at the heart of addiction it became apparent that a theory of addiction needed to be built on a theory of motivation, and that involved creating a synthetic model of motivation. A first draft of a theory was constructed, aiming to be as parsimonious as possible, while still accounting for the full range of ‘big observations’. The goal was not only to explain, but also to generate hypotheses about how one might intervene more effectively to combat addiction. It was always intended that the theory would continue to develop, both in order to account for more observations and to make it more useful when it comes to designing interventions.

Since the first edition was published, new findings have accumulated and experience has been gathered in communicating the theory. After 6 years, it seemed appropriate to update the book to take account of this. Important revisions include the following:

1.

Updating the definition and conceptualisation of addiction.

2.

Updating descriptions of theories in the literature.

3.

Providing a functional classification of theories and models of addiction.

4.

Providing a description of core concepts involved in these theories.

5.

Updating the description of the synthetic theory of addiction (PRIME Theory) to improve clarity and take account of new observations.

6.

Assessing PRIME Theory in the light of new evidence.

7.

Setting the PRIME Theory motivation in the context of a more general theory of behaviour that also incorporates capability and opportunity.

The theory is still very much ‘work in progress’. There is much to be done to fill in gaps, test assumptions and examine how far the theory adds value when designing interventions.

Chapter 1INTRODUCTION: JOURNEY TO THE CENTRE OF ADDICTION

This book aims to take you on a journey. The starting point is the simplest possible common-sense theory of addiction and the destination will be a theory that accounts for the available evidence on how addiction develops, who becomes addicted, what they become addicted to and how some of them recover. The path is traced by exploring with successive versions of the theory how it needs to be extended or changed to take account of the available evidence. The goal is to arrive at a theory that is comprehensive yet parsimonious, coherent, and above all useful. It aims to stimulate research and to guide clinicians and policy makers in coming up with better ways of tackling this global scourge. This is a continuing journey. As new evidence emerges and better ways of explaining the evidence are brought to light, the theory will need updating.

Preparing for the journey

Many theories but not much progress

The field of addiction is not short on theories. There are psychological theories, biological theories, sociological theories, economic theories, biopsychosocial theories and more. Almost all of the theories in the field of addiction capture important elements of the phenomenon. The problem is that each theory seems to stem from an idea or set of ideas that accounts for a part of the problem but does not account for other features that were previously addressed by other theories. They view addiction from a particular perspective and focus on what is immediately visible from that point of view. They neglect key features that are visible from other points of view. This militates against developing an ‘incremental science’ of addiction in which new theoretical principles build on what has gone before, correcting areas where they fail to account for data and creating new avenues for exploration.