Transcript New and Emerging Theories of Addiction

Cognitive Theories of Addiction
Dr Tony Moss
London South Bank University
Session Outline
• Tiffany’s Cognitive Model of Drug Urge
• Franken’s Neurobiological Model of Craving
• Moss & Albery’s Dual-Process Model of the
Alcohol-Behaviour Link
• Dyer, Moss & Albery’s Dual Systems Theory of
Addiction
Tiffany’s (1990) Cognitive
Model of Drug Urge and Use
• Argued that dependence is a form of
automatic behaviour
• Repeated use of drugs leads to the
automatisation of drug urges, which in turn
increase the future frequency of actual use
• Therefore, craving is a non-automatic process
that does NOT always have to precede drug
use
Tiffany’s (1990) Cognitive
Model of Drug Urge and Use
• Tiffany argued that
‘craving’ has two
components
– Automatic: linked to
withdrawal etc.; activates
schemata linked to use, so
possibly nonconscious
– Controlled: when use is
not possible, conscious
evaluation of the ‘craving
state’ lead to subjective
‘wanting’ experience
Tiffany, 1999, Alc. Res. Health
Tiffany’s (1990) Cognitive
Model of Drug Urge and Use
• Importantly, Tiffany sees subjective craving as
being the result of interrupting an automatic
drug-seeking schemata
• This may be due to either individual or
environmental influences:
• E.g. having no alcohol available will ‘interrupt’ an
automatic ‘drink alcohol’ schema, and induce craving,
or;
• Consciously trying to stop oneself from accepting a
drink offered at a party may lead to increased
subjective craving
Tiffany’s (1990) Cognitive
Model of Drug Urge and Use
• This model is supported by studies of Attentional
Bias in problem drinkers, e.g.
– Sharma, Albery, & Cook ; Townshend & Duka (2001)
• These studies show that dependent drinkers are
massively distracted by drug-related stimuli, to
the extent that performance on an unrelated task
becomes impaired
– E.g. responding to the colour of a word in a stroop,
identifying the location of a dot in the dot-probe
Tiffany’s (1990) Cognitive
Model of Drug Urge and Use
•
In addition, Sayette et al. (1994), amongst
others, have shown that attentional biases are
positively related to craving
– E.g. attentional bias for smoking related words is
associated with factors such as subjective craving
and time since last cigarette
Tiffany’s (1990) Cognitive
Model of Drug Urge and Use
• Presaging Tiffany’s work, Ludwig (1988),
commenting on the automaticity of
alcoholism, said:
– “Others essentially think instinctively, short
circuiting both imagery and cognitions, and are
inclined to act without knowing why. When
alcohol becomes readily available, they drink
before they think.”
Franken’s Neuropsychopharmacological Model
of Craving and Relapse
• Franken attempted to integrate evidence from
attentional bias research into a wide range of
other evidence to explain craving and relapse
• Essentially a cognitive model:
– Stimulus – Evaluation/Processing – Response
• Provided convincing neurological and
pharmacological evidence to explain the
mechanism of attentional bias
Franken’s Neuropsychopharmacological Model
of Craving and Relapse
• Conditioning of drug
stimuli increases
dopamine levels
• This serves to increase AB
for drug stimuli (cf. I-S
theory)
• ‘Hypervigilance’ then
occurs, increasing craving
and decreasing
attentional resources for
other mental activities
Franken’s Neuropsychopharmacological Model
of Craving and Relapse
• A useful model in that it demonstrates, quite
convincingly, that attentional biases have a
neuroanatomical underpinning
• Helps us understand the role of craving in
relapse and drug use
• Perhaps not so clear if the model is ‘new’, or
just reinforcing previous theories (esp. I-S and
Tiffany) with solid
neuropsychopharmacological evidence
Moss & Albery’s (2009) Dual-Process Model of
the Alcohol-Behaviour Link
• A theory of the effects of alcohol on behaviour
and cognition
• Based on dual-process models of cognitive
processing
• The model distinguishes between pre-and
post-consumption drinking phases
– Argues that different effects of alcohol before and
after consumption starts are important to
understand behavioural change
Moss & Albery’s (2009) Dual-Process Model of
the Alcohol-Behaviour Link
• Based on a theoretical dichotomy between
types of cognitive processing
 Automatic
○ AKA: System 1, Implicit, Associative…
○ Features: Fast, (often) Unconscious, Parallel, High
Capacity, Contextualised, Independent of Intelligence
 Controlled
○ AKA: System 2, Explicit, Propositional…
○ Features: Slow, Conscious, Serial, Low Capacity, Abstract,
Linked to Intelligence
Moss & Albery’s (2009) Dual-Process Model of
the Alcohol-Behaviour Link
• Pre-consumption Phase
– Involves the activation of mental representations in
long term memory relating to alcohol
• E.g. expectancies, beliefs, action schemata
– This can lead to changes in behaviour prior to the
commencement of drinking
– These changes in behaviour could manifest in terms of
subtle social behaviours (becoming more outgoing,
chatty, relaxed), or even serve to moderate drinking
behaviour once it begins (ordering high-alcohol
content drinks, drinking the first few drinks more
quickly)
Moss & Albery’s (2009) Dual-Process Model of
the Alcohol-Behaviour Link
• Consumption Phase
– Once alcohol enters the bloodstream, it begins to
impair cognitive processing
– Specifically, alcohol reduces the capacity and influence
of controlled processing
– As yet, no evidence has shown impairments in
automatic processing
• Therefore, active mental representations may still influence
behaviour via the automatic system as they normally would
• Goals and actions that are derived in the controlled system
will be less ‘effective’
Moss & Albery’s (2009) Dual-Process Model of
the Alcohol-Behaviour Link
Dyer, Moss & Albery’s
Dual Systems Theory of Addiction
• An attempt at unifying the diverse evidence
and theory in addictions
• Aims to demonstrate both theoretical
coherence and practical utility
• Based on a Dual-Process model of cognitive
processing, and an extension of the previous
model in to the field of addiction
– …And still a work in progress!
Dyer, Moss & Albery’s
Dual Systems Theory of Addiction
From Moss & Dyer, 2010
Dyer, Moss & Albery’s
Dual Systems Theory of Addiction
From Moss & Dyer, 2010
Dyer, Moss & Albery’s
Dual Systems Theory of Addiction
From Moss & Dyer, 2010
Dyer, Moss & Albery’s
Dual Systems Theory of Addiction
From Moss & Dyer, 2010
Dyer, Moss & Albery’s
Dual Systems Theory of Addiction
From Moss & Dyer, 2010