Theory of Addiction

274 Pages·2013·2.62 MB·English

by  Robert West

Theory of Addiction
AddictionPressaimstocommunicatecurrentideasandevidenceinthis
expandingfield,notonlytoresearchersandpractisinghealthprofessionals,
butalsotopolicymakers,studentsandinterestednon-specialists.These
publicationsaredesignedtoaddressthesignificantchallengesthataddiction
presentstomodernsociety.
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Theory of Addiction
Second Edition
Robert West and Jamie Brown
University College London
Thiseditionfirstpublished2013,(cid:2)C 2013byJohnWiley&Sons,Ltd.
Firsteditionpublished2009(cid:2)C 2009RobertWest
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CONTENTS
Preface ix
1 Introduction:journeytothecentreofaddiction 1
Preparingforthejourney 1
Intheend 3
Whatthisbookdoes 5
Thesynthetictheoryofaddictioninbrief 7
References 9
2 Definition,theoryandobservation 10
Definingaddiction(addictionisnotanelephant) 10
Diagnosingandmeasuringaddiction 20
Theoryandsupposition 22
‘Bigobservations’inthefieldofaddiction 30
Recapitulation 36
References 36
3 Beginningthejourney:addictionaschoice 41
Addictionasareflectivechoice 41
Box3.1 Themythofaddiction 44
Box3.2 Vaguelyrightorpreciselywrong?TheTheoryof
RationalAddiction 45
Box3.3 TheSelf-medicationModelofaddiction 50
Box3.4 OpponentProcessTheory 53
Irrational,ill-informedchoiceandunstablepreferences 60
Box3.5 ExpectancyTheories 62
Box3.6 Skog’sChoiceTheory 65
Box3.7 Slovic’sAffectHeuristic 67
Box3.8 CognitiveBiasTheories 70
Box3.9 BehaviouralEconomicTheories 72
Box3.10 GatewayTheory 78
Box3.11 TheTranstheoreticalModelofbehaviourchange 80
Box3.12 Identityshiftsandbehaviourchange 86
Addictionastheexerciseofchoicebasedondesires 87
References 89
v
vi ■ Contents
4 Choiceisnotenough:theconceptsofimpulseandself-control 95
Reportsoffeelingsofcompulsion 95
Powerfulmotivesversusimpairedcontrol 96
Box4.1 TheDiseaseModelofaddiction 96
Personalityandaddictiontypologies 98
Box4.2 TridimensionalPersonalityTheory 98
Self-efficacy 100
Box4.3 Self-efficacyTheory 100
Thetransitionfromlapsetorelapse 102
Box4.4 TheAbstinenceViolationEffect 102
Impulsecontrol 105
Box4.5 InhibitionDysregulationTheory 106
Self-regulationasabroadlybasedconcept 108
Box4.6 Self-regulationTheory 108
Urgesandcraving 108
Box4.7 ACognitiveModelofDrugUrges 109
Addictionasafailureofself-controloverdesiresandurges 110
References 111
5 Addiction,habitandinstrumentallearning 114
Instrumentallearning 114
Box5.1 Instrumentallearning(operantconditioning)andaddiction 115
Mechanismsunderpinninginstrumentallearning 118
Box5.2 TheDopamineTheoryofDrugReward 119
Box5.3 Addictionarisingfromfunctionalneurotoxicityofdrugs 121
Classicalconditioning 122
Box5.4 Classicalconditioningandaddiction 122
Morecomplexlearningmodels 124
Box5.5 Addictionasalearning/memoryprocess 125
Box5.6 IncentiveSensitisationTheory 126
Box5.7 Balfour’stheoryofdifferentialdrugeffectswithinthe
nucleusaccumbens 129
Sociallearning 130
Box5.8 SocialLearningTheory 131
Associativelearning 133
References 133
6 Addictioninpopulations,andcomprehensivetheories 136
Addictioninpopulations 136
Box6.1 DiffusionTheory 137
Comprehensivetheoriesofaddiction 139
Box6.2 ExcessiveAppetitesTheory 140
Box6.3 ThePathwaysModelofpathologicalgambling 146
Whatisaddictionandhowcanweexplainit? 149
References 150
Contents ■ vii
7 Developmentofacomprehensivetheory 152
Afunctionalclassificationoftheoriesofaddiction 153
Addictionasreflectivechoice 158
Addictionasirrationalchoice 162
Addiction,compulsionandself-control 165
Addiction,instrumentallearningandhabit 168
Addiction,choice,compulsionandhabit 179
References 185
8 Asynthetictheoryofmotivation 192
Understandingbehaviourincontext:theCOM-Bmodel 192
Focusonmotivationaltheory 194
Thehumanmotivationalsystem 194
Structureandfunctionofthehumanmotivationalsystem 195
The‘headmodel’ 205
Momentumandinertia 206
Adaptation:waysinwhichexperienceaffectsmotivationaldisposition 207
The‘representationalsystem’,consciousnessanddualprocessmodels 210
Selfandself-control 213
Mentaleffortandmotivationalresources 216
Whatmotivatesus 216
Theunstablemind 218
Asummary:keypropositionsfromPRIMEtheory 225
References 227
9 Atheoryofaddiction 229
Addictionis 229
Thepathologiesunderlyingaddiction 230
Areturntosome‘bigobservations’aboutaddiction 233
Theabnormalitiesunderlyingaddiction 241
Effectsofinterventions 244
Recommendationsandpredictionsregardingaddictioninterventions 244
Testingthetheory 250
Firstresults 251
Conclusions 252
References 253
Index 257
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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 ‘addic-
tion’andsynthesisetheseintoanoverarchingtheorythatcapturedtheirmaincore
features. It was borne out of a need for a single model that could account for
featuresofaddictionthatinvolveconsciouschoice,powerfuldesiresandimpulses,
andattemptsat,andfailureof,self-control.Itneededtobringinideasofpleasure-
seekingaswellasrelieffrommentalandphysicaldiscomfort.Itneededtoaccount
for individual differences in susceptibility to addiction and explain when and
why many addicts ‘recover’ without help but also why some interventions help
someaddicts.Itneededtoexplainwhypopulation-levelinterventionssuchasprice
increases and reductions in availability can influence the prevalence of addiction
and why some medicines can help addicts recover without appearing to provide
anyofthefunctionsprovidedbytheaddictivebehaviour.
Given that motivation lay at the heart of addiction it became apparent that a
theoryofaddictionneededtobebuiltonatheoryofmotivation,andthatinvolved
creatingasyntheticmodelofmotivation.Afirstdraftofatheorywasconstructed,
aimingtobeasparsimoniousaspossible,whilestillaccountingforthefullrangeof
‘bigobservations’.Thegoalwasnotonlytoexplain,butalsotogeneratehypotheses
abouthowonemightintervenemoreeffectivelytocombataddiction.Itwasalways
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 expe-
rience has been gathered in communicating the theory. After 6 years, it seemed
appropriatetoupdatethebooktotakeaccountofthis.Importantrevisionsinclude
thefollowing:
1. Updatingthedefinitionandconceptualisationofaddiction.
2. Updatingdescriptionsoftheoriesintheliterature.
3. Providingafunctionalclassificationoftheoriesandmodelsofaddiction.
4. Providingadescriptionofcoreconceptsinvolvedinthesetheories.
5. Updatingthedescriptionofthesynthetictheoryofaddiction(PRIMETheory)
toimproveclarityandtakeaccountofnewobservations.
ix