Psychology Addiction: Review Notes for A-Level Psychology (2023)

describe the addiction

Addiction is characterized by the following main features:

  • dependency
  • tolerance
  • withdrawal symptoms

Addiction is listed in the Statistical Manual of Mental Disorders (DSM 5) under the Substance Use Disorders and Dependence category.

The only behavior included is gaming, as there has not been enough research into other behaviors, such as Internet use, to justify its inclusion.


Physical Dependence: Occurs when a person uses a substance so often and in such amounts that they experience withdrawal symptoms when they stop using it.

Psychological dependence: It is an emotional need to consume a substance or perform a behavior that is not based on a physical need. For example, when people stop smoking, they recover physically in a very short time, but their emotional need for nicotine takes much longer.


Tolerance occurs when a person has a diminished response to a drug as a result of repeated use. The individual needs to increase the dose of the substance to obtain the same effects as the initial reaction.

Tolerance is a physical effect of repeated drug use and is not necessarily a sign of addiction. Tolerance can develop with many types of drugs: legal, such as benzodiazepam (Valium), and illegal, such as cocaine.

The degree of tolerance varies according to the effect of the substance. For example For example, to get the euphoric feeling produced by cocaine, a person may need to increase the dose, but the respiratory effects increase with the amount ingested, which can lead to respiratory arrest and death.

withdrawal symptoms(AO1)

This occurs in people dependent on drugs and alcohol who discontinue or reduce drug use. This is because the brain has adapted its function to the presence of the drug. When the level drops or the drug is lacking, the brain looks for the substance to increase the level.

This can cause very uncomfortable psychological symptoms, such as depression.Sufferingand physical symptoms such as nausea, insomnia, and weight loss.

The type and severity of symptoms depend on the type of medication, the amount used and how long the substance has been used.

Fear of withdrawal often motivates people to continue using the drug.

Question about the AO2 scenario

Marie started smoking a few years ago and found smoking to be relaxing. However, she now finds that although she smokes a lot more than before, cigarettes don't help her relax as well as when she started.

Use what you know about the main characteristics of addiction to explain what is happening to Marie.

(4 points)

Marie smokes much more than when she started because she has developed a physical addiction to nicotine. You've used nicotine so often and in such quantities that if you don't smoke for a short period of time, you'll experience withdrawal symptoms, making you want to smoke much more often than when you started.

He also developed a tolerance to nicotine. Due to repeated use of nicotine, she responds less to nicotine. Because of that, she doesn't think the cigarette doesn't relax her as much as it used to. You need to increase the dose of the substance to get the same effects as your initial relaxation response.

table of contents

Risk factors for developing an addiction(AO1)

genetic vulnerabilityAO1

Genetic factors play a role in addiction, making people addicted to certain substances. They do this by affecting how different substances are metabolized and by affecting the response to the substance, increasing the positive or negative effects of the drug.

For example, Europeans generally metabolize alcohol quickly so they don't feel nauseous, but 50% of Asians metabolize alcohol slowly, leaving them very nauseous after drinking even a small amount of alcohol. Therefore, they are unlikely to become addicted to alcohol.

There has to be a gene-environment interaction because obviously if the person is not exposed to the drug he will not become addicted.


  • There is evidence of the influence of genetic factors. For example, Kendler et al. in 1997, he performed a twin study on a sample of 2,516 male Swedish twins and found a concordance rate of 33% for MZ twins and 15% for DZ twins. This indicates a significant influence of genetic factors.
  • However, it also underlines the importance of environmental factors, as the concordance rate for MZ twins was less than 100% in all studies. Furthermore, studies assume that twins have exactly the same social environment, but that MZ twins are treated more similarly in their social environment than DZ twins.
  • Furthermore, the samples are not representative of the general population because their developmental environment differs from that of non-twins; For example, before birth, they must share nutrients and oxygen from their mother, something non-twins do not. This may have influenced its development.
  • Furthermore, Kendler et al., 2012, found that people with addicted parents who were adopted by biological parents had a higher risk of becoming addicted (9%) compared to those who were also adopted by biological parents and did not have addictions. (4). %.
  • This type of study is now relatively rare. However, they are important because they allow distinguishing the contribution of genetic and environmental factors, since biological relatives only share genes with the adopted individual. Adoptive parents share only one environment with the adoptee; The relative influence of shared genetic and environmental factors can be estimated by comparing the frequency of a disorder or the similarity of a trait in biological relatives with adoptive relatives.
  • However, adoptees can still have contact with their biological family. Furthermore, prior to adoption, the individual shared and may have been influenced by the family's social environment, so the influence of the shared environment is not completely eliminated.
  • Susceptibility varies by substance, so susceptibility to addiction to a substance is specific and not general.
    This explanation does not take into account social factors such as social norms, peer pressure and moral values, eg. For example, some people choose not to use drugs or drink alcohol for moral or religious reasons.
  • It is an example of biological reductionism, as this explanation suggests that an individual is likely to become addicted to a substance due to their genetic makeup, but does not take into account other factors, e.g. B. Social factors such as peer pressure, social norms, and moral values. An interactionist approach that combines genetic influence with social factors would be more appropriate and more likely to lead to more effective ways of overcoming addiction.
  • It is a deterministic explanation because it does not take into account free will in the development of an addiction in a person.
  • It is a socially sensitive statement as it implies that people are not responsible for their condition and the consequences e.g. B. Steal to buy drugs.


High stress increases the risk of addiction. As a coping mechanism, they may turn to substances or behaviors that provide temporary relief. However, addiction is less likely to occur in stressful situations when mediating factors such as social support are present.

Stress can be due to the social environment, for example in the family, but also to where people live. There are more drug addicts in cities than in the countryside; However, this may be due to the fact that drugs are more widely available in urban settings.


  • Stress can also be caused by childhood trauma such as sexual abuse. This is supported by Epstein et al. supports. 1998 found that women with a history of childhood rape had twice as many symptoms of post-traumatic stress disorder (PTSD) as women who had not been raped. They also had significantly more alcohol symptoms.
  • Additionally, child rape victims with PTSD symptoms had twice as many alcohol-related symptoms as victims without PTSD symptoms. This suggests that post-traumatic stress disorder may be one of the contributing factors to alcohol use. People with post-traumatic stress disorder may use alcohol to ease lingering memories of the abuse.
  • Tovalacci et al., 2013 found that highly stressed college students (stress measured using a questionnaire) were more likely to smoke and abuse alcohol and were at greater risk for Internet addiction. This suggests a link between stress and addiction; However, as this was a correlation study, no causal relationship between the two factors could be demonstrated. In addition, stress was measured using a questionnaire, so social desirability may have influenced the results.


Eysenck (1997) suggested that some personality types are more prone to addiction. For example those withhigh neuroticism(high levels of irritability and anxiety) and those with high psychoticism (aggressive and emotionally distant).

However, this theory is now rejected by most psychologists. The link between personality and addiction is still being studied, and one factor appears to be key to addiction: impulsivity. This is characterized by lack of planning, risk-taking and a desire for immediate gratification.


  • Ivanov et al. 2008 showed a strong association between impulsivity and drug use. Morein-Zamir et al. 2015 found inhibition difficulties mediated by frontostriatal circuits. This suggests that there is a neurological cause for impulsivity, which in turn leads to addiction. However, more research is needed on this topic.
  • A strength of this statement is that it could help identify people at risk of developing addiction and get help before it happens. This would reduce the personal cost to the individual and society.

family influencesAO1

Two main characteristics of family influences: social learning theory and perceived parental approval:

Social Learning Theory or Social Learning - AO1:

The individual (child or adolescent) observes parents smoking or drinking and the consequences of their behavior, for example. B. Parents feel more relaxed or appear happy; The individual imitates the behavior to achieve the same result. Over time and with repeated exposure, the person becomes addicted.


  • However, cognitive factors determine whether a child smokes or not. You may be influenced by other sources such as health messages and peers. Furthermore, the influence depends on the age of the individual. Younger children are more influenced by their families than older ones.
  • It also depends on how much you identify with the behavior model.

Perceived Parental Consent - AO1:

Adolescents perceive their parents to have a positive or at least liberal attitude towards a particular drug or addictive behavior such as gambling. This perception may be due to the fact that the parents themselves take the medication or do not control their behavior, e.g. B. Allowing teen to drink excessively at home.


  • In 1990, Quine and Stephenson conducted a study of a sample of 2,336 Australian children aged 10 to 12 years and found that the children were significantly more likely than other children to have tried to drink or to have had a glass of alcohol when they were the parents were drinking. less weekly.
  • Furthermore, Bonomo et al. (2001) found that teens who suffered an alcohol-related injury were 1.8 times more likely than other teens to have parents who drank alcohol daily.
  • However, it is difficult to separate and measure family influence from all other influences such as peers and the media. Furthermore, these studies are correlative and therefore do not show cause and effect.

Like-minded people – AO1:

According to Quine and Stephenson (1990), peer influence is greater than family influence.

O'Connell points out that there are three peer-influencing characteristics that lead to addiction to alcohol or other drugs.

  • An individual's alcohol or drug use is influenced by interactions with peers who drink or use drugs.
  • These peers provide opportunities (and possibly access) to use alcohol or drugs.
  • Individuals overestimate how much others drink or consume and increase their own consumption to keep up.


  • It is difficult to verify peer influence. It may be due to the peers' decision to follow the addiction rather than the addiction being the result of association with a particular group.
  • Peer influence varies in size depending on the age of the individual. Peers are most important in adolescence, after which their influence diminishes.
  • It is impossible to separate peer influence from other social influences such as family and media influence.
  • This approach does not take into account other possible factors such as social disadvantage, unemployment and stress.
  • Most investigations carried out are correlative and, therefore, do not show a causal relationship between the studied factor and dependence.
  • No single factor is the cause of addiction. These and other factors lead to addiction in different ways, but also to avoidance of drugs, alcohol and gambling. These factors can be social in nature, such as social norms and health messages, but also personal experiences. For example, a person who has observed his or her parents drinking to excess on a regular basis may choose to avoid alcohol and become abstinent; others may choose to abstain from drugs and alcohol for moral or religious reasons. So these are risk factors but not causes.
  • However, research on this topic is important because it can provide the basis for addiction prevention and treatment. For example, teenagers who do not use alcohol, cigarettes or other drugs are less likely to use them as adults. Therefore, prevention and health messages aimed at young people are an effective way to prevent addiction in adulthood.

Question about the AO2 scenario

Julie comes from a family of drinkers. At age 12 she started drinking vodka with her school friends. Now in her early twenties, she has tried to stop drinking but has found it difficult, especially now that she has a very busy and demanding job.

Explain the risk factors relevant to Julie's alcohol addiction.

(Video) Addiction - AQA Psychology in 26 MINS! *NEW* Quick Revision for Paper 3

(4 points)

Julie's addiction can be explained by genetic factors. Her parents drink alcohol. They may have passed on genes that affect how alcohol is metabolized, thus affecting the response to alcohol, increasing its positive effects and reducing its negative effects.

However, it could also be explained by social learning, and she observed members of her family drinking alcohol and experiencing positive consequences, such as: B. Feeling more relaxed (indirect reinforcement), so she mimicked the observed behavior to get the same pleasurable consequences .

Furthermore, according to O'Connell, Julie may have been influenced by her school friends, as she has been associating with friends who drink vodka, may have given them opportunities and access to alcohol, and may have overestimated how much her colleagues drank. and the weight gained has its own consumption to accompany.

Another possible reason is that you have a demanding job that increases your stress, so you may turn to alcohol as a coping strategy because it gives you temporary relief.

Explanations about nicotine addiction

brain neurochemistry

Desensitization hypothesis - AO1:

Acetylcholine (ACh) is a neurotransmitter that, like all neurotransmitters, binds to receptors and activates postsynaptic neurons. A subtype of ACh receptors is called nicotinic receptors and binds both nicotine and ACh.

When nicotine binds to nicotine receptors, the neuron is stimulated; However, the receptors shut down almost immediately and the neuron stops responding to any neurotransmitter (desensitization).

This also leads to the production of dopamine in the body.Nucleus accumbens. This creates a sense of comfort, increased alertness and reduced anxiety.


  • The desensitization hypothesis is supported by Domino (2004), who used functional magnetic resonance imaging that showed a change in blood flow in the nucleus accumbens, amygdala, and hippocampus immediately after smoking the first cigarette in the morning.
  • After smoking the second cigarette, the effects were less than after smoking the first. Low-nicotine cigarettes caused less change in blood flow than cigarettes after the average first cigarette.
    In 2013, D'Souza and Markou found that blocking glutamate transmission in rats reduced nicotine addiction.
  • These results cannot be extrapolated without caution, as animals are physiologically and psychologically different from humans. However, they may lead to human research and treatments aimed at blocking glutamate transmission and thereby reducing nicotine dependence.

Nicotine Regulation Model – AO1:

If the smoker goes without nicotine for a long period, the nicotine is metabolized and excreted, and the nicotine receptors are resensitized, causing feelings of restlessness and anxiety (withdrawal symptoms) that motivate the individual to stop smoking.

Psychology Addiction: Review Notes for A-Level Psychology (1)

Furthermore, increased ACh transmission is accompanied by decreased dopamine activity.

Repetition of this cycle results in chronic desensitization of nicotine receptors, requiring increased nicotine intake to achieve the same effects (tolerance).

In addition, prolonged use of nicotine causes an increase in the number of nicotine receptors.

Nicotine also stimulates the release of glutamates, which also increase and accelerate the release of dopamine, enhancing the rewarding effects of nicotine.


  • The link between nicotine consumption and dopamine is also supported by the study of patients with Parkinson's disease (this disorder is due to the loss of dopamine-producing cells). Studies show that smokers are less likely to develop Parkinson's disease than non-smokers.
  • This suggests that nicotine has a protective effect against the development of Parkinson's disease and supports a link between nicotine and dopamine.
  • Cosgrove et al. (2014) compared the brains of men and women when they smoked through PET scan and found that dopamine action occurred in different regions of the brain. This suggests that men and women may smoke for different reasons. This is not considered in this explanation.
  • This explanation is limited, as research shows that many more neurotransmitters are involved in nicotine addiction, such as serotonin and GABA.
    This investigation is very important since tobacco dependence causes very serious diseases such as lung cancer, which can be fatal and its treatment is very expensive. Therefore, the development of treatments based on these researches can contribute to the well-being of people and the economy.
  • This explanation is reductionist; It focuses only on neurochemical processes and does not take social and psychological factors into account. Therefore, it cannot explain why, as Choi et al. (2003) found that teens most likely to become addicted to nicotine were those who felt they were unwell. It cannot explain individual differences. For example, some people can be and continue to be occasional smokers, while others become addicted to nicotine very quickly.

Question about the AO2 scenario

Josh has been a heavy smoker for many years. You've tried to quit smoking, but the urge to smoke is so strong that you always fail. He always smokes a cigarette before bed and smokes the first thing he does when he wakes up. He always says that the first cigarette in the morning is the best cigarette of the day.

Use what you know about the neurochemical explanation of nicotine addiction in the brain to explain Josh's behavior. (4 points)

(4 points)

When Josh smokes a cigarette, the nicotine in the tobacco is absorbed into the bloodstream and reaches the brain very quickly. There it binds to nicotinic receptors and neurons are stimulated; However, the receptors are deactivated almost immediately and the neurons stop responding to the neurotransmitters (desensitization).

This also leads to the production of dopamine in the nucleus accumbens. This creates a sense of comfort, increased alertness and reduced anxiety. However, as Josh does not smoke at night, the nicotine is metabolized and excreted, the nicotine receptors are re-sensitized, leading to feelings of restlessness and anxiety (withdrawal symptoms) and waking up wanting to smoke.

The first cigarette of the day is the best because the receptors have been sensitized, so you feel the effects of nicotine more than after the other cigarettes you smoke during the day, as you smoke often enough to avoid the unpleasant effects of nicotine. awake.

learning theory

The learning theory explanation of nicotine dependence aims to explain the onset, maintenance, and relapse of nicotine dependence.

Introduction -> Social Learning Theory (SLT)

Maintenance -> Operant Conditioning

Backup -> Signal reactivity

Social Learning Theory (SLT) – AO1:

SLT assumes that people start smoking, especially at an early age, because they learn from their social environment. You observe people B. Peers or parents who smoke and the consequences of the behavior, p. B. that they like, that they look "cool" and that they are popular (indirect reinforcement).

They then mimic the behavior (smoking) to get the same reinforcers.

Mayeux et al. (2008) led alongitudinal studyand found significant positive correlations between smoking at age 16 and popularity two years later among boys. However, they found a negative association between smoking at age 16 and popularity at age 18 among girls.

This suggests that popularity is indirect rather than direct positive reinforcement for boys but not for girls.


  • DiBlasio and Benda (1993) found that adolescent smokers related to other smokers and were more likely to conform to the social norms of a group of smokers.
  • This explanation explains the motivation to start smoking, but does not explain why smoking persists despite consequences (penalties) such as costs, health warnings and health problems resulting from smoking.
  • This statement has practical application in smoking prevention. Individuals could learn the skills needed to resist social influence (Botvin, 2000).

Operant Conditioning – AO1:

operant conditioningexplains why people continue to smoke after quitting. When a person smokes, the effects of nicotine on the dopamine reward system positively strengthen it.

Nicotine causes the release of dopamine in the nucleus accumbens, which induces a mild feeling of euphoria and thus rewards the behavior (smoking).

However, not smoking causes feelings of restlessness and anxiety, and this works as anegative reinforcement. Therefore, the behavior (smoking) is more likely to be repeated to avoid withdrawal symptoms.


  • Levin et al., 2010, trained rats to self-administer nicotine by licking one of two gargoyles. With each training session, the number of licks increases, suggesting that the effects of nicotine (higher levels of dopamine leading to a mild euphoria) amplify nicotine consumption behavior.
  • However, since this study was conducted on animals, we cannot make inferences about humans without caution, as we are psychologically and physiologically different and therefore the effects may be different in humans.
  • Also, only nicotine was used in the study, but cigarettes and other tobacco products contain many other components that can also affect behavior, so the results may not reflect the response to smoking as a whole.

Signal Reactivity - Classical Conditioning - AO1:

Stimulus reactivity is the theory that people associate situations (e.g. meeting friends)/places (e.g. a pub) with the rewarding effects of nicotine and that these stimuli can trigger cravings.

These factors become smoking-related cues. There is an association between these factors and smoking with prolonged use of nicotine.

This is based on classical conditioning. this is nicotineunconditional stimulus (UCS), and the pleasure caused by the sudden increase in dopamine levels is the unconditional response (UCR).

After this surge, the brain tries to reduce dopamine levels to normal levels. Nicotine-associated stimuli were neutral stimuli (NS) before "learning" occurred, but became conditioned stimuli (CS) through repeated pairings.

You can generate the conditioned response (CR). However, when the brain is not supplied with nicotine, dopamine levels drop and withdrawal symptoms occur; Therefore, they are more likely to feel the need to smoke when they have signs associated with nicotine use.


  • This may explain continuation of smoking and relapse in people who stop, but it may not explain why people start smoking.
  • Carter and Tiffany, 1999 support the stimulus reactivity theory and performed a meta-analysis examining 41 stimulus reactivity studies comparing the responses of alcoholics, cigarette smokers, cocaine addicts, and heroin addicts to neutral and drug-related stimuli. They found that addicts responded strongly to the presented cues, reporting desire and physiological arousal.
  • Calvert, 2009 found that when smokers viewed cigarette packs, they experienced strong activation in the nucleus accumbens. This supports stimulus reactivity, as the cigarette packs acted as a stimulus and elicited the same activation pattern produced by nicotine ingestion.

Social Learning Theory (SLT) – AO3:

  • There are practical applications: some treatments, such as aversion therapy and covert sensitization, follow from this explanation (see Dependency Reduction).
  • These treatments have proven to be effective. It does not explain why men and women have certain differences. For example, women have more difficulty giving up smoking than men and relapse more often than men.
  • It does not explain why many people start smoking but do not become addicted. This suggests that other factors are at play that are not taken into account in this theory.
  • Operant conditioning and classical conditioning are deterministic explanations; However, the SLT accepts that the individual can choose not to imitate the behavior presented by the models, therefore, some free will is recognized in this case.
  • This theory does not take into account other negative environmental factors.
  • Robin (1973) conducted research on American Vietnam veterans. About 20% of US soldiers used heroin during the Vietnam War; However, when they returned home, he found that "only 5% of men who became addicted in Vietnam relapsed within 10 months of returning, and only 12% had a brief relapse within three years."
  • These results are reported by Alexander et al. supported. (1981). They put the rats in a cage where they could drink from two water fountains. One dispenser contained a morphine solution and the other tap water.
  • When the mice were alone, they drank 19 times more morphine solution than when they were with other mice.
    These studies suggest that negative environmental factors can lead to drug use and perpetuate addiction.

Question about the AO2 scenario

William is 25 years old, has smoked since he was 14 and has decided to quit because he wants to run a marathon next year. He has big problems, especially on Friday and Saturday nights when he goes to bars and clubs with his friends. You also feel like smoking after a stressful day.

Using your knowledge of the learning theory explanation of nicotine addiction, explain why William has difficulty giving up smoking. (4 points)

(4 points)

(Video) AQA A-Level Psychology Addiction (Paper 3)

Over time, William associated pubs and clubs with the rewarding effects of smoking, to the point where they became smoking-related signs.

They can cause increased dopamine levels with associated feelings of pleasure and reduced anxiety; However, after this increase, the brain tries to reduce dopamine levels to normal levels.

However, as William's brain has not received nicotine since he no longer smokes, his dopamine levels plummet and William experiences withdrawal symptoms. Therefore, he has more problems on these tracks.

Also, you struggle even after a stressful day because you crave the negative reinforcement (anxiety reduction) that smoking nicotine provides.

Explanations about gambling addiction

Social Learning Theory (SLT)

SLT assumes that people start playing games because they learn from their social environment. You observe people, for example peers or parents, as they play and the consequences of the behavior, for example. B. They enjoy the thrill and earn money (reinforcement for power). Then they mimic the behavior (the game) to get the same reinforcers.

operant conditioning

Play is maintained through positive and negative direct reinforcement.

A reinforcer is anything that increases the likelihood that a behavior will be repeated.

positive reinforcement: anything that rewards the behavior, e.g. B. Winning money, the thrill of gambling, the social life associated with gambling, eg. B. in casinos and bookmakers.

Negative reinforcement: anything unpleasant that is avoided during the performance of the behavior, e.g. B. Gambling can offer a way out of a stressful life and loneliness.

Plano B

continuous reinforcement: Skinner's studies with rats and pigeons demonstrated that when behavior, e.g. For example, pecking a disc was reinforced with food each time it was performed (fixed ratio), the behavior was repeated, but when the rewards stopped, the behavior quickly stopped (extinction). ).

Variable Ratio Gain: When the behavior was rewarded only unpredictably (only occasionally, and it is impossible to say when the reward will occur), the behavior took longer to learn, but once learned, it was highly resistant to extinction.

Variable Ratio GainIt is a kind of partial reinforcement. Applying the theory to the game: A fruit machine could be set to pay out a payout every 30 spins, on average.

However, an individual can win in game 5 and only later in game 47 (variable ratio), but the individual continues to play despite the losses and expects a reward.


  • It can be argued that operant conditioning does not explain why people keep gambling if they lose more than they win, since losing is a penalty. So this should make gambling less likely.
  • However, the magnitude of losses is less obvious than the magnitude of gains. For example, losses on a slot machine are a few pounds each, so it's not as obvious, but the win can be £50 all at once, so it's more noticeable.
  • Furthermore, the fact that the defeat is relatively small each time does not cause great anxiety, but the victory causes a feeling of euphoria, so the link between the behavior and the feeling of triumph is stronger.
  • Parke and Griffiths, 2004 found support for the reinforcing role of victory, but also for "almost victory" (being very close to victory, for example, the horse comes in second place). This means that the game is not only rewarded with a win, but also with a near win, increasing the potential for addiction.
  • Operant conditioning cannot explain how people start to play (see SLT), but it can explain how behavior is maintained.
    Operant conditioning requires contiguity between behavior and consequences (brief delay between betting and winning or losing).
  • However, in some gambling activities, such as poker or betting on the outcome of a sports game or a horse race, there is a fairly long gap between the two, so the link between the behavior and the consequences must be more weaker than slot machines. However, this doesn't seem to be the case, as both types of games appear to be equally addictive.
  • This theory does not explain why many people gamble and experience a craving at some point in their lives. Relatively few people develop a gambling addiction.
  • This suggests that other factors are involved in the development of gambling addiction.
  • This theory has a beta bias (does not take into account the difference between men and women). According to a 2009 study by Hare on gambling in Victoria, Australia, which included a sample of 15,000 adults, 1.3% of men were addicted to gambling, compared to just 0.6% of women. .
  • They also found that men were more likely than women to play games for social or general entertainment reasons, but women were more likely to play games to relieve stress, loneliness and boredom. This suggests that there are gender differences that theory cannot explain.
  • This theory is reductionist. It does not take into account the physiological rewards that players experience, such as the adrenaline and dopamine rush that accompany the “high” of winning.
  • Operant conditioning is deterministic; It does not recognize free will and behavior is dictated by consequences, but the SLT recognizes that individuals may not want to mimic observed behavior in the game for moral or religious reasons.
  • This explanation has practical applications: some treatments, such as B. aversion therapy and covert sensitization, follow from the learning explanation (see addiction reduction). These treatments have proven to be effective.

Question about the AO2 scenario

Alice started going to the casino with her friends and didn't like it very much at first, but she had two big wins and a few narrow misses. Then he found he wanted to go back there every weekend. Now he gambles online when he can't make it to the casino and found out last month that he was spending more than half of his salary that way.

Use your knowledge of the learning theory explanation of gambling addiction to explain Alice's addiction. (4 points)

(4 points)

Operant conditioning could explain Alice's addiction. According to this theory, gambling behavior is supported by direct positive reinforcement, in Alice's case, winning twice.

However, wins are received intermittently and unpredictably (variable win). For example, a fruit slot machine can be set to pay out a prize every 30 spins on average. However, an individual can win in game 5 and only later in game 47 (variable ratio), but the individual continues to play despite the losses and expects a reward.

The behavior takes longer to learn, but once learned it is highly resistant to extinction. In addition, Parke and Griffiths (2004) found support for the reinforcing role of victory, but also for "near victory" (being very close to victory, for example, the horse comes in second).

This means that the game is rewarded not only with a win, but also with a near win, as Alice did a few times, making the game even more addictive.

Cognitive theory to explain gambling addictionAO1

Cognitive theory explains play in terms of irrational/maladaptive thought processes. It focuses on the reasons people give for gambling.

According to cognitive theory, gambling behavior can be explained by a cognitive bias.

Acognitive distortionIt is a pattern of thinking and processing information about the world that leads to distorted perceptions, attention, and memories of the people and situations around us.

These biases operate at an automatic and preconscious level, but affect the attention and memory associated with the behavior.

Rickwood et al. (2010) identified four main categories of cognitive biases:

  1. Skill and Judgment: Gamblers tend to overestimate their control over their chances of winning, even in random forms of gambling such as the lottery. They may be looking back on past draws and thinking they can spot patterns in the winning numbers.
  2. Personal Traits and Rituals: Players sometimes believe that they are inherently luckier than other people. They engage in ritual behaviors before or during the game that they believe can tip the odds in their favor, such as B. if they have a lucky number.
  3. Selective recall: The tendency to overestimate gains and underestimate losses, regarding large losses as completely inexplicable.
  4. Misperceptions: This includes the gambler's fallacy, the notion that random events even out over time, e.g. B. "I haven't won in three weeks, so it should be my turn soon."


  • Griffiths (1994) conducted a study to find out whether regular slot machine players behaved and thought differently from non-regular players (the control group).
  • They gave each participant £3 to spend on the fruit machine, and the Aces were asked to "speak out loud" so that their cognitive activity could be assessed. Subsequently, they were interviewed to assess their perceived skill level.
  • They found that regular players considered themselves more skilled than non-gamers; in fact, there was no difference. They tended to make unreasonable statements, such as statements that suggested the machine had a personality or a vibe (this machine doesn't like me). They were also more likely to explain losses as near misses or even near wins.
  • The theory is also supported by Michealczuk et al. supports. (2011). They compared 30 addicted gamblers with 30 non-gamblers while each group played slot machines. In the case of gamblers, the probability was much higher.cognitive distortionsand a much greater sense of control.
  • The results of these two studies support the cognitive explanation, as they show the presence of expected cognitive biases and irrational beliefs, eg. B. the attribution of personality and humor to a slot machine by addicted gamblers.
  • However, it could be argued that what participants said while playing slots did not reflect what they really thought. However, as these biases operate at a preconscious level, it is very difficult to access these beliefs in any other way.
  • It is impossible to know whether cognitive distortions are a cause or a symptom of gambling addiction. If they occur before addiction, the theory does not explain how these biases arise or why they occur in some people and not others.
  • This theory is a beta bias. According to a 2009 study by Hare on gambling in Victoria, Australia, which included a sample of 15,000 adults, 1.3% of men were addicted to gambling, compared to just 0.6% of women. . They also found that men were more likely than women to play games for social or general entertainment reasons, but women were more likely to play games to relieve stress, loneliness and boredom. This suggests that there are gender differences that theory cannot explain.
  • This explanation is reductionist; sees players isolated from their social environment. For example, if people are struggling financially, it might make sense to buy lottery tickets regularly in hopes of winning a big ticket that will solve their problems. Furthermore, it does not take into account the physiological rewards that players experience, such as the adrenaline and dopamine that accompany the “high” of winning.
  • A more holistic explanation, combining cognitive, physiological and social factors, would be more complete.
  • Knowing how players think has practical applications. For example, cognitive-behavioral therapy aims to address these preconceptions and irrational beliefs in order to reduce gambling addiction.

Question about the AO2 scenario

Ben plays the lottery every week; He could do it online, but says he wouldn't win that way. He always goes to the same store at the same time, always uses his lucky pen and chooses his numbers carefully after looking at the results from the last 12 weeks, where he recognizes patterns.

Explain Ben's behavior using what you know about the cognitive approach. (4 points)

(4 points)

Ben provides evidence of the use of some of the methods by Rickwood et al. identified cognitive biases. (2010). One such bias is skill and judgment. You think you can spot patterns in winning lottery numbers. It gives you the illusion that you have some level of control in a game where the results are completely random.

Another cognitive bias that Ben exhibits is ritual use, such as using the same pen at the same time in the same store every week. He believes these rituals could tip the odds in his favor, while online gambling would keep him from winning.

reduce addiction

pharmacological treatments

There are three basic types of drug treatment:

  1. aversive:
    These drugs have unpleasant consequences, e.g. B. Vomiting and nausea when taken with certain medications. For example, when people consume alcohol while taking disulfiram, a drug in Antabuse, they experience nausea, vomiting, dizziness, blurred vision, and severe headaches. They work on the principle of behavioral counterconditioning, replacing pleasant associations with unpleasant ones.
  2. Agonists:
    These drugs are actually drug substitutes. They serve as a less harmful substitute for the drugs people are addicted to. You have fewer side effects. They bind to the same neural receptors as addictive drugs and produce similar effects. They allow a gradual and controlled withdrawal of the substance. One example is methadone used to treat heroin addiction.
  3. antagonists:
    These drugs block neural receptor sites, preventing chemical dependence from having its usual effects, such as the feeling of euphoria, for example, naltrexone used in the treatment of heroin dependence.

Of these treatments, only agonists prevent withdrawal symptoms, so patients receiving aversive medications or antagonists may need additional treatments to alleviate these uncomfortable symptoms, such as: B. Anxiolytics such as benzodiazepines (Valium) to reduce withdrawal anxiety.

Drug therapy for nicotine addiction – AO1:

Nicotine replacement therapy (NRT) uses patches, gum and inhalers to deliver nicotine, the psychoactive substance in tobacco, in a less harmful and controlled way than smoking.

NRT uses “clean” means to deliver nicotine into the bloodstream. While it still increases heart rate and blood pressure, it is not taken with other harmful chemicals found in tobacco products such as cigarettes.

Nicotine works in the same way as tobacco products. Stimulates nicotine receptors and releases dopamine in the nucleus accumbens, causing feelings of pleasure and reducing anxiety.

Over time, the amount of nicotine gradually decreases. For example, patches are reduced so that withdrawal symptoms are controlled over a period of two to three months.

Stead et al. (2012) reviewed 150 studies involving 50,000 people and found that the odds of quitting smoking were increased by 50-70% with the use of NRT compared with placebo and no treatment.

They found no overall difference in effectiveness between different forms of NRT (patch, spray, or gum). This supports the effectiveness of the treatment, but it also supports the biological explanation for nicotine addiction.

Pharmacological treatment for gambling addiction – AO1:

There is no specific medicine to treat gambling addiction. However, naltrexone, which is typically used to treat heroin addiction, is used in the United States because of the similarities between gambling addiction and substance abuse.

(Video) The Whole of AQA A Level Psychology | Revision for Exams

Like nicotine, heroin and other drugs, gambling triggers the release of dopamine, thus activating the reward system.

Naltrexone, an opioid antagonist, reduces the release of dopamine in the nucleus accumbens, thereby decreasing pleasure, and increases the release of GABA in the mesolimbic system, a neurotransmitter that reduces cravings.

In the UK, naltrexone is only used to treat heroin addiction. However, in the United States it is increasingly used for other addictions.

A big problem with naltrexone is that this medication can have serious side effects such as anxiety, drowsiness, fatigue, panic attacks and depression.

Furthermore, this medicine can also cause patients to lose enjoyment in all other areas of their life, leading to non-compliance (patients discontinuing the medicine) and thus reducing the effectiveness of the treatment.

Kim, 2001, conducted a 12-week double-blind, placebo-controlled study with naltrexone and found that a dose of 188 mg/day reduced the frequency and intensity of gambling urges, as well as behavior itself, in 45 pathological gamblers. compared. for others. to the placebo group.

Another group of drugs is also used, the selective serotonin reuptake inhibitors (SSRIs). The serotonin system is involved in impulse control by inhibiting serotonin reuptake. These drugs make more available at the synapses. Therefore, they should increase impulse control and reduce gambling.

This is suggested by Hollander et al. supports. (2000) showing a significant improvement in theexperimental groupcompared to the placebo group; Saiz-Ruiz et al. (2005) found no differences.


  • Drug treatment is cheaper than other forms of treatment, such as cognitive-behavioral therapy, because it only requires a prescription and medical supervision. However, the use of drugs raises ethical issues, as some of the drugs used have serious side effects.
  • This must be clearly discussed with the people being treated. However, due to the harm caused by drugs, some drug users may not have the mental capacity to give informed consent.
    This treatment requires regular intake of pills/injections. This can be difficult for substance abusers who lead highly disorganized lives or who have suffered memory damage through the use of drugs such as cannabis, ecstasy and cocaine.
  • Drug treatment alone may not be effective, according to McLellan et al. (1993) found that a group of substance abusers who took methadone and who also received psychological intervention responded better to treatment than a group treated with methadone but without psychological help.
  • By focusing only on the biological problem and not viewing addiction as a choice, this approach removes the stigma of addiction and the blame culture that surrounds it.
  • On the other hand, difficulties that may have initially led to addiction are not discussed, e.g. B. stress, loneliness, or other social problems such as unemployment.
  • Furthermore, it does not address the issue of cognitive biases involved in some addictions, such as gambling.

Question about the AO2 scenario

Mia is addicted to cigarettes. You smoked 20 to 30 cigarettes a day for over 10 years. He realizes that this is bad for his health and costs him a lot of money that he could use for other better things, like a vacation. You want to quit smoking, but you've tried and failed. This time you have decided to use nicotine patches but are worried about withdrawal symptoms.

He explained to Mia how nicotine patches work and the benefits of using them.

(4 points)

Nicotine patches are a form of nicotine replacement therapy (NRT). They provide nicotine, the psychoactive substance in tobacco, in a less harmful and controlled way than smoking.

NRT uses “clean” means to deliver nicotine into the bloodstream. While it still raises your heart rate and blood pressure, it's not taken with the cocktail of other harmful chemicals found in tobacco products such as cigarettes, so your breathing should improve.

Nicotine works in the same way as tobacco products. Stimulates nicotine receptors and releases dopamine.Nucleus accumbens, thus evoking feelings of pleasure and reducing anxiety.

So Mia doesn't have to worry about withdrawal symptoms, she might miss holding a cigarette, but she won't have any of the symptoms that come with nicotine withdrawal, such as anxiety and moodiness, so they're more likely. to succeed in her attempt.

Over time, the amount of nicotine gradually decreases. For example, patches are reduced so that withdrawal symptoms are controlled over a period of two to three months.

behavioral interventions

Aversion therapy – AO1:

This is based on classical conditioning. According to learning theory, two stimuli are associated when they frequently occur together (pairing). In dependence, the drug, alcohol or behavior, in the case of gambling, are associated with pleasure and high excitement.

Aversion therapy uses the same principle but changes the association and replaces pleasure with an unpleasant state (counterconditioning).

Alcohol addiction and aversion therapy.

Patients are given an aversive drug that induces vomiting: an emetic. There is nausea. At that point, they are given a drink that smells strongly of alcohol and begin vomiting almost immediately.

The treatment is repeated with a higher dose of the drug.

Another treatment involves the use of disulfiram (eg Antabuse). This drug interferes with alcohol metabolism. Alcohol normally breaks down into acetaldehyde and then into acetic acid (vinegar).

Disulfiram prevents the second stage from occurring and causes very high levels of acetaldehyde, the main ingredient in a hangover. This causes a severe, throbbing headache, increased heart rate, palpitations, nausea and vomiting.

Aversion Therapy for Gambling Addiction

Electric shocks are used for behavioral addictions such as gambling, and although painful, they do not cause harm.
The player creates reference cards with key terms associated with the game, then similar cards for neutral statements.

While reading the statements, they administer a two-second electric shock for each game-related statement. The patient himself determines the intensity of the shock with the aim of making it painful but stressful.

Covert Sensitization – AO1:

This will be used today instead of aversion therapy. It is also based on the principle of counterconditioning.

Rather than experiencing electric shocks or vomiting, the client is asked to imagine what it would be like to experience them. This is called in vitro conditioning.

The client is asked to first relax and then imagine an aversive situation, e.g. B. Nausea, vomiting or seeing a snake wrapped around your drink if you are afraid of snakes. The therapist encourages the client to go into detail, imagining color, texture, smell, etc. In your head.

They then imagine smoking, drinking, or gambling while contemplating the unpleasant consequences. This could include smoking cigarettes with a dirty face.

The aim is to make the scene as vivid as possible to create a strong association. It is assumed that the more negative the situation, the greater the chances of success.

Evaluation of behavioral interventions as a way to reduce addiction(AO3)

  • Meyer and Chesser (1970) found that with aversion therapy, 50% of alcoholics abstained from alcohol for at least one year, and that treatment was more successful than no treatment. This supports the effectiveness of interventions based on classical conditioning.
  • However, Hajek and Stead (2011) reviewed 25 studies on the effectiveness of aversion therapy and found that all but one had major methodological flaws, meaning that their results should be treated with caution.
  • Due to the unpleasant nature of the stimuli used, e.g. B. cause violent vomiting, treatment adherence is low.
  • There are ethical issues associated with the use of aversion therapy, such as: B. Physical harm (vomiting can cause electrolyte imbalance) and loss of dignity. For this reason, covert sensitization is now preferred over aversion therapy.
  • Ashem et al. (1968) found that 40% of a group of alcohol dependents who received covert sensitization were still abstinent at six months, compared with a group of alcoholics.control groupin which everyone continued their normal consumption habits.
  • McConaghy et al. (1983) found that 90% of gamblers who received covert sensitization reduced their gambling activities after one year, compared with 30% of participants who received aversion therapy.
  • This suggests that the effect of covert sensitization lasts longer than that of aversion therapy.
  • However, relapse is an issue with both therapies. Outside the controlled environment in which behavior/drug associations form with unpleasant stimuli, addictions often recur.
  • Behavioral therapies are mostly used in combination with other therapies [(CBT) or biologics (drugs)]. Therefore, it is difficult to assess its effectiveness.
  • Behavioral interventions focus on the behavior but do not address the underlying cause of the addiction, such as biological factors, cognitive biases, or the social environment (i.e., the reason that leads to the addictive behavior in the first place). A more holistic approach can be more effective in achieving lasting improvements.

Question about the AO2 scenario

Melanie has smoked for many years. He had tried several times to stop smoking, but he couldn't even with the nicotine patches.

He is very concerned about his morning cough, which he thinks is due to smoking. Her doctor advised her to consider aversion therapy. She's not sure what she's capable of and asks her advice.

Using your knowledge of behavioral interventions to reduce addiction, explain how aversion therapy could help Melanie stop smoking and whether you would recommend this treatment.

(6 points)

Aversion therapy is based on classical conditioning. According to learning theory, two stimuli are associated when they frequently occur together (pairing).

For Melanie, smoking is now associated with pleasure and relaxation. Aversion therapy uses the same principle but changes the association and replaces pleasure with an unpleasant state (counterconditioning).

In Melanie's case, she can receive an electric shock every time she sees an image of a cigarette or picks up a lighter. After repeated matings, he began to associate cigarettes with electric shocks and stopped smoking.

Aversion therapy can be effective for alcohol addiction. For example, Meyer and Chesser (1970) found that with aversion therapy, 50% of alcoholics abstained from alcohol for at least one year, and that treatment was more successful than no treatment.

However, it is an uncomfortable treatment and they may find it difficult to maintain it and stop the treatment before the link between cigarettes and electric shock pain is strong enough to stop.

Furthermore, aversion focuses on the behavior but does not address the underlying cause of the addiction, such as biological factors, cognitive biases, or the social environment (i.e., the reason that leads to the addictive behavior in the first place). A more holistic treatment, such as a combination of nicotine replacement therapy and cognitive behavioral therapy, may be more effective in achieving lasting improvement.

(Video) Psychological Research: Crash Course Psychology #2

Cognitive behavioral therapy (CBT)

CBT believes that behavior and addiction are determined by how we think. Therefore, the goal of therapy is to recognize the way people think about their addiction and to change it more adaptively (functional analysis).

The second objective is to help the client develop strategies to avoid situations that trigger addictive behaviors (skills training).

Functional analysis - AO1:

The client and therapist identify situations where he is likely to gamble, use drugs, or drink alcohol. They explore thoughts and motivations before, during and after the event to help the patient identify “thinking errors”, cognitive biases or cognitive distortions.

These are questioned by the therapist. A functional analysis is performed throughout treatment to assess the therapy's success and determine its future direction.

Skills Training – AO1:

Addicts often respond to the challenges of everyday life by turning to their addiction. CBT helps by suggesting other strategies.

Cognitive Restructuring: Treatment helps the client change their irrational beliefs and cognitive biases.

Specific Skills: The objective is to enable the client to deal with situations that lead to the use of alcohol/gambling or drugs. The skills taught vary according to the client's needs. This might include assertiveness training to help an alcoholic firmly but politely refuse a drink offered at a party.

Social Skills: These skills help people avoid situations that might prevent them from dealing effectively with social situations. The therapist explains and models the behavior, then the client acts out the behavior.

Evaluation of cognitive interventions as a way to reduce addiction(AO3)

  • Ladouceur et al. (2001) randomly assigned 66 gamblers to a CBT group, in which their irrational thoughts about gambling were questioned and trained in relapse prevention, and a control group, in which participants were placed on a waiting list for treatment. .
  • Results show that 86% of participants in the CBT group have reduced their gambling to the point where they are no longer defined as addicted. This improvement continued after one year.
  • This supports the effectiveness of cognitive behavioral therapy.
  • This is also supported by Petri (2006), who compared pathological gamblers who attended Gambler's Anonymous (GA). They had GA and CBT or just GA. One year later, participants in the CBT group played significantly less than the GA group.
  • Cowlishaw et al. (2012), however, reviewed 11 studies on the effectiveness of CBT and found that there are medium to large positive effects in the short term (3 months), but no differences at 12 months.
  • Cognitive-behavioral therapy is delivered in 10 to 15 weekly one-hour sessions. Furthermore, an important aspect of this therapy is “homework”, as after each session the client is asked to practice new skills in real situations. This makes CBT time-consuming and also requires commitment from the client. This can be a problem for certain types of addicts, such as drug addicts who lead very disorganized lives.
  • This leads to a high dropout rate. Cuijpers (2008) found that the dropout rate from cognitive-behavioral therapy is five times that of other types of therapy. Therefore, only highly motivated clients should benefit from therapy.
  • CBT does not take into account the influence of biological factors. However, it can be used with other treatments such as B. The drugs are used to relieve withdrawal symptoms.
  • An advantage of cognitive-behavioral therapy is that, unlike other therapies, it teaches skills to resist social pressures and deal with everyday situations without using drugs or alcohol.
  • Another limitation of cognitive-behavioral therapy is that it does not address social stressors that may have led to addiction or perpetuated addiction, such as: B. demanding jobs, difficult private lives, or housing issues. A more effective solution to addiction must take a broader approach that considers the community.
  • In addition, people with a long history of abuse face other difficulties, such as unemployment and homelessness, and drugs and alcohol are part of their culture and environment. They may not have the necessary skills and resources to transition to a new life and will need more than cognitive behavioral therapy to adjust.

Application of behavior change theories to addictive behaviors.

Theory of Planned Behavior (TPB)

This is a cognitive theory proposed by Azjen and Fishbein (1975) according to which a person's decision to perform a certain behavior, such as gambling or giving up, can be predicted by his intention to perform that behavior.

according to theoryof planned behaviorIntents are determined by three variables:

personal settings– This is our personal attitude towards a certain behavior. It is the sum of all our knowledge, attitudes and prejudices, whether positive or negative, that we think about when we think about behavior. For example, our individual attitudes towards tobacco might include that tobacco is relaxing and makes me feel good, but it makes me cough in the morning, costs a lot of money and smells bad.

subjective norms– This takes into account how we perceive other people's ideas about certain behaviour, e.g. B. smoke. This could be the attitude of family, friends and co-workers towards smoking. What matters is not what others think, but our perception of the attitudes of others.

Perceived behavioral control– It is the degree to which we believe we can control our behavior (self-efficacy).
This depends on our perception of internal factors, such as our own ability and determination, and external factors, such as the resources and support available to us.

The theory states that our perceived behavioral control has two effects:

  • It influences our intentions to behave in a certain way, ie. H. The more control we feel we have over our behavior, the stronger our intention to perform the behavior will be.
  • It also directly affects our behavior; When we realize that we have a high level of control, we will work harder and longer to succeed.


  • TPB is the most widely used model in health psychology. It has been shown to be useful in predicting smoking and drinking intentions, as reported by Hagger et al. supports. (2011). He found that all three components of the model (personal attitudes, subjective norms, and perceived behavioral control) were correlated with alcoholics' intentions to reduce or stop drinking. He also found that these intentions were reflected in his behavior and could predict the approximate number of units consumed per month and over three months. However, it was not an indication of excessive alcohol consumption.
  • Penny (1996) found that the more often smokers are unable to quit, the less likely they are to believe that they will, and therefore the less willing they are to try. This shows how important perceived behavioral control is in shaping our intentions, as predicted by the TPB.
  • Webb et al. (2006) conducted a meta-analysis of 47 studies and found that although there is an association between intention and actual behavior, this association is small. This suggests that there is a significant gap between intentions and behavior.
  • There are methodological problems associated with the investigation of this theory. All components of the model are evaluated through questionnaires or interviews, so the answers are influenced by social desirability. Furthermore, these interviews or questionnaires are carried out when participants are not under the influence of drugs/alcohol, but are in situations that trigger their addictive behavior (bar, party, etc.), they can quickly forget their intentions and resume the behavior. .
  • A strength of TPB is that it takes into account peer influence (subjective norms), which is important for both initiation and maintenance of behavior (SLT and operant conditioning).
  • TPB assumes that all behavior is intentional, reasonable, and planned; However, it does not consider the role of emotions such as sadness and frustration, which can play an important role in influencing behavior.
  • TPB has been used in health education campaigns. Anti-drug campaigns often provide data on the percentage of people who engage in risky behavior, such as smoking or taking drugs, in order to change the subjective norm. For example, adolescent smokers tend to belong to a peer group that smokes. So you might think that smoking is the norm; However, since most teenagers do not smoke, dealing with statistics that show them the true extent of smoking should change their subjective norm.

Question about the AO2 scenario

Miguel smokes about 40 cigarettes a day and fears that this will negatively affect his health. Costs also concern you. His family and colleagues want him to give up. However, he doesn't feel he has the willpower to do so.

Using your knowledge of the theory of planned behavior, explain whether Michael is likely to be able to quit smoking. (4 points)

Miguel has a positive personal attitude towards quitting, recognizing that smoking is harmful to his health and concerned about the cost of smoking.

He also has a subjective norm that should help him in his attempt, as his family and peers make it clear that they want him to give up. However, he does not have perceived behavioral control (self-efficacy), as he does not believe he can stop smoking.

According to the theory of planned behavior, this is the most important factor in your success. Therefore, you are unlikely to be able to quit smoking.

Prochaska's six-step behavior change model

Prochaska and DiClemente (1983) found that the transition from unhealthy behavior (smoking) to healthy behavior (not smoking) is complex and involves several steps.

These phases do not occur in linear order. The process is usually cyclical. Some stages may be missed or addicts may regress to an earlier stage before progressing again.

The model takes into account people's willingness to quit and adapts the intervention to the stage the client is at.

Phases of the Prochaska behavior change model

1. Visualization

Right now, people don't think about changing their behavior in the near future. They may deny or feel discouraged by the failure of previous attempts. Intervention at this stage should focus on helping them to see that they have a problem.

2. Contemplation

People are increasingly aware that they need to change. They consider the benefits and costs of a change. This phase can last a long time. At this stage, the intervention should help the client see that the benefits outweigh the disadvantages.

3. Preparation

At this stage, the person has made the decision to make a change, but does not have a plan on how to do so. Any intervention should focus on helping the client decide what support he needs to make the change successful, for example B. Contacting a GP, specialist clinics or hotline.

4. Action

At this stage, people change their behavior, e.g. B. abstain from all tobacco products and lighters…. Relapses may occur. The intervention should focus on supporting the individual with practical help, praise, and rewards to sustain change.

5. Maintenance

The person has maintained the change for at least six months and is increasingly confident that the change can be permanent. Intervention at this stage focuses on learned strategies to prevent relapses, e.g. B. emphasize the benefits of breaking addiction...

6. Termination

Change is permanent and stable. Withdrawal is now automatic; there is no relapse. Some people do not reach this stage and remain in the maintenance phase for many years. For them, a relapse is still possible.


  • The model is flexible and dynamic. It reflects changes in emotions and attitudes that addicts have towards their condition. Sometimes they seem to deny it and other times they realize their addiction is a problem.
  • In addition, it offers a different intervention approach in each phase. This should lead to interventions that are more individually tailored and more likely to be successful than a one-size-fits-all approach.
  • However, research on the effectiveness of this model is inconclusive. Velicer et al. (2007) reviewed five studies and found a success rate of 22 to 26, which compares well with other interventions. Furthermore, Aveyard et al. (2009) found that adapting the intervention to changing stages did not increase its effectiveness in people trying to quit smoking. Likewise, Baumann et al. (2015) conducted a study with alcohol dependents randomly distributed into an experimental group and a control group. They found no positive effect from a graded intervention.
  • The model encourages a more realistic view of relapse, seen as an inevitable part of the process rather than the client's fault. This is a strength because it avoids the low confidence and demotivation that are likely to occur when the client sees the relapse as a failure.
  • A weakness of the model is that the difference between phases is often "fuzzy", eg. B. the difference between contemplation and preparation is vague. Therefore, it is worth asking whether these are really two distinct phases.
  • Another weakness is that the model ignores the influence of social factors such as living conditions and unemployment in this environment. It also doesn't take into account the influence of wider social norms, as some societies do, and people are expected to drink alcohol when socializing, so it would be very difficult to do without.

Question about the AO2 scenario

Layla has been smoking for a few months, but realizes that it is affecting her health and costing her a lot of money. On the other hand, she feels that she likes her first cigarette in the morning and that cigarettes help her relax when she is stressed at work.

Using Prochaska's behavior change model, explain what stage Layla is in. Justify your answer. (4 points)

Layla is in the contemplation phase of the model, the second phase. You realized that you need to change your smoking habit as it affects your health and costs a lot of money.

He thinks about the benefits, in his case better health and some savings, but also the disadvantages like lack of money. B. the lack of pleasure from the first cigarette of the day and the need to find another way to deal with stress at work.

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This phase can last a long time. At this stage, the intervention should help Layla see that the pros outweigh the cons.

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