Describe the characteristics of addictive behavior
Addiction sits in a somewhat patchy area of diagnosis. There are some
addictions, often substance-based, which are well catered for in terms of
diagnosis, but others, usually behavioral, are left in a grey area where their
recognition of their official status is still under review. In general, there are 2
categories of addiction: substance, e.g. opiod, and behavioral, e.g. gambling.
People exhibiting addictive behaviors can be assessed using either the DSM-
5 (USA) or ICD-11 (UK and Europe), which are mental health diagnostic
manuals, to see whether someone meets the criteria for a particular
addiction. Addiction is also understood in 2 stages: initiation (the reasons
people start) and maintenance (the reasons why people continue).
Within the DSM-5 there are 10 categories of substance addiction and 1
behavioral category (gambling). It uses a set of 11 criteria, which are tailored
to each potential addiction, e.g. cocaine use, and patients are measured
along those criteria. If they fulfill 2-3 it is considered a mild addiction, 4-5
denotes moderate and 6+ highlights a severe addiction.
It is notable that the DSM-5 focuses largely on substance-based addictions
and in 2005 Griffiths promoted the argument that this definition of addiction
was too narrow. We could, he argued, become addicted to pretty much
anything and the reasons for our addiction were biopsychosocial. As a result,
he created a different model for understanding addiction based on 6 much
broader categories:
1- Salience – it becomes the most important issue
2- Mood modification – the addiction changes behavior
3- Tolerance – sufferers must increase their intake/participation in the
addiction to achieve the same high
4- Withdrawal – stopping causes physical and psychological changes for
our mind and body
5- Conflict – with oneself (interpersonal) and with others, such as family
or relationships (intrapsychic)
6- Relapse – addicts often re-engage with their addiction to avoid
withdrawal symptoms
This broader understanding allowed more types of addiction to be
recognized, for example, gaming, screen time or sex addictions, and that this
more inclusive definition was more fit for purpose in modern society as
different addictive behaviors and substances become available. This
,newer/broader approach is now being adopted by the ICD-11, which is
seeking to include a greater range of behavioral addictions.
Describe the dopamine explanation for addiction (BIO)
One biological explanation for addiction is dopamine, which is a
neurotransmitter associated with pleasure and reward. When an individual
engages in a behavior that has an evolutionary advantage such as food or
sex, the brain responds by increasing the release of dopamine at the key
dopamine release area = VTA, in the mesolimbic pathway. The dopamine is
then projected along the mesolimbic pathway to the nucleus accumbens,
which results in a feeling of pleasure to reward and encourage us to repeat a
behavior. However, this process becomes maladaptive when addictive
behaviors or substances are engaged in as these also stimulate this process,
and due to the dopamine releases and pleasurable feeling, the addictive
behavior is positively reinforced, leading to a continuation of the addictive
behavior. This relationship can be seen in research by Boileau, which found
increased levels of dopamine in the brain when using alcohol.
Dopamine can also explain the key features of addiction, tolerance and
withdrawal. The brain is overstimulated by the excessive dopamine produced
and received when engaging in addictive behavior or substances and so
seeks to redress the balance= neuroadaptation, by reducing dopamine
production and D2 receptors, so there is less uptake of dopamine at the
post-synaptic neuron. A series of studies by Volkow has shown, by PET scans,
that there is a decrease in the D2 receptors in abusers of cocaine, alcohol
and heroin compared to non-addicted controls. The result of this is tolerance,
where the addict will need to take more of the substance to achieve the
same rush and pleasure. This reduction in dopamine and dopamine uptake
also means that when the individual stops taking the substance or behavior,
their dopamine levels will be well below normal, resulting in unpleasant
withdrawal symptoms, such as headaches and irritability, encouraging
relapse in order to increase the dopamine to a normal level. The individual is
now taking the drug or engaging in the behavior to avoid unpleasant
negative symptoms, explaining maintenance.
The longer-term maintenance and relapse of addictive behaviors can be
explained via changes to the frontal cortex such as reduced blood flow,
activity and volume, caused by the high levels of dopamine which is
transported to the frontal cortex by the mesocortical pathway when
,continually engaging in addictive behaviors or substances. These changes
can result in an alteration in decision making, planning and attention. In
particular, it has been found that the continual high levels of dopamine can
cause frontal cortex changes that alter the amount of attention we pay to
various stimuli. For example, Wang found that cocaine users had higher
metabolic rates in the frontal cortex when exposed to cues relating to
cocaine use in the areas which relate to control and expectancy. This
suggests that addicts pay more attention to stimuli associated with the
addictive behavior, which is known as salience, making relapse more likely.
Volkow also found that frontal cortex changes can persist for months after
detoxification, showing how they could cause relapse after several months of
abstinence.
, Evaluation of the dopamine explanation for addiction (BIO)
One strength of the dopamine explanation for addictive behaviors is that it is
deterministic - by suggesting that addiction is biologically determined, it
reduces patient blame. The projection of dopamine along the mesolimbic
pathway and resulting increase of dopamine at the nucleus accumbens in
response to taking an addictive drug or engaging in addictive behavior, and
this subsequent pleasurable reward acting as a positive reinforcement, is not
under our control, and therefore, neither is the resulting addictive behavior.
For example, Olds and Milner in their work on rats, found that rats would
stimulate their reward system until they were exhausted and starving,
because the rewarding feeling was so strong. Rat’s behavior is driven by
dopamine and its subsequent rewards, and their behavior is not under their
own control, but rather biologically determined. If we suggest that an addict
is not in control of their behavior, it changes the way addiction is viewed by
society, reducing the associated stigma as people are not seen as to blame,
or viewed as weak-willed individuals. If addiction is seen as like other
biologically determined conditions/diseases, then this means addicts may
feel more willing to seek help and medical intervention and treatments.
Society will also be more willing to invest money to provide resources.
However, it is possible that suggesting that an addict’s behavior is beyond
their control may make them feel powerless to change and less likely to seek
help.
One weakness of the dopamine explanation of addictive behavior is that
there is evidence that contradicts the role of dopamine in addictive
behaviors and as such, it may not be a suitable explanation for all types of
addiction. Much of the early research into addiction and dopamine came
from the study of stimulants and the assumption was made that all drugs
would have a similar effect. In fact, although there is evidence for the central
