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AQA GCSE Psychology – Psychological Problems

This Chapter Covers:

Chapter 8: Psychological Problems

An introduction to mental health

  • Characteristics of mental health, e.g. positive engagement with society, effective coping with challenges
  • Cultural variations in beliefs about mental health problems
  • Increased challenges of modern living, e.g. isolation
  • Increased recognition of the nature of mental health problems and lessening of social stigma.

Effects of significant mental health problems on individuals and society

  • Individual effects, e.g. damage to relationships, difficulties coping with day to day life, negative impact on physical wellbeing.
  • Social effects, e.g. need for more social care, increased crime rates, implications for the economy.

Characteristics of clinical depression

  • Differences between unipolar depression, bipolar depression and sadness.
  • The use of international classification of diseases in diagnosing unipolar depression: number and severity of symptoms including low mood, reduced energy levels, changes in sleep patterns and appetite levels, decrease in self-confidence.

Theories of depression

  • Biological explanation (influence of nature): imbalance of neurotransmitters, e.g. serotonin in the brain
  • Psychological explanation (influence of nurture): negative schemas and attributions.

Interventions or therapies for depression

  • Use of antidepressant medications.
  • Cognitive behaviour therapy (CBT).
  • How these improve mental health, reductionist and holistic perspectives. Wiles’ study of the effectiveness of CBT

Characteristics of addiction

  • The difference between addiction/dependence and substance misuse/abuse.
  • The use of International Classification of Diseases in diagnosing addiction (dependence syndrome), including a strong desire to use substance(s) despite harmful consequences, difficulty in controlling use, a higher priority given to the substance(s) than to other activities or obligations.

Theories of addiction

  • Biological explanation (influence of nature): hereditary factors/genetic vulnerability. Kaij’s twin study of alcohol abuse.
  • Psychological explanation (influence of nurture): Peer influence.

Interventions or therapies for addiction

  • Aversion therapy
  • Self-management programmes, eg self-help groups, 12 step recovery programmes.
  • How these improve mental health, reductionist and holistic perspectives.

Navigation:

Chapter 1: Memory

  • Processes of memory
    • Different types of memory
      • Episodic memory
      • Semantic memory
      • Procedural memory
    • How memories are encoded and stored
  • Structures of memory
    • The multi-store memory model
      • Sensory memory store
      • Short-term memory store
      • Long-term memory store
    • The features of each store
      • Encoding
      • Capacity
      • Duration
  • Primacy and recency effects
    • The effects of serial position
    • Murdock’s serial position curve study
  • Memory as an active process
    • The Theory of Reconstructive Memory, including the concept of ‘effort after meaning’
    • Bartlett’s War of the Ghosts study
    • Factors affecting the accuracy of memory, including interference, context and false memories

Chapter 2: Perception

  • Sensation and perception
    • Sensation
    • Perception
  • Visual cues and constancies
    • Monocular depth cues: height in plane, relative size, occlusion and linear perspective
    • Binocular depth cues: retinal disparity, convergence
  • Gibson’s direct theory of perception and the influence of nature
    • Role of motion parallax in everyday perception
    • Evaluating Gibson’s direct theory of perception and the influence of nature
  • Visual illusions
    • Explanations for visual illusions: ambiguity, misinterpreted depth cues, fiction, size constancy.
    • Examples of visual illusions: the Ponzo, the Müller-Lyer, Rubin’s vase, the Ames Room, the Kanizsa triangle and the Necker cube
  • Gregory’s constructivist theory of perception and the influence of nature
    • Evaluating Gregory’s theory of perception
  • Factors affecting perception
    • Perceptual set and the effects of the following factors affecting perception: culture, motivation, emotion, expectation
    • The Gilchrist and Nesberg study of motivation and the Bruner and Minturn study of perceptual set

Chapter 3: Development

  • Early brain development
    • A basic knowledge of brain development, from simple neural structures in the womb, of the brain stem, thalamus, cerebellum and cortex, reflecting the development of autonomic functions, sensory processing, movement and cognition
    • The roles of nature and nurture
  • Piaget’s stage theory and the development of intelligence
    • Piaget’s Theory of Cognitive Development including concepts of assimilation and accommodation
  • The role of Piaget’s theory in education
    • The four stages of development: sensorimotor, pre-operational, concrete operational and formal operational. Application of these stages in education. Reduction of egocentricity, development of conservation
  • McGarrigle and Donaldson’s ‘naughty teddy study’; Hughes’ ‘policeman doll study’

Chapter 4: Research Methods

  • Formulation of testable hypotheses
  • Types of variable
  • Sampling methods
  • Designing research
  • Correlation
  • Research procedures
  • Planning and conducting research
  • Ethical considerations
  • Quantitative and qualitative data
  • Primary and secondary data
  • Computation
  • Descriptive statistics
  • Interpretation and display of quantitative data
  • Normal distributions

Chapter 5: Social Influence

  • Conformity
  • Obedience
  • Prosocial behaviour
  • Crowd and collective behaviour

Chapter 6: Language, Thought and Communication

  • The possible relationship between language and thought
  • The effect of language and thought on our view of the world
  • Differences between human and animal communication
  • Non-verbal communication
  • Explanations of non-verbal behaviour

Chapter 7: Brain and Neuropsychology

  • Structure and function of the nervous system
  • Neuron structure and function
  • Structure and function of the brain
  • An introduction to neuropsychology

Characteristics of good mental health

Good mental health is more than simply not having a mental health problem. A person with good mental health will display some (not necessarily all) of these characteristics:

  • Not being overcome by difficult feelings
  • Able to have good relationships with other people
  • Able to deal with disappointments and problems they face
  • Able to cope with the stresses and demands of everyday life
  • Being able to make decisions
  • Being able to cope effectively with difficulties or challanges
  • Positive engagement with society
  • Functioning as part of society

When people suffer from mental health problems, these affect the way they think, feel and behave. There are many different types of mental health problems with some more common than others, such as depression and anxiety. Other mental health problems such as Schizophrenia and bipolar disorder occur less often.

Mental health problems are diagnosed using two recognised ways: The World Health Organization’s (WHO) International Classification of Diseases (ICD-10) and the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Symptoms Of Mental Health Problems

Cultural variations in beliefs about mental health problems

All throughout history, mental health problems have often previously been attributed to supernatural or spiritual causes. These have ranged from possession by evil spirits, being cursed or being a witch. Throughout Europe and North America, during the fourteenth to seventeenth centuries, many women were accused and tried for being witches. It is now believed that mental health problems have resulted in some of the behaviours displayed by those accused.

In many cultures, having mental health issues is seen negatively. For example, in Asian cultures, mental health problems are stigmatised and seen as a form of personal weakness. The stigma attached to mental health problems can cause people to further experience further problems including economic, social and legal discrimination. In other cultures, a person’s behaviour can be seen to reflect on the whole family and it is common for people with mental health problems to be kept away from other people and cared for by the family.

Cultural beliefs about the cause of mental health problems can also influence how people with such issues are treated. In cultures where such problems are seen as having a biological cause, medication is often used. In other cultures, where they are attributed to spiritual causes, treatments may range from prayers to exorcisms. Self-help groups and therapy are more popular in cultures where sharing openly about yourself, your problems and emotions are valued. In cultures where mental health problems are seen as shameful, people may be kept isolated and be unable to talk to others about what they are going through.

Research suggests that more people than ever are being diagnosed with mental health problems globally. Some disorders such as schizophrenia occur at a consistent rate, however, others such as depression have a growing rate of diagnosis. This may not necessarily be down to more people having mental health problems but changes in the classification of disorders which results in more people meeting the criteria for diagnosis. There are also more people seeking medical and psychiatric treatment across cultures as they come to be less reliant on traditional methods of addressing mental health problems.

Challenges of modern living and its effects on mental health

Research suggests that living in more populated (modern) areas can increase stress levels. Brain scans have shown that people who live in cities also have more active amygdala compared to people living in less populated areas. One of the roles of the amygdala is responding to threats, which suggests a link to increased stress levels. 

Other factors such as loneliness and isolation can also contribute to mental health problems such as depression an anxiety. A survey for the Mental Health Foundation found that one in ten people in the UK report feeling lonely and this is increasing amongst young people. Changes in the way people live may be a possible cause for increasing levels of loneliness. More people may also be living on their own away from family and friends due to the demands of work, family breakdown or simply people living longer. The advancements of technology and social media has also changed how people interact. Although people can connect with one another all over the world, there is also concerns that such technology is replacing the need for face-to-face interaction. In the survey for the Mental Health Foundation, 18% of people reported that they thought they spent too much time communicating with family and friends online rather than in person.

Increased recognition of the nature of mental health problems

Although mental health problems have been recognised throughout history, they have been viewed as having various different causes. For example, the current western understanding of biological and psychological causes began to develop during the nineteenth century when classification systems were first developed and psychiatry became a specific area within medicine.  The twentieth century saw the development of psychoanalysis and while the mid-twentieth saw drugs being increasingly common as a way of treating mental health problems. 

The traditional explanations of mental health problems has focused on the supernatural and spiritual causes. Today, biological and psychological causes are more accepted however myths and misconceptions are still widespread, particularly in rural areas within developing countries. As the biological and psychological nature of mental health problems become more recognised, this is likely to lead to increases in worldwide diagnosis rates as the subsequently seek medical and psychiatric treatment. 

Reducing Social Stigma with Mental Health

The term “mental health” was first coined in the early twentieth century in an attempt to reduce the stigma associated with it by focusing on health, rather than illness. Despite almost a hundreds years later, being diagnosed with a mental health problem can still be hugely stigmatising.

Recent findings in the National Attitudes to Mental Illness survey show that opinions are in the UK are changing. This could be attributed to various reasons including campaigns such as “Time to Change” as well as celebrities also speaking about their own personal experiences.

The World Health Organisation (WHO) views stigma and discrimination towards those suffering with mental health issues as one of the worlds most important health issues. A possible explanation for increasing levels of diagnosis may be due to the lessening of social stigma attached to it thus people feel more confident in seeking treatment to address their issues. 

The effects of mental health problems on individuals

Mental health problems can result in people struggling to cope with everyday life. This may manifest itself through trouble sleeping, low energy levels and even poor concentration which can make work or education difficult. If an individual develops a mental health problem earlier in life, this can stop them from finishing their education or training. People diagnosed with a mental health problem in the UK are four times more likely to also be out of work. Unemployment and low income can increase stress and anxiety levels and may well make the mental health problems worse. 

Poor mental health can also have a detrimental effect on physical wellbeing. For example, due to their mental health problem, they may find it difficult to follow treatment programmes. Individuals may feel anxious about the side effects of their medication, feel too depressed to attend appointments or also forget to take their medication due to concentration difficulties. The changes in appetite or side effects from medication can result in weight gain or weight loss, low energy and mood can also reduce exercise levels. Individuals with mental health problems also have higher rates of drug and alcohol abuse although it is difficult to fully establish cause and effect for this.

People with mental health problems can also see their relationships become damaged. Research suggests that around 50 per cent of family members with someone with mental health problems also develop a disorder too. This may be because family members end up as carers which increases stress levels and leads to conflict. The effect on the household income can also increase stress levels. Children may also subsequently be affected as they are not cared for adequately by parents who have mental health problems. For example, some children may end up in the care system or become carers for their parents which places a huge amount of stress and anxiety on them. People with mental health problems may also become isolated due to the stigma of having a mental health problem and thus struggling to talk about their problems. This may lead to them withdrawing into themselves even further.

The effects of mental health problems on society

One of the main society effects of mental health problems is the implication this has for the economy. A study by WHO (World Health Organisation) found that in the UK, 15% of the cost of all health economic issues can be attributed to mental health problems. According to the Sainsbury Centre for mental health, over £15 billion pounds are lost every year due to decreased work productivity. 

Although most individuals with mental health problems do not commit violent crimes, a significant portion of prisoners are found to suffer from mental health problems. A Ministry of Justice study found that 49% of females and 23% of males in prison were suffering from anxiety and depression. This is significantly higher when compared to the general population where 19% of females and 12% of males suffer from mental health issues. These findings suggest a link between mental health problems and crime or at least, a link between imprisonment and mental health problems. 

The impact of mental health problems on society feeds through in increased social care costs. A person with mental health issues may require a variety of different needs being met to function. In a welfare state such as the UK, this can result in increased spending in areas such as the health system social housing and benefit payments to sufferers. This would then translate into high levels of tax for workers and businesses.

The clinical characteristics of depression

Before we try and look at the characteristics of depression, it is best to try understand exactly what depression is. Depression is classified as a mood disorder under DSM-IV-TR. Mood disorders include depressive disorder (depression) and bipolar disorder. While some people only suffer depression, others experience states of mania which alternate with their depression (bi-polar disorder). 

In its mildest form, depression can involve a person being in low spirits however in its most severe form, major depression can be life threatening. The Global Burden of Disease Project (Lopez et al 2006) established depression as first among the top 10 causes of worldwide disability.

The differences between unipolar depression, bipolar depression and sadness

Depression is often linked with the main symptoms of sadness or general low mood which makes it difficult for people to distinguish the difference between them. Sadness is a normal emotional reaction to certain situations or events, while depression occurs without any obvious trigger. Sadness may seem like it goes on for a long time however it is not a continous feeling that lasts for weeks or months. Depression on the other hand, affects every part of our daily lives and often does not get better without medical or therapeutic intervention.

Unipolar depression is also known as clinical depression or just depression. People suffering from unipolar depression have a continuous low mood and loss of enjoyment and energy. The word “uni” is derived from Latin and means “one”. This is used to define unipolar depression because someone experiencing this changes their mood only in one direction. 

The medical term for bipolar depression is bipolar affective disorder and is also known as manic depression. The term “Bi” comes from Latin also and means “two”. It is described as such because someone with bipolar depression experiences two types of mood changes. For example, although they may display depressive type symptoms involving low moods, they will also experience high moods known as mania. During these manic episodes. they may experience increased energy, feelings of extreme excitement and struggle to sleep, talk excessively or engage in risky or extreme behaviours.

Diagnosing unipolar depression

In order for a doctor to diagnose depression, they ask a number of standardised questions based around the diagnostic criteria set out in the ICD-10 or DSM-5. As some medical conditions have very similar symptoms to depression, a doctor may also do a physical examination as well as blood tests and urine tests.

The ICD-10 gives a number of possible symptoms for depression. The number and severity of symptoms an individual experiences determines whether a depressive episode is considered mild, moderate or severe. Symptoms would usually need to be continuously present for at least two weeks for a diagnosis of depression to be made.

The ICD-10 outlines the symptoms for a depressive episode as:

  • Low Mood
  • Reduced energy and activity levels
  • Changes in sleep pattern
  • Changes to appetite levels
  • Decreased self-confidence
  • Lack of interest and enjoyment
  • Reduced concentration and focus
  • Feelings of guilt and worthlessness
  • Negative thoughts about the future
  • Suicidal thoughts

What causes depression?

Research into the explanations of depression suggest that a mixture of biological, psychological and social causes can be attributed to its onset. Each of these factors and the relationship between them is complex which is why it makes it difficult to determine a definitive cause for depression.

The influence of nature: A biological explanation for depression

When we refer to “nature” we are talking about inherited biology and genetics. One explanation for depression suggests it is nature (the genetics and biology of a person) which pre-determines whether a person may be likely to suffer from depression. One biological explanation suggests an imbalance of neurotransmitters (chemicals) may be the cause. The brain uses neurotransmitters to communicate within itself and with the nervous system and body. These chemical messages are received and sent by the brain’s nerve cells (neurons). Neurons are communicating constantly with one another using neurotransmitters and this is very important for the brain to function properly. The two main neurotransmitters linked with depression are serotonin and norepinephrine.

Serotonin helps control a persons biological functions such as sleep patterns, aggression levels, appetite and mood. Researchers have used PET scans to study the link between serotonin and depression, comparing people suffering with depression with those who are not. The levels of a serotonin receptor found in the hippocampus is measured. The hippocampus is part of the temporal lobe and is involved in the storing of memories and connecting them to our emotions. MRI scans have also found that people who are depressed also have a smaller hippocampus.

Norepinephrine is released during the fight and flight response and gets the body and brain ready for action. Autopsy studies conducted on people with depressive episodes have found they have fewer neurons that release norepinephrine. Other research has found that in some people, low levels of serotonin may cause lower levels of norepinephrine.

Research seems to suggest a link between neurotransmitters and depression however it is difficult to measure the actual levels within the brain. The brain is complex with many chemical reactions affecting mood and it is therefore unlikely an imbalance of one neurotransmitter can explain why depression occurs.

The influence of nurture: A psychological explanation for depression

When we refer to “nurture”, this refers to the life experiences and environment a person experiences which can affect them as they grow up. One psychological explanation for depression is the cognitive explanation (cognitive theory). Cognitive theory is a psychological approach that proposes our thought processes determine our behaviour. Cognitive theory proposes our behaviours and emotions are influenced by the way people explain the things that happen to them and the views they have about the world and themselves. The theory is based on the idea of Schemas, which were first introduced by Piaget.

Schemas are based on our previous experiences and are developed and changed to fit new experiences and information. Having negative schemas have been linked to the development of depression. For example, traumatic events in childhood may contribute to the development of negative schemas which affect the way people view themselves and the world.

People who have developed negative schemas are thought to perceive situations negatively to an exaggerated degree. For example, if something bad happens in their life, they may exaggerate how bad things are or will get when presented with such situations. The cumulative effects of this negative type of thinking and perception is applied to all aspects of their life and world. This is then believed to contribute to the onset of depression. 

How attributions influence depression

Attributions have also been linked to depression. Attributions are the way in which people explain the causes of behaviours and situations. Two dimensions of attributions are internal-external and stable-unstable.

With an internal attribution, people explain situations or behaviours as being caused by dispositional factors such as personality or ability. People with external attribution tendencies would explain situations or behaviours as being caused by situational factors, such as the weather or the economy.

People who make a stable attribution would explain situations or behaviours as being caused by factors that do not change i.e. gender. When people make an unstable attribution, they explain the behaviour or situation as being caused by factors are are temporary i.e. tiredness.

So a working example would be: Someone who fails an exam and believes they are not clever enough to pass or do anything about this would explain the failed exam as internal and stable. However, someone who fails the exam and believes it is because they did insufficient revision or illness, would explain the failed exam as external and unstable.

Linking this back to depression, research has found that people who are more likely to be depressed have attributions that are internal and stable. People who have attributions that are external and unstable will see negative things as being caused by factors beyond their control and only temporary and thus less likely to be depressed.

Treatments for depression: Antidepressants

Antidepressants are drugs which are used to treat depression. Antidepressants work by increasing the levels of the neurotransmitters such as serotonin and noradrenaline. There are over approximately 30 different types of antidepressants with the most commonly prescribed for the UK as being Serotonin Reuptake Inhibitors, also known as SSRIs. SSRIs stop the reuptake of serotonin. After a neaurotransmitter has communicated its message to the neuron, the message needs to be prevented from being constantly communicated. To achieve this, the neuron reabsorbs the neurotransmitter it released. This process is called reuptake. Stopping this reuptake process increases the levels of serotonin which contributes to the reduced affects of depression.

Antidepressants first became available in the 1950s and their usage as increased since then. Between 2000 and 2010, statistics show that the use of antidepressants as increased each year by 20 percent. The UK has the forth highest level of antidepressant use in Europe with more than 50 million prescriptions written every year.

Despite the high number of people being prescriped antidepressants, there are questions into exactly how affective they are. People generally report some improvement due to taking antidepressants and this is more apprent in cases of severe depression. However research suggests antidepressants are not as effective for people suffering from mild depression. 

The Royal College of Psychiatrists say 50-65% of people with depression who take antidepressants will show improvement. However, 25-30% of people will also report improvements when taking a placebo (fake pill). Research into the effectiveness of treating depressed children and adolescents with antidepressants concluded that almost all antidepressants show a similar effect to what is seen when a placebo is taken.

Antidepressants also have a number of side effects. These include weight gain, insomnia, dry mouth or increased aggression and suicidal thoughts.

Treatments for depression: Cognitive behaviour therapy

Cognitive behaviour therapy (CBT) is based on cognitive theory and the assumption that our thought processes affect our behaviour and emotions. CBT is a “talking therapy” that looks to help people change their thinking patterns, such as negative schemas which may have developed. CBT tackles depression by getting people to focus on the “here and now” problems rather than those from the past or imagined ones. CBT sessions will attempt to get sufferers to identify their thought patterns and challenge them on how rational, logical or pragmatic (helpful) they are. CBT can be run by a therapist in one-to-one sessions or it can be run in groups. Wiles’ effectiveness of CBT study (2013) showed positive results for the use of CBT in treating depression. 

Wiles’ effectiveness of CBT study (2013)

Aim: The aim of the study was to investigate the effective of cognitive behavioural therapy (CBT) in treating depression people who did not show improvement from taking medication.

Study type: The study was a longitudinal field experiment carried out in the real-life environment of participants with limited control over extraneous variables. Participants lived in the UK and were aged between 18-75 years old. They had been taking antidepressants for at least 6 weeks with little or no improvement.

Method: Participants were randomly allocated to one of two groups. An experimental group of 234 participants were allocated to receive CBT as well as antidepressant medication along with other medical care for depressed patients. A control group of 235 participants were allocated to continue to take only antidepressants and normal medical care. The only significant different between the two groups was the second group did not receive CBT. Participants in the CBT group received 12 individual one-hour sessions of CBT from a trained therapist with regular followups.

Results: After 6 months, 90% of participants were followed up. Researchers found 46% of the group who received CBT showed a notable improvement in symptoms compared to only 22% of the control group. 

At the 12 month stage, the perceived improvements to the quality of life were found to be greater for participants who were receiving CBT.

Conclusion: When CBT is used in addition to antidepressants and normal medical care, it is an effective way of reducing the symptoms of depression for those people who do not respond well to antidepressants alone.

  • Wiles CBT study showed that CBT could be an effective way of reducing symptoms of depression in people not responding to antidepressants.
  • Although Wiles research showed CBT was effective. it also highlighted that antidepressants were effective, especially those with severe depression.
  • Other research conducted into the effectiveness of CBT saw participants take antidepressants, a placebo or CBT. After four months, people whose symptoms had improved after taking antidepressants either kept taking the medication or began taking a placebo. Participants who improved after having CBT were stopped from having regular sessions and were only allowed 3 follow-up sessions. Of the participants given a placebo, 76% relapsed and their symptoms returned. This is compared to only 31% of the participants who had CBT. This demonstrates CBT having a lasting effect that is not found with antidepressants.
  • Although almost half of participants in Wiles’ study showed improvement after having CBT, 54% of participants did not. 
  • The study was a longitudinal study that took place over a period of 12 months (1 year). 32% of participants did not attend all 12 sessions of CBT which lead to a decreased sample size making generalisations difficult. It may be that those who did not attend still had symptoms which would have greatly affected the results.
  • Longitudinal studies such as this useful as they show the changes and effects over a period of time.
  • As the study was a field experiment, it is not possible to control for extraneous variables that may be influencing the results. It can be difficult for researchers to know for certain what factors contribute to improvement or detriment as they are exposed to a number of unknown variables as they go about their life.
  • There are some ethical concerns raised as the research meant some people suffering from depression were not able to receive appropriate care as they were in the control group that prevented CBT intervention.

The differences between substance misuse and substance abuse

A number of substances that have an addictive quality are used by people. Examples of such include caffeinated drinks such as coffee or energy drinks to even legal drugs such as alcohol, tobacco or pain killers. This may even include illegal drugs such as heroin, cocaine or even cannabis to name a few. Some substances are more addictive than others and more harmful however they can all be misused and abused.

Substance misuse refers to using a substance for purposes or in amounts which may be harmful and different from the way the drug is meant to be used. For example, a person misusing medication may not follow the instructions on its usage, perhaps taking more painkillers than they are meant to to address some pain they are experiencing. A common problem in the UK is the misuse of alcohol where people drink more than the recommended limits which exceeds 14 units per week. Substance misuse may lead to substance abuse and even addiction if it is something that begins to happen on more than one occasion. 

Substance abuse is when a person uses a substance is used in a way that will be harmful or dangerous for the user. Substance abuse can affect family members too and individuals may abuse substances so they can feel an altered state or as a coping mechanism to deal with difficult emotions. Abusing substances usually leads to side effects such as dependency and addiction.

The differences between addiction and dependence

 Addiction has biological and behavioural effects on a person. Continued substance abuse causes biochemical changes in the brain as well as changes in behaviour. Using the substance becomes the main focus of the addicted individual, regardless of the harm they may cause to themselves or others. Addicts then need to “use” regularly in order to avoid the effects of withdrawal symptoms. A person can be dependent without necessarily being addicted however the two generally go hand in hand.

Dependence is a biological effect which is caused when a person repeatedly uses a substance. The body can then only function normally when the substance is present. If the substance is not present, the person may experience withdrawal symptoms which can include headaches, irritability, nausea, anxiety, tiredness and even trouble sleeping.

Diagnosing dependence syndrome

The actual medical term for addiction is dependence syndrome. The ICD-10 describes this as when using a substance becomes more important than other behaviours and there is a strong and overwhelming need to take a substance. Dependence syndrome may be for just one substance or it may be for a group of substances such as opioid drugs, alcohol or cannabis. The ICD-10 sets out criteria for diagnosis as the occurrence of three or more symptoms being present within the past year. The symptoms identified in the ICD-10 for dependence syndrome are:

 

  • A strong desire to use a substance despite harmful consequences.
  • Difficulty in controlling use.
  • A higher priority given to substance use than other activities or obligations.
  • Experiencing withdrawal symptoms when substance use is reduced or stopped.
  • Increased tolerance to the substance requiring increasingly larger amounts for the same effects to be experienced.

The influence of nature – a biological explanation for addiction

Biological explanations for addiction suggest people may inherit a genetic vulnerability towards addiction. This would then pre-dispose them as more likely to develop an addiction compared to others although this does not necessarily mean they will definitely become addicted (simply they have a higher chance when trying substances). Other factors such as environmental influences may still be involved in the development of addiction.

Evidence supporting genetic explanations for addiction comes from Kaij’s twin study (1960) which is detailed below. Twin and adoption studies strongly suggest that addiction to alcohol, tabacco and drugs all have a hereditary element that is passed through genes. Research suggests environmental factors have a stronger effect on someone starting substance use while hereditary factors have a stronger effect on a persons likelihood of progressing from a regular user to an addict.

One issue with genetic explanations is there is thought to be hundreds to thousands of possible genetic variations involved with addiction. 

The influence of nurture – a psychological explanation for addiction

Psychological explanations for addiction Environmental influences are also believed to contribute to addiction. 

Kaij’s alcohol abuse in twins study (1960)

Aim: The aim of the study was to see if hereditary factors influence the development of alcohol addiction.

Study type: The research was a case study which included questionnaires, interviews of twins and family members, psychological testing. Information was also gathered from birth records and a public register of alcohol abusers to identify participants for the study.

A total of 174 pairs of participants were gathered. 48 of the pairs were identical twins (also known as monozygotic) and 126 pairs were non-identical twins (known as dizygotic). All the participants were male and born in southern Sweden after 1880.

Method: Using information gathered from the methods outlined, Kaij categorised each twin dependent on their level of alcohol usage. In total there were 5 categories ranging from not drinking at all to chronic alcoholic.

Results: Kaij’s results of the study found that 54% of identical twins were in the same category of alcohol use compared to only 28% of non-identical twins. Also, as the level of alcohol usage increased, there was a higher concordance rate between identical twins with 72% of chronic alocholic twins being in the same category as their co-twin.

Conclusion: Kaij concluded that herediatry factors were involved in the levels of alcohol usage in alochol addiction.

 

Evaluating Kaij’s alcohol abuse study (strengths and weaknesses)

  • Kaij’s study was important as it provided supporting evidence for heridatary factors being involved in alcohol addiction and levels of alochol usage.
  • Limitations however were that the information on alcohol usage was provided by the participant and family members which is largely subjective and difficult to verify. The information may be inaccurate for a number of reasons from wanting to please researchers (demand characteristics) to lying about levels of alcohol consumption to appear more socially desirable or acceptable. 
  • The study focused primarily on alcohol abuse and therefore could not be generalised to include addiction to other substances.
  • The samples were limited because all the people involved were twins, male and Swedish. This means the findings can not be generalised to females, people who are not twins or even outside of Swedish nationals.
  • The higher concordance rates between twins can just as easily be attributed to nurture and the environment. Twins may be treated in a very similar way by those around them as they appear identical and it is highly likely they are exposed to the same environmental influences (similar peer groups, friends and environment). This could be the actual cause rather than any biological link as the study suggests.

Treatments and interventions for addiction

One treatment for addiction is aversion therapy. Aversion therapy attempts to help people stop their addictive behaviours by pairing the behaviour with some unpleasant stimuli (which results in unpleasant feelings) . This results in them learning to connect the addictive behaviour with the unpleasant feeling instead of the enjoyable feelings they had previously associated with the behaviour i.e. feelings of being “high”.

One way aversion therapy is implemented with addicts is through the affected individual taking some medication or substance that causes an unpleasant reaction when drugs, tabocco or alcohol are consumed. This is usually an emetic which causes vomiting. The emetic used with alcoholics is usually disulfra, (also known as Antabuse) and consuming alcohol after its consumption results in instant and severe hangover type symptoms even if small amounts of alcohol are consumed.

Another treatment of addiction is electrical aversion therapy which involves a safe but painful electrical shock that is given to the individual when they carry out the unwanted addictive behaviour.

Research into aversion therapy shows it to be effective but only in the short-term. When aversion therapy is combined with other support such as counselling ot self-management programmes, it is seen to be its most effective. A major issue with aversion therapy is the unpleasant treatment people experience. Due to this, there is a high dropout rate but it also raises ethical concerns as individuals are harmed in various ways with unwanted stimuli.

Self-management programmes are interventions designed to give addicts the help they need to manage their addictions. The programmes provide peer support, accountability and opportunities to develop greater self-awareness. The groups may be facilitated by a psychologist, therapist or relevant expert.

Also referred to as “self-help” groups, they consist of people with a problem in common they all share and involve them sharing their experiences so they can gain support from others and see they are not alone in their problem. Members of the groups who are experienced can also provide a positive example to new members.

Two well known groups are Alcoholics Anonymous (AA) and Narcotics Anonymous and consist of a 12-step recovery programme for addiction. The 12-steps provide addicts with guidelines to help them move towards and through recovery. The 12-step programmes have a strong spiritual element, but they allow for a personal understanding of God rather than any set religious beliefs. Research has found non-religious people have found the programme helpful however people who have no belief in a god at all are less likely to continue this treatment. The programme also provides a 12-step programme without the religious or spiritual componant underpinning it.

Studies into the effectiveness of self-management programmes are difficult to compile because of the need to allow group members anonymity. Also, control groups cannot be used for ethical and methodological reasons. However research available has found these programmes have similar success rates to other treatments and are most effective for those who attend regularly and for longer periods of time.

Self-management programmes are a holistic approach to dealing with the addiction as they help people deal with other factors involved in their addiction too such as environmental and social factors. They also provide an opportunity for individuals ot explore issues from the past, present and future that may contribute to their addiction.