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Theory of Addiction, 2nd Edition



Theory of Addiction, 2nd Edition

Robert West, Jamie Brown

ISBN: 978-1-118-48491-3 August 2013 Wiley-Blackwell 280 Pages

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The word ‘addiction’ these days is used to refer to a chronic condition where there is an
unhealthily powerful motivation to engage in a particular behaviour. This can be driven by
many different factors – physiological, psychological, environmental and social. If we say that it
is all about X, we miss V, W, Y and Z. So, some people think addicts are using drugs to escape
from unhappy lives, feelings of anxiety and so on; many are. Some people think drugs become
addictive because they alter the brain chemistry to create powerful urges; that is often true.
Others think that drug taking is about seeking after pleasure; often it is. Some take the view that
addiction is a choice – addicts weigh up the pros and cons of doing what they do and decide
the former outweigh the latter. Yet others believe that addicts suffer from poor impulse control;
that is often true… And so it goes on.

When you look at the evidence, you see that all these positions capture important aspects of
the problem – but they are not complete explanations. Neuroscience can help us delve more
deeply into some of these explanations, while the behavioural and social sciences are better at
exploring others. We need a model that puts all this together in a way that can help us decide
what to do in different cases. Should we prescribe a drug, give the person some ‘tender loving
care’, put them in prison or what? Theory of Addiction provides this synthesis.

The first edition was well received:

‘Throughout the book the reader is exposed to a vast number of useful observations...The
theoretical aims are timely, refreshing, ambitious and above all challenging. It opens up a new
way of looking at addiction and has the potential to move the field of addiction a considerable
leap forward. Thus we wholeheartedly would like to recommend the book for students as well
as scholars. Read and learn!’ Nordic Studies on Alcohol and Drugs

‘The book provides a comprehensive review of existing theories - over 30 in all - and this
synthesis of theories constitutes an important contribution in and of itself... West is to be
commended for his synthesis of addiction theories that span neurobiology, psychology and
social science and for his insights into what remains unexplained.’ Addiction

This new edition of Theory of Addiction builds on the first, including additional theories in
the field, a more developed specification of PRIME theory and analysis of the expanding
evidence base.
With this important new information, Theory of Addiction will continue to be essential reading
for all those working in addiction, from student to experienced practitioner – as urged above,
Read and learn! 
Preface ix

1 Introduction: journey to the centre of addiction 1

Preparing for the journey 1

In the end 3

What this book does 5

The synthetic theory of addiction in brief 7

References 9

2 Definition, theory and observation 10

Defining addiction (addiction is not an elephant) 10

Diagnosing and measuring addiction 20

Theory and supposition 22

‘Big observations’ in the field of addiction 30

Recapitulation 36

References 36

3 Beginning the journey: addiction as choice 41

Addiction as a reflective choice 41

Box 3.1 The myth of addiction 44

Box 3.2 Vaguely right or precisely wrong? The Theory of Rational Addiction 45

Box 3.3 The Self-medication Model of addiction 50

Box 3.4 Opponent Process Theory 53

Irrational, ill-informed choice and unstable preferences 60

Box 3.5 Expectancy Theories 62

Box 3.6 Skog’s Choice Theory 65

Box 3.7 Slovic’s Affect Heuristic 67

Box 3.8 Cognitive Bias Theories 70

Box 3.9 Behavioural Economic Theories 72

Box 3.10 Gateway Theory 78

Box 3.11 The Transtheoretical Model of behaviour change 80

Box 3.12 Identity shifts and behaviour change 86

Addiction as the exercise of choice based on desires 87

References 89

4 Choice is not enough: the concepts of impulse and self-control 95

Reports of feelings of compulsion 95

Powerful motives versus impaired control 96

Box 4.1 The Disease Model of addiction 96

Personality and addiction typologies 98

Box 4.2 Tridimensional Personality Theory 98

Self-efficacy 100

Box 4.3 Self-efficacy Theory 100

The transition from lapse to relapse 102

Box 4.4 The Abstinence Violation Effect 102

Impulse control 105

Box 4.5 Inhibition Dysregulation Theory 106

Self-regulation as a broadly based concept 108

Box 4.6 Self-regulation Theory 108

Urges and craving 108

Box 4.7 A Cognitive Model of Drug Urges 109

Addiction as a failure of self-control over desires and urges 110

References 111

5 Addiction, habit and instrumental learning 114

Instrumental learning 114

Box 5.1 Instrumental learning (operant conditioning) and addiction 115

Mechanisms underpinning instrumental learning 118

Box 5.2 The Dopamine Theory of Drug Reward 119

Box 5.3 Addiction arising from functional neurotoxicity of drugs 121

Classical conditioning 122

Box 5.4 Classical conditioning and addiction 122

More complex learning models 124

Box 5.5 Addiction as a learning/memory process 125

Box 5.6 Incentive Sensitisation Theory 126

Box 5.7 Balfour’s theory of differential drug effects within the nucleus accumbens 129

Social learning 130

Box 5.8 Social Learning Theory 131

Associative learning 133

References 133

6 Addiction in populations, and comprehensive theories 136

Addiction in populations 136

Box 6.1 Diffusion Theory 137

Comprehensive theories of addiction 139

Box 6.2 Excessive Appetites Theory 140

Box 6.3 The Pathways Model of pathological gambling 146

What is addiction and how can we explain it? 149

References 150

7 Development of a comprehensive theory 152

A functional classification of theories of addiction 153

Addiction as reflective choice 158

Addiction as irrational choice 162

Addiction, compulsion and self-control 165

Addiction, instrumental learning and habit 168

Addiction, choice, compulsion and habit 179

References 185

8 A synthetic theory of motivation 192

Understanding behaviour in context: the COM-B model 192

Focus on motivational theory 194

The human motivational system 194

Structure and function of the human motivational system 195

The ‘head model’ 205

Momentum and inertia 206

Adaptation: ways in which experience affects motivational disposition 207

The ‘representational system’, consciousness and dual process models 210

Self and self-control 213

Mental effort and motivational resources 216

What motivates us 216

The unstable mind 218

A summary: key propositions from PRIME theory 225

References 227

9 A theory of addiction 229

Addiction is 229

The pathologies underlying addiction 230

A return to some ‘big observations’ about addiction 233

The abnormalities underlying addiction 241

Effects of interventions 244

Recommendations and predictions regarding addiction interventions 244

Testing the theory 250

First results 251

Conclusions 252

References 253

Index 257

“I enjoyed reading this book and strongly recommend that it be read by all professionals working in the field of addiction.”  (Journal of Clinical Psychiatry, 1 February 2015)