Addiction

In defining addiction, what does 'tolerance' specifically mean?

• ANeeding increasing amounts of a substance to achieve the same effect once obtained by a smaller dose✓
• BThe unpleasant physical and psychological symptoms felt when the substance is stopped
• CA strong desire or compulsion to take the substance
• DContinuing to use despite knowledge of harm

Answer: Tolerance is the reduced response to a drug with repeated use, so larger doses are needed for the original effect. The unpleasant symptoms on cessation describe withdrawal, the compulsion describes craving/dependence, and continued use despite harm is a separate diagnostic feature.

Which statement best distinguishes physical dependence from psychological dependence?

• APhysical dependence involves a compulsion to use for emotional reasons; psychological dependence produces bodily withdrawal symptoms
• BThe two terms describe the same underlying process and are used interchangeably by clinicians recording a patient's substance use
• CPhysical dependence is confined to illegal drugs, while prescribed medicines and legal substances such as alcohol lead to psychological dependence
• DPhysical dependence is shown by a physiological withdrawal state when use stops; psychological dependence is a compulsive need to use for its perceived benefits✓

Answer: Physical dependence is indicated by a withdrawal syndrome (physiological symptoms) when the drug is removed, reflecting bodily adaptation. Psychological dependence is the compulsive desire to keep using because of the perceived emotional or psychological benefits. Attaching the emotional compulsion to physical dependence and the bodily withdrawal to psychological dependence reverses the two.

Twin and family studies are used to argue for a genetic vulnerability to addiction. Which finding would best support this claim?

• AConcordance for addiction is identical in monozygotic and dizygotic twins
• BConcordance for addiction is significantly higher in monozygotic than dizygotic twins✓
• CAdopted children always resemble their adoptive, not biological, parents in addiction risk
• DAddiction occurs only in people with no family history of it

Answer: If monozygotic (100% shared genes) twins show higher concordance than dizygotic (about 50% shared) twins reared in similar environments, this points to a genetic contribution. Equal concordance would suggest no genetic effect, and the other options contradict a heritability argument.

Which combination of risk factors for addiction is correctly identified by the AQA specification?

• ABlood type, eye colour, handedness and adult height, recorded at eighteen years
• BGenetic vulnerability, stress, personality, and family/peer influences✓
• CGenetic vulnerability acting as the single cause, with upbringing, stress and peers irrelevant
• DPeer pressure as the one true cause, with biology and personality left out of it

Answer: The specification lists genetic vulnerability, stress, personality (e.g. impulsivity/sensation-seeking), and family and peer influences as risk factors in the development of addiction. Addiction is multifactorial, so single-cause options and irrelevant physical traits are incorrect.

According to the neurochemical (dopamine) explanation, why is nicotine addictive?

• ANicotine blocks dopamine receptors in the nucleus accumbens, the striatum and the prefrontal cortex, so the pleasure of smoking falls
• BNicotine destroys neurons in the nucleus accumbens, removing the smoker's capacity to feel reward from other activities
• CNicotine acts on the serotonin pathways of the raphe nuclei, leaving the mesolimbic dopamine reward system untouched
• DNicotine stimulates nicotinic acetylcholine receptors, increasing dopamine release in the mesolimbic reward pathway✓

Answer: Nicotine binds nicotinic acetylcholine receptors on dopaminergic neurons, boosting dopamine release in the mesolimbic reward pathway (e.g. ventral tegmental area to nucleus accumbens). This reinforcing surge of dopamine underlies the rewarding, addictive effect of smoking.

How does learning theory use operant conditioning to explain the maintenance of nicotine addiction?

• ASmoking is positively reinforced by pleasant effects and negatively reinforced by relief of withdrawal/craving✓
• BSmoking is punished by the body's aversive reaction and is therefore strengthened
• CSmoking becomes an unconditioned reflex, present from birth and never learned
• DSmoking is maintained by inherited differences in dopamine receptor density

Answer: Operant conditioning maintains smoking through both positive reinforcement (the pleasurable dopamine-driven effects) and negative reinforcement (smoking removes the aversive withdrawal symptoms and craving). This dual reinforcement strengthens the behaviour over time.

Which cognitive bias is central to the cognitive explanation of gambling addiction, in which gamblers overestimate their ability to influence chance outcomes?

• AThe 'just-world' belief
• BHostile attribution bias
• CThe fundamental attribution error
• DThe illusion of control✓

Answer: The illusion of control is a key cognitive distortion in gambling: players believe their skill, rituals or choices can influence outcomes that are actually random. Related distortions include the gambler's fallacy and near-miss effect. The other options are unrelated social-cognitive biases.

Why is a variable-ratio reinforcement schedule particularly important in explaining the persistence of gambling behaviour?

• AIt pays out on a fixed-ratio schedule, delivering a win after a set number of bets
• BRewards arrive unpredictably after a varying number of responses, producing high, persistent response rates resistant to extinction✓
• CIt punishes the gambler at every fixed interval, which paradoxically increases play
• DIt reinforces on a fixed-interval schedule (a set time between wins), producing a scalloped pattern

Answer: Gambling pays out on a variable-ratio schedule: wins occur after an unpredictable number of bets. Such schedules generate very high, steady rates of responding and are highly resistant to extinction, which helps explain why gambling persists despite frequent losses.

Aversion therapy as a behavioural intervention for addiction works by:

• AReinforcing the addictive behaviour with a pleasant stimulus each time it occurs, so that the habit is gradually strengthened
• BTeaching relaxation to replace cravings only
• CPairing the addictive behaviour with an unpleasant stimulus so it becomes associated with aversion (classical conditioning)✓
• DReplacing the drug with a chemically identical substitute

Answer: Aversion therapy uses classical conditioning to pair the addictive behaviour (e.g. drinking) with an unpleasant stimulus, so the behaviour comes to elicit an aversive response. Disulfiram works this way in alcohol addiction: it does not make the patient ill by itself, but causes flushing, nausea and vomiting if alcohol is then consumed. Covert sensitisation uses an imagined aversive scene instead. Drug substitution and relaxation training are different approaches.

In Prochaska and DiClemente's six-stage (transtheoretical) model, a smoker who acknowledges they have a problem and intends to quit within the next six months, but has not yet committed to act, is in which stage?

• AContemplation✓
• BPrecontemplation
• CAction
• DMaintenance

Answer: In the transtheoretical model the six stages are precontemplation, contemplation, preparation, action, maintenance and termination. Contemplation is the stage where the person is aware of the problem and is thinking about changing within around six months but has not yet committed to a plan. Precontemplation involves no intention to change; action is active behaviour change.

What are Griffiths' components of addiction?

• ASalience, motivation, tolerance, withdrawal, conflict and eventual recovery
• BCraving, dependence, tolerance and withdrawal symptoms only
• CInitiation, maintenance, relapse and abstinence in order
• DSalience, mood modification, tolerance, withdrawal, conflict, relapse✓

Answer: Griffiths' six components define addiction behaviourally rather than by substance, which is why the model extends to gambling and gaming. Not every component need be present at once.

What role does dopamine play in nicotine addiction?

• ANicotine blocks dopamine release, thereby producing withdrawal
• BNicotine triggers dopamine release, reinforcing the behaviour✓
• CNicotine converts directly into dopamine within the brain itself
• DNicotine has no established effect on dopamine levels

Answer: Nicotine binds nicotinic acetylcholine receptors in the ventral tegmental area, causing dopamine release in the nucleus accumbens. Downregulation of receptors then produces tolerance and withdrawal.

What does the theory of planned behaviour add to reasoned action?

• ASubjective norms held by the person's immediate social group
• BThe person's own personal attitude towards performing the behaviour
• CPerceived behavioural control over performing the behaviour✓
• DThe actual behaviour that is eventually performed

Answer: Ajzen added perceived control to account for behaviours not fully under voluntary control, which matters for addiction. Intention still predicts behaviour imperfectly — the intention-behaviour gap.

What are the stages of Prochaska's model of behaviour change?

• APrecontemplation, contemplation, relapse, action and eventual abstinence
• BInitiation, maintenance, tolerance, withdrawal and subsequent relapse
• CAlarm, resistance, adaptation, exhaustion, recovery
• DPrecontemplation, contemplation, preparation, action, maintenance✓

Answer: The model's value is matching the intervention to the stage — information suits precontemplation, practical strategies suit action. Relapse is treated as part of the cycle rather than as failure.

How does aversion therapy treat addiction?

• APairing the addictive behaviour with a strongly pleasant stimulus
• BRemoving all of the cues associated with the addictive behaviour
• CPairing the addictive behaviour with an unpleasant stimulus✓
• DRewarding periods of abstinence with tokens or privileges

Answer: Classical conditioning creates a new association, as with disulfiram producing nausea if alcohol is drunk. Effects often fade outside the treatment setting, and there are ethical concerns about deliberately causing distress.

What is the cognitive bias known as the gambler's fallacy?

• ABelieving skill can influence a purely random outcome
• BBelieving past outcomes influence future independent events✓
• CRecalling wins more readily than the losses incurred
• DExplaining losses away as near misses rather than failures

Answer: Independent events have no memory, so a run of reds does not make black more likely. Illusion of control, recall bias and near-miss reasoning are related but distinct distortions maintaining gambling.

What is a risk factor for developing an addiction?

• AFamily influence and genetics with no environmental role
• BPeers and stress only, with no genetic contribution
• CAge of first use, which is the only established factor
• DFamily influence, peers, stress and personality traits✓

Answer: Risk is multifactorial, with genetic vulnerability interacting with modelling, peer pressure, stress and traits such as impulsivity. That interaction is why no single-cause explanation works well.

How does covert sensitisation differ from aversion therapy?

• AThe unpleasant consequence is experienced rather than imagined
• BThe unpleasant consequence is imagined rather than experienced✓
• CIt uses positive reinforcement instead of any punishment
• DIt requires medication to produce the aversive response

Answer: The client vividly imagines an aversive scene rather than undergoing it, which is more ethically acceptable and less invasive. Whether an imagined consequence conditions as strongly is debated.

What is meant by tolerance in addiction?

• AMore of the substance is needed for the same effect✓
• BLess of the substance is needed for the same effect
• CUnpleasant symptoms appear when use is stopped
• DThe user denies that a problem exists at all

Answer: Repeated exposure causes the body to adapt, often by downregulating receptors, so the original dose produces less effect. Withdrawal is the separate set of symptoms appearing when use stops.