Literature Risk behavior and addiction
Lecture 1
1.1 Gladwin, T. E., Figner, B., Crone, E. A., & Wiers, R. W. (2011).
Addiction, adolescence, and the integration of control and motivation.
Developmental Cognitive Neuroscience, 1(4), 364-376.
In this review, we will focus on symmetries between adolescence- and addiction related changes in
motivation and cognitive control that may help explain increased the likelihood of substance abuse
and the onset of addiction in adolescence. During adolescence, children increasingly master the
ability to control their behavior for the benefit of longer-term goals.
Risky decision making in adolescence
Adolescents are known to have a tendency to take more and greater risks than individuals in other
age groups in many life domains. This pattern (U-shape) has only recently been demonstrated in
experimental studies, which dissociated between “hot” affect-charged versus “cold” predominantly
deliberative processes in risky choice and risk taking. Studies have shown that heightened
involvement of affective processes in risky decision-making (in the hot CCT) leads to increased risk
taking in adolescents (associated with impoverished use of risk relevant information), compared to
children and adults. In contrast, when risky decisions are made involving mainly deliberative
processes and no or little affect (cold CCT), adolescents show the same levels of risk taking as
children and adults.
Neural developments underlying risky decision making
Insights from anatomical and functional changes in the rodent and the human brain have led to
neurobiological models characterizing the “adolescent brain” by two interacting systems:
1. The first is the relatively early maturing and “hot” affective-motivational bottom-up system
a. Involves subcortical brain areas (dopamine rich areas)
2. The second is the more slowly developing “cold” top-down control system.
a. Involve prefrontal regions, which have been implicated in self-control, planning,
abstract thinking.
The above frontostriatal model of adolescent decision making thus describes a potential for
imbalance in motivational bottom-up versus controlling top-down processes.
Addiction
Current neurobiological research has identified two broad types of neuro-adaptations that result
from repeated alcohol and drug use. First, neural sensitization leads to strong impulsive reactions
(e.g., attentional biases and approach tendencies) to classically conditioned cues that signal alcohol
or drugs. In later phases of addiction, habitual responses become important, with cues automatically
triggering approach-reactions, outside voluntary control. Increased incentive salience may result in
attentional capture (“attentional bias”) of substance-related cues. Finally, negative affect may trigger
an urge to take drugs through associative processes. Second, there is evidence that heavy alcohol
and drug use results in impaired control functions.
Interventions
1. Working memory training
a. Aimed at training the likelihood of successful control
, b. The top-down biasing aspect of working memory, or executive control functions, as
well as control of access to WM are trainable.
c. In addition to behavioral WM training, there is also emerging evidence that low
voltage electrical stimulation at the scalp (transcranial Direct Current Stimulation, or
tDCS) can facilitate dorsolateral prefrontal activity, leading to enhanced working
memory (Fregni et al., 2005) and reductions in craving.
2. Cognitive bias modification
a. Attentional bias modification: For example, in a visual probe test, two stimuli
(pictures or words; usually one related to the problem and one neutral) are
presented at the same time, after which a probe appears on one of the two stimuli
locations. In an assessment instrument, the probe to which people react, appears
equally often in the location of the disorder-related stimulus and the neutral
stimulus.
b. Approach bias modification: The AAT (alcohol Approach Avoidance Task) contains a
“zoom-feature” which has the effect that upon a pull movement, the picture size on
the computer screen increases, and upon a push movement, it decreases, which
generates a strong sense of approach and avoidance, respectively, and
disambiguates the meaning of pushing (is this encoded as “moving towards” or
“pushing away?”) and pulling the joystick. Alcoholics and heavy drinkers have an
approach bias for alcohol.
c. Further developments: For example, evaluative conditioning, neurofeedback
training, and inhibition training.
Conclusion
It was noted that concerns have been raised about the adequacy of dual-process models as a
theoretical foundation. However, such concerns appear to be addressable in principle by carefully
considering levels of description: motivational processes and top-down biasing can be understood as
intertwined, co-developing components of more versus less reflective states of processing. In
practical terms, dual process models of addiction not only provide hypotheses why adolescents are
at increased risk of substance abuse, but have also suggested interventions that have already been
successfully applied in adults. In conclusion, the integration of motivation and control appears critical
not only to the development of individuals, but also to the further development of theory in
cognitive neuroscience. Finally, behavioral interventions for addiction are discussed. Insights in the
development of control and motivation may help to better understand – and more efficiently
intervene in – vulnerabilities involving control and motivation.
1.2 Dobbs, D. (2011). Beautiful Brains. Moody, Impulsive, Maddening. Why
do teenagers act the way they do? Viewed through the eyes of evolution,
their most exasperating traits may be the key to success as adults.
National Geographic, October 2011.
Teenagers act the way they do, because the brain doesn’t actually grow very much during this
period. The process of maturation continues throughout adolescence. When this development
proceeds normally, we get better at balancing impulse, desire, goals, self-interest, rules, ethics, and
even altruism, generating behavior that is more complex and, sometimes at least, more sensible. But
at times, and especially at first, the brain does this work clumsily. It's hard to get all those new cogs
to mesh.
,In a experiment, neuroimaging was used to study the teen brain, were a simple test was used. She
scanned the brain while they performed a task. Ten-year-olds stink at it, while teens do much better.
But Luna thought the brain scans were much more interesting. Compared with adults, teens tended
to make less use of brain regions that monitor performance, spot errors, plan, and stay focused—
areas the adults seemed to bring online automatically. This let the adults use a variety of brain
resources and better resist temptation, while the teens used those areas less often and more readily
gave in to the impulse to look at the flickering light—just as they're more likely to look away from the
road to read a text message.
However, thee troublesome traits don't really characterize adolescence; they're just what we notice
most because they annoy us or put our children in danger. We have to look at broader traits that
underlie those acts. This upside probably explains why an openness to the new, though it can
sometimes kill the cat, remains a highlight of adolescent development. Even 14- to 17-year-olds—the
biggest risk takers—use the same basic cognitive strategies that adults do, and they usually reason
their way through problems just as well as adults. Contrary to popular belief, they also fully recognize
they're mortal. And, like adults, says Steinberg, "teens actually overestimate risk." So why do teens
take more chances? Teens take more risks not because they don't understand the dangers but
because they weigh risk versus reward differently: In situations where risk can get them something
they want, they value the reward more heavily than adults do.
As Steinberg's driving game suggests, teens respond strongly to social rewards. Physiology and
evolutionary theory alike offer explanations for this tendency. Physiologically, adolescence brings a
peak in the brain's sensitivity to dopamine, a neurotransmitter that appears to prime and fire reward
circuits and aids in learning patterns and making decisions. This helps explain the teen's quickness of
learning and extraordinary receptivity to reward—and his keen, sometimes melodramatic reaction to
success as well as defeat. During adolescence, teens prefer the company of those of their own age
more than ever before.
This adaptive-adolescence view, however accurate, can be tricky to come to terms with—the more
so for parents dealing with teens in their most trying, contrary, or flat-out scary moments.
1.3 Sussman, S. (2017). Chapter 1: A general introduction to the concept
of addiction and addictive effects. In Substance and Behavioral Addictions:
Concepts, Causes, and Cures (pp. 3-31). Cambridge University Press.
Substance addiction pertains repetitive intake of a drug or of food, whereas behavioral addiction
pertains engaging in types of behaviors repetitively which are not directly taken into the body such as
gambling or sex. Physiological withdrawal symptoms (the appearance of both physical and
psychological symptoms which are caused by physiological adaptations in the central nervous system
and the brain due to chronic exposure to a substance) were until recently only seen as an ‘addiction’.
Behavioral addictions alter endogenous ligand functions. In Table 1.1 there is a list of 12-step
organizations for substance and behavioral addictions.
At its origin, addiction generally referred to “giving over” or being “highly devoted” to a person or
activity, or engaging in a behavior habitually, which could have positive or negative implications.
History of different kinds of addiction
Tobacco addiction: Deep inhalation of tobacco did not occur until after flue-curing (four- to eight-
week air curing, which results in tobacco low in sugar, and which gives tobacco smoke a light, sweet
, flavor, and a high nicotine content). The public consensus that nicotine was addictive, and the driving
force behind regular tobacco use, occurred with publication of the Surgeon General’s report on
nicotine addiction in 1988.
Alcohol addiction: Alcohol misuse has been noted throughout written history. Also, Abraham Lincoln
attributed much vise, misery, and crime to the abuse of alcohol but also supported kind treatment of
those who had fallen victim to alcohol addiction.
Opium-related addiction: Initial use of opium was described as “divine enjoyment”. After the opium
wars, the opium trade was legalized in China and production increased, maintaining relatively high
prevalence of opium addiction and related social and economic problems in China.
Cocaine addiction: Replacement medications that did not contain opiate derivatives to treat opiate
addictions led to new problematic drug use.
Marijuana addiction: Marijuana was viewed as a hilarious herb that was purchased regularly and
without good sense.
Food addiction: No history.
Gambling and sex addictions were always viewed as behavioral addictions in history. Gambling
shorter than sex addictions, because there were no electric devices back then.
Intensional definition of addiction: causal or process model type statements of addictions. They
attempt to describe at minimum an addictive behavioral process.
1. Physiological and psychological dependence (cellular or acquired tolerance and withdrawal):
The addict is trapped into a pattern of increasing involvement with the behavior.
Tolerance refers to the need to engage in the behavior at relatively greater level than in the
past to achieve previous levels of appetitive effects.
Withdrawal is the abrupt termination of the addictive behavior. This will lead to intense
physical disturbances.
Craving is now one of the criteria of substance use disorder in the DSM-V. This is an intense
desire for engagement reoccurs, is compelling, and one often gives in to this desire.
2. Impulsive-obsessive/compulsive behavior (egodystonic separate from self): engagement
in the addictive behavior leading to pleasure or relief rather than on a notion focusing on
maintaining an equilibrium. Difference with addiction simple behaviors that remove
anxiety, addiction have more complex. Two variants (can also occur at the same time):
a. Positive reinforcement: there is a building up of tension which is then released.
b. Negative reinforcement: building up of tension, stress, and anxiety, resulting in relief
from the anxiety but no particular pleasure.
3. Self-medication: pertains to relief from disordered emotions and sense of self-preservation
through engaging in the addictive behavior.
a. Trauma: through addiction people try to handle their trauma.
4. Self-regulation: the present state of being cues attempts to reach a standard at which point
satiation is achieved, until the present state is no longer at the desired standard state.
a. BAS-BIS model (behavioral approach and behavioral inhibition system): these
interdependent systems influence whether an individual is likely to withdraw form or
avoid situations that involve novel or threatening cues. BAS is mediated by dopamine
(novelty and reward) and BIS is mediated by the septo-hippocampal system (which
detects competing goals and leads to approach or avoidance behavior).
b. Incentive-Sensitization theory: focuses on the influence of neural adaptation to
addictive behaviors. They differentiate neural processes involved in motivational
mechanisms (wanting) and liking. Through repeated engagement in the behavior,
Lecture 1
1.1 Gladwin, T. E., Figner, B., Crone, E. A., & Wiers, R. W. (2011).
Addiction, adolescence, and the integration of control and motivation.
Developmental Cognitive Neuroscience, 1(4), 364-376.
In this review, we will focus on symmetries between adolescence- and addiction related changes in
motivation and cognitive control that may help explain increased the likelihood of substance abuse
and the onset of addiction in adolescence. During adolescence, children increasingly master the
ability to control their behavior for the benefit of longer-term goals.
Risky decision making in adolescence
Adolescents are known to have a tendency to take more and greater risks than individuals in other
age groups in many life domains. This pattern (U-shape) has only recently been demonstrated in
experimental studies, which dissociated between “hot” affect-charged versus “cold” predominantly
deliberative processes in risky choice and risk taking. Studies have shown that heightened
involvement of affective processes in risky decision-making (in the hot CCT) leads to increased risk
taking in adolescents (associated with impoverished use of risk relevant information), compared to
children and adults. In contrast, when risky decisions are made involving mainly deliberative
processes and no or little affect (cold CCT), adolescents show the same levels of risk taking as
children and adults.
Neural developments underlying risky decision making
Insights from anatomical and functional changes in the rodent and the human brain have led to
neurobiological models characterizing the “adolescent brain” by two interacting systems:
1. The first is the relatively early maturing and “hot” affective-motivational bottom-up system
a. Involves subcortical brain areas (dopamine rich areas)
2. The second is the more slowly developing “cold” top-down control system.
a. Involve prefrontal regions, which have been implicated in self-control, planning,
abstract thinking.
The above frontostriatal model of adolescent decision making thus describes a potential for
imbalance in motivational bottom-up versus controlling top-down processes.
Addiction
Current neurobiological research has identified two broad types of neuro-adaptations that result
from repeated alcohol and drug use. First, neural sensitization leads to strong impulsive reactions
(e.g., attentional biases and approach tendencies) to classically conditioned cues that signal alcohol
or drugs. In later phases of addiction, habitual responses become important, with cues automatically
triggering approach-reactions, outside voluntary control. Increased incentive salience may result in
attentional capture (“attentional bias”) of substance-related cues. Finally, negative affect may trigger
an urge to take drugs through associative processes. Second, there is evidence that heavy alcohol
and drug use results in impaired control functions.
Interventions
1. Working memory training
a. Aimed at training the likelihood of successful control
, b. The top-down biasing aspect of working memory, or executive control functions, as
well as control of access to WM are trainable.
c. In addition to behavioral WM training, there is also emerging evidence that low
voltage electrical stimulation at the scalp (transcranial Direct Current Stimulation, or
tDCS) can facilitate dorsolateral prefrontal activity, leading to enhanced working
memory (Fregni et al., 2005) and reductions in craving.
2. Cognitive bias modification
a. Attentional bias modification: For example, in a visual probe test, two stimuli
(pictures or words; usually one related to the problem and one neutral) are
presented at the same time, after which a probe appears on one of the two stimuli
locations. In an assessment instrument, the probe to which people react, appears
equally often in the location of the disorder-related stimulus and the neutral
stimulus.
b. Approach bias modification: The AAT (alcohol Approach Avoidance Task) contains a
“zoom-feature” which has the effect that upon a pull movement, the picture size on
the computer screen increases, and upon a push movement, it decreases, which
generates a strong sense of approach and avoidance, respectively, and
disambiguates the meaning of pushing (is this encoded as “moving towards” or
“pushing away?”) and pulling the joystick. Alcoholics and heavy drinkers have an
approach bias for alcohol.
c. Further developments: For example, evaluative conditioning, neurofeedback
training, and inhibition training.
Conclusion
It was noted that concerns have been raised about the adequacy of dual-process models as a
theoretical foundation. However, such concerns appear to be addressable in principle by carefully
considering levels of description: motivational processes and top-down biasing can be understood as
intertwined, co-developing components of more versus less reflective states of processing. In
practical terms, dual process models of addiction not only provide hypotheses why adolescents are
at increased risk of substance abuse, but have also suggested interventions that have already been
successfully applied in adults. In conclusion, the integration of motivation and control appears critical
not only to the development of individuals, but also to the further development of theory in
cognitive neuroscience. Finally, behavioral interventions for addiction are discussed. Insights in the
development of control and motivation may help to better understand – and more efficiently
intervene in – vulnerabilities involving control and motivation.
1.2 Dobbs, D. (2011). Beautiful Brains. Moody, Impulsive, Maddening. Why
do teenagers act the way they do? Viewed through the eyes of evolution,
their most exasperating traits may be the key to success as adults.
National Geographic, October 2011.
Teenagers act the way they do, because the brain doesn’t actually grow very much during this
period. The process of maturation continues throughout adolescence. When this development
proceeds normally, we get better at balancing impulse, desire, goals, self-interest, rules, ethics, and
even altruism, generating behavior that is more complex and, sometimes at least, more sensible. But
at times, and especially at first, the brain does this work clumsily. It's hard to get all those new cogs
to mesh.
,In a experiment, neuroimaging was used to study the teen brain, were a simple test was used. She
scanned the brain while they performed a task. Ten-year-olds stink at it, while teens do much better.
But Luna thought the brain scans were much more interesting. Compared with adults, teens tended
to make less use of brain regions that monitor performance, spot errors, plan, and stay focused—
areas the adults seemed to bring online automatically. This let the adults use a variety of brain
resources and better resist temptation, while the teens used those areas less often and more readily
gave in to the impulse to look at the flickering light—just as they're more likely to look away from the
road to read a text message.
However, thee troublesome traits don't really characterize adolescence; they're just what we notice
most because they annoy us or put our children in danger. We have to look at broader traits that
underlie those acts. This upside probably explains why an openness to the new, though it can
sometimes kill the cat, remains a highlight of adolescent development. Even 14- to 17-year-olds—the
biggest risk takers—use the same basic cognitive strategies that adults do, and they usually reason
their way through problems just as well as adults. Contrary to popular belief, they also fully recognize
they're mortal. And, like adults, says Steinberg, "teens actually overestimate risk." So why do teens
take more chances? Teens take more risks not because they don't understand the dangers but
because they weigh risk versus reward differently: In situations where risk can get them something
they want, they value the reward more heavily than adults do.
As Steinberg's driving game suggests, teens respond strongly to social rewards. Physiology and
evolutionary theory alike offer explanations for this tendency. Physiologically, adolescence brings a
peak in the brain's sensitivity to dopamine, a neurotransmitter that appears to prime and fire reward
circuits and aids in learning patterns and making decisions. This helps explain the teen's quickness of
learning and extraordinary receptivity to reward—and his keen, sometimes melodramatic reaction to
success as well as defeat. During adolescence, teens prefer the company of those of their own age
more than ever before.
This adaptive-adolescence view, however accurate, can be tricky to come to terms with—the more
so for parents dealing with teens in their most trying, contrary, or flat-out scary moments.
1.3 Sussman, S. (2017). Chapter 1: A general introduction to the concept
of addiction and addictive effects. In Substance and Behavioral Addictions:
Concepts, Causes, and Cures (pp. 3-31). Cambridge University Press.
Substance addiction pertains repetitive intake of a drug or of food, whereas behavioral addiction
pertains engaging in types of behaviors repetitively which are not directly taken into the body such as
gambling or sex. Physiological withdrawal symptoms (the appearance of both physical and
psychological symptoms which are caused by physiological adaptations in the central nervous system
and the brain due to chronic exposure to a substance) were until recently only seen as an ‘addiction’.
Behavioral addictions alter endogenous ligand functions. In Table 1.1 there is a list of 12-step
organizations for substance and behavioral addictions.
At its origin, addiction generally referred to “giving over” or being “highly devoted” to a person or
activity, or engaging in a behavior habitually, which could have positive or negative implications.
History of different kinds of addiction
Tobacco addiction: Deep inhalation of tobacco did not occur until after flue-curing (four- to eight-
week air curing, which results in tobacco low in sugar, and which gives tobacco smoke a light, sweet
, flavor, and a high nicotine content). The public consensus that nicotine was addictive, and the driving
force behind regular tobacco use, occurred with publication of the Surgeon General’s report on
nicotine addiction in 1988.
Alcohol addiction: Alcohol misuse has been noted throughout written history. Also, Abraham Lincoln
attributed much vise, misery, and crime to the abuse of alcohol but also supported kind treatment of
those who had fallen victim to alcohol addiction.
Opium-related addiction: Initial use of opium was described as “divine enjoyment”. After the opium
wars, the opium trade was legalized in China and production increased, maintaining relatively high
prevalence of opium addiction and related social and economic problems in China.
Cocaine addiction: Replacement medications that did not contain opiate derivatives to treat opiate
addictions led to new problematic drug use.
Marijuana addiction: Marijuana was viewed as a hilarious herb that was purchased regularly and
without good sense.
Food addiction: No history.
Gambling and sex addictions were always viewed as behavioral addictions in history. Gambling
shorter than sex addictions, because there were no electric devices back then.
Intensional definition of addiction: causal or process model type statements of addictions. They
attempt to describe at minimum an addictive behavioral process.
1. Physiological and psychological dependence (cellular or acquired tolerance and withdrawal):
The addict is trapped into a pattern of increasing involvement with the behavior.
Tolerance refers to the need to engage in the behavior at relatively greater level than in the
past to achieve previous levels of appetitive effects.
Withdrawal is the abrupt termination of the addictive behavior. This will lead to intense
physical disturbances.
Craving is now one of the criteria of substance use disorder in the DSM-V. This is an intense
desire for engagement reoccurs, is compelling, and one often gives in to this desire.
2. Impulsive-obsessive/compulsive behavior (egodystonic separate from self): engagement
in the addictive behavior leading to pleasure or relief rather than on a notion focusing on
maintaining an equilibrium. Difference with addiction simple behaviors that remove
anxiety, addiction have more complex. Two variants (can also occur at the same time):
a. Positive reinforcement: there is a building up of tension which is then released.
b. Negative reinforcement: building up of tension, stress, and anxiety, resulting in relief
from the anxiety but no particular pleasure.
3. Self-medication: pertains to relief from disordered emotions and sense of self-preservation
through engaging in the addictive behavior.
a. Trauma: through addiction people try to handle their trauma.
4. Self-regulation: the present state of being cues attempts to reach a standard at which point
satiation is achieved, until the present state is no longer at the desired standard state.
a. BAS-BIS model (behavioral approach and behavioral inhibition system): these
interdependent systems influence whether an individual is likely to withdraw form or
avoid situations that involve novel or threatening cues. BAS is mediated by dopamine
(novelty and reward) and BIS is mediated by the septo-hippocampal system (which
detects competing goals and leads to approach or avoidance behavior).
b. Incentive-Sensitization theory: focuses on the influence of neural adaptation to
addictive behaviors. They differentiate neural processes involved in motivational
mechanisms (wanting) and liking. Through repeated engagement in the behavior,
