1. Cognitive Theories of Addiction
Dr Tony Moss
London South Bank University

2. Session Outline Tiffany’s Cognitive Model of Drug Urge
Franken’s Neurobiological Model of Craving
Moss & Albery’s Dual-Process Model of the Alcohol-Behaviour Link
Dyer, Moss & Albery’s Dual Systems Theory of Addiction

3. Tiffany’s (1990) Cognitive Model of Drug Urge and Use
Argued that dependence is a form of automatic behaviour
Repeated use of drugs leads to the automatisation of drug urges, which in turn increase the future frequency of actual use
Therefore, craving is a non-automatic process that does NOT always have to precede drug use

4. Tiffany’s (1990) Cognitive Model of Drug Urge and Use
Tiffany argued that ‘craving’ has two components
Automatic: linked to withdrawal etc.; activates schemata linked to use, so possibly nonconscious
Controlled: when use is not possible, conscious evaluation of the ‘craving state’ lead to subjective ‘wanting’ experience
Tiffany, 1999, Alc. Res. Health

5. Tiffany’s (1990) Cognitive Model of Drug Urge and Use
Importantly, Tiffany sees subjective craving as being the result of interrupting an automatic drug-seeking schemata
This may be due to either individual or environmental influences:
E.g. having no alcohol available will ‘interrupt’ an automatic ‘drink alcohol’ schema, and induce craving, or;
Consciously trying to stop oneself from accepting a drink offered at a party may lead to increased subjective craving

6. Tiffany’s (1990) Cognitive Model of Drug Urge and Use
This model is supported by studies of Attentional Bias in problem drinkers, e.g.
Sharma, Albery, & Cook ; Townshend & Duka (2001)
These studies show that dependent drinkers are massively distracted by drug-related stimuli, to the extent that performance on an unrelated task becomes impaired
E.g. responding to the colour of a word in a stroop, identifying the location of a dot in the dot-probe

7. Tiffany’s (1990) Cognitive Model of Drug Urge and Use
In addition, Sayette et al. (1994), amongst others, have shown that attentional biases are positively related to craving
E.g. attentional bias for smoking related words is associated with factors such as subjective craving and time since last cigarette

8. Tiffany’s (1990) Cognitive Model of Drug Urge and Use
Presaging Tiffany’s work, Ludwig (1988), commenting on the automaticity of alcoholism, said:
“Others essentially think instinctively, short circuiting both imagery and cognitions, and are inclined to act without knowing why. When alcohol becomes readily available, they drink before they think.”

9. Franken’s Neuropsychopharmacological Model of Craving and Relapse
Franken attempted to integrate evidence from attentional bias research into a wide range of other evidence to explain craving and relapse
Essentially a cognitive model:
Stimulus – Evaluation/Processing – Response
Provided convincing neurological and pharmacological evidence to explain the mechanism of attentional bias

10. Franken’s Neuropsychopharmacological Model of Craving and Relapse
Conditioning of drug stimuli increases dopamine levels
This serves to increase AB for drug stimuli (cf. I-S theory)
‘Hypervigilance’ then occurs, increasing craving and decreasing attentional resources for other mental activities

11. Franken’s Neuropsychopharmacological Model of Craving and Relapse
A useful model in that it demonstrates, quite convincingly, that attentional biases have a neuroanatomical underpinning
Helps us understand the role of craving in relapse and drug use
Perhaps not so clear if the model is ‘new’, or just reinforcing previous theories (esp. I-S and Tiffany) with solid neuropsychopharmacological evidence

12. A theory of the effects of alcohol on behaviour and cognition
Moss & Albery’s (2009) Dual-Process Model of the Alcohol-Behaviour Link
A theory of the effects of alcohol on behaviour and cognition
Based on dual-process models of cognitive processing
The model distinguishes between pre-and post-consumption drinking phases
Argues that different effects of alcohol before and after consumption starts are important to understand behavioural change

13. Based on a theoretical dichotomy between types of cognitive processing
Moss & Albery’s (2009) Dual-Process Model of the Alcohol-Behaviour Link
Based on a theoretical dichotomy between types of cognitive processing
Automatic
AKA: System 1, Implicit, Associative…
Features: Fast, (often) Unconscious, Parallel, High Capacity, Contextualised, Independent of Intelligence
Controlled
AKA: System 2, Explicit, Propositional…
Features: Slow, Conscious, Serial, Low Capacity, Abstract, Linked to Intelligence

14. Moss & Albery’s (2009) Dual-Process Model of the Alcohol-Behaviour Link
Pre-consumption Phase
Involves the activation of mental representations in long term memory relating to alcohol
E.g. expectancies, beliefs, action schemata
This can lead to changes in behaviour prior to the commencement of drinking
These changes in behaviour could manifest in terms of subtle social behaviours (becoming more outgoing, chatty, relaxed), or even serve to moderate drinking behaviour once it begins (ordering high-alcohol content drinks, drinking the first few drinks more quickly)

15. Moss & Albery’s (2009) Dual-Process Model of the Alcohol-Behaviour Link
Consumption Phase
Once alcohol enters the bloodstream, it begins to impair cognitive processing
Specifically, alcohol reduces the capacity and influence of controlled processing
As yet, no evidence has shown impairments in automatic processing
Therefore, active mental representations may still influence behaviour via the automatic system as they normally would
Goals and actions that are derived in the controlled system will be less ‘effective’

16. Moss & Albery’s (2009) Dual-Process Model of the Alcohol-Behaviour Link

17. Dyer, Moss & Albery’s Dual Systems Theory of Addiction
An attempt at unifying the diverse evidence and theory in addictions
Aims to demonstrate both theoretical coherence and practical utility
Based on a Dual-Process model of cognitive processing, and an extension of the previous model in to the field of addiction
…And still a work in progress!

18. Dyer, Moss & Albery’s Dual Systems Theory of Addiction
From Moss & Dyer, 2010

19. Dyer, Moss & Albery’s Dual Systems Theory of Addiction
From Moss & Dyer, 2010

20. Dyer, Moss & Albery’s Dual Systems Theory of Addiction
From Moss & Dyer, 2010

21. Dyer, Moss & Albery’s Dual Systems Theory of Addiction
From Moss & Dyer, 2010

22. Dyer, Moss & Albery’s Dual Systems Theory of Addiction
From Moss & Dyer, 2010