Theory of Addiction

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!

Auteur

Robert West is Director of Tobacco Studies at the Cancer Research UK Health Behaviour Unit at University College London. He has been researching tobacco and nicotine dependence since 1982 and has published more than 250 scientific works. His research involves surveys of smoking patterns, clinical trials of aids to smoking cessation and laboratory studies of nicotine withdrawal symptoms. He is co-author of the English National Smoking Cessation Guidelines that provided the blueprint for the English Stop Smoking Services and is also Editor-in-Chief of the journal, Addiction.

Résumé
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!

Contenu

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…