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Cognitive schemata: A core postulate of the excessive appetite model of how an addiction is generated is, therefore, that a combination of operant reward, usually in the form of some powerful emotional change, plus wide cue elicitation of conditioned responses that assist consumption in one way or another, operating within diverse social contexts, between them constitute a powerful set of processes responsible for the amplification of a small and unremarkable liking into a strong and potentially troublesome attachment. An additional step has been taken by a number of theorists who have posited a combining of learning and memory elements into 'cognitive schemata'. An early example was Leventhal & Cleary's (1980) 'multiple regulation model'. They believed that emotional regulation was the key to smoking, but that several emotional processes might operate simultaneously. Smokers formed a strong emotional memory of this complex action of smoking. It was this 'memory schema' that was responsible for provoking desire or, as they called it, 'craving'. A later model of tobacco dependence based upon this idea of an integrated system or schema of elements that provides the motivating force for continued excessive appetitive behavior, was Niaura, Goldstein & Abrams's (1991) bioinformational model. This posits that information concerning drug use and its effects is represented as a 'propositional' neural network that encodes information about stimulus elements (setting and events that activate the network), response elements (including cognitions, physiological responses and drug-seeking behaviors) and meaning elements. Such networks develop through experience with drugs. 'Dependence', in this framework, is not defined by any single element, and can only be understood in terms of the extent and articulation of the network, the threshold for activation of part or all of it, the amount of automaticity and coherence among the response elements, and the dominance of the system in overriding other ongoing activities. White's (1996) model, based on the idea of three parallel learning and memory processes, is yet another in this apparently growing tradition of trying to account for excessive appetitive behavior in terms of complex memory schemata based on past experience of the substance or activity.
Such models represent a definite step forward in conceptualizing addiction. Most importantly for our purposes, they have the great merit of being applicable beyond the domain of substances within which the addiction field has been unnecessarily confined in the past. On the other hand, it may be argued that positing a memory schema that represents addiction, dependence or strong attachment is little more than a modem form of 'mentalism' unless 'schema' can be more precisely defined, located or accessed. The cue-reactivity paradigm is one method of testing for the existence of such appetitive cognitive processes or schemata, involving recording physiological and psychological responses to photographic, video, laboratory objects or real world representations of substance or activity-related materials (Carter & Tiffany, 1999).
Another procedure that has become popular for examining cognitive processes in the context of excessive eating, in particular, is the Stroop color-naming reaction-time test. There have been consistent findings that people concerned about their excessive eating show the expected effect of interference with color-naming words related to eating, shape and weight, as revealed by comparatively long reaction-times to such words, and that the effect disappears after successful treatment (Cooper & Fairburn, 1992). Other methods for examining addiction-related cognitive biases include visual probe detection tests of attentional bias, that have been used with excessive eaters (Rieger et al., 1998) and heroin users (Lubman et al., 2000) and word-stem completion tests of implicit memory, used with excessive gamblers (McCusker & Gettings, 1997). Hence, there does appear to be considerable evidence that people whose appetitive behavior is excessive show biases in cognitive processes such as attention and memory, specifically concerning materials that relate to the object of their excessive appetite.
Secondary amplifying processes: Although the proposal is that the mechanisms outlined above are at the core of addiction, and although some years ago Reinert told us that we should 'Never underestimate the strength of a habit' (1968,pp. 37-38), the excessive appetites model supposes that there are additional processes that further amplify a person's state of attachment and further propel him or her to the further reaches of the consumption distribution curve. I think of these as constituting a set of 'secondary' processes in distinction to the 'primary' conditioning, learning and cognitive processes described earlier. They are of two kinds.
The first might be termed acquired emotional regulation cycles. In accordance with the law of proportionate effect, it is supposed that the stronger an attachment becomes the more likely it is that these new processes will 'kick in', providing further incentive for consumption by serving new emotional regulating functions. Some of these processes may be peculiar to particular forms of addiction. For example, a number of students of 'compulsive gambling' have identified 'chasing losses' as an important additional source of drive (e.g. Lesieur, 1984; Custer & Milt, 1985). Based on our results of semistructured interviews with problem gamblers we also concluded that, in addition to the primary positive experiences associated with their gambling (largely described in terms of arousal and excitement), there existed a powerful set of attachment-promoting secondary processes which had the effect of adding a strong drive-reduction component to the primary positive incentive element. The main component of this secondary acquired motivational cycle was a strong, negative feeling state associated with losing at gambling, associated with an increased desire to recoup losses by further gambling (Orford et al., 1996). Indeed, 'chasing' might be thought of as the gambling equivalent of neuroadaptation as a secondary, attachment-enhancing process. Although neither is central (e.g. Jaffe, 1992), nor even essential, each, when it occurs, provides a strong further push towards greater excess, helping to further overcome natural controlling and restraining influences.
Another secondary process of a kind that sets up a new cycle of emotions and hence further appetitive drive towards excess, is the so-called abstinence violation effect (AVE). This phenomenon, first described in the context of excessive alcohol use, now represents one of a small but growing number of points where literatures on excessive drinking and excessive eating overlap (Cummings, Gordon & Marlatt, 1980). The AVE includes feelings of guilt and self-blame, self-attributions that are internal, global and uncontrollable, and feelings of helplessness and hopelessness (Hsu, 1990; Grilo & Shiffman, 1994).
The second type of additional, amplifying processes may be thought of as the consequences of conflict. The development of a strong appetite alters in a fundamental way the balance that has to be struck between inclination and restraint. What characterizes strong and troublesome appetite, as distinct from relatively troublefree, restrained, moderate, or normal appetitive behavior, is the upgrading of a state of balance into one of conflict resulting from the harms or 'costs' associated with growing attachment to an appetitive activity. It is the consequences of the conflict brought about by strong attachment to appetitive behavior which are of concern here.
Continued commitment to a form of behavior which is harmful or troublesome calls for dissonance reduction in the interests of consistency. Thus, on theoretical grounds, if it is right to think of someone whose appetitive behavior is excessive as essentially someone who faces a dilemma or conflict of a behavioral, conduct, or even moral kind, we should expect such a person to experience discomfort and to be motivated to escape from it, much as people wish to escape from pain or anxiety. Indeed, this 'dissonance' should not be thought of as simply theoretical, but as something very real, experienced as tension, depression, confusion or panic. The consequences of appetitive conflict are numerous, varying from biased or non-vigilant information processing (Janis & Mann, 1977) through to changes in terms of the social groups to which a person belongs (Bacon, 1973). The key point is that each alters the motivational nexus, often in an upgraded direction, hence contributing a further escalating or amplification mechanism responsible for creating yet stronger attachment.
- Orford, Jim; Addiction as excessive appetite; Addiction; Vol. 96 Issue 1; Jan 2001
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