Integrating a disease and social learning perspective

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SMOKING AND ALCOHOL USE
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What factors can pair with the conditioned stimulus? Two types of factor can
pair with the conditioned stimulus: external (e.g. the pub) and internal (e.g. mood) cues.
In terms of a potentially addictive behaviour, smoking cigarettes may be associated
with external cues (e.g. seeing someone else smoking, being with particular friends), or
with internal cues (e.g. anxiety, depression or happiness). It has been argued that a
pairing with an internal cue is more problematic because these cues cannot be avoided.
In addition, internal cues also raise the problem of generalization. Generalization occurs
when the withdrawal symptoms from a period of abstinence from an addictive behaviour
act as cues for further behaviour. For example, if an individual has paired feeling anxious
with smoking, their withdrawal symptoms may be interpreted as anxiety and therefore
elicit further smoking behaviour; the behaviour provides relief from its own withdrawal
symptoms.
Operant conditioning
The rules of operant conditioning state that the probability of behaviour occurring is
increased if it is either positively reinforced by the presence of a positive event, or negatively
reinforced by the absence or removal of a negative event. In terms of an addictive
behaviour such as smoking, the probability of smoking will be increased by feelings
of social acceptance, confidence and control (the positive reinforcer) and removal of
withdrawal symptoms (the negative reinforcer).
Observational learning/modelling
Behaviours are also learned by observing significant others carrying them out. For
example, parental smoking, an association between smoking and attractiveness/
thinness, and the observation of alcohol consumption as a risk-taking behaviour may
contribute to the acquisition of the behaviour.
Cognitive factors
Factors such as self-image, problem-solving behaviour, coping mechanisms and
attributions also contribute to the acquisition of an addictive behaviour.
Integrating a disease and social learning perspective
Researchers often polarize a disease and a social learning perspective of addiction. For
example, whilst some researchers argue that smoking is entirely due to the addictive
properties of nicotine others argue that it is a learned behaviour. However, implicit
within each approach is the alternative explanation. For example, whilst a disease model
may emphasize acquired tolerance following smoking or drinking behaviour and therefore draws upon a disease perspective, it implicitly uses a social learning approach to
explain why some people start smoking/drinking in the first place and why only some
continue to the extent that they develop acquired tolerance. People need exposure and
reinforcement to make the smoke or drink enough to develop tolerance. The concept of
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