Transcript for:
Understanding Social Learning Theory in Addiction

during this session um we're moving on from our last focus on learning theories of addiction where we looked at classical behaviorism that includes classical and operant conditioning by way of understanding the development of addictive behaviours in this session we're going to be focusing on social learning theory which is in historic terms a kind of a development on the earlier learning theories i'll say a little bit about uh before we get into uh the application of social learning theory for understanding addictive behavior to some of the history that sits behind social learning theory so that you can place that uh in context um so i'll say first and things about the historical development and key concepts of social learning theory and as i mentioned in the last session it's really important to understand social learning theory is the development of learning theory as opposed to a completely new theory in its own right um we'll then go on to look at social learning theory and addiction uh and then consider the role of self-efficacy and outcome expectancies which are two particularly important concepts that social learning theory bring to our understanding of addictive behaviors and then we're going to look at some more applied research in recent years looking at things like peer pressure parental influences and other things like framing and problem recognition which stem from some of these core ideas in social learning theory so the first thing to say about social learning theory a key figure who you read if you if you read around the area that you can't help but come across is albert bandura who developed social learning theory as an attempt to introduce a social cognitive model of human behavior so if we understand learning theory itself as being a sort of it's not simple but a simplistic idea that all human behavior is the product of direct experience and learning there's this idea particularly in classical conditioning of a stimulus response relationship so we as organisms exist in a world and we just respond to cues and things that go on around us in a very uh definitive way um what bandura did and his contemporaries was to reintroduce the mind to reintroduce cognition so the idea being that you experience things in the world and of course they shape your behavior as learning theories suggested they would but they don't necessarily always influence them in a completely direct way so your interpretation of the experiences that you have the way that you internally process those experiences will act as a kind of a mediator of the way in which those experiences will affect the way that you go on to act in future so it departed from this stimulus response model and importantly then understood learning is something that happens in a social context it really brought the kind of wider social influences as well as the internal cognitive processes back into our kind of core thinking about the development of human behavior and it's often thought of social learning theory the transitional step between behaviour behaviorist and much more modern cognitive theory a lot of what we talk about in the context of certainly early social learning theory was still very much restricted to the domain of understanding cognition and information processing as being a very conscious intentional activity without so much of an understanding in the early days of the implicit automatic processes that can exist sort of below the levels of conscious awareness so that's some key points about social learning theory the general principles of social learning theory and the ones i want to draw attention to because they have particular relevance for our discussion about addictive behavior one key general principle of social learning theory is that we can learn vicariously this is a really really important and really powerful concept um in learning theory social learning theory when we talk about vicarious learning sometimes also caused by called behavioral mimicry effectively what this means is that i can observe you doing something i can have an internal conscious experience and thought process which says that thing that you're doing seems to be giving you some sort of reward or pleasure and because of that fact i'm going to model that behavior myself in future i'm going to do the thing that i now think is going to bring me some reward simply because i've observed you in my interpretation experiencing a reward from the same behavior now importantly that process is not something that could be accounted for by learning theorists because learning theorists rejected the mind they rejected the importance of these internal mental processes and understanding human behavior so the idea of vicarious learning if you think about what that really means the only way that i can learn through your experience in that indirect way is if i can stop and think about what i think you're experiencing you don't need to tell me you don't need to say to me tony i'm doing this thing and it's you know really is really enjoyable i can interpret that based on the way that you react in that situation so vicarious learning can be a powerful shaper of behavior and of course it will be influenced by things for example like whether or not you respect the person or like the person who you're observing if you think that you're similar to the person who's doing the thing that that seems to be enjoyable or indeed seems to be doing something they're not enjoying at all it will be more likely that i'll decide to mimic that behavior in future or to model that behavior and so that's a really important component of social learning theory particularly if we think about as we'll come to at the end of this session some factors like for example peer pressure and the effects of social norms on behaviors such as addictive behaviors you know why do young people begin smoking you know lots of different reasons why but peer pressure is a really important one and peer pressure if you think about it is a form of vitamin a form of vicarious learning it's not entirely it's its own distinct concept but i can't kind of reinforce enough the importance of this concept of vicarious learning or modelling because humans are social we learn from one another all the time another key principle of social learning theory is the like this idea that learning an experience doesn't always precipitate behavior change so what we mean by this what social learning theory is meant by this is that unlike learning theorists who said that all of your experiences will kind of almost unavoidably shape your behavior and increase the probability of you doing something in future for social learning theorists your experiences are only only an indirect factor in whether or not you change your behaviour in future you can experience something that to other people may appear to be an unpleasant experience but whether or not that changes your behavior is going to depend on a complex set of factors such as the internal interpretation that you make of the consequences that you're experiencing so if you do something and it leads to a negative outcome from a learning theory's perspective that should stack the odds against you doing that thing again in future for a social learning theorist the argument would be well it would depend on for example whether or not you attribute the negative outcome to the thing that you did if you make a determination that these bad things have happened as a result of something that you've done are actually not a direct consequence of the thing that you did you could use concepts like denial for example that would be relevant in the context of addictive behavior if you simply don't believe that the things that are happening to you that are bad or in any way linked to your behavior then it's unlikely your behavior is going to change in the short to medium term so this is an important idea from social learning theory that again is absent from learning theory where your own personal evaluation or observation about rewards and reinforcements and punishments are actually by the by it's all just a simple kind of probabilistic process in a way so reinforcement and punishment then there are these indirect factors and they're indirect because cognitive processes internal thought processes are now within social learning theory understood to play an important role so rather than stimulus response what we have is stimulus information processing and response something happens to you in your environment you process and interpret that experience and your interpretation of the experience is the thing that shapes your behavior not just the experience itself what this also means is our expectations of reinforcement or punishment can be as powerful in predicting our behavior as the actual experience of those reinforcements or punishments so this links back to the idea of vicarious learning if because of my observations of someone for example having a drink is that that person appears to be having a really good time and i think that that's going to happen to me it increases the likelihood that i'll then decide to drink alcohol for instance because i've learned vicariously through somebody else doing the behaviour that it seems to be really great and this comes back if you think about things like for example marketing and the way in which um in the media and the press and the videos and movies and so on the restrictions that we put in place around things like alcohol and smoking not glamorizing drug use and so on the idea of that is that is intended to be that actually some of these vicarious learning experiences seeing something and being told that it's good by people who you respect is going to have an impact on your behavior so again thinking about back to the last session on learning theory this is a real development on the ideas about the way in which our experiences shape our behavior for social learning theory is not just our experiences it's our anticipated experiences the things that we think might happen even if we've never done the behaviour before a really important concept in social learning theory is this and we're going to focus on two concepts in particular through the session self-efficacy and we'll come on to in a moment outcome expectancies self-efficacy is effectively a feeling of competence or capability in performing a behavior this is really important because if you have a low degree of self-efficacy it's likely to lead to behavioral avoidance we're unlikely to try to do things for which we feel it's likely we're going to fail we don't think we're going to do well the behavior and equally if we feel highly efficacious if we have a high degree of self-efficacy in a particular behavior or achieving an outcome it increases the likelihood that we're going to do it because who doesn't want to succeed and get positive experiences or experience positive affect from doing things where we're successful and again this notion that it's not just about the actual the actual knowledge it's not about any absolutist sense of you know you you definitely are really good at doing a certain thing or you definitely are really bad the belief about whether or not you think you're going to be whether you have higher low self-efficacy regardless of your own experiences is likely to increase or decrease effort and persistence certainly if you believe that you're capable of doing something not only are you more likely to try but you're also more likely to persevere and to keep putting more effort in particularly if you experience early failure in terms of smoking cessation we'll come on to just uh shortly it's certainly the case that people who have a higher degree of self-efficacy in their ability to quit smoking not only are they more likely to try in the first place but they're also more likely to be able to deal with slips you know with the occasional relapse or lapse so alongside self-efficacy beliefs outcome expectancies are another really important component introduced into our model of a way of understanding human behavior from social learning theory as we build on what we understand from learning theory and outcome expectancies are best described as being if then beliefs that are related to behaviors or outcomes so the idea of an if then belief you know if i do x then why would occur is those simple forward-looking predictive beliefs that we have about the way the world works and that's largely built on our experiences but can also be based upon vicarious learning modelling things that we've been told and that we've learned in other ways so these if their beliefs are really powerful predictors of behavior they're important because if you think about what this means that actually if you were building a kind of a you know your own human from scratch or your own robot from scratch and actually building it in such a way that based upon its experience of living in the world it starts to be able to think ahead and think if i do this then that will happen that sort of predictive power is a really important component of what our mind is able to do so there are lots of different types of expectancies and we'll give some examples of them in a moment so you can have these outcome expectancies you know if i do this then that will happen but you can also have and self-efficacy and outcome expectancies are not really entirely distinct they they overlap with one another you can have self-efficacy self-efficacy expectancies so expected outcomes that are based upon your self-efficacy beliefs because i have a low degree of self-efficacy in my ability to do something i expect that i will foul if i attempt to do it so these two things interact with one another quite closely we can also further deconstruct outcome expectancies into different subtypes so you can have an action outcome expectancy so i have an expectancy about the outcome in the sort of wider world as it were based upon an action that i'm thinking of performing so if i buy a lottery ticket i could have an expectancy that i will win the lottery a thing will happen to me as a result of my action of buying a lottery ticket you can also have action action outcome expectancies which are things that if i do i think will have an impact on my ability to do something else so if i work hard at the gym and train i'll be able to run faster in the marathon and of course similarly to when we were looking at the concepts of operant and classical conditioning where i was giving sort of very simplistic one-to-one examples equally you can probably also start to see that actually expectancies and self-efficacy beliefs won't operate in a really sort of one-to-one way there'll be lots of expectancies and self-efficacy beliefs or competing with one another all at the same time so these are just simple examples but actually you can sort of think if you're planning to do something over a long period of time studying for a qualification you know looking to try to get a job it's not just going to be a simple action action or action outcome expectancy that you have it'll be a really complicated one with lots of different branches and you know and if this happens then i'll feel that way and so on and so forth but hopefully that's useful just to understand that the core concept of what these expectancy beliefs can look like now it's also important to think about what the potential outcomes of actions could include and as far as expectancy theory is concerned it can it can be it can relate to a range of different things but some important ones in particular would be outcomes related to the in the external world so if i do something then a thing will happen in the world around me but also intrapersonal and extra personal affective changes affective changes meaning emotional changes intrapersonal meaning things that happen to me so if i do this then it will make me feel good if i do this it will make me feel bad but also you can have these beliefs these outcome expectancy beliefs about the way that your behavior will affect somebody else if i do this it will make my partner happy if i do this it'll make my partner feel sad so these different sorts of beliefs that we can have can relate to some really complex social outcomes and particularly those relating to emotion and because particularly for our own personal emotions they can be quite powerful drivers of behavior you can easily imagine how outcome expectancies can can really have quite strong impact on the way that people choose to behave and interact another important dimension that often in talking about outcome expectancies tends to get forget forgotten is this notion of expectancy value and this was based on work from fishbane and eisen and edwards back in 54. and expectancy value models of motivation really based on this idea that yes okay you can have these beliefs about what's going to happen if you do something in the world around you you can you can believe that if you do something it will make somebody sad now on a simple analysis you could say okay well in that case maybe you won't do that thing if you think it's going to make someone that you know sad but what if you don't care you know what if you don't care about that particular person what if their feelings are not important to you then actually regardless of the fact that you have an outcome expectancy that if you do behave your ex or if you do you know whatever it may be then that person would be upset if you don't care about that person their emotions are not important to you then actually that expectancy that belief in and of itself may have a very limited impact on your behavior perhaps only to the extent that so long as doing the thing that you're thinking about isn't itself important to you you may be less likely or more likely to do it so this subjective value is important we can hold all of these different beliefs but we also need to care about the outcome and caring about the outcome is going to be really important in judging more people determining what people do next and what i describe here is expectancy and value being orthogonal dimensions what that means is that each can go up and down it's called independently of one another you can have more or less strong beliefs and you know expectancies and not just absolute we don't simply believe in a very simplistic way you know if i do behavior x then y will happen 100 of the time we can have stronger or weaker expectancies about things it could be about likelihood so if i do behavior x behavior wire might probably will happen or is it might happen but but on balance is probably less likely than it is to happen but the idea of it being orthogonal with value is that value can equally go up and down as well and of course if again start thinking about sort of complex interpersonal relationships and dynamics you can also see how expectancies and subjective value beliefs can change over time so you could care more or less about what person thinks of you depending upon how your wider relationship with them goes so these things can interact in quite complicated ways and have a really significant impact on behaviour the final category of expectancies and this isn't really a different type of expectancy as such it's more of a sub category of expectancies in general but identified by irving kirsch back in the 80s is this notion of response expectancies and these are particularly important in the context of addictive behaviors when we're talking about things like withdrawal and tolerance for example and response expectancies are simply expectancies regarding the automatic outcomes or responses that we'll experience so for example pain fear physiological arousal you know cognitive arousal and so on and the reason that kirsch identified these and said that they're important to understand as a distinct subset is that these sorts of responses or outcomes for us experience of pain experiences of fear experiences of anxiety are really powerful attention-grabbing things that influence our behavior disproportionately it's it's worth considering um some of the literature around for example chronic pain uh people who experience chronic pain it's a really difficult thing to live with because it's pain that won't go away is often not influenced or helped positively by medication and other interventions but it's really difficult to distract yourself from being in pain you know we all know if we're in pain if you've got bad back or you've hurt yourself it just makes you miserable because the natural human response to physiologically when you're experiencing pain is to almost pay attention to the pain to try to do something about it so what kirsch was identifying here wasn't that there's a different type of expectancy per se but simply that when we when we think about the sorts of expectancies people have these sorts of outcomes these sorts of beliefs if i try to quit smoking then the nicotine withdrawal by experience could be completely unmanageable it could be catastrophic for me i could hate that feeling of anxiety that goes with nicotine withdrawal um if i believe that and if i also don't believe that i'm able to cope with it i have a low degree of self-efficacy you can see how that's again going to be quite a powerful shaper of behavior so the cognitive appraisals that we make of these different outcomes you know whether we think they're likely to happen do we think we're able to cope i.e do we have a degree of self-efficacy in dealing with the outcome and so on is all going to impact on behavioural changes but i mentioned these in particular as i say because of the link with withdrawal which is a very physiological very immediate and very aversive response for many people both in terms of behavioral addictions as well as addictions to drugs one other concept i want to say something about is this notion of self-regulation because while it's uh we'll come on to this in future sessions looking at impulse and self-control theories of addiction and so on but social learning theory is really important in the sense that it presents as well as all of these different concepts that build upon operant and classical conditioning so we've got self-efficacy and expectancy and expectancy value and so on and so forth while that's really useful and builds the kind of the complexity of our ways of understanding human behavior there's a really important distinction to be made about this concept of self-regulation what it means to engage in self-regulation from a behaviorist or learning theorist perspective compared with a social cognitive or social learning theorist perspective now behaviourists would argue that self-regulation is really just a kind of a sort of a meta construct it's something that we observe is epi phenomenal meaning that it's not real we don't really control our own behavior because effectively we are a product of our learned experiences we're not making kind of conscious intentional decisions about what to do we're simply sort of acting in this automatic way being influenced by in effect the entire history of all of our reinforcements over time so we're being controlled more externally than internally social cognitive theorists on the other hand are arguing that we consciously do set our own goals and standards we make different appraisals of the experiences that we have which means that for a social cognitive theory self-regulation means something quite um quite specific you know as opposed to behaviorists with the really didn't say a great deal about it self-regulation from a social learning theory's perspective is is much more definitive that we are making decisions we are making appraisals of the things that go on around us and that is guiding our future behavior so i want to break down a particular model in self-efficacy work which is the self-efficacy and relapse prevention model because this shows uh i think quite an important practical application of some of the theoretical ideas um around self-efficacy that came from alan marlott's work and my latin colleagues identified these five different subtypes of self-efficacy that they felt were important in both relapse and prevention work in the context of addiction they break down here you can see that the first two times resistant self-efficacy and harm reduction self-efficacy as being particularly important if your work is in the prevention field so if you're interested in trying to stop young people from smoking you know stopping people from drinking too heavily you know or developing problems with drugs or gambling or whatever it may be so resistance and harm reduction self-efficacy are important for prevention they then identified three subtypes of self-efficacy that are important for both treatment and relapse prevention which are pre-action self-efficacy maintenance self-efficacy and recovery self-efficacy and because i think this model is important and because i think it generates some important insights for both understanding addictive behavior but also seeing the practical potential practical application of this concept or idea of self-efficacy i'm just going to walk through each of these types briefly now so resistant self-efficacy is essentially you what you could think of as being um primary prevention so by primary prevention we mean things that we can do to try to prevent a person from ever you know smoking for example so a primary prevention strategy to try and reduce smoking would be successful if young people for example never picked up a cigarette in the first place so resistant self-efficacy comes from the confidence that we have in one's in our own ability to avoid substance use in the first place so it's not about if i experiment can i control it it's about do i think i might be able to resist doing the behavior in the first place and the example here from the work of conrad and stacy and others shows that a combination of peer pressure and low resistance self-efficacy predicts the onset of smoking and drug use in adolescents so if in effect you're a young person who said who experiences peer pressure so you've got a group of people around you who are encouraging you to smoke or try cannabis or whatever it may be but you also have a low degree of resistant self-efficacy are you kind of the confidence in yourself to say no to people when they're offering that increases the likelihood that you are going to take it up to try so thinking about that from a prevention perspective the things that you might do would be to identify young people who have a low degree of self-efficacy i mean there's you could argue maybe let's try and get rid of peer pressure but of course that may be a much taller order you know young people are inevitably going to pressure one another i'll come on to some work just uh shortly uh looking at peer pressure amongst adults you know it continues into into adulthood for sure it's not just a young person's gain so low self-efficacy is perhaps something you could target are there things that you can do to you know provide sort of refusal skills training you know to help develop confidence amongst young people to be able to say no you know if you're in that situation put on the spot how would you deal with it without making yourself look you know uncool or whatever it might be that you're concerned about so resistant self-efficacy is that that first step before you've even gone near using a drug placing a bet you know drinking alcohol or whatever do you feel that you'd be able to resist the pressure uh to do it harm reduction self-efficacy is for many things and particularly for for substances like alcohol which are of course you know widely socially acceptable and it's not something where there's know unlike smoking the messages just don't do it with things like alcohol or indeed gambling there's this notion that you can perhaps somehow do it safely um harm reduction self-efficacy is really secondary prevention is you know if somebody's going to experiment or going to try different things what level of confidence do they have in their ability to reduce their risk after experimentation and beyond that first experimentation phase and again this idea that people can have a greater or lesser degree of self-confidence or self-efficacy is important because people with a low degree of self of harm reduction self-efficacy may be at greater risk of developing problems with alcohol or drugs or whatever it may be i.e if they ever feel like it's getting out of control but they don't feel confident in their ability to be able to sort of row it back a bit then the likelihood is that they'll just continue kind of snowballing and a problem could develop coming on then to the three types of self-efficacy which are related to prevention sorry to treatment and relapse prevention so pre-action self-efficacy is effectively your confidence in your intention to change behavior plus your motivation to act so a combination of two things your degree of efficacy in um or confidence in being able to change your behavior and the motivation that you have to do it so it kind of overlaps with that notion of expectancy value a person with a higher degree of uh pre-action self-efficacy is the sort of person who just imagines themselves succeeding so before you actually do something do you actually imagine yourself being successful in achieving the thing that you're trying to do could be quitting smoking cutting down drinking quitting gambling whatever it may be a low degree of self-efficacy would be characteristic of a person who imagines failure so they think about quitting but they're telling everybody that they know it's not going to work you know i've done this 20 times before i know it doesn't stick for very long and again this is predictive of whether or not a person is likely to actually be successful in their attempt action self-efficacy is this sort of confidence in the ongoing confidence in changing your behavior so once you're actually doing it what level of self-efficacy do you have in your ability to perform the action you know if you're trying to quit do you think you're going to be able to do it and action self-efficacy in some of marlat's work was shown to predict attempts to quit smoking if you just don't think you're going to be able to cope with the demands of the task you know because it's not just as simple as kind of sticking with the example of smoking it's not just as simple as not smoking anymore it's all the complex dynamics that go with it could be that in the workplace you're always going out for a cigarette break with friends or whatever how are you going to deal with that if you're then invited out you lose that part of your day and do you feel like if you you know drink when you smoke when you drink how how confident are you feeling being able to deal with those situations do you think once you've had a few drinks you're going to sort of not be able to resist them temptation as it were so this self belief that you have in your ability to to engage in the action is also really important and we have maintenance self-efficacy as well which is essentially your belief in your ability to cope with behavior change in the long term so you know once a person gets through that sort of initial stage of trying to overcome um you know smoking or you know to sort of stop smoking or drinking or whatever it may be there'll be all this sort of the early things around the withdrawal effects and coping with that you know whether or not you try and do it in the case of smoking with or without nicotine replacement or vaping or whatever it may be there's that sort of early part the initial effort but what about the longer term what about you know six months down the line 12 months down the line two years down the line what level of belief do you have in your ability to maintain because of course it could be that you're quite able and you do quite well at kind of giving up whatever it is you're giving up early on but then maybe something goes wrong in your life maybe you get to a really stressful time in work maybe you decide to move house maybe you have problems in your relationship how do you think you're going to cope when you're experiencing stress how do you think you're going to cope if 12 months down the line you have a cigarette you just a moment of weakness whatever you want to call it and and you just have a cigarette will you be able to deal with those lapses and relapses or will you interpret them as being really catastrophic so maintenance self-efficacy is quite literally your your self-efficacy or confidence in the ability to maintain this behavior over a much longer period of time beyond just the initial abstinence or quit or reduction attempt and recovery self-efficacy is then linked to this idea of maintenance what happens if something goes wrong what happens if you're trying to give up smoking and you have a cigarette whether it's because you're at a party because you were just having a really bad day at work whatever it may be you know something that pacific could just be that you just really fancied it and you were sort of fed up that day and decided that you would just have one so recovery self-efficacy defined designed here by luzinska and schwarzer as being one's conviction to get back on track after being derailed so if you experience a lapse which is really common when we're trying to change behavior of any kind not just addictive behaviors but in any form of behaviour change whether it's improving diet or being more active or you know whatever it may be lapses occur we sometimes you know for whatever reason don't do continue doing the behavior that we were trying to do now a person with a high degree of recovery self-efficacy is somebody who wouldn't uh attribute that to external factors so if you have a high degree of recovery self-efficacy and the lapse occurs if you have a high degree of self-efficacy in this area you're likely to say well it was just something going on you know things were just really tough for me at that point and that was it but as a result you remain hopeful for the for the future because you don't blame yourself you sort of blame other people or other situations you know they were putting me under they were you know encouraging me to have a drink or you know wouldn't give over offering me cigarettes or whatever and so if you have a high degree of recovery self-efficacy that's a good thing because it means you're actually more likely to kind of you know get back on track afterwards whether it's you know reducing consumption or quitting altogether if you have a low degree of self-efficacy recovery self-efficacy then the likelihood is that you will attribute these lapses to internal stable and global causes as in you take it all on yourself the reason that i've quit is because i'm never going to be able to stop i'm weak this is never going to change it's happened before and this lowers again as you can understand if you're thinking like that the future chances of of successfully continuing so you'll catastrophize the the lapse that you have rather than just brushing it off and saying you know what moment of weakness not the end of the world it was it was because of xyz if you have a low degree of recovery self-efficacy you're much more likely to internalize it and to blame yourself and that's of course a bad thing because it means that you're then taking full responsibility and you're less likely to either continue or to try again in future now in terms of outcome expectancies and their application to addiction it is important to understand certainly from bandura's perspective that self-efficacy and outcome expectancies are distinct but the type of outcomes that we expect are of course heavily influenced by self-efficacy expectancy so the level of confidence we have in things so in addition to the value that we place on expected outcomes which determines whether we bother trying effectively the self-efficacy beliefs that we have are also going to influence the likelihood that we think the outcome will occur so i could think that if i um you know if i play poker for example that i know that one outcome is i could really win big but i could also have a really low degree of self-efficacy as you know i barely know the rules of poker and i don't think i can bluff and therefore you know my self-efficacy expectancy is that i don't think i'm able to make the outcome occur so again it's important to remember these aren't just conceptually completely distinct things but they interact in complicated ways goldman's done a lot of work around alcohol expectancy theory in particular and gives a good definition here which is that expectancies should be thought of as information templates or memories stored in the nervous system that prepare one for the future circumstances based upon his or her previous experiences and i like this because i think it gets to this idea that this isn't just a sort of a memory thing it's also hardwired into people we're hardwired as organisms to try to predict the future it's a really useful survival skill it doesn't always work in our favor but it is really important and when we think about outcome expectancies we can also sub categorise them into different ways um i've already mentioned some of the different types of expectancies action action action outcomes different types of expectancies about you know emotional expected outcomes impacts on the world around us and so on but we also distinguish between positive and negative outcome expectancies because these can influence our behavior in different ways broadly speaking positive outcome expectancies will increase our motivation if you you know eg if i will enjoy myself more at a party if i have a few drinks so if you think a good thing will happen as a result of doing something makes it more likely you feel motivated to do it we want good things to happen and equally and again sort of fairly self-evidently negative outcome expectancies will decrease motivation so if i'll have a hangover if i drink have too much to drink now using those two situations of drinking at a party again you can see that it's not just going to be a definitive thing it's not going to be you go to a party either with positive or with negative outcome expectancies you can turn up with both you can think if i don't have a drink i might feel more self-conscious i might not have such a good time but if i drink too much i'm going to feel terrible at work tomorrow because i'll be a bit hungover so these two things will then compete and there'll be lots of different um things that impact on the decision we make in that moment one of the things that could impact on it is our self-efficacy and our ability to control our drinking do i think if i begin drinking at this in this social situation do i feel confident in my ability to be able to make sure that i don't have too much you know am i the sort of person that once i've had a few my effective my belief in my ability to control my drinking completely diminishes although i think that i can set myself a limit and i'm going to have no more than four drinks i'll space them out and that's it i'll stick at it and so the self-efficacy beliefs that we have about our ability to perform these behaviors could determine whether the positive or negative outcome expectancy influences us more so if i really don't think i'm very good at controlling my alcohol consumption in a party situation then actually even though i know that having a drink might make me feel more relaxed and i'll enjoy it more it may be that i'm more concerned about the negative outcome because i know that if i start i might not be able to stop so that self-efficacy belief about control could make it that could almost determine whether positive outcome expectancies or negative outcome expectancies end up taking precedence in my decision-making i want to say something now about some of the more applied aspects of self-efficacy and social and outcome expectancy and social learning theory and i want to start by looking at these what we describe as intergenerational influences now we know for example that alcohol expectancies develop in childhood and influence the decision to drink and how to drink throughout your lifetime we've known this for a long while alcohol outcome expectancies for example we know that heavy drinkers tend to expect positive and kind of physiologically arousing influences if i drink i'll become more outgoing i'll become louder lighter drinkers tend to expect positive things but they also expect more sedation so people that are light drinkers will report expectancies which are along the lines of yeah if i have a drink i'll become more relaxed and it'll be great but you know if i have too many i'll start to get really sleepy and so on so heavy and light drinkers have different types of expectancies but we know from research in this area that young children as young as six seven eight years old start to develop those same sorts of alcohol outcome expectancies as their parents have and that tends to then influence their drinking behavior into later adulthood it's also in this this was one of the studies stated in newcomer bendla uh in 91 looking over a nine year period found exactly that which is in the context of drug taking behavior the expectancies that adolescents had when they were much younger predicted the way that they interacted with drugs when they were older so these are really powerful and they're sort of the beliefs that we hold these memories that we hold really do shape our behavior in the long run now with some colleagues a couple of years ago we did some work looking at the drinking motivations and problem drinking amongst young children and adults and in this particular study we actually had a sample of 148 parent child diets meaning a parent who filled out a questionnaire and one of their children who were aged between 10 and 17 years looking at their drinking the parents drinking and the impact that it had on their children's drinking and what we found was that the parental drinking motives the reason that parents gave for their drinking predicted substance use alcohol use and their own children's drinking motives and importantly what we found is that parents who reported that they drank to cope had children who are more likely to also drink to cope now there's a particular measure called the drinking motives questionnaire that categorises four different types of primary motive for drinking drinking to cope in particular is a problematic motive for using alcohol people who drink to cope are more at risk of developing alcohol related problems in future i.e if if the reason that i say i drink is because i do it when i'm stressed or if i've had a bad day at work i'll come in and have a drink what will tend to happen unfortunately is if you then experience anything bad in your life your alcohol use will go up and of course if the bad things that happen in your life that cause you to drink to cope kind of don't go away and just get worse and worse over time then actually what can happen is your alcohol use can go up and get worse and worse over time so a degree of drinking to go you know having a glass of wine or a pint of beer and it just calms you down or chills you out or whatever it may be isn't in and of itself a bad thing but if that's a really strong motive for your alcohol use it does increase your chances of developing problems of alcohol later in life apologies for the slightly complicated model here but we were looking at a number of different things and i just want to point out a couple of these so this is a diagram essentially showing the relationship between all of these different variables with on the right hand side of the diagram being outcomes for children including the measured coping and conformity motives that children reported for their alcohol use children's alcohol use the craft score is a measure of alcohol and substance misuse and on the left-hand side of the model in the top and left-hand side of the measures that we took from parents and essentially if you want to read this paper in more detail it's you'll understand a bit more about this the inter relationships here but but basically the the hard lines there represent significant predictive relationships and the dotted lines represent where we didn't find the significant direct influence so what we found here for example was that on the left hand side parents coping motives so the coping motives that the parents reported predicted their audit score and the audit is a measure of alcohol use and alcohol problems so the more that a person reports and it's quite a strong relationship the more that they reported drinking to cope the higher their alcohol use overall was and the more likely they were to report problems with their own alcohol use that in itself predicted a strong positive relationship between predicting a positive relationship between with their children having coping motives so what this means if you look at the diagram where you've got parents coping motives and children's coping motives there's no direct relationship between them so the parents having a relationship with alcohol which means they drink to cope didn't directly predict their children also drinking to cope or having motives about drinking to cope what was happening in terms of interpreting this diagram is that if you are a parent who drinks the code that increases your use of alcohol it's the increased use of alcohol which is probably being seen by your child which increases the likelihood that your child will develop this coping motive for alcohol use moving further along the diagram from that box of children's coping motives you can also then see that children's coping motives had a significant positive relationship with their alcohol and substance misuse so what this is showing is this sort of intergenerational influence or transgenerational influence so you're moving from the way that your parents drink and if you were to go further back you i would predict that you would find a positive relationship between the parents and the child's coping motives and you can see that's what's happening that there's this link between the two so this is really important in terms of understanding particularly i think with alcohol more so than probably any other drug because of the really strong cultural connections that we have with our alcohol use how embedded culturally alcohol use has become in different ways in different societies over time this is really starting to sort of unpick the work that we did here and another work in the area is really starting to unpick how these relationships can have an impact you know if you have a particularly if you have a bit of an unhealthy relationship let's say with alcohol as a parent and you drink more your children do see it they are observing it and that does have an impact on how they come to think alcohol should be used and subsequently it has an impact both on their own beliefs and motivations but on their actual behavior as well i want to move on now i've already mentioned peer pressure as in the context of social learning theory another important area thinking about the role that social norms and the role that other people's beliefs can have on our behaviour and we did this several years back now you may be familiar with a remember the fad that was neck nomination so net nomination was essentially this kind of risky drinking game that spread across social media very quickly and it's kind of largely disappeared now it's been replaced by some other things um and as tends to happen on social media uh neck nomination effectively involved recording yourself um doing something stupid necking a drink or not serious not necessarily something stupid there were probably slightly less dangerous things but there were some really dangerous things that people did so doing something dangerous downing a drink and nominating someone else's neck nominate neck a drink nominate a friend to do the same and there are a couple of examples here of deaths that were associated with it so quite sadly these two young men as a result of you know i think it was jumping into a river in one case in another case i think it was alcohol poisoning uh due to drinking far too much um that there were deaths associated with this what we found was we were interested in trying to understand the the the dynamics from a social learning perspective what the dynamics of this sort of peer pressure is because social media as we know can be a really important part of some young people's lives you know what if somebody nominates me and i don't respond what if somebody nominates me and they did something really cool like jumping off a drift bridge into a river you know how do i top that you know can i can i just do something really quite mild will everyone laugh at me all these different sorts of things and importantly what we found is that as you would expect whether or not a person reported having neck nominated or engaged in that nomination it was more common amongst heavy drinkers but importantly it was more common amongst people who were susceptible reported being susceptible to peer pressure so simply being more susceptible to peer pressure puts you at greater risk of doing these things that could actually put you greater risk of harm also looking at drinking motives and peer pressure and other sorts of risky drinking behaviors we did some work a few years back now looking at um pre-partying so pre-partying is essentially drinking before you go out but in particular drinking quite a lot so not just having you know a drink while you're getting ready before you go out but but often getting completely drunk or you know you're very very drunk before you go out and there are different motivations for doing that we use something called the pre-partying motives index or inventory and what we found that was that it was common amongst both underage and adult drinkers so this was a piece of research carried out in a college so 16 to 18 year old 16 to 17 year olds was in the sample and university students who were kind of in the uk legally able to drink alcohol and so we looked at these different motives amongst both underage drinkers and university or adult drinkers and what we found is that both groups reported pre-partying to enhance social interactions so this idea that the reason that you pre-party is because of a degree of social anxiety because i'm going to go out i'm going to be mixing with other people and both groups underage and university age drinkers reported pre-partying to enhance social interactions but interestingly and perhaps not expectedly university students also reported doing it to uh for motives related to intimate pursuit so thinking that it's more likely to help you you know whether it's to build the confidence or whatever it may be to initiate an intimate sexual relationship with somebody on a night out so these sorts of motives again thinking about where these come from thinking about how we learn that vicariously if you go off to university and you join other people and it's what everyone else is doing then these sorts of motivations for drinking can can build and it can shape drinking behavior and we could see quite a high rate of pre-partying amongst both both of these groups and so that's another important way in which you can see that these sorts of social learning concepts the expectancies that we have about what we're going to do can influence and pre-partying it also should be said is again heavily associated with uh strongly associated with various adverse outcomes more likely to you know to sort of have an accident or to whatever it may be because of course you're going out before you've even gone out you're not just a little bit tipsy you can be quite drunk and so it can be in itself a risky drinking behavior that's influenced by these social pressures and what we also found uh in this more recent um study was looking at a qualitative review of a systematic qualitative review looking at peer pressure amongst adults and finding that actually amongst adult drinkers it persists and there are a number of different um beliefs that people held and different factors that influence people's drinking but it was the first because a lot of the research around peer pressure has actually been looking at young people it's been looking at the groups similar to what i've just mentioned college and university age samples and this sort of view is you know almost uh that peer pressure is really something that happens to young people and so uh this paper we were looking at the evidence around adult drinking and found that actually there was quite a strong relationship and different sorts of things that influenced people's drinking and here we put together looking across all of the different factors related to peer pressure some of which were things that influenced peer pressure so in the center of this diagram here peer pressure to drink alcohol was influenced by the wider social context the conditions affecting peer pressure and also the strategies that people had for dealing with peer pressure but we also found evidence around the experiences of peer pressure and the consequences of peer pressure again this is amongst older adults um the wider social context included things particularly for male drink because this sort of idea of manning up you know that you've got to you've got to have a drink you've got to drink more when you're out you can't go out with the lads and and just you know just have a couple or have a sort of soft drink every other drink because it might be advised to reduce your alcohol consumption and people didn't want to feel like an outsider they wanted to fit in it's the sociable thing to do you know let go have a drink be sociable um and you know being perceived as being boring or dull uh if you didn't um drink along with everybody else um and other things like dealing with you know not wanting to to drink needing an acceptable reason what do we know what do adults consider the acceptable reasons to not drink to be if you say i'm not drinking will people say are you on medication are you on antibiotics could it you know the people feel that it's okay to say well i just don't fancy drinking but i also want to come to the pub and socialize you know that's something in our culture certainly in the uk i think is is a far harder thing for people to convey this idea that you're not on the same level as everybody else um and people often reported that one of the consequences of peer pressure is just caving in drinking when you don't want to and so you can see these sorts of social pressures and self-efficacy beliefs of course would play a role in this as well as outcome expectancies what do i think people will say if i turn up and say i'm not having a drink with you tonight but i'll happily stay and have a soft drink and we can have a good night out you know how do you think people are going to react to that those are outcome expectancies self-efficacy beliefs you're going to be around your ability to deal with the consequences of that and so the last thing i wanted to come on to was just to say something about framing and problem recognition because this is yet another consequence of um uh the the sort of social pressures that people face the expectancies that we hold uh the outcome expectancies that we have self-efficacy beliefs that we have and we've shown in this particular study was another systematic qualitative review we've shown that some groups of people at high risk of alcohol harms in particular this was middle-aged men who who are getting into a range of an age range if you're a heavy drinker you're getting into middle age you're much more likely to start seeing some of the harms that come with long-term alcohol use not the acute harms that people often think about you know alcohol poisoning or you know having an accident or having terrible hangovers but the long-term chronic effects from drinking higher rate high amounts of alcohol over a lifetime as you get into middle age it starts to become you're a greater risk of starting to see some of those things happening heart disease liver problems kidney problems and so on but interestingly amongst these groups who are actually objectively at high risk of alcohol harms and may even be experiencing some of them already they don't see their own drinking as problematic they saw they contrasted their drinking they framed their drinking um around this idea that you know that i'm not a problem drinker to be a problem drinker means getting up in the morning they saw it around this you know sort of framed it this idea of being an alcoholic that it was a binary that you either you know if you if you're if you're not getting up first thing in the morning and needing a drink then you don't have a problem with your alcohol use and it couldn't be further from the truth you can be drinking quite a lot of alcohol and not have really sort of strong signs of physical dependence and put yourself a really significant harm as you're getting older but but people tended to want to think of it in that way that they would contrast their very heavy drinking without a problem drinker i'm not alcohol dependent i'm not you know sort of i've still got a job and you know still got a family and so on um and they also tended to frame their own drinking choices as freely chosen now what just describes some of the work around peer pressure suggests that it's not that free you know it's not as if people are forcing you to do something but your freedom in that sense around the way that you choose to drink is is strongly influenced by what other people think you should be doing and that's a sort of an unavoidable truth i'd say and also in the context of framing we've looked at this idea of of what happens if you uh frame drinking as being a sort of a binary or a continuum type issue so what i mean by that um is this this binary idea was as i just described exactly what we found middle-aged men were doing they were taking it as a binary alcohol problems problem drinking is is quite simply an either or if you've got a problem or you haven't and if you have a problem it's sort of a disease it's the addiction alcoholism whatever you want to call it and if i don't have that then i don't really have a problem and it's just this very black or white binary view what we found was if you were to present problem drinking as actually being more of a continuum or a spectrum that actually you can have more or less of a problem yes at some extreme end some people may need specialist support from a drug and alcohol treatment professional or substance abuse use professional they may be getting up in the morning have really strong dependence might even need medication to support them during a period of withdrawing from alcohol but at the same time there's there's kind of shades of grey in between it's not either or you don't either have a problem that severe or no problem at all and what we found was that by presenting people with a vignette which in this particular study was a recording of somebody talking about their own problem with alcohol and talking about it in a way that either couched it in those binary terms or couched it in terms of a continuum saying hey you know i've had a problem with alcohol for a while it's actually something that's developed over time i really think it could happen to anybody you know i've managed to sort of cut it back now because i found ways of coping with it and making it seem as though it was this kind of continuum which is in clinical terms actually a much more accurate way of thinking about problem drinking what we found was that increased the likelihood that people would recognize their own problem they would be more likely to so amongst harmful drinkers so people who objectively based on objective measures we would consider to be people who are harmful drinkers experiencing harms already whether it's health problems or concern from other people people were more likely to recognize those problems if you spoke to them about problem drinking as a continuum than as if it was some sort of binary either or so that's a really important kind of application of thinking about some of these social approaches to or social learning approaches to understanding addictive behaviour and i hope that's been useful so just to sum up on what we've learned uh hopefully um through this session the first thing is that we've got social learning theory is this development on on classical learning theory behaviorism which takes the basic concepts of classical and operant conditioning which is still really important ways in which we learn and pick up information and associations in the world around us but it's then been applied or it's then been expanded to take into account the broader social context but importantly it also adds in the human mind it takes what you know you could think about behaviourism or learning theories essentially being the psychology of behavior whereas social learning theory more modern psychology is often described as the psychology of mind and behavior seeing those two things is intrinsically interwoven so social learning theory brings these really important concepts of self-efficacy which is your degree of confidence and outcome expectancies which is what you think is going to happen and helps us to understand various different dynamics that go on when a person is is deciding whether or not to do something we looked at alan marlott's work and saw that there were different types of self-efficacy that can impact on different stages of whether you're trying to prevent a problem from occurring so amongst young people in schools and trying to help them quit smoking or stop smoking not smoke in the first place but also in terms of treatment and relapse prevention self-efficacy plays an important role and these can be and often are in fact targets in clinical interventions for helping people to more successfully recover and also deal with lapses and slips during their recovery uh more effectively than if they just catastrophized them and then during the last part of the session we looked at some of the more practical applications of this social learning theory perspective the idea that there are these motivations that are the result of both our expectancies as well as our self-efficacy beliefs and how they can lead to influences of peer pressure modelling amongst young people picking up you know really important beliefs about alcohol use and why you drink from a very young age that stick with you uh into your own adulthood and will shape and impact upon your own drinking we learn those from a very young age from our parents and from people adults that are close to us when we're young and then we looked at just towards the end some of the influences of adult peer pressure which you know this peer pressure isn't just a kids game it is something that happens to older people as well adults not even just older people but adults in general um and then we finally finished on a consideration of framing and how presenting things to people in different ways can have an impact on how they view in the particular examples i gave of recognition of their own problems of alcohol so i hope that's been useful