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.

• Preface ix1 Introduction: journey to the centre of addiction 1Preparing for the journey 1In the end 3What this book does 5The synthetic theory of addiction in brief 7References 92 Definition, theory and observation 10Defining addiction (addiction is not an elephant) 10Diagnosing and measuring addiction 20Theory and supposition 22‘Big observations’ in the field of addiction 30Recapitulation 36References 363 Beginning the journey: addiction as choice 41Addiction as a reflective choice 41Box 3.1 The myth of addiction 44Box 3.2 Vaguely right or precisely wrong? The Theory of Rational Addiction 45Box 3.3 The Self-medication Model of addiction 50Box 3.4 Opponent Process Theory 53Irrational, ill-informed choice and unstable preferences 60Box 3.5 Expectancy Theories 62Box 3.6 Skog’s Choice Theory 65Box 3.7 Slovic’s Affect Heuristic 67Box 3.8 Cognitive Bias Theories 70Box 3.9 Behavioural Economic Theories 72Box 3.10 Gateway Theory 78Box 3.11 The Transtheoretical Model of behaviour change 80Box 3.12 Identity shifts and behaviour change 86Addiction as the exercise of choice based on desires 87References 894 Choice is not enough: the concepts of impulse and self-control 95Reports of feelings of compulsion 95Powerful motives versus impaired control 96Box 4.1 The Disease Model of addiction 96Personality and addiction typologies 98Box 4.2 Tridimensional Personality Theory 98Self-efficacy 100Box 4.3 Self-efficacy Theory 100The transition from lapse to relapse 102Box 4.4 The Abstinence Violation Effect 102Impulse control 105Box 4.5 Inhibition Dysregulation Theory 106Self-regulation as a broadly based concept 108Box 4.6 Self-regulation Theory 108Urges and craving 108Box 4.7 A Cognitive Model of Drug Urges 109Addiction as a failure of self-control over desires and urges 110References 1115 Addiction, habit and instrumental learning 114Instrumental learning 114Box 5.1 Instrumental learning (operant conditioning) and addiction 115Mechanisms underpinning instrumental learning 118Box 5.2 The Dopamine Theory of Drug Reward 119Box 5.3 Addiction arising from functional neurotoxicity of drugs 121Classical conditioning 122Box 5.4 Classical conditioning and addiction 122More complex learning models 124Box 5.5 Addiction as a learning/memory process 125Box 5.6 Incentive Sensitisation Theory 126Box 5.7 Balfour’s theory of differential drug effects within the nucleus accumbens 129Social learning 130Box 5.8 Social Learning Theory 131Associative learning 133References 1336 Addiction in populations, and comprehensive theories 136Addiction in populations 136Box 6.1 Diffusion Theory 137Comprehensive theories of addiction 139Box 6.2 Excessive Appetites Theory 140Box 6.3 The Pathways Model of pathological gambling 146What is addiction and how can we explain it? 149References 1507 Development of a comprehensive theory 152A functional classification of theories of addiction 153Addiction as reflective choice 158Addiction as irrational choice 162Addiction, compulsion and self-control 165Addiction, instrumental learning and habit 168Addiction, choice, compulsion and habit 179References 1858 A synthetic theory of motivation 192Understanding behaviour in context: the COM-B model 192Focus on motivational theory 194The human motivational system 194Structure and function of the human motivational system 195The ‘head model’ 205Momentum and inertia 206Adaptation: ways in which experience affects motivational disposition 207The ‘representational system’, consciousness and dual process models 210Self and self-control 213Mental effort and motivational resources 216What motivates us 216The unstable mind 218A summary: key propositions from PRIME theory 225References 2279 A theory of addiction 229Addiction is 229The pathologies underlying addiction 230A return to some ‘big observations’ about addiction 233The abnormalities underlying addiction 241Effects of interventions 244Recommendations and predictions regarding addiction interventions 244Testing the theory 250First results 251Conclusions 252References 253Index 257

“I enjoyed reading this book and strongly recommend that it be read by all professionals working in the field of addiction.”  (Journal of Clinical Psychiatry, 1 February 2015)