Reducing Addictive Behaviour

Based on the theory of reasoned action, which states that an individual's voluntary behaviour can be predicted by an interaction between the individual's attitudes towards a behaviour and how they think others will view the behaviour. 

The theory of planned behaviour has an additional component - percieved behavioural control - which involves the beliefs we have about the amount of control we have over our behaviour.

• There is little research into this area
• As cognitive processes are thought to play a role in problem gambling behaviours, prevention programmes have focused on changing faulty thinking and providing accurate information about gambling.
• Canadian Study - high school students given information on gambling, possible negative consequences and strategies to control gambling behaviour. The study found a significant improvement in gambling knowledge but had no influence on actual gambling behaviour.

• Based on the idea of associating the undesirable behaviour with something unpleasant.

ALCOHOL

• A drug is given which makes the individual sick. Just before they throw up they are given a shot of alcohol.
• The process is repeated on a regular basis and a link is established between alcohol and vomiting.
• Meyer and Chesser (1970) - 50% success rate after 12 months. HOWEVER most research suggests benefits are only short term. 

SMOKING

• Individuals sit in a closed room and take puffs on a cigarette every 6 seconds
• This makes them feel nauseous and they associate the unpleasant feeling with smoking
• Some evidence to show this has been effective, but results are inconsistent.
• May not be appropriate for individuals with heart/lung disease as it can worsen symptom

The techniques require the individual to be compliant, so drop out rates tend to be high, and they do not consider the cause of the addiction.

CONTINGENCY MANAGEMENT

• Based on operant conditioning. Patients and their family/friends or therapists are encouraged to provide rewards when behaviours that are 'inconsistent' with the addictive behaviour are formed. These rewards often consists of vouchers which can be swapped for goods.
• Davison et al (2004) stated that contingency management is one of the most effective treatments for addiction.
• Petry et al - two groups of alcoholics, one group had received 'standard outpatient care' and the other received the same care as well as CM. The relapse rate for those undergoing CM was only 26% compared to 61% for the standard treatment group.

Behavioural therapies can be effective, however they do not address the underlying cause of the addiction. This makes the effects of the treatment short lived. It is more effective to combine them.

• CBT states we can train people to think differently - be more commited to giving up the addictive behaviour, help them make a specific plan for giving up and develop self-monitoring strategies to prevent relapse.

FUNCTIONAL ANALYSIS

• The client and therapist work together to try and recognise the circumstances under which the behaviour occurs. 
• They explore the feeling and motivations before, during and after the event. This is an attempt to help the patient determine the risk factors. This is useful in helping the patient identify possible reasons for their behaviour.

SKILLS TRAINING

• The therapist teaches the patient better/more appropriate coping strategies.

EVALUATION

• Carroll et al (1994) - both a drug and CBT were found to be effective but CBT was generally more effective.

MI (motivational interviewing) is a relatively new form of brief CBT. It focuses on trying to help individuals with addictive behaviours develop the motivation to give up.

The client is encouraged to review their habits and consider the positive and negative effects the addiction has on their lives.

This is a non-directive approach where the therapist aims to get the client to argue their own case for changing their habits.

AO2/3

Meta-Analysis (2003) - MI led to a 56% reduction in alcohol consumption in individuals offered this treatment.

Study in 2001 - MI was effective with helping clients with substance addictions, especially as a way of encouraging clients to progress on to more intensive treatment programmes.

• Based on the idea that addiction is a disease
• Usually involve medication
• Normally aim for complete abstinence
• If an individual abstains from a previously addictive substance withdrawal symptoms are inevitable. These treatment programmes aim to manage these symptoms.

e.g. nicotine gum, patches, nasal sprays.

These mimic the effects of nicotine derived from tobacco.

They help people stop smoking by: 

• relieving withdrawal symptoms
• providing positive reinforcement - due to their arousal and stress-relieving effects.

They allow smokers to self-administer nicotine when they have the urge to smoke a cigarette (but not patches as this is gradual). They seem to desensitise nicotine receptors - if the person lapses and smokes a cigarette while on NRT the cigarette will appear less satisfying.

Nicotine replacement therapy can be effective however as they deliver nicotine into the bloodstream more slowly than cigarette smoking they are not as satisfying so some individuals give up the therapy and relapse.

NRT does not solve the underlying nicotine addiction, and there are concerns that nicotine can lead to cardiovascular disease and cancer. It can also increase heart rate and blood pressure. It is important to consider cost-benefit analysis as these side effects may not be as common or serious as those from cigarettes.

BUPROPION

• Antidepressant drug that has also been used as a treatment for smoking addiction.
• Blocks nicotine receptors so reduces the positive reinforcement from a cigarette in the case of a lapse

VARENICLINE

• Drug that causes dopamine release in the brain. Also blocks the effects of any nicotine added to the system.

Clinical trials have found that varenicline is more effective than bupropion in helping people give up smoking. It has been shown to reduce relapse in smokers who had been abstinent 12 weeks after initial therapy.

• Biological interventions can be very helpful in reducing addictive behaviour, especially in individuals who are very dependent.
• However they reduce the responsibility of the individual and so this can have an effect on the effectiveness and appropriateness.
• These therapies categorise addictive behaviour as a disease and so can lead to the individual being treated differently in society due to the stigma attached to psychological illnesses.
• The therapies are reductionist as addictive behaviours involve a complex combination of factors and no single type of intervention works well alone.

Doctor's Advice

• Doctors are viewed as authoritative and credible sources of information about health issues, so they can help teach about the dangers of excessive drinking/smoking.
• Ogden (2007) - 5 London GP practices looked at patients with varying degrees of assistance. Group 1 were given a follow up appointment and Group 2 were given a follow up appointment, a leaflet with tips on giving up and their doctor advised them to quit. After 12 months only 0.3% of Group 1 had given up compared to 5.1% of group 2.

Workplace Intervention

• Businesses and workplaces are adopting strategies to discourage smoking.
• These strategies are now also being enforced by government legislation.

Restricting or banning advertising 

• Refers to the effects media has been shown to have. In 2003 smoking advertising was banned, and there have also been restrictions on alcohol advertisements.
• American Study (2006) found correlation in 15-26 year olds between number of alcohol adverts watched and amount of alcohol consumed.
• It is difficult to study this in a controlled, empirical way due to ethical issues.

Increasing Cost

• This can prevent individuals starting the behaviour in the first place. It may be a powerful factor when considering cost vs benefit.

Controlling or banning sales

• Age restrictions are in place (as well as time constrictions in some areas) however alcohol and cigarettes are generally widely available.

Ban on smoking in public

• Aimed to reduce likelihood of common cues to smoking becoming associated with smoking.