Addiction - Types of intervention

This is based on punishment rather than reward and has been used to treat smoking and alcoholism. Early programmes involved an individual gettimg small shocks every time they had a sip of alcohol or a puff of a cigarette. This however was not successful as it did not last outside the clinic setting. To avoid this problem alcoholics have been given the drug Antabuse which make the person vomit when they have alcohol. This establishes a link between drinking alcohol and vomitting. This has been shown to be effective (Lang and Martlatt 1982) but it has 2 major limitations:

• The person has to take the drug and they may not be willing to comply.
• It does not deal with the causes of alcoholism.

For smoking, rapid smoking has been used. The individual is required to sit in a closed room and take a puff of a cigarette every 6 seconds which is faster than normal. The rapid inhalation causes nausea and makes the individual feel quite ill. It is believed that the smoker will associate smoking with the unpleasant feelings and so develop an aversion to cigarettes (Spiegler and Guvremont 2003). There is some evidence that this works, particularly when used as part of a multicomponent programme. However results have not been consistent and there is a slight risk for people with cardiopulmonary disorders. Another problem is that it focuses on the action of smoking, not the underlying addiction.

• Addictive behaviours are often aroused in the presence of various stimuli, or cues. For instance, smoking is often associated with drinking, so alcohol become a cue that stimulated smoking. 
• Cue exposure involves presenting the person with a cue and helping them to control their reaction to it, i.e developing coping strategies. 
• In this way the response of smoking in the presence of alcohol extinguishes. 
• This is thought to be more effective than trying to avoid the cues, for example never drinking.

This involves the use of nicotine gum, nasal sprays etc. They provide positive reinforcement.

Bupropion

It is an anti-depressant drug that has been used as a treatment for smoking. It works by increasing brain levels of dopamine and norepinephrine, simulating the effects of nicotine on these neurotransmitters. It seems to block the nicotine receptor, so, as with the nicotine replacement therapies, it could reduce the positive reinforcement from a cigarette in the case of a lapse. It has been shown to be reasonably successful in treating cigarette smoking (Watts et al 2002)

Varenicline

It causes dopamine release in the brain. It also blocks the effects of any nicotine added to the system. Clinical trials have found that varenicline is superior to bupropion in helping people to stop smoking. It has also been known to reduce relapse in smokers who had been abstinent 12 weeks after initial therapy.

Problems - nicotine is delivered slower than normal cigarrette so it is not at satisfying.