Interventions for Addictive Behaviour

Biological interventions for treating addictive behaviour involve the use of medication. In other words, the addict is given a drug to help them to overcome their addiction. Drugs are mainly given to individuals with chemical addicitions, but are now increasingly being used for treatment of behavioural addicitions. There have been a variety of biologically based approaches designed to change the way addicitive behaviours are experienced. People who design medicines are trying to find ways to prevent people from experiencing the alternative substances that have some of positive effects but without their addicitive properties.(Agonist) 

Agonist drugs - Work to mimic the effect of a neurotransmitter in the brain. 

Antagonist- work by blocking neurotransmitters in the brain 

Agonist substitution : 

This biological intervention involves providing the addict with a safer drug that is chemically similar to the addictive drug, and therefore will mimic the effects but without the addicitive properties. 

Supporting research - Heroin addicition and methadone 

Methadone is a drug widely used in treatment of heroin addiction. Mimics the effects of herion but less addicitive. Produces positive feeling of euphoria, but to a lesser degree. Addicts in methadone programmes are administered the grug in liquid form which addict drinks under supervision. As methadone is taken orally in the form of a drink, the opiate levels in the brain increases slowly, it doesn't produce immediate 'high' like heroin would. The effects of methadone last a long time and therefore even if the addict injected heroin under the influence of methadone, it would have very little effect on the brain and body. Initially addict is prescribed slowly increasingly amounts of methadone to increase tolerance to the drug. Dose is slowly decreased until addict no longer needs methadone or herion. Research has idicated that it is an effective way of treating herion addiction.    However a problem ..... an individual could become dependent on methadone instead. Granted this would be without addictive properties of heroin but still could end up substituting one addiction for another

Smoking addicition and nicotine replacement strategies 

Hughes (1993) suggested that one way to reduce a smoker's craving for nicotine through smoking a cigarette is by providing the nicotine in an alternative and safer form, such as nicotine gum or patches. The aim is to mimic or replace the effects of nicotine that the addict usually gets from smoking a cigarette. Both methods maintain high level of nicotine in brain in order to decrease cravings in form of cigarette. Once habit is subsided the dose of nicotine is gradually reduces over several months to help give them give up the nicotine replacement method. Research shown that nicotine replacement strategies have been successful in helping to stop smoking but work best in combination with supportive physchological therapies. 

However, research has also found that ex smokers can becomes dependent on nicotine gum. H/e even if this is the case  the prolonged use of nictotine gum is much less of health risk that smoking. 

helps to avoid ingestion of other harmful substances.

involves giving drugs to addict that blocks effect of the drug they are addicted to.

Supporting research- 

Naltrexone and gambling addiction - Kim and Grant (2001) studied 12 pts who had been diagnosed as pathological gamblers. After 6 week course of treatment on nalterxone they found that the gamblers showed a significant decrease in gambling thoughts, urges and behaviours. Indicates that administration of naltrexone worked by reducing the rewarding and reinforcing properties of the gambling behaviour, thus reducing urge to gamble.

Selective Serotonin Reuptake Inhibitors (SSRI's) and gambling addiction - Hollandar et al 2000  found that pathological gamblers treated with SRRI's to increase serotonin showed significant improvement in their gambling behaviour. 10 pathological gamblers were put on a 8 week course of fluvoxamine and a significant reduction in gambling behaviour was observed. This suggests that there is a rile of serotonin dysfunction in pathological gamblers which can be improved through the use of SSRIs leading to a reduction in gambling behaviour. 

Evaluation - small sample , short duration doesn't show long term effects. 

Studies with larger sample size and longer durarion found no improvement from SSRI treatment in gambling addicts. 

Most effective when combined with CBT- issues with time, availablity and costs. 

Strengths

• subsitute drugs to help stabalise addictive behaviour - safe and effective way to prevent/treat addictive behaviour 
• evidence to support effectiveness of drugs 
• drugs are cheap and easily available, quick to act on the body and can rapidly treat individuals who are suffering severe addicition. 

Weaknesses

• ignore underlying reasons for addicition 
• addicts may relapse when stop taking pharmacological treatment. 
• biological assumptions- addicition is a disease involving physical changes in the brain can be treated using medication, takes away idea of a personal responsibilty for addicitive behaviours removing free will and suggesting they would not be able to quit without help of drugs, 
• highly deterministic
• research has shown that use of drugs is highly effective if combined with psychological therapies rather than alone. 

Based on assumption that if we are able to learn addictive behaviours then we are also able to unlearn them.   Operant conditioning - principles of OC have been applied in treatment of addictive behaviours. Idea behind this treatment is by giving people rewards for not engaging in the addictive behaviour, this will actually reduce it. 

Supporting research- Sindelar et al (2007) 

Aims: Investigated whether provision of money as reward would produce better patient outcome on a methadone treatment programme.   

Pts randomly allocated ti 2 groups, 1) reward (money) condition 2) no rewards condition   All received usual care , individual group counselling and daily dose of methadone.  pts in group 1 drew for prizes whenever they tested negative for drugs

Findings: found that drug use dropped significantly in reward condition with no. of negative urine samples being 66% higher than in control condition. This suggests that the principles of operant conditioning in particular positive reinforcement, led to reduction of addictive behaviour.

Difficult to establish effectiveness- reduction, abstinence.   risk of relapse after research as no incentive to not do the behaviour.

based on the idea that addicitive behaviours are maintained by the person's thoughts about these behaviours. The main goal of CBT is to help people change the way that they think about their addiction and to learn new ways of coping more effectively with the circumstances that led to these behaviours in the past.

In gambling addicition, cognitive errors, such as the belief that the individual can control and predict the outcomes play a key part in maintenance of gambling.CBT attempts to coreect these cognitive errors in thinking, making them into rational thoughts and therefore reducing the urge to gamble. 

Supporting research - Ladouceur et al (2001) randomly allocated 66 pathological gamblers either to CBT group or waiting list group. 86% of those who recieved CBT cognitive therapy no longer fulfilled the DSM criteria for pathological gambling. It was also found that after cognitive therapy gamblers had a better perception of control over their gambling problem and had increased eslf efficacy; improvements that were maintained at a one year follow up.

This supports the idea that CBT is effective in treating those with addicitive behaviours. Also shows that changing the way in which people think about their control over the behaviour can influence whether they engage in it or not.This research can therefore also link to support TPB. Also because improvements were maintained it suggests that it is effective in reducing pathological gambling. 

Other treatments have combined cognitive and behavioural aspects of gambling and attempted to alter cognitions and behaviour through the use of CBT. 

Sylvain et al (1997) evaluated the effectiveness of CBT in a sample of male pathological gamblers. Treatment included cognitive therapy, social skills, training and relapse revention. They found significant improvements in gambling behaviour, with these gains maintained at a one year follow up. 

Relapse prevention involves several cognitive and behavioural strategies to help the individual stay away from the addictive behaviour and also to provide support for people who do relapse. Therapists help to identify situations that present a risk for relapse for the individual. They also provide the addict with techniques to learn how to cope with temptation combined with the use of covert modelling. 

Supporting research - Hajek et al (2005) found that relapse prevention was useful in helping people to stay off cigarettes once they had managed to give up smoking. Relapse prevention involved exploring the positive and negative consequences of continuous use of cigarettes, self monitoring and helping the person to recognise situations where they are at high risk of relapse. Once these situations have been identified, effective coping strategies were learnt to deal with these. 

Behavioural therapy may eliminate the behaviour but not the problem- therefore this suggests that the initial cause of the addicitive behaviour is not overcome/resolved so the addict will always be vulnerable to relapse . Might not be learnt might be underlying psychological disorder. Could develop addicition due to something else. 

Behavioural therapies are often used in conjunction with other treatments- This means that it is time consuming, more effort , expensive to undergo treatment also because have to be combined it questions the effectiverness. Difficult to evaluate which is most effective on its own, 

The effectiveness of CBT- They are reasonally effective but better when combined. 

Feeney et al (2002) only 14% abstinence on CBT alone 38% for drugs and CBT.

Difficult to define/ measure the effectiveness - a reduction ot complete abstinence?