'Addiction is a repetitive habit patten that increases the risk of disease and/or associated personal and social problems. Addictive behaviours are often experienced subjectively as 'loss of control' - the behaviour contrives to occur despite volitional attempts to astain or moderate use. These habit patterns are typically characterised by immediate gratification, often coupled with delayed deterious effects. Attempts to change an addictive behaviour are typically marked with high relapse rates.'
Components model of addiction
- Salience: Importance of the behaviour to the individual - addictive behaviours become the most important activity for a person so that even when they aer not doing it, they are thinking about it.'
- Mood modification: The experience people report while carrying out their addictive behaviour - people with addictive behaviour patterns commonly report a 'rush', a 'buzz' or 'high'.
- Tolerance: The increasing amount of activity that is required to achieve the same effect.
- Withdrawal symptoms: The unpleasant feelings and physical effects that occur when the addictive behaviour is suddenly discontinued or reduced - this can include 'the shakes', moodiness and irritability.
- Conflict: People with addictive behaviours develop conflicts with the people around them, often causing great social misery, and also develop conflicts within themselves.
- Relapse: The tendency for repeated reversions to earlier patterns of the particular activity to recur and for even the most extreme patterns, typical of the height of the addiction, to be quickly restored after many years of abstinence or control.
Models of addictive behaviour
- The disease model: Suggests that addiction comes from a disorder of the body, such as neurochemical imbalance - in this model, the individual has limited control over their behaviour.
- The genetic model: Suggests that there is a genetic predisposition towards addictive behaviour.
- The experiential model: Commonly associated with Stanton Peele - in brief, this model suggested that addictive behaviours are much more temporary and dependent on the situation we are in than either of the previous two models would suggest.
- The moral model: Suggests that they key issue with addiction is a lack of character - in this view, addiction is a result of weakness, or moral failure within the individual.
- A neurotransmitter is a chemical that moves in the gaps between nerve cells to transmit messages.
- If the chemical is blocked or replaced, for example, then the message changes and there is an effect on the physiological systems, and also on cognition, mood, and behaviour.
- Most common neurotransmitter is dopamine, but other chemicals have also found to have an effect (Potenza).
- Chemicals activate the 'pleasure centres' in the brain, acting as a motivation towards addiction and thus repeating the behaviour.
- Not only do neurotransmitters play a role in chemical addictions, but they have also been implicated in behaviours such as gambling (Comings et al) and videogame playing (Koepp et al).
- Main way of investigating genetic factors in human behaviour was to study family relationships; more recently, it has been possible to carry out genetic analysis and look for differences in the genetic structure of those with and without addictive behaviours.
- Family studies tend to emphasize the role of environmental factors in the development of addictive behaviours.
- Han et al's study of over 300 MZ twins and just under 200 same-sex DZ twins estimated the contribution of genetic factors and environmental factors to substance use in adolescence.
- It concluded that the major influences on the decision to use substances were environmental rather than genetic.
- Jang et al's study suggested that there is a link between personality traits and addictive behaviour.
- The study of over 300 MZ twins and over 300 DZ twins looked at the relationship between alcohol use and personality.
- The study suggessts that there is a connection between genetics and antisocial personality characteristics, and between alcoholism.
- Reinforcement is defined as being anything that increases the probability that the behaviour will recur in similar circumstances.
- The terms commonly refers to 'operant conditioning' or 'classical conditioning'.
- Something reinforcing stems from 'pleasure centres' in the brain - Olds and Milner found that rats would press a lever for a reward of mild electrical stimulation in particular areas of the brain. The rats would continue to press the lever in preference to other possible rewards, such as food, drink or sexual activity,
EVAL OF BIO
- Countless incidents of people who live in exactly the same environment but addiction is only present in some cases. Bio explanations help to account for inherent vulnerabilities and susceptibilities and may provide a reason why people are more resistant to treatment and more prone to relapse.
- Neurotransmitter complex effects are not fully understood - the difficulty with looking at which neurotransmitter produces which reward is that the brain is remarkably complex, and the effects of one drug can be very diverse.
- Ashton and Golding suggest that nicotine can simultaneously affect a number of systems, including learning and memory, the control of pain, and the relief on anxiety. Generally believed that smoking nicotine can increase arousal and reduce stress: two responses that ought to be incompatible.
- The pleasures and escapes associated with taing a drug are highly varied and depend on the person, the dose, the social situation they are in and the wider social context of the society that they live in (Orford 2001). For example, drug taking was prevelant in Vietnam but drug use stopped in the home environment (Robins et al).
- Studies that analyse the genetic structure of individuals tend to emphasize the role of genetics rather than the environment in addictive behaviours. DRD2 gene.
COG EX: Faulty thinking/Irrational biases
- Cog explanations focus on the way that we process info - if we are making faulty judgements then we might develop addictive behaviours.
- Addiction may be maintained by irrational or erenous behaviour (Griffiths)
COG: Beck et al - 'Vicious circle'
- Low mood can be relieved by addictive behaviour
- Addiction causes problems
- Problems cause low moods
COG: Self-medication model
- Initiation - intentionally use the addictive behaviour to cope with stress/psychological problems.
- Addiction not chosen at random - selected to help a particular problem.
- Helps to fulfil 3 major functions:
- 1) Mood regulation
- 2) Perfomance management
- 3) Distraction
COG: Expectancy theory
- Expectations about the outcomes of addictive behaviour are thought to contribute to their excessive use.
- Addicts differ from non-addicts in terms of their expectations about the pos vs neg effects of these behaviours.
- Initiation: Heavier drinkers have more positive expectations about the effects of alcohol compared to lighter drinkers
- Maintenance and relapse: Brandon (2004) as the addiction develops, the activity is influenced less by conscious expectations and more by unconscious expectations.
- This explains the loss of control many addicts experience, and the difficulties they experience, in abstaining.
COG: Self-Efficacy Theory
- Bandura: Refers to a belief in ones self to organize and control any actions required to meet particular goals.
- Self-efficacy plays an important part in whether or not a person will start to engage in addictive behaviour.
- And whether they believe they can do anything about it once it is established at relapse/maintenance.
COG: Rational choice theory
- Brecker and Murphy (1998) engage in activity by weighing up cost/benefit.
- Calculate activity - weigh up costs against benefits.
- Addiction is an increase in consumption - individuals make a rational choice, determining the future utility of drug taking.
- Maintenance and relapse: Addicts are rational consumers who look ahead and behave in a way that is likely to maximise the preferences they hold.
BM: Operant conditioning
- Addicts change their behaviour in response to changes in the environment, such as rewards and punishments.
- These rewards (reinforcers) and punishments bring about changes in mood, or material changes.
- One of the striking findings is that Skinner discovered in his work with animals was that he was able to achieve greater behavioural change if he gave less reinforcement rather than more.
- This effect was further amplified if he made the arrival of these reinforcements less predictable.
- The schedule for producing the strongest behavioural change he found was the 'variable ratio' which describes a situation where rewards are given not every time you do the behaviour, but, on average, every fifth time you do it.
- In behavioural models of addictive behaviour, it is assumed that a person would be most susceptible to addiction during the iniation phase (because initial rewards can shape future behaviour) and the maintenance phase (because continued rewards can maintain behaviour).
- BM also assumes that all individuals are equally susceptible to developing an addictive behaviour.
- However, if a person managed to give up their addiction, relapse may be less likely if they have 'unlearned' the addictive behaviour.
- In the countless instances of people engaged in the same activity, addiction is only present in some cases. Learning explanations help to account for individual differences while engaged in the same activity, during the development and maintenance stage.
- Despite evidence supporting both theories, neither is entirely satisfactory on its own. Classical conditioning theory seems useful to explain people's motivation in initiation of a gambling session, but appears less useful to explain maintenance of gambling behaviour.
- Conversely, while OC might explain maintenance of behaviour, it appears less useful in explaining why people initiate gambling or reccomence gambling after a prolonged period of abstinence - Griffiths, 1995.
- Researchers have also raised questions about the extent to which behaviours like excessive gambling adhere to operant theory at all, since gamblers lose more than they win and because reinforcement magnitudes are not independent of player responses, e.g. stake sizes, Delfabbro and Winefield 1999.
- There are difficulties to develop general operant theories of very specific activities such as gambling. Some activities appear more suited to this form of explanation, e.g. slot mahines and scratchcards, where there is a short time-interval between stake and outcome, and where outcomes are entirely determined by chance.
- It seems more difficult to apply these theories to skilled gambling games such as blackjack, poker and sports betting, where player decisions can significantly influence outcomes.
- As with other psychological theories, learning theory cannot explain why people exposed to similar stimuli respond differently; why some smoke, drink or gamble whereas others do not, or why some people smoke, drink or gamble more than others.
- In addition, the effectiveness, or strength, of the conditioning may be a function of motivational factors and type of activity. Some, but not all, people engage in these behaviours for excitement or relaxation, and people satisfy these needs by different activities.
- Thus, it is unlikely that CC will affect all types of addictive behaviour in the same way.
SA: Thorgeirsson on genetic susceptibility to smok
- This study in Iceland by Thorgeirsson and colleagues suggests that particular genetic variants make people more addicted to nicotine once they start smoking.
- Began with a smoking-history questionnaire distributed to over 50,000 Icelanders; this asked them whether they had ever smoked, were still smokers, and, if so, how many cigarettes they smoked each day.
- Researchers then studied the DNA of over 10,000 current and former smokers that responded to the questionnaire.
- They found a particular pattern of gene variation at two points of chromosome 15 was more common among people who developed lung cancer (and were dependent on smoking), than among those who remained healthy.
- In their sample, the genetic variant had an effect on the number of cigarettes smoked per day and there was a highly significant association with nicotine dependence.
The variant was less common among smokers who smoked less than 10 cigarettes per day than it was among non-smokers, supporting the notion that the variant does not influence smoking initiation, but rather confers risk of nicotine dependence among those who start.
SA: Learned conditioning in smoking
- Smoking addiction occurs when a person has formed an uncontrollable dependence on cigarettes to the point where stopping smoking would cause severe emotional, mental, or physical reactions (Leshner 1999).
- Learned conditioning expresses the idea that nicotine addiction is a learning process, in that the smokers learn when, where, and how to take the drug to get the most rewarding effects.
- The taste, smell, visual stimuli, handling, and other movements closely associated with the rewarding pharmacological effects gradually become more rewarding themselves.
- Environmental cues paired in time with the initial drug-use experience - take on classically conditioned stimulus properties.
- When cues are present at a later time, they elicit anticipation of a drug experience and thus generate tremendous drug craving (Leshner, 1999).
- These become linked with its rewards and with the relief of withdrawal.
- Come to serve as signals or triggers for the urge or craving for nicotine's effects.
SA: Evaluation of learned conditioning in smoking
- Confusion arises because of the out-of-date distinction between whether specific drugs like nicotine are 'physically' or 'psychologically' addictive.
- Those who become addicted in their home setting are constantly exposed to the cues conditioned to their initial nicotine use, such as the locality where they live, other smokers, or where they bought cigarettes.
- Simple exposure to those cues automatically triggers craving and can lead to relapses.
- This is one reason why someone who apparently overcame nicotine cravings at another dwelling could quickly revert to use upon returning home.
SA: Conditioning in gambling
- In operant conditioning models for problem gambling (Delfabbro and Winefield), persistent gambling is seen as a conditioned behaviour maintained by intermittent schedules of reinforcement, most likely a variable-ratio schedule.
- This involve the provision of infrequent rewards after varying numbers of responses.
- Classical conditioning models proposed by Anderson and Brown argue that people continue to gamble as a result of being conditioned to the excitement or arousal associated with gambling, so that they feel bored, unstimulated and restless when they are not gambling.
Both models have been central to the development of measures of 'impaired control' over gambling, in which the self-restraint which most people exercise over recreational gamlbing breaks down.
SA: Situational and structural characteristics
- Situational characteristics are the factors that often facilitate and encourage people to gamble in the first place - Griffiths and Parke.
- They are features of the environment but can also include features of the venue itself or facilitating factors that may influence gambling in the first place.
- Structural characteristics can be important in the development and maintenance of the addictive behaviour.
- For example, slot machines are known to be one of the most addictive types of gambling - Griffiths; Parke and Griffiths.
- Structual factors that are unique to slot machines (e.g. fast game speed, large jackpots, 'near misses) are specifically incorporated into the machine by designers and operators in the gambling to maintain the behaviour.
SA: Parke on personality traits in gamblers
- This study assessed the predictive values of 3 personality traits on pathological gambling (sensation seeking, deferment of gratification and competitiveness)- two of which (gratification and competitiveness) have not been investigated before.
- Adminstered a questionnaire to an opportunity sample of 114 gamblers (91 males and 23 females) of whom 38% were classified as pathological gamblers.
- A gambler in this study was defined by participating in any of these activities: Playing on the national lottery, slot machines, casino games and sports betting.
- Questionnaire included the Sensation Seeking Scale (Zuckerman) and the Deferement of Gratification Scale (Ray and Najman) and the Gambling Competitiveness Scale constructed by authors specifically for this study.
- It was hypothesized that:
- 1) Pathological gamblers would have higher levels of sensation seeking that non-gamblers; 2) PG's would have lowe levels of deferment of gratification (Less able to tolerate waiting for desired things); 3) PG's would have higher levels of competitiveness than N-PG.
- Results showed that 2/3 hypotheses were supported. Competitiveness had a strong, positive predictive value for PG - DoG had a relatively strong, negative predictive value.
SA: Eval of addiction to gambling
- Behavioural addictions like gambling can be chemical too; biopsychosocial explanatory model is just as relevant to behavioural addictions as to chemical addictions.
- Despite evidence supporting both theories, neither is entirely satisfactory on it's own; CC seems useful to explain people's motivation to commence a gambling session, but appears less useful to explain persistent gambling behaviour. Conversely, operant conditioning might explain ongoing behaviour, but appears less useful in explaining why people commence gambling or recommence after a long period of abstinence.
- Biopsychosocial factors are not the only major sets of influences in the development of addictive behaviour. Different structural characteristics may have implications for the gambler's motivations, and, subsequently, have a wider social impact.
- Structural characteristics can be applied to chemical addictions - it is for this reason above all others that this approach could be potentially useful. For drug addictions, structural characteristics would include things such as the dose amount, drugs toxicity and route of administration.
VTA: S-E, addictive personality and ID
- Jessor reports low self-esteem as predictive of involvement in problematic behaviours such as addiction, although some studies suggest that no such evidence exists.
- Van Hasselt et al compared adolescent substance users and non-substance users. Although the drug users were more likely to be depressed, there were no differences between them in terms of self-esteem.
- An earlier study by Newcomb et al examining risk factors for substance abuse found that in order of importance, self-esteem ranked behind peer drug use, general deviance, percieved drug use by adults, early alcohol use, sensation seeking, poor relationship with parents, low religiosity, poor academic achievement and psychological distress.
- Those who believe in the concept of addictive personality claim that some people are more prone to addiction than others - Nathan.
- Addictive personality is a concept that was used to explain addictive as the result of pre-existing character defects in individuals.
- However, personality is complex and the role of personality is uncertain. It is difficult to disentangle the effects of personality on addiction from the effects of addiction on personality (Teeson).
VTA: Evaluation of individual differences
- Although there is lots of research showing that certain traits are common among addicts, this does not prove that these are specific to addictive behaviour.
- According to Nathan, there must be standards of proof to show that valid links between personality and addictive behaviour exist. He reported that for addictive personality to exist, the personality trait factor must:
- 1) Either precede the initial signs of the disorder or be a direct and lasting feature of the disorder; 2) Be specific to the disorder rather than antecedant, coincident or consequent to other disorders/behaviours that often accompany the addictive behaviour; 3) Be discriminative; 4) Be related to the addictive behaviour on the basis of independently confirmed empirical, rather than clinical, evidence.
- Research has shown that no personality trait guarantees addiction. In short, there is little evidence for an addictive personality to exist.
- Attributions theory relates to how people explain the behaviour of others in an attempt to make sense of the world.
- Has been used to illustrate how the use of addiction as a label can promote irresponsibility, learned helplessness and passivity - Preyde and Adams
- Concern that the label of 'addict' may lead to a self-fulfilling prophecy fostering hopelessness, dependency and low self-efficacy - Preyde and Adams
VTA: Davies on the attributional stages of addicti
- Davies argues that the explanations people make for their behaviour are functional. He asserts that people make different attributions for the same event in different contexts.
- His study suggests that as addiction develops, there are five attributional stages that a person might progress through .
- Each of these stages is marked by a different attribution style and may vary in terms of:
- Purposiveness - how intentional the behaviour is portrayed; Hedonism - How positively the behaviour is described; Contradictoriness - whether the attributions contradict across the course of a given time period; Addiction self-ascription; whether attributions make use of the concept of addiction as an explanation for the behaviour.
- To formulate and confirm the attributional stages, Davies interviewed 20 drug addicts and alcoholics, both in and out of treatment.
- Investigators assigned each respondent to one of the five stages based upon the ratings.
- Consensus between 4 judges rating the same participants was good
- Average agreement was 71%.
- In all instances, the judges never disagreed by more than one stage.
VTA: Davies- Stages in study
- Stage 1: Before drug-using becomes a problem, people's attributions for their drug use are high of purposiveness and hedonism
- Stage 2: Problem starts to arise, discourse becomes contradictory and varies from context to contect and controlled attributions reflect the ambivalance that emerges during the development of addiction.
- Stage 3: People refer to themselves as addicted, explain their drug use as out of their control, and view it as negative.
- Stage 4: People begin to reject the usefulness of the 'addiction' concept in the explanation of their behaviour, and their discourse becomes mixed and contradictory.
- Stage 5: People can be pos/neg; their attributions are relatively stable at this stage and do not contradict in diff contexts; do not refer to their behaviour in terms of addiction; Pos - people may have given up drug but return to a view of their past behaviour as controllable and a desc that highlights the pos and neg behaviour; neg version, behaviour in uncontrollable and drug use is negative.
VTA: Evaluation of attribution theory
- Davies demonstrated good reliability of his model and stated that these models related to the stages of addiction.
- Davies did not provide info about how attribution stages correspond to the actual temporal progression of addiction in his interviewees. Given his claim that movement between at least two of the stages is irreversible, which contradicts established research on addiction stages (Prochaska, Norcros and DiClemente), further research is needed to verify the model.
- Although Davies developed his model based on years of observations and interviews of drug addicts, he only tested it on 20 people.
- Given the theoretical basis of the model, it is important to test this model and its stages in different samples of substance users and different settings.
- Nelson argues that Davies' model of attribution change needs to be validated, but argues that the model is important for the questions it raises - if these patterns reliabilty correspond to diff stages of an addiction, it is important to determine whether these attributions predict change or reflect.
- Both possibilities stress the importance of a person's subjective understanding and interpretation in guiding future behaviour.
VTA: Social context- Availability
- There are a number of environmental factors that affect the incidence of addictive behaviours in a society.
- One factor that affects the level of alcoholism is the availability of alcohol and the consumption of alcohol by the general popn.
- Comparison studies have found near-perfect correlations between the no of deaths through liver cirrhosis.
- The availabilty factor also affects the consumption of cigarettes and gambling.
VTA: Eval of social context
- Much of the evidence examining the relationship between accessibility and addiction is correlational in nature, so we cannot establish causality. Furthermore, the massive reduction in smoking over recent decades is unlikely to be because of price and accesibility restriction.
- Although Volberg showed a correlation between increased availability of gambling opportunities and problem gambling, she then reported that in a no of replication studies problem-gambling rates had stabilised or decreased.
- Looking at these jurisdictions in more detail, she reported that all of them had introduced comprehensive services for problem gamblers. She concluded that the relationship between increased opportunities to gamble and problem-gambling may be moderated by the availability of problem-gambling services
- Collins also reviewed this evidence and concluded that if a jurisdiction introduces new forms of gambling and does nothing else, it will most likely see and increase in problem gambling.
RAB: Godin on preventing cigarette smoking
- A study by Godin aimed to verify the basic assumption underlying the theory of planned behaviour for the prediction of cigarette smoking intentions and the behaviour among adults of the general popn.
- Basline data was collected about smoking behaviour from trained participants with the use of a questionnaire.
- Self-report on behaviour was obtained 6m after the baseline data collection.
- Results showed that the most important predictors for smoking intention were percieved behavioural control, attitudes and subjective norm.
- Most important predictors of actual smoking behaviour were percieved behavioural control and habit.
- Study suggested that promotional programmes should help smokers to know and develop their willpower regarding non-smoking of cigarettes and should be informed of the effort required in order to modify smoking behaviour.
PAB: Stages of change model
Prochaska's stage of change model
- Precontemplation stage - Person has no intention to change their behaviour and probably does not even percieve that they have a problem.
- Contemplation stage - Person is aware that they have a problem and think they should do something about it. However, they have not yet made a commitment to take action.
- Preparation stage - Person is intending to take action in the near future and may well have started to do soemthing.
- Action stage - People change their behaviour, or their experience, or their environment so that they can overcome their problem. A person is said to be in the action stage if they have successfully altered their behaviour for a period of between 1 - 6 months.
- Maintenance stage: Person works to prevent a relapse and to consolidate the changes they have made. Someone is said to be in the maintenance stage if they are able to remain free from the problem behaviour for more than 6m.
RAB: Spiral model of change
Prochaska et al's spiral model of change
- The model prevents change as a spiral.
- This takes account of the observation that most people who take action to change a habit are not successful at the first stage.
- Prochaska et al suggest that smokers commonly make three or four action attempts before they reach the maintenance stage.
- People can stay in one stage for a long time; unassisted changes.
- Various techniques can be used to help people prepare for readiness.
- The goal of treatment can either be abstinence or simply to cut down.
PAB: Evaluation of prevention models
- Theory of reason action is deficien in explaining behaviour, especially that of people who have little or feel they have little power over their behaviours (such as addictions).
- Research has shown that the theory of planned behaviour can in some circumstances be used to successfully prevent potentially addictive behaviours (teenage smoking, Winge 2003)
- There has been criticism that both these theories are limietd to conscious and deliberate behaviours, and do not predict well behaviours that are not consciously intented (Bohner 2001) which could include addictive behaviours.
- Given the limitations of the TRA and TPB, other models such as the 'stages of change' model may be more productive in explaining non-conscious behaviours such as addiction.
- Aversive agent treatment - Only available treatment of this kind is disulfiram which, when combined with alcohol, produces nausea and possibly vomiting.
- Agonist treatment (Methadone) - Usually given to opiate addicts in outpatient settings. Long-lasting opiates are administered orally to prevent withdrawal symptoms, block effects of illicit opiate use and decrease craving. Addicts using methadone can engage more readily in counselling and other behavioural interventions essential to recovery and rehabilitation.
- Narcotic antagonist (Naltrexone) treatment - Usually given to opiate addicts in outpatient settings, although iniation usually begins after detoxification in a residential setting. Naltrexone treatment is a long-lasting synthetic opiate antagonist with few side effects, which blocks the effects of self-administered opiates (e.g. euphoria).
Evaluation of biological interventions
- Main criticism of treatments in that although the symptoms may be being treated, the underlying reasons for the addictions may be being ignored.
- On a more pragmatic level, what happens when the drug intervention is taken away? It is very likely that the addict will return to their addiction if this is the only method of treatment used.
- Methadone maintenance has been shown to be safe and very effective on a variety of measures. Buprenorphine is probably equally effective, although it is more expensive in some countries (Luty 2003).
- Value of the 'substitution therapies' lies in the opportunity they provide for addicts to stabilize their health and social functioning and reduce their exposure to risk behaviours before addressing the physical adaptation dimension of addiction.
Classical conditioning therapies
- Based on the view that addiction is a learned, maladaptive behaviour and can therefore be unlearned.
- Aversion therapy - Pairing of an aversive stimulus with a specific addiction response, orit may randomly be interspersed while engaging in the addictive behaviour.
- In-vivo desensitization - Pairing cues with no addiction behaviour and feelings of boredom.
- Imaginal desensitization - Differs from IVD by having the addict imagine the cues for addiction and then pairing these imagined cues with a competing response, such as feelings of boredom.
- Systematic desensitization - Gradient or increasingly powerful cues for the addiction. At each step, any arousal that the addict is experiencing is extinguished by imagined scenes of tranquility or direct muscular relaxation.
- Relaxation therapy - Training in relaxation techniques that can be used when the urge to engage in the behaviour arises.
- Satiation therapy - Involves presenting the addict with no other stimuli and no other activities but those associated with the addiction.
Operant conditioning therapies
- Rewards are given for not taking the substance - 1) Rewards are reinforcement for the behaviour ; 2) A distractor from the pleasurable reinforcement of the substance.
Higgins on the voucher therapy approach
- Programme in the USA, reported by Higging and colleagues, treid to change the behaviour of people with a serious cocaine problem.
- 28 addicts (all white males) had urine tested several times a weak for traces of cocaine, and every time it was clear they were given vouchers with a value of $2.50 - value went up by $1.50 each time.
- Best way to cash in was to stay clear of cocaine for as long as possible - vouchers were teamed with counselling on how best to spend the money.
- 85% stayed in the programme for 12wks, and 2/3 stayed in for 6m.
- The voucher-based treatment was compared with a more traditional outpatient programme over a 12wk period - 11/13 assigned to behaviour-change programme completed 12wks of treatment, compared with 5/15 in the traditional programme.
- The voucher-based system creates an alternative, builds coping skills and strengthens social relationships.
- Involves more than vouchers and urine tests; includes intensive counselling directed at employment, recreation, relationships, skills training and structuring the day, and family and friends are brought into the counselling process.
Cognitive Behavioral Therapy
- Techniques in CBT assume that addicion is a means of coping with difficult situations, dysphoric mood and peer pressure.
- Is based on theories of cognitive dissonance and attempts to promote an favourable attitude change.
- Encourages clients to give their own reasons for attempting to change their drug use.
- Miller and Rollnick (2002) argue that MI is primarily about the motivational aspects of changing people's behaviour in the therapeutic setting, particularly for those people who engage in addictive behaviours.
- Client can use MI to resolve ambivalance and allow the client to build commitment and reach a decision to change.
- Consists of a mnemonically structured list of 8 effective motivational strategies:
- 1) giving ADVICE; 2) removing BARRIERS; 3) providing CHOICE; 4) decreasing DESIRABILITY; 5) practising EMPATHY; 6) providing FEEDBACK; 7) clarifying GOALS; 8) active HELPING.
- This is intertwined with the 5 general principles of MI - 1) expressing empathy; 2) developing discrepancy; 3) avoiding argumentation; 4) rolling with resistance; 5) supporting self-efficacy.
- Psychotherapy can include anything from Freudian psychoanalysis and transactional analysis, to more recent innovations like drama therapy, family therapy and minimalist intervention therapies (Griffiths and MacDonald 1999).
- Therapy can take place on an individual, couple, family or group level and is basically viewed as a 'talking cure', consisting of regular sessions with a psychotherapist over a period of time.
- Most psychotherapies view maladaptive behaviours as the symptom of other underlying problems.
- Is often very eclectic by trying to meet the needs of the individual and helping the addict develop coping strategies.
- If the problem is resolved, the addiction should disappear.
Dijkstra and De Vries on changing cognitions and b
- Investigated the extent to which self-help interventions change specific cognitions, and the extent to which changes to these cognitions are related to behaviour.
- Carried out a field study with follow-ups after 2 wks and 12 wks.
- Over 1500 smokers were randomly assigned to one of four conditions offering self-help materials to aid givingup smoking.
- Research used two types of information; Info about the outcomes of smoking and self-efficacy info telling people how to be successful at giving up.
- Four groups were as follows: 1) Just given info about the outcomes of continuing to smoke; 2) Just given self-efficacy enhancing info; 3) Given outcome and self-efficacy info; 4) Given no info.
- The response rate of the smokers was 81% after 2wks and 71% after 12 wks.
Evaluation of psychological interventions
- It would seem as if behavioural therapies could curtail addictive behaviour, but to achieve a long-term improvement the addict must learn how to satisfy their needs in more adaptive ways. It could be argued that if the addiction is caused by some underlying psychological problem, then behavioural therapy would at best only eliminate the behaviour but not the problem, so the person may engage in an different addictive behaviour instead.
- It is hard to evaluate treatment effectiveness in some studies because behavioural therapy and psychotherapy are often used with other treatment techniques.
- The problem with operant conditioning does not concern its success rate but the reaction of other people to the idea of giving drug users money not to take drugs. The hostile reaction of politicians and the general public to this reaction is likely to be similar to that met by harm-minimization programmes seeking to reduce dangers to health in people carrying out risky behaviours.
- CBT therapy appear to be reasonably succesfull, but not necessarily better than other addiction treatments.
- Some types of therapy or combined therapy may be more effective than others.
- Gaining control of behaviour may be just as good a treatment objective as abstinence.
- Most successful self-help therapy worldwide is the Minnesota Model 12-step programme.
- Treatment programme uses a group therapy technique and only ex-addicts as helpers (Griffiths 1995).
- Addicts attending 12-step groups become involved in accepting personal responsibility and come to view the behaviour as an addiction that cannot be cured but merely arrested.
- For the therapy to work, the 12-step programme asserts that the addict must come to them voluntarily and must really want to stop engaging in their addictive behaviour.
- Further to this, they are only allowed to join when they have reached 'rock bottom'.
Evaluation of self-help therapies
- No case records are kept; no attempt is made at objective evaluation, and the only evidene is subjectively based self-report of the member. As there is little in the way of data than an external body can audit or evaluate, there is no evidence that this is an effective treatment for gambling addiction.
- 12-step groups can only accept those at 'rock bottom' - membership is continually changing and some members attend multiple meetings. As Gamblers Anonymous (GA) only accepts a certain type of client from a group that is self-selected, there is no way of knowing whether they are offering an effective treatment and/or whether it is only effective to those in an extremely vulnerable state. These factors also rule out the possibility of comparison with a control group, making evaluation of the treatment almost impossible.
- In 12-step groups, the criterion for success is complete abstention. Among those who drop out and those who 'fall', there is no measure of the success that the 12-step programme has achieved.