Psychological Treatments for Substance Abuse

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Aversion Therapy

  • Uses classical conditioning of the behaviourist approach
  • Works by pairing the abused substance with something unpleasant, commonly an emetic (substance that causes nausea and vomiting)

Before Treatment

Emetic (UCS) --> Nausea and vomiting (UCR)

During Treatment

Emetic (UCS) + Alcohol (NS) --> Nausea and vomiting (UCR)

After Treatment

Alcohol (CS) --> Nausea and vomiting (CR)

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Smith and Frawley

  • Aim- To find the level of success in abstaining from alcohol in treated patients, at least one year after in-patient aversion therapy
  • Method- 427/600 randomly selected patients were interviewed 12-20 months after treatment. Verification interviews were carried out with 40% of participants
  • Results- 65% of participants reported abstinence from alcohol 12 months after treatment
  • Conclusion- High success rate for 12 month abstinence
  • Evaluation- Self report can be unreliable although attempts were made to verify data, results are consistent with many others (Mayer and Chasser reported 50% abstinence after 12 months, Elkins reported 60% abstinence after 12 months)
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Evaluation of Aversion Therapy

  • Schuckit (1998)- Aversion therapy only makes up around 1% of treatments for substance abuse in the US with the UK's nationaly treatment agency stating that the therapy is not recommmended because although it is effective, it is expensive
  • Long term- Schuckit pointed out aversive treatment weakens over time. Found that if reinforcement treatment was used on two occasions in the first year, abstinence was a lot higher (69%) than if no reinforcement was used (29%). Shock therapy used for smoking provided reinforcement through the use of an elastic band round the wrist which the patient would 'ping' when they had the urge to smoke
  • Relapse- Up to 40% of those treated by aversion therapy relapse in the first 12 months. A smoking study showed abstinence in non smoking house holds was 86% compared to 14% in smoking house holds--> Other factors such as social norms and triggers, can influence relapse, more than one therapy needed
  • Ethics- The use of electric shocks and emetics raises ethical concerns with there being a high drop out rate from the treatment. However, many participants reported that they found treatment less unpleasant than the personal disclosures involved in other kinds of therapy
  • Active role- The patients do not take an active role in their treatment meaning they may not have the self efficacy needed to abstain in everyday life
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Covert Sensitisation

  • Tackles the ethics behind the use of emetics
  • The therapise takes the participant through a detailed story of vomiting, lack of coordination and subsequent hangover that is designed to cause nausea and anxiety
  • The participant is encouraged to imagine the scene and to repeat the process when they feel an urge to use the substance
  • Cautela recommends that the unpleasant outcomes should be associated with the intention to drink, rather than being associated with the action, so that the conditioning acts at an earlier stafe in the process

Evaluation

  • Hard to evaluate as the treatment is usually combined with others, and some researchers, for example Barrett and Sachs, suggest that success may partly be the result of raised motivation from the participants
  • Olsen et al found thatthis treatment led to 70% six month abstinence rates
  • Telch et al raised questions about the value of covert sensitation for outpatients as supportive group therapy proved more effective
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