REDUCING ADDICTIVE BEHAVIOUR

In order for psychologists to develop ways to change addictive behaviour we need to understand what contributes to a person’s intention/desire to change.

This theory explains the relationship between our attitudes and our behaviours towards particular behaviours such as smoking and gambling. This theory explains this in the following five steps. It also involves the individual’s perception of the amount of control they have is very important in determining whether or not they choose to carry out behaviours.

1. ATTITUDE –  Throughout our lives, we develop beliefs that can influence our attitudes about different behaviours (e.g. smoking and gambling.) “I think smoking is unhealthy. None of my friends smoke and they are all healthy”

2. SUBJECTIVE NORMS – This is what we think others’ attitudes are about the behaviour (smoking/gambling). “I bet all my friends think smoking is bad”

3. INTENTION – This is how likely it is that the individual will carry out the behaviour. If they individual has a high intention then it’s likely that they will carry out the behaviour (smoking/gambling). “I would not like to try a cigarette”

4. PERCEIVED BEHAVIOURAL CONTROL – Whether or not the person feels they have control over themselves will affect their choices i.e. if they have an internal locus of control (you have responsibility) “It is my decision and I can make it for myself. I am completely in control of my actions”

5. BEHAVIOUR – This is where the intention becomes an action. The individual smokes/gambles or does not. 

• Research Support (ARMITAGE AND CONNOR, 2001): Carried out a meta analysis and found that the TPB was successful at predicting intention to change but not at predicting an actual behaviour change. Having an intention doesn’t mean you’re going to follow through.
• Argument that TPB is too rational; fails to incorporate emotions that also influence human behaviour therefore reductionist as we are simplifying a very complex decision 

Biological therapies work on the assumption that addictions are a type of disease and therefore need to be treated with medication. It is also suggested that individuals abstain completely from the addictive behaviour, therefore biological therapies focus on ways to deal with the inevitable withdrawal symptoms (seizures, delirium) experienced.

These include nicotine gum, patches, inhalers, lozenges and nasal sprays. All types of NRT work by blocking nicotine receptors in the brain so even if the individual does relapse they are not likely to find it rewarding or satisfying.

They all help because they relieve withdrawal symptoms in some way. The gum and nasal spray seems to help because it allows the individual to administer the nicotine whenever they have the urge to smoke. On the other hand, the nicotine patches provide a steady supply of nicotine. 

This is an anti depressant that acts by increasing dopamine and norepinephrine levels in the brain. Bupropion therefore has the same effect as smoking. Bupropion also works by blocking nicotine receptors (like NRT) therefore this drug could also reduce the satisfying effects of smoking if an individual does relapse.

This drug also works by increasing levels of dopamine in the brain and it also blocks the effect that nicotine has on the brain. Varenicline has also been shown to be more effective in reducing relapse than bupropion.

Currently, nicotine vaccinations are undergoing clinical trials. It is suggested that they would work by giving individuals an immunisation so that the body can develop antibodies to nicotine. When nicotine enters the body the antibody will attach to it which then slows down it’s entry to the brain. Consequently this will reduce the rewarding and satisfying effects of smoking and hopefully prevent relapse.

• Does help people avoid smoking and helps those who are particularly dependent.
• Some relapse because they don’t find NRT as satisfying as cigarettes - release nicotine much more slowly into the bloodstream.
• Individual is still subject to harmful effects of nicotine (cardiovascular disease, cancer, reproductive disorders, reduced immune system activity, etc).
• Reduces personal responsibility.
• Reductionist – better to combine with psychological intervention.

The aim of CBT is to change the way in which individuals think about their addictive behaviours and to enable them to develop self control so that they are able to deal more effectively with cravings/urges and situations in which they may be exposed to their addictive behaviour.

LADOUCEUR ET AL : Randomly allocated 66 participants (all pathological gamblers) to a CBT group or a waiting list.

CBT group – 86% no longer fulfilled DSM criteria for pathological gambling. After CBT they also had a better perception of control over gambling and increased self efficacy (these had been MAINTAINED AT A ONE YEAR FOLLOW UP).

SYLVAIN ET AL (1997) found similar findings.

HAJEK (2005) found that it is useful to help people refrain from smoking cigarettes once they have given up.

This type of therapy encourages individuals to be motivated to change their behaviours. It involves the individual weighing up the positive and negative effects that their addictive behaviour has on their lives. It is important that the individual weighs up both sides of this argument for themselves.

Evaluation

DUNN, DEROO AND RIVARA (2001) found that motivational interviewing is effective in treating substance addictions.

BURKE ET AL (2003) found a 56% reduction in alcohol consumption in those offered MI

Early examples of aversion therapy have involved administering electric shocks every time an individual drunk some alcohol or had a cigarette. Unfortunately this was not found to very effective, largely because it could not be used outside of the therapy sessions.

More recent examples of aversion therapy involve the drug called ‘ANTABUSE’. Alcoholics take this drug and when combined with alcohol it makes them vomit. Addicts then make a link between drinking alcohol and vomiting, thus preventing them from drinking alcohol. 

This is linked with classical conditioning - because the individual learns to make an association between alcohol and vomiting.

‘Rapid smoking’ is something that is used to treat smoking addictions. This is where the individual is required to sit in a room and smoke puffs every six seconds (much faster than normal). Consequently, this causes feelings of nausea. It is hoped that the individual will make an association between the unpleasant feelings and smoking so that they wish to avoid smoking in the future.

+ some studies have shown this is successful in treating smoking addictions

- aversion therapy is not as successful in treating alcohol addictions

- Requires the individual to actually take the drug

- focuses on the actual addictive behaviour but does not focus on the reasons for developing the addictive behaviour in the first place

This approach was developed by HIGGINS ET AL (1994) and it was used to treat individuals with serious cocaine dependencies. 

It involved individuals having several urine tests for cocaine each week. Any clear test resulted in them receiving a voucher for the value of $2.50. If the next time they were tested their urine was also found to be clear the value of the voucher increased by $1.50 to $4.00. If they continued to have consistent clear tests the value of their voucher would continue to increase by $1.50 each time. Therefore, they would receive a voucher to the value of $17.00 on the tenth consecutive clear test. 

The individuals would also have counselling about the best ways to use their money for example on taking up a hobby or treating their family to a meal (this can help rebuild relationships that may have broken as a result of their cocaine addiction). 

It was found that 85% of the addicts stayed in this programme for twelve weeks and two thirds stayed for six months. In other drug treatment programmes the normal drop out rate is 70% within six weeks.

+ does seem to be effective

- not really applicable to real life

- if it was used widely, the fact that drug users would be rewarded with money for simply obeying the law wouldn’t be received very well by tax payers.

- therapy involves counselling also so difficult to assume success is based purely on rewards (vouchers)

- limited sample size/ ethnicity (all white males in Vermont- a rural state)