Addiction Flashcards

Question

Reducing addiction - behavioural interventions AO3?

Answer 1

Strength - McConaghy et al compared electric shock aversion therapy with covert sensitisation in treating gambling addiction. After a one year follow-up, 90% of covert sensitisation participants compared with just 30% undergoing a vision had significantly reduced their gambling habits. They also reported experiencing fewer and less intense gambling cravings than the aversion treated patients. This suggests that covert sensitisation is a highly promising behavioural intervention. Strength - Ashem and Donner investigated the efficacy of covert sensitisation and found that 40% of patients were abstaining from alcohol 6 months after treatment compared to the 0% of patients from the control group. Weakness - However, covert sensitisation requires motivation and imagination. Aversion therapy must be used in some cases because some people are incapable of this imagination and motivation. Weakness - Hajek and Stead criticised the effectiveness of aversion therapy. They suggested it was not possible to conclude the effectiveness of a therapy without the use of a ‘blind’ study in which a placebo is used. Without the use of this methodology, there is a possibility of bias within the research of eversion therapy and therefore appear more effective than it is. Weakness - ISSUE AND DEBATE. Furthermore, aversion therapy is criticised for its ethics. Aversion therapy inflicts extreme nausea, pain and emotional distress (humiliation). These factors suggest that covert sensitization may be more effective and more ethical than aversion therapy. Weakness - However both aversion therapy and covert sensitisation are criticised because neither address the root cause of the addiction, such as CBT.

Answer 2

Cognitive behavioural therapy (CBT) aims to change the irrational thinking which leads to drug dependence. CBT involves functional analysis; ongoing therapy sessions in which a therapist analysises the thoughts of a patient before, during and after a theoretical situation in which the addictive substance is readily available. Then, skills training; the therapist teaches the client strategies to cope with stress/issues to replace the need for the addictive substance. This involves cognitive restructuring (tackling the unconscious biases of the client), specific skills (teaching the client personalised techniques, such as anger management) and SST (teaching the client to cope with anxiety in social situations and refuse the offer of their addictive substance).

Answer 3

Strength - Petry and colleagues recruited gamblers and randomly allocated them to a control group (gamblers anonymous) or CBT. It was concluded that gamblers undergoing the CBT were gambling significantly less than the control group up to 12 months later. This shows the effectiveness of CBT as a therapy for addiction. Strength - Less ethical issues than other therapy (like drug therapy). CBT does not cause any emotional or physical distress. Infact, CBT therapists teach patients to avoid emotional distress such as guilt and anger when relapsing by providing new perspectives on failure. E.g. “Relapsing is an inevitable part of an addicts life” and “This is not failure, this is an opportunity to learn and grow stronger”. This suggests that CBT may be a more ethical way of treating addiction. Weakness - criticised for methodology. Cuijpers emphasised the demanding characteristics of CBT, including homework and attending therapy sessions. This can be hard for addicts, making the drop-out rate for CBT five times higher than other therapies. The lack of treatment adherence for CBT makes it difficult to understand the true effectiveness of the therapy.

Answer 4

This theory explains how we change behaviour that we can control. It can be applied to addiction. The theory of planned behaviour (TPB) explains how someone initially decides to change a behaviour through three key influences. Personal attitudes refers to the addicted individuals beliefs towards their addiction. For example, a dependent gambler may have favourable beliefs towards gambling (e.g. “it makes me feel good”), and unfavourable attitudes (e.g. “I lose a lot of money”). The addicts overall attitude towards their addiction is calculated by weighing up the positive and negative beliefs. Subjective norms refers to the individuals beliefs about whether the people closest to them approve or disapprove of their addictive behaviour. For example, these people might have unfavourable views about gambling (e.g. “gambling is a waste of money”,) or favourable views about gambling (e.g. “gambling is so much fun!”). These beliefs influence the addicted gamblers beliefs and therefore, influence decisions about whether or not they should change their behaviour. Perceived behavioural control is the extent to which a person believes they are in control of their behaviour (self-efficacy). This depends on external (e.g. money) and internal (e.g. determination) resources available to the addict. This can have two effects; influence desire to behave to withhold control; or directly influence how hard or long a person will try to quit their addictive behaviour.

Answer 5

Strength - The theory has been used in the real world. Health economics and health psychology look at the cost effectiveness of treatments. This suggests how high in validity the theory is because it is used by trusted practitioners who value the predictive power of the theory. Strength - Practitioners also use this theory to decide whether a treatment is going to be effective so that time, money and effort is not wasted. Weakness - Methodological issues. The TPB is based on research that uses self-report methods (Ogden). This needs to be done because attitudes, norms and behavioural control are subjective variables and so the answers can only be found through self-report. However, social desirability bias may occur whereby participants respond to questions in a way that they think will make them look good. Addicted individuals also think irrationally and may not perceive their addiction to be as problematic or damaging compared to what it really is. This lowers the reliability of the study. Weakness - The TPB is a limited exclamation of addicted related behaviour because it over emphasises rational reasoning in decision-making and choice. It has difficulty in accounting for other factors that influence intentions and behaviours involving drugs such as, emotions cognitive biases or even past experiences.

Answer 6

This model explains the stages people go to in order to change their behaviour. Prochaska’s six stage model is a cyclical process which attempts to explain how addictive behaviours are overcome. The stages are not necessarily followed in a linear order. ``` The stages: Precontemplation, Contemplation, Preparation, Action, Maintenance, Termination. ``` Precontemplation describes an individual who is not thinking about changing their addictive behaviour in the near future. Precontemplation is due to denial (the person does not believe they have a problem) or demotivation (the person does not have the energy to try). Contemplation describes an individual who has become aware of their need for change and is considering changing their addictive behaviour in the near future. Preparation describes an individual that believes the benefits of quitting their behaviour will outweigh the costs. The individual will decide to change their behaviour in the next month and will begin seeking advice on how to do so. Action describes an individual who has attempted to quit their addictive behaviour in the last six months. Maintenance describes an individual who has maintained change of behaviour for more than 6 months. The focus of a person who is in this stage is on relapse prevention - avoiding cues which trigger the addictive behaviour. Termination describes an individual who’s newly acquired behaviours such as abstinence become automatic. The person no longer returns to the addictive behaviour to cope with emotions. This stage is not always possible for people to achieve.

Answer 7

Strength - Velicer conducted a meta analysis and found that there was a 22-26% success rate when people tried to quit smoking using this model, compared to other interventions. No demographic differences in success (Gender/age). Strength - The attitude to relapse. (This can be used as double with below). DiClemente et al ‘relapse is the rule rather than the exception’. The model does not view relapse as failure, but rather than an inevitable part of the untidy, non-linear, dynamic process of behaviour change. The model also takes relapse seriously though, because when relapse does occur, the person starts again from the begging of the stages. Strength - Realistic view of addiction (valid explanation) - earlier theories focused on all or nothing events, in contract the model provides more flexibility e.g different lengths of stages, ability to go back and forth/ skip stages. This suggests the model provides a realistic view of the complex nature of addiction. The model recognises that addictive behaviours are continuing process and overcoming them is a dynamic process. (My idea: this also allows for individual differences to be reduced. Some people take longer/skip stages/relapse more. There is no structured schedule on overcoming addiction and individuals are different and so experience overcoming addiction differently. This model is flexible and realistic for everyone). Weakness - The nature of the stages is too arbitrary. Sutton points out that if an individual plans to stop smoking in 30 days, they are in the preparation stage but if they plan to stop smoking in 31 days, they are still in contemplation stage. Bandura further suggests that the first two stages - precontemplation and contemplation - are not qualitatively different, only quantitively different. This suggests that the model is too arbitrary and could possible be reduced to two useful stages, without the quantitive measurements; precontemplation and the rest of the stages together. Weakness - Contradictory research evidence. Taylor et al analysed the evidence available at the National Institute for Health and Care Excellence (NICE). Taylor concluded that stage based approaches are no more effective than alternatives in treating nicotine addiction. A later analysis by Kate Cahill et al Came to precisely the same conclusion. Robert west is brutal in his assessment of the six stage model. He concludes that “the problems with the model are so serious… It should be discarded. The model has been little more than a security blanket for researchers and clinicians “.