Addiction: Reducing addiction

Question 1

What are the three types of drug therapy?

Answer 1

• Aversives
• Agonists
• Antagonists

Question 2

How do aversives work?

Answer 2

• Produce unpleasant consequences like vomiting.
• E.g. disulfram is an aversive that when taken with alcohol cause a hypersensitivity to alcohol, leading to severe hangover effects.
• This allows for an association to form between the substance (e.g. alcohol) and the unpleasant consequences caused by the drug (e.g. vomiting)

Question 3

How do agonists work?

Answer 3

• ‘Drug substitutes’
• They activate neuron receptors, providing a similar effect to the addictive substance.
• E.g. methadone is an agonist used to treat heroin addiction by satisfying the addicts craving for euphoria.
• They have fewer harmful side effects and are ‘cleaner’ as they can be administered medically in controlled doses.
• They stabilise the addict as they are used to control the withdrawl syndrome, allowing a gradual reduction in dose and symptoms.

Question 4

How do antagonists work?

Answer 4

• They block receptor sites so the substance of dependence cannot have its usual effects (as it/as much cannot bind) - especially the feeling of euphoria.
• E.g. Naltrexone is an opioid antagonist used to treat heroin addiction.
• Other therapy methods should be used alongside antagonist drug treatment to tackle the psychological causes of the addiction.

Question 5

What is nicotine replacement therapy (NRT)?

Answer 5

• Other sources of nicotine (substitutes a cigarette) is used to deliver nicotine to the body e.g. patches, gum, inhaler.
• Provides the user with a clean, controlled dose of nicotine, activating nAChRs in the mesolimbic pathway, allowing for the dopamine reward system to be activated.
• NRT allows for the dose of nicotine to be reduced over time- encouraging dependence to be fully eradicated for the addict while also allowing for the reduction of withdrawl symptoms.

Question 6

Explain drug therapies to treat gambling addiction:

Answer 6

• Although there are no officially approved drugs to treat gambling addiction, there is ongoing research into it.
• Opioid antagonists like naltrexone are currently the most promising. This has come about due to the similarities between gambling and substance addiction, which are now recognised in the DSM-5.
• The neurochemical explanation is that they both impact the dopamine reward system.
• Opioid antagonists enhance the release of the neurotransmiter GABA in the mesolimbic pathway. Increased GABA activity reduces the release of dopamine in the nucleus accumbens- linking to reductions in gambling behaviour.

Question 7

What are the 4 evaluation points for using drug therapy to treat addiction?

Answer 7

1) Research support (S)
2) Reduces stigma (S)
3) Major benefits (S)
4) Side effects (L)

Question 8

Explain research support (S) for using drug therapy to treat addiction:

Answer 8

• Boyce conducted a meta-anlaysis of 136 studies into the effectiveness of NRT.
• Concluded that all forms of NRT were significantly more effective in helping smokers quit than placebo and no therapy at all.
• NRT products increase the rate of quitting by 60%.
• Research shows that NRT does not foster dependence.
• Overall, NRT is an effective therapy which may save lives and reduce costs to the NHS.

Question 9

Explain reduces stigma (S) for using drug therapy to treat addiction:

Answer 9

• Addiction becomes less stigmatised through association with drug therapy.
• Many people believe addiction is a psychological weakness. This stigma attached to addiction can lead to self-blame and depression, which makes recovery more difficult.
• Fortunately stigma around addiction is being eroded due to its successful association with drug therapy- encouraging the perception that addiction has a neurochemical basis.
• Perceiving addiction as something that can be treated with drugs helps people with addiction avoid self-blame and aids in recovery.

Question 10

Explain side effects (L) for using drug therapy to treat addiction:

Answer 10

• All drug therapies have side effects.
• The risk with side effects is that the addict will discontinue their therapy.
• Symptoms can include sleep disturbances, gastrointestinal issues and headaches.
  -Major concern for potentially treating gambling addiction with opioid antagonist naltrexone as higher doses are needed for it to have an effect with gambling addictions- meaning the side effects are correspondingly worse e.g. muscle spasms, anxiety, depression.
• Therefore side effects shoukd be compared with the benefits of the drug and other therapies available.

Question 11

Explain major benefits (S) for using drug therapy to treat addiction:

Answer 11

• Drug therapues have major benefits in treating addiction.
• They aid in controlling unpleasent withdrawl symptoms- which may make side effects tolerable if they are veey effective at treating the addivtion- encouraging clients to stick to the treatment.
• They are also cost-effective and are non-disruptive to people’s lives. They are cheaper than alternative therapies like CBT, reducing costs to the NHS. They are also a small commitment to clients lives.

Question 12

What is aversion therapy?

Answer 12

• A behavioural intervention for addiction based on classical conditioning.
• Allows for association of the addictive behaviour/substance and an unpleasant state.

Question 13

How does aversion therapy work for alcohol addiction?

Answer 13

• Client is given aversive drug like disulfram.
• Disulfram increases hypersensitivity to alcohol, so a person will experience severe hangover effects if they consume it.
• The aim of this treatment is for the client to learn a new association. The aversive and alcohol together make a conditioned stimuli, and the severe hangover effects are the conditioned response.
• The client will expect the CR when they drink, which is enough to prevent them from drinking.

Question 14

How does aversion therapy work for gambling addiction?

Answer 14

• Painful (but safe) electric shock will become associated with gambling behaviour
• The gambler will write down phrases in cards that link to their gambling behaviour, alongside some non-gambling related cards.
• When they read out a gambling related phrase they are shocked- the intensity and duration of the shock are selected by the client.
• The client will associate the pain (UCR) with gambling related behaviour (now CS), so the clients cravings reduce and they stop gambling.

Question 15

Briefly explain what covert sensitisation is:

Answer 15

A form of aversion therapy based on classical conditioning where a client imagines and unpleasant stimulus and associates with a substance/behaviour.

Question 16

How does covert sensitisation work in practice to treat an addiction?

Answer 16

• Client is encouraged to relax while the therapist reads from a script instructing the client to imagine an aversive situation.
• The client sees them doing a behaviour/taking a substance, followed by them imagining the most unpleasant consequences, such as nausea and vomiting. The more details, the better (why the therapist reads from a script, so all the senses can be associated).
• Towards the end of a session, the client imagines a situation where they stop doing a behaviour/taking a substance and they feel relief.

Question 17

What are the 3 evaluation points for aversion therapy?

Answer 17

1) Methodological issues (L)
2) Poor long-term effectiveness (L)
3) Ethical issues (L)

Question 18

Explain methodological issues (L) as an evaluation points for aversion therapy:

Answer 18

• Hajek and Stead reviewed 25 studies of averison therapy for NRT.
• They concluded that it was impossible to judge the effectiveness of aversion therapy because most of the studies had ‘glaring’ methodological issues- with no blind or double blind trials, so the researchers knew which patients were receiving the therapy or the placebo.
• This may have influenced the researchers judgements of the therapy’s success. Therefore this research tells us little about the value of aversion therapy.

Question 19

Explain poor long-term effectivness (L) as an evaluation points for aversion therapy:

Answer 19

• Aversion therapy lacks long-term benefits
• Fuller gave alchohol addicts disulfram everyday for a year, and another addict group a placebo. Both groups had weekly counselling for 6 months.
• There was no significant difference in total abstinence from drinking between these groups after one year.
• Suggests that aversion therapy for alcohol addiction is no more effective than a placebo- which may be because the counselling had a bigger impact.

Question 20

Explain ethical issues (L) as an evaluation points for aversion therapy:

Answer 20

• Aversion therapy is unethical as it uses punishment to treat addiction.
• Aversion therapy may cause physiological or psychological harm, which is why drop-out rates are so high.
• However it may be more ethical than using drugs to treat addiction- as drugs risk danger to life while aversion therapy doesn’t.

Question 21

What are the 3 evaluation points for covert sensitisation?

Answer 21

1) Research support (S)
2) Methodological issues (L)
3) Symptom substitution (L)

Question 22

Explain research support (S) as an evaluation point for covert sensitisation:

Answer 22

• McConaghy compared covert sensitisation an electric shock aversion therapy for gambling addiction.
• Found that after 1 year those with covert sensitisation were significantly more likely to have reduced gambling (90% of CS, compared to 60% AV).
• CS patients also reported that they experienced fewer cravings
• Suggests that covert sensitisation is a highly promising behavioural intervention.

Question 23

Explain methodological issues (L) as an evaluation point for covert sensitisation:

Answer 23

• Many studies of covert sensitisation do not include a suitable comparison group.
• For example, the studies do not use non-behavioural therapies as a comparison group. Instead they compare covert sensitisation to aversion therapy.
• Addiction has many non-learning causes (such as cognitive factors). Non-behavioural therapies address these whereas covert sensitisation nor aversion therapy do.
• This means that the benefits of covert sensitisation may be exaggerated.

Question 24

Explain symptom substitution (L) as an evaluation points for covert sensitisation:

Answer 24

• Covert substitution (like aversion therapy) only suppresses addition, it is not a cure.
• People undergoing covert sensitisation may appear to recover is to change the behaviour, but the issues that caused the addiction remain and then new symptoms appear.
• However the whole point of behavioural interventions is to change the behaviour - the behaviour is the addiction
• If symptoms arise to replace the ones that have disappeared, how useful is covert sensitisation.

Question 25

What are the two parts of cognitive behaviour therapy?

Answer 25

• Cognitive functional analysis
• Behavioural skills training

Question 26

Explain cognitive functional analysis:

Answer 26

• Client and therapist work together to identify high-risk situations where the client is likely to gamble/take substance.
• They reflect on what the client would be thinking before, during and after the situation.
• The therapist then challenges the clients cognitive biases and must not accept them. They must have a strong relationship as the client is vulnerable and may find it difficult to open up.

Question 27

Explain cognitive restructuring within cognitive functional analysis:

Answer 27

• All CBT programmes aim to change a client’s addiction based cognitive biases.
• The biases are confronted and challenged by the therapist. There is an initial educational element, in which the therapist gives the client information about their addiction
• It is a gradual therapy. In the early phases it helps a client identify the triggers for their addiction. In the later phases it helps a client develop in circumstances they may struggle with and develop coping skills.

Question 28

Explain behavioural skills training for specific skills:

Answer 28

• CBT is a broad spectrum treatment as it focuses on wider aspects of a client’s life that are related to their addiction e.g. functional analysis may find that the client lacks skills that allow them to cope with situations where the substance/behaviour is available.
• Assertiveness training could be used to help a client confront interpersonal conflicts in a controlled and rational way instead of using maladaptive methods e.g. aggression, avoidance.
• Anger management can help some clients cope with the situations that make them angry enough to resort to drinking.

Question 29

Explain behavioural skills training for social skills:

Answer 29

• Most clients can benefit from learning skills that can help them cope in social situations. E.g. a recovering alcoholic will learn to cope in social situations where alcohol is available.
• Social skills training (SST) will help them learn to refuse alcohol sensibly e.g. making eye contact and politely decline a drink.
• The therapist may role play with the client in order to demonstrate to the client how to act in high-risk situations and may explain why this behaviour is being encouraged.

Question 30

What are the 4 evaluation points for cognitive behaviour therapy to treat addiction?

Answer 30

1) Relapse prevention (S)
2) Treats cognitions (S)
3) Short term only (L)
4) High drop-our rate (L)

Question 31

Explain relapse prevention (S) as an evaluation points for cognitive behaviour therapy to treat addiction:

Answer 31

• CBT is especially useful in preventing relapse
• CBT promotes a very realistic view of recovery and incorporates the likelihood of relapse into treatment.
• Relapse is viewed as an opportunity for further cognitive restructuring and learning rather than as a failure. It is an inevitable part of an addict’s life, but is manageable with improving psycho-social functioning.

Question 32

Explain treats cognitions (S) as an evaluation points for cognitive behaviour therapy to treat addiction:

Answer 32

• CBT addresses cognitions in order to improve how it interacts with our behaviour to successfully treat addictions.
• Behavioural interventions may work partially because of their effect on changing cognitions.
• E.g. when an alcohol addict has successfully reduced their alcohol intake they may say that they don’t actually need alcohol to cope- leading to further behavioural changes