Addiction - Theories of Behaviour Change

Question 1

What are the key features of the theory of planned behaviour applied to addiction?

Answer 1

• intention to change must be deliberate and linked to three key influences
• 1. personal attitudes: favourable and unfavourable
• 2. subjective norms: what is normal?
• 3. perceived behavioural control: self-efficacy

Question 2

What is the theory of planned behaviour applied to addiction?

Answer 2

Ajzen’s (1985; 1991) theory of planned behaviour (TPB) suggests that changes in addictive behaviour depend on exercising self-control and deliberate behaviours.

Central to the model is a person’s intention to change. Subsequent behaviour can be predicted from a person’s intentions.

These intentions arise from three key influences:

1. personal attitudes towards the addiction
2. subjective norms: perception of what others think
3. perceived behavioural control: beliefs about ability to quit

Question 3

What are personal attitudes?

Answer 3

Personal attitudes refers to the entire collection of the addicted person’s attitudes towards their addiction.

The addict’s overall attitude is formed from weighing up the balance of favourable and unfavourable attitudes.

Question 4

What are subjective norms?

Answer 4

Ideas of ‘normality’ are based on what key people in the addict’s life believe to be ‘normal’ behaviour.

For example, in the case of gambling: do others gamble? how much? what views have they expressed about it?

If the addict concludes that others are unhappy about their gambling, this would make them less likely to intend to gamble.

Question 5

How are subjective norms about perception?

Answer 5

The most influential aspect of subjective norms is the person’s perception of whether the people closest to them approve or disapprove of their gambling.

For example, parents may express favourable attitudes towards something in general (e.g. getting drunk) but disapprove of their own children doing it. Nevertheless the perception is that they approve.

Question 6

What is perceived behavioural control?

Answer 6

Perceived behavioural control is about how much control we think we have over our behaviour. This is called self-efficacy.

For example, does the addicted gambler believe they are capable of giving up gambling?

This may be related to their perception of resources available to them (e.g. support, time, skill, determination).

Question 7

How can perceived behavioural control be direct or indirect?

Answer 7

According to the theory of planned behaviour, perceived behavioural control has two possible effects:

1. it can influence behaviour directly: the greater the perceived control, the longer and harder the addict will try to stop.
2. it can influence intentions to behave: the stronger the self-efficacy, the stronger the intention to stop the gambling

Question 8

What are the strengths of applying the theory of planned behaviour to addiction?

Answer 8

• some research support

Question 9

What are the weaknesses of applying the theory of planned behaviour to addiction?

Answer 9

• does not explain the intention-behaviour gap
• prediction of long-term changes makes it not entirely valid
• methodological issues
• assumes behaviour is rational
• difficult to measure

Question 10

What research support is there for the theory of planned behaviour?

Answer 10

Hagger et al. (2011) found that the the TPB’s three factors all predicted an intention to limit drinking. Intentions were also found to influence actual alcohol consumption after one and three months.

However, the time periods between intention and behaviour were relatively short. Also, the theory was not able to predict behaviour related to all addictions (e.g. binge drinking).

Therefore, the success of TPB may depend on the addiction that is being studied.

Question 11

How does the theory of planned behaviour not explain the intention-behaviour gap?

Answer 11

Howell (2005) found strong support for the element of TPB that predicts gambling intentions from attitudes, norms and perceived behavioural control in underage teenagers.

However, the model did not predict the occurrence of actual gambling behaviour. Psychologists now question whether TPB is an effective model of behaviour change.

If the theory can’t predict behaviour change, it is difficult to create drug-related interventions that bridge the gap between intention to reduce the behaviours and the actual behaviours themselves.

Question 12

How does the theory of planned behaviour not predict long-term changes?

Answer 12

McEachan et al. (2011) conducted a meta-analysis of 237 studies and found that the strength of correlation between intention and behaviour varied according to the length of time between the two.

Intention to stop drinking, for example, may be a good predictor of giving up, but only if the time between intention and behaviour is short (i.e. less than five weeks). If the time span was longer then intention was not a good predictor.

This may help to explain why the research evidence for the TPB is mixed. Therefore the TPB cannot be accepted as an entirely valid explanation of addictive behaviour.

Question 13

What methodological issues are there to applying the theory of planned behaviour to addiction?

Answer 13

The TPB is based on measurement of attitudes, norms and perceived behavioural control which are subject to social desirability.

Also correlational studies do not allow us to conclude that drug-related intentions cause drug-related behaviours. It may even be that behaviours influence our attitudes.

If the evidence on which the TPB is based is flawed, this affects the validity of the theory.

Question 14

How does the theory of planned behaviour assume behaviour is rational?

Answer 14

The TPB explanation of drug-related behaviours is limited because it emphasises rational reasoning in decision-making.

It has difficulty in accounting for less rational factors such as emotions, cognitive biases and past experiences.

Therefore, the TPB lacks explanatory power for the different ways that people think about their behaviour.

Question 15

What are the key features of Prochaska’s six-stage model of behaviour change?

Answer 15

• each stage represents differences in readiness to change
• stage 1: pre-contemplation
• stage 2: contemplation
• stage 3: preparation
• stage 4: action
• stage 5: maintenance
• stage 6: termination

Question 16

What is Prochaska’s six-stage model of behaviour change?

Answer 16

Prochaska and DiClemente (1983) suggest a six-stage model in which overcoming addiction is a cyclical process.

Some stages may be reached in order but there is also some backtracking or even missing out of stages.

The model is based on two insights about behavioural change:

1. people differ in how ready they are to change
2. the usefulness of a treatment intervention depends on the stage the person has reached

Question 17

What is stage 1 of Prochaska’s six-stage model of behaviour change (pre-contemplation)?

Answer 17

People in this stage are not thinking about changing their addiction-related behaviour within the next sixth months. This could be due to denial or demotivation.

Intervention should focus on helping the addicted person to consider the need for change.

Question 18

What is stage 2 of Prochaska’s six-stage model of behaviour change (contemplation)?

Answer 18

Someone at this stage is thinking about making a change to their behaviour in the next sixth months. They are aware of both the benefits of change and the costs.

Intervention should focus on helping the person see that the pros outweigh the cons and help them reach a decision to change.

Question 19

What is stage 3 of Prochaska’s six-stage model of behaviour change?

Answer 19

Now the individual believes that the benefits are greater than the costs and has decided to make a change within the next month. However, they have not decided how to do this.

Intervention is support in constructing a plan (e.g. to see a drugs counsellor, to ring a helpline, to see a GP).

Question 20

What is stage 4 of Prochaska’s six-stage model of behaviour change?

Answer 20

People at this stage have done something to change their addictive behaviour in the last six months. For example, they may be having cognitive treatment or have done something less formal such as remove alcohol from the house.

Intervention should focus on coping skills needed to quit.

Question 21

What is stage 5 of Prochaska’s six-stage model of behaviour change?

Answer 21

The person has maintained some behavioural change (e.g. stopped gambling) for more than six months.

Intervention should focus on relapse prevention by encouraging application of coping skills and offering support.

Question 22

What is stage 6 of Prochaska’s six-stage model of behaviour change?

Answer 22

At this stage abstinence is automatic and the person no longer returns to addictive behaviours to cope with anxiety, stress, loneliness and so on.

Intervention is not required at this stage but it may not be possible or realistic for everyone to reach this point.

Question 23

What are the strengths of the application of Prochaska’s model to addictive behaviour?

Answer 23

• this model recognises the nature of addictive behaviour

- the attitude to relapse

Question 24

What are the weaknesses of the application of Prochaska’s model to addictive behaviour?

Answer 24

• contradictory research
• arbitrary nature of the stages
• the model’s lack of predictive validity

Question 25

How does Prochaska's model recognise the nature of addictive behaviour?

Answer 25

Traditional theories have considered recovery from addiction as an 'all-or-nothing' event. However, the six-stage model stresses a dynamic and continuing process and the importance of time. This is why the model proposes that behavioural change occurs through six stages of varying duration for each person and that these stages may not be linear. Therefore, a strength of the model is that it recognises that changing addictive behaviours is a dynamic process.

Question 26

How is Prochaska's attitude to relapse a strength?

Answer 26

DiClimente et al. (2004) suggest that 'relapse is the rule rather than the exception'. The model does not view relapse as a failure, but as an inevitable part of the dynamic process of behaviour change. The model takes relapse seriously and does not underestimate its potential to blow change off course. Changes to behaviour require several attempts to reach the maintenance or termination stages. Therefore, it could be said that this model is more realistic and sympathetic in its assessment of behaviour change than other models.

Question 27

What contradictory research is there for the application of Prochaska's model to addictive behaviour?

Answer 27

Taylor et al. (2006) reviewed available evidence and concluded that stage-based approaches are no more effective than alternatives in treating nicotine addiction. West (2005) is brutal in his assessment of the six-stage model. He concluded that the problems with the model are so serious they should be discarded. So despite optimistic claims made for the model, the overall research picture is negative.

Question 28

What is the arbitrary nature of Prochaska's six-stage model?

Answer 28

Sutton (2001) points out that if an individual plans to stop smoking in 30 days' time they are in the preparation stage, but in the contemplation stage if they plan to give up in 31 days' time. Bandura (1997) claims that the first two stages are not even qualitatively different, because the only difference between them is quantitative (how much a person wants to change). These criticisms challenge the usefulness of the model. Kraft et al. (1999) have even suggested that the stages 2-5 should be grouped together.

Question 29

How does Prochaska's model lack predictive value?

Answer 29

Most research on the model tries to show that the different stages are associated with addiction-related or treatment-seeking behaviours. However, this research has produced mixed findings which suggests the model is not a good predictor of who is likely to make changes. This limits the usefulness of the model and questions the underlying validity.