Biopsychological Treatments for Addictive Behaviours

Question 1

treatments for substance use disorders

Answer 1

• Pharmacological treatments for substance use vary in their mechanism of action, either blocking the effects of the substance on the brain, blocking an enzyme that builds up after consuming the substance (e.g., ALDH) or replacing the substance (e.g., nicotine).
• Pharmacological treatments do not address psychological or social/environmental reasons for substance use
• Opioid use disorders
  
  • Treatments focus on blocking opioid receptors or replace, by prescribing a less addictive opioid, such as naltrexone, or replace the addictive substance (such as methadone)
• Alcohol use disorders
  
  • Treatments like naltrexone block opioid receptors, reducing the release of dopamine, and making alcohol consumption less pleasurable
• Smoking cessation
  Treatment focuses on replacing the nicotine smokers receive from smoking with nicotine delivered in a different form (e.g., nicotine patches or gum, e-cigarettes)

Question 2

social basis for heroin use

Answer 2

• During the Vietnam war, many soldiers became regular users of Heroin.
• Robins et al. (1974) – out of a sample of 450 enlisted men who returned to USA, 43% reported opiate use in Vietnam.
• 8-12 months after returning to USA, 10% reported any level of Heroin use, 1% reported becoming re-addicted.
• Why was there a reduction in heroin use?
  
  • Not due to issues with access – many participants could obtain heroin with ease.
• Instead, participants cited the following reasons:
  
  • Fear of becoming addicted
  • Experiencing adverse health effects
  • Being arrested
  • Disapproval of friends and families
• Other differences:
  
  • Price of drug
  • Purity of drug
  • Social acceptability of drug use
    Smoked rather than injected

Question 3

biological treatments for opioid use

Answer 3

• Opioid antagonists - antagonists (such as Naltrexone) bind to receptors and prevent an agonist (e.g., heroin) from binding to that receptor
  
  • Works by blocking euphoric effects of opioids and suppresses opioid cravings.
  • Often used for those who have already stopped taking the opioid and are no longer dependent on the substance.
• Opioid agonist therapy – treatment which administers a substance to substitute for a stronger agonist opioid (e.g., heroin).
  Works by preventing withdrawal and reduces cravings for opioid drugs.

Question 4

effectiveness of naltrexone as a treatment

Answer 4

• Minozzi et al. (2011) – reviewed 13 studies (N = 1158)
  
  • Compared oral naltrexone vs placebo or no pharmacological treatment.
  • Findings: no significant difference for opioid abstinence.
  • However, issues with the data – only 28% of participants retained in treatment
  • Authors conclude that the available data did not permit an adequate investigation of the efficacy of oral naltrexone.
• What might have lowered retention?
• Form of administration
  
  • Oral naltrexone should be taken 3+ times per week.
• Side effects
  Difficulty sleeping, anxiety, nausea, headaches (among others)

Question 5

treatments for opioid use- opioid agonist theory

Answer 5

• Opioid agonist therapy – treatment which administers a substance to substitute for a stronger agonist opioid (e.g., heroin)
• Two main drugs prescribed for opioid agonist therapy:
  
  • Methadone – synthetic opioid primarily used for treatments of opioid use
    Buprenorphine – strong opioid painkiller (often used for acute and/or chronic pain as well)

Question 6

effectiveness of opioid agonist therapy

Answer 6

• As with heroin, methadone interacts with opioid receptors in the brain
• Mattick et al. (2009) - Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence
• 6 RCTs demonstrated that methadone appeared more effective than non-pharmacological approaches in:
  Retaining patients in treatment and suppressing heroin use (RR = 0.66, 95% CI [0.56 – 0.78).

Question 7

motivational interviewing

Answer 7

• Motivational interviewing – a form of counselling - involves meeting between a client and counsellor.
  
  • The counsellor aims to understand how the client feels about the substance abuse problem – support is given for clients to make their own decisions.
  • Discussion of possible consequences of altering or maintaining behaviour.
  • Discussion of client goals and how far/close client is to obtaining those goals.
• 4 principles of motivational interviewing
  
  • Express empathy – seeing world through client’s eyes
  • Support self-efficacy – client held responsible for carrying out actions to change
  • Roll with resistance – counsellor does not fight client resistance
    Develop discrepancy – perceiving discrepancy between where they are and where they want to be.

Question 8

contingency management

Answer 8

• Individuals are reinforced/rewarded for positive change in behaviour
• Often used in substance use treatments
  
  • E.g., the incorporation of a monetary reinforcers for a negative drug sample
• Recommended by UK National Institute for Health and Clinical Excellence.
  Voucher-based reinforcement therapy (a type of contingency management) shown to be effective in treatment of substance use disorders (Lussier et al., 2006)

Question 9

psychosocial and pharmacological use

Answer 9

• Amato et al. (2011) – reviewed the effectiveness of psychosocial intervention in combination with agonist maintenance treatment vs agonist treatment for opiate dependence.
  
  • Reviewed 35 studies (N = 4319) – included 13 different psychosocial interventions.
  • Findings:
  • No evidence that psychosocial interventions improved:
    ○ Retention in treatment (RR = 1.03, 95% CI [0.98, 1.07])
    ○ Abstinence of opiates (RR = 1.12, 95% CI [0.92, 1.37])
• Rice et al. (2020) – an updated systematic review comparing opioid agonist therapy (OAT) only vs opioid agonist therapy + psychosocial therapy.
  
  • Reviewed 72 RCTs.
  • Key findings:
  • No difference between the two groups for opioid use and opioid abstinence
  • Reward-based interventions (e.g., contingency management) + OAT more effective than OAT alone for treatment retention.
• Why might so many studies show a lack of enhanced effectiveness of psychosocial and pharmacological treatment combined?
• Typically, psychosocial treatments for substance use disorder (including OUD) involves following a therapist manual.
  
  • This can limit the amount of flexibility for tailoring treatments to the patients’ preferences.
• Alternative approach:
• Case-formulation approach
  Involves selection of interventions through discussion with the patient – focuses on identifying cognitive, affective, interpersonal factors which may maintain the disorder.

Question 10

Marsden et al., 2019

Answer 10

• Individuals from the UK who were seeking opioid agonist therapy were recruited and allocated to either the psychosocial intervention group (psychosocial + OAT; N = 136), or the control group (OAT; N = 137)
  
  • Participants in the psychosocial intervention group completed a case formulation with a psychologist.
  • Toolbox of methods: CBT, contingency maintenance, 12-step group facilitation, engagement of partners and/or family members in participants’ treatment.
  • Lasted for 12 weeks.
    Primary outcome: At 18 weeks after condition allocation - treatment response (i.e., no reported use of opioid use in past 28 days, negative urine test over same period)
• PDA = percent days abstinent in last 28 days
• WSAS = work and social adjustment scale
  Psychosocial intervention increased odds of greater PDA and WSAS scores after 18 weeks compared to control group.

Question 11

why do people drink alcohol

Answer 11

• Cox and Klinger (1988) argue that people drink alcohol for various reasons:
  
  • biological (drinking is rewarding),
  • psychological (drinking is enjoyable)
    social/environmental (peer drinking)

Question 12

psychosocial treatments for AUDs

Answer 12

• A range of treatments exist which focus on psychological processes.
• Many overlap with psychosocial treatments of other disorders (such as opioid use disorder)
  
  • Cognitive behavioural therapy
  • Motivational Interviewing
  • Family/social support
  • 12-step intervention programmes (e.g., alcoholics anonymous)
  • Self-help group lead by professional or former alcohol dependent
    Offers a model of abstinence for those recovering from alcohol dependence

Question 13

motivational interviewing and substance use

Answer 13

• Smedslund et al. (2011)
• 59 studies (N = 13,342) – 29 studies measured alcohol abuse
• Compared motivation interviewing to no treatment
• A significant effect on substance use – strongest at post-intervention (immediately after the intervention had finished)
  
  • Significant effect also shown for short- and medium-term follow-up.
    Importantly though, no significant differences shown between motivational interviewing and treatment as usual for substance use disorders.

Question 14

CBT for alcohol and drug disorders

Answer 14

• Magill and Ray (2009)
  
  • Meta-analysis including 53 controlled trials using CBT.
  • Participants were adults diagnosed with alcohol- or illicit-drug-use disorders.
  • CBT shown to produce a small effect (hedges g = 0.154, p <.005)
  • The effect size diminished as follow-up period increased
    ○ 6-9 months follow-up – hedges g = 0.1, p <.005
    ○ 12 months follow-up – hedges g = 0.096, p <.05
    The effect of CBT was greatest when comparison was with a no-treatment control (hedges g = 0.796, p <.005).
• Magill et al. (2019) – examined 30 RCTs, testing the efficacy of cognitive-behavioural therapy on alcohol-use and substance-use disorders.
• CBT vs minimal therapy
  
  • Showed moderate and significant effect size
• CBT vs non-specific therapy/treatment
  
  • Showed effect for consumption frequency and quantity at early follow-up (but not late follow-up).
• CBT vs specific therapy (e.g., motivational interview, contingency management)
  
  • Nonsignificant difference across outcomes and follow-up time points.
    Conclusion – CBT more effective than no treatment, minimal treatment, or non-specific control, but not specific therapy.

Question 15

self help groups

Answer 15

• Self-help treatments include alcoholics anonymous
• Involves group meetings
• Ferri et al. (2006) – investigated the effectiveness of alcoholics anonymous and other 12-step programs on changes in alcohol-related outcomes compared with other psychosocial interventions
  
  • 8 trials (N = 3417)
    Shown to have similar effectiveness of reducing drinking measures compared with other psychosocial interventions.

Question 16

comparison of psychosocial treatments on alcohol related outcomes

Answer 16

• Klimas et al. (2018) findings
  
  • CBT vs twelve-step program
    ○ No difference in alcohol abstinence between conditions after one year.
  • Motivational interviewing versus treatment as usual
    ○ No difference in alcohol use between groups
  • Brief motivational interviewing versus assessment only
    ○ More participants in the motivational interviewing group reduced alcohol use than in the control group.
  • Intensive motivational interview vs motivational interviewing
    No difference between groups in alcohol use

Question 17

biological basis of treatments for AUDs

Answer 17

• Because alcohol affects multiple aspects of brain activity, treatments have been developed that work in different ways:
• Blocking the opioid receptor system (Naltrexone)
  Pairing drinking with negative biological effects (Disulfiram)

Question 18

effectiveness of naltrexone

Answer 18

Rosner et al. (2010)
- Rosner et al. (2010) reviewed 50 RCTs with 7793 patients. Naltrexone reduced the risk of heavy drinking to 83% of the risk in placebo (Risk Ratio = 0.83; CI[0.76;0.90])
- The authors conclude that although small treatment effects, these should be valued against the relapsing nature of alcoholism

Question 19

effectiveness of pharmacotherapy and CBT

Answer 19

• Ray et al. (2020):
• Meta-analysis – included 30 studies (15 studies focused on alcohol use disorder)
  
  • Combined cognitive behavioural therapy and pharmacotherapy was associated with increased benefit versus usual care and pharmacotherapy (hedge’s g ranging from 0.18 – 0.28).
  • Effect size was greater when looking only at alcohol use disorder.
    CBT alone did not perform better when compared with a specific therapy

Question 20

disulfiram for AUD treatment

Answer 20

• Disulfiram blocks the enzyme aldehyde dehydrogenase (ALDH)
• When a patient who has taken Disulfiram has an alcoholic drink there is a build up of acetaldehyde which leads to a Disulfiram ethanol reaction (DER)…
• Nausea
• Vomiting
• Tachycardia (increased heart rate)
  Dizziness

Question 21

how does disulfiram reduce drinking?

Answer 21

• Knowing that drinking leads to unpleasant effects quickly—because Disulfiram blocks the liver’s ability to break down the ALDH into acetaldehyde—changes patients’ beliefs about the effects of alcohol…
  Disulfiram combines a biological mechanism of action with a psychological mechanism of action

Question 22

effectiveness of disulfiram

Answer 22

• Skinner et al. (2014)’s systematic review compared the efficacy of Disulfiram to various control groups.
• They included 22 trials (N = 2414) patients
• Patients given disulfiram did better than control groups on a range of outcomes
• Skinner et al. also tested :
  
  • The effect of being supervised when taking disulfiram
    The effect of knowing you are receiving disulfiram (open label) compared to being blind to condition on treatment effectiveness

Question 23

supervised vs unsupervised treatments

Answer 23

• In 12 studies, patients were supervised when taking Disulfiram by either a family member, friend or clinic staff; in 8 studies there was no supervision
• Supervised treatment had a significant effect on outcomes
  Unsupervised treatment did not have a significant effect on outcomes

Question 24

blind vs open label designs

Answer 24

• In most RCTs, we want patients to be blind to condition, because if they know what condition they are in there could be demand characteristics (performance bias)
• However, because Disulfiram has its effects by creating negative beliefs about taking the treatment, unless patients know that they are taking it, there may be no effect!
• Blind design (K = 7) = patients don’t know they are on Disulfiram
• Open label design (K = 15) = patients know they are on Disulfiram
• For blind designs, there was no difference in outcome between the Disulfiram groups and control groups
  For open label designs, there was a difference between the Disulfiram groups and control groups

Question 25

how safe is disulfiram

Answer 25

• Skinner et al. found that while patients taking Disulfiram were more likely to suffer adverse events overall there was no difference in the mortality rate between patients taking Disulfiram and patients in the control groups
  Overall, Skinner et al. state that they view Disulfiram as fairly safe, although, if you remember the video on Disulfiram you will know that there are lots of potential side effects.

Question 26

pharmacological treatments for AUDs- blocking the substances effects

Answer 26

• Pharmacological Treatments for alcohol use disorders block the effects of alcohol on the body: naltrexone blocks alcohol’s effects on the opioid system; disulfiram blocks the enzyme ALDH
• However, there are also psychological, social/environmental reasons for why people drink; this explains why pharmacological treatments have a small effect at reducing drinking.
  Disulfiram works psychologically as well as biologically; unless patients know they are taking disulfiram it does not work

Question 27

why do people smoke

Answer 27

• Shahab & West (2010) argue that people smoke for various reasons:
• biological (nicotine is rewarding),
• psychological (smoking is enjoyable)
  social/environmental (peer smoking)

Question 28

decreasing rates of smoking- example of changing the environment

Answer 28

• Smoking ban introduced in England in July 2007
  
  • Prohibited smoking in workplaces and enclosed public places
• The ban had a positive impact on health due to reduced exposure to second-hand smoke
• It also reduced levels of tobacco consumption and increased quitting of smoking (Hackshaw et al., 2010; Hargreaves et al., 2010)
• Hackshaw et al. (2010) – smoking quit attempts greater in July 2007 (8.6%) compared with one year later (5.7%)
  
  • Increase in quitting behaviour shown in this study equivalent to over 300,000 additional smokers in England attempting to quit.
• Hargreaves et al. (2010) – reasons for reduction in consumption:
  
  • Inconvenience of going outdoors to smoke
    Concerns of experiencing disapproval if seen smoking.

Question 29

why is it hard to quit smoking?

Answer 29

• Inhaling nicotine is associated with dopamine release, which is reinforcing
• Over time nicotine receptors attach themselves to neurons in the brain, leading smokers to crave nicotine to promote dopamine release
  Quitting smoking is hard because smoking stimulates dopamine release, which is rewarding

Question 30

NHS stop smoking services

Answer 30

• Most smokers want to quit, however, when they try to quit find they relapse and take up smoking again, for the reasons we just discussed.
• This does not stop smokers from trying to quit without support
• It has been claimed that only 5% of quit attempts without support lead to long term smoking cessation, hence the need for products that can boost successful quitting attempts.
• NHS Stop Smoking Services comprises several elements designed to support smokers to quit:
• Smoking cessation medications: Nicotine replacement therapy, bupropion, varenicline
  Group or one-to-one meetings with a stop smoking advisor

Question 31

how effective are NHS stop smoking services?

Answer 31

• Bauld et al. (2009) reviewed 20 studies that tested the effectiveness of NHS stop smoking services
• They found a quit rate of 53% at four weeks…
• …which dropped to 15% at 1 year
  While this is a dramatic fall over time, it is estimated that quitting without support only leads to 5% success!

Question 32

nicotine replacement therapy

Answer 32

• Nicotine Replacement Therapy (NRT) is used to help smoking cessation – replaces the nicotine inhaled from cigarettes
• NRT products were first licensed in the USA in 1984
• Hartmann-Boyce et al.’s (2018) Cochrane review of RCTs analysed 133 studies (N = 64,640) to compare quitting among groups receiving any form of NRT (gum, patches etc.) with non-NRT control group.
• They estimated that the Risk Ratio (RR) of quitting for any form of NRT, relative to control, was 1.55 [1.49;1.61]
• This means that smokers using NRT have a 55% higher chance of quitting relative to smokers not given NRT
  Prescriptions are declining

Question 33

side effects of gum

Answer 33

• Nausea
  
  • Hiccups
    Irritation of the mouth

Question 34

side effects of the patch

Answer 34

• Skin irritation
  
  • Dry mouth
    ‘Weird’ dreams

Question 35

why is NRT unpopular? patient beliefs

Answer 35

• Vogt et al. (2008) Study 1 reported interviews with 27 smokers (9 men; 18 women; M age = 46) about NRT.
• Vogt et al. (2008) Study 1 found that patients believed there were several barriers to accessing NRT
  
  • NRT perceived to be expensive (not all patients were aware that NRT is available on prescription)
  • Patients were concerned about how long it would take to make a GP appointment to get a prescription
  • Others believed they would be wasting time waiting around for GP appointments.
• Vogt et al. (2008) Study 1 found that patients associated taking NRT with the following side effects:
  
  • Skin reactions
  • Feeling unwell
  • Mouth pain
  • Bad taste
  • Bad dreams
• Some patients believed taking NRT would be like swapping addiction to cigarettes smoking to addiction to NRT
• Some patients viewed quitting using NRT as admitting to being ‘weak-willed’, and quitting in this way would diminish the achievement
• Vogt et al. (2008) Study 1 reported that patients were unsure NRT would stop them craving cigarettes
  
  • “I am slightly unsure [NRT] would actually work…because I know people who had nicotine patches but then have gone back to smoking because…it has not stopped the cravings”
  • They also found that patients were certain NRT would not address psychological reasons for smoking cigarettes
    “It [NRT] would cut down the craving…but other times out of boredom or stress…when you want to do something with your hands…I can’t see it helping”

Question 36

can e-cigs help stop people smoking?

Answer 36

• Electronic cigarettes (E-cigarettes)
• Nicotine is inhaled in a vapour instead of smoke
• Use of E-cigarettes do not burn tobacco – users are not exposed to same number of disease-causing chemicals vs conventional smoking.
• Colloquially referred to as ‘vaping’
• Hartmann-Boyce et al. (2022) – investigated the effectiveness of E-cigarettes for smoking cessation.
• Reviewed 78 studies (N = 22,052)
  
  • Findings: In RCTs, there was high certainty that those randomised to nicotine e-cigarettes had higher quit rates vs those randomised to NRT (RR = 1.63, 95% CI [1.30, 2.04])
    ○ Equivalent to additional 4 quitters per 100.
    ○ Moderate certainty that there was no evidence in adverse effects between two groups.
  • Findings: behavioural support only/no support vs nicotine e-cigarettes resulted in higher quit rates in the e-cigarette condition (RR = 2.66, 95% CI [1.52, 4.65])
    ○ Some evidence that non-serious adverse effect more common for nicotine e-cigarettes.
    Most commonly reported adverse effects of e-cigarettes were: throat/mouth irritation, headaches, cough, nausea – although these often dissipated with continued use.

Question 37

how safe are e cigarettes

Answer 37

• Taken from the World Health Organisation Website:
• “There are many different types of e-cigarettes in use, also known as electronic nicotine delivery systems (ENDS) and sometimes electronic non-nicotine delivery systems (ENNDS). These systems heat a liquid to create aerosols that are inhaled by the user. These so-called e-liquids may or may not contain nicotine (but not tobacco) but also typically contain additives, flavours and chemicals that can be toxic to people’s health.”
  Marques et al. (2021) – review of the impact of e-cigarettes on health (see lecture slide notes or reference list)

Question 38

group counselling vs self help- smoking cessation

Answer 38

• Group counselling may offer the following benefits:
  
  • Social learning: sharing knowledge and skills about different behavioural techniques
  • Opportunity to share problems/experiences with others attempting to quit.
  • Providing mutual support
• Bauld et al. (2009) on group vs. 1-to-1 counselling
• Included in Bauld et al.’s (2009) where two studies that compared group vs 1-to-1 counselling
• Judge et al. (2005) found smokers who received group counselling more likely to quit (OR = 1.38; CI [1.09;1.76])
• McEwan et al. (2006) found that 30% of clients receiving group treatment vs. 19% of clients receiving 1-to-1 treatment were abstinent at 4 weeks
• Bauld et al. note that group sessions are not attractive for many smokers and may not be feasible to deliver in rural areas.
• Stead et al. (2017) review of group vs. self-help
  
  • Stead et al.’s (2017) Cochrane review compared group therapy with (1) self-help, (2) brief support from a healthcare professional and (3) individual counselling,
  • Outcome was abstinence at 6 months
  • 13 trials (N = 4395) compared group programmes to self-help (Risk Ratio = 1.88; CI [1.52;2.33])
  • Smokers who received group therapy were 88% more likely to be abstinent at 6 months than those who used self-help
• Stead et al. (2017) review of group vs. 1-to-1 counselling
  
  • 14 trials (N = 7286) compared group programmes to brief support from a healthcare provider (Risk Ratio = 1.22; CI [1.03;1.43])
  • Smokers who received group therapy were 22% more likely to be abstinent than those receiving brief support from HCP
  • 6 trials (N = 980) compared group programmes to intensive individual counselling (Risk Ratio = 0.99; CI [0.76;1.28])
  • No difference between group and intensive individual counselling
• Conclusion of Stead et al. (2017)
  
  • Behaviour therapy programme delivered in group aids smoking cessation.
    Effect strongest when comparing group therapy vs individual self-help programme.

Question 39

pharmacological treatment for smoking cessation- replacing the substance

Answer 39

• Pharmacological treatments for smoking cessation have a clear mechanism of action à NRT replaces the nicotine that smokers get from smoking cigarettes
• However, there are also psychological, social/environmental reasons for why smokers smoke; reviews show the effectiveness of pharmacological treatments is increased when delivered in combination with counselling
  Stead et al. (2017) show that group counselling significantly increased abstinence rates relative to trying to quit alone.

Question 40

conclusion

Answer 40

• Treatments for substance use vary in their biological mechanism of action, either blocking the effects of the substance on the brain (e.g., dopamine release), blocking an enzyme that builds up after consuming the substance (e.g., ALDH), or replacing the substance (e.g., nicotine).
• Addressing biological underpinnings of substance use is only part of the solution – need to recognize the psychological and social/environmental reasons for substance use as well.

Question 41

substance use and stigma

Answer 41

• Substance use disorder is a very heavily stigmatised health condition
• Dyregov and Burland-Selseng (2020) - Individuals with a substance use disorder are commonly viewed as:
  
  • Dangerous
  • Unpredictable
  • Helpless
  • Non-human
    Compared with a person who has a mental disorder unrelated to substance use, those with alcohol use disorder perceived as more dangerous and more responsible for their condition (Kilian et al., 2021)

Question 42

public stigma and self stigma

Answer 42

• Public stigma – defined as negative beliefs/attitudes held by the public against a specific group, leading to discrimination of that group.
• Public stigma can cause self-stigma for individuals who have a substance use disorder (Maurage et al., 2012), leading to feelings of:
  
  • Marginalisation
  • Social exclusion
  • Affecting attempts to change consumption levels
• Healthcare professionals can show stigmatising attitudes towards individuals seeking treatment support (Janulis et al., 2013) which can lead to
  
  • Suboptimal care
    Less efficacious treatment

Question 43

what are the factors which may affect perceptions of substance use

Answer 43

• Previous research has focused on how the labelling of substance misuse (e.g., brain disease, problem) can affect public stigma
• Different labels relate to different aetiological perspectives of addiction
• For example, biological explanations (or labels) of addiction vs a non-biological label of addiction
  This relates to the brain disease model of addiction

Question 44

brain disease model recap

Answer 44

• Brain adaptations form the basis of addiction
• Several key brain regions show adaptations following (chronic) drug use. These are
  what makes treatment, and achieving and maintaining abstinence so hard.
• These neuro-adaptations underlie behavioural effects (‘wanting’)
  A biological model of addiction may imply that the disorder is largely outside of the individuals control.

Question 45

biogenetic explanations and stigma

Answer 45

• Disorders classified by their biological causes
• The models explanation has led to an Increase in psychopharmacological treatment
• This change has affected how the average person thinks about abnormalities.
• Kvaale et al. (2013) – meta-analysis investigating link between biogenetic explanations of different disorders and stigma
  
  • Correlational and experimental studies showed that biogenetic explanations were associated with:
  • Reduction in tendency to blame an individual for their disorder
  • Increased tendency to perceive this individual as dangerous and unpredictable.
  • Greater desire for social distance
  • Greater prognostic pessimism

Question 46

how can manipulation of labels and stigma be measured?

Answer 46

Often, a vignette methodology is used – a description of an individual is presented. Certain details of the vignette are manipulated.

Question 47

Evidence of mixed blessing model in substabce use disorders- Kelly et al (2021)

Answer 47

• N = 3635
• Presented with one of twelve vignettes
  
  • Describing a man or woman being treated for opioid-dependence
  • Man or woman is currently receiving treatment
  • Vignette manipulated in terms of label and sex of the person in the vignette.
  • Label conditions:
    § ‘A chronically relapsing brain disease’, ‘a brain disease’, ‘a disease’, ‘an illness’, ‘a disorder’, ‘a problem’
  • Label conditions:
    § Male or female
    Same gender-neutral name used across all vignettes – ‘Alex’
• Blame attribution lower in ‘chronically relapsing brain disease’ condition compared to all others.
• Prognostic optimism greater in the ‘problem’ label condition
  These findings suggest that there may not be one term/label which can reduce all forms of stigma

Question 48

Evidence of mixed blessing model in substance use disorders- Rundle et al.(2021)

Answer 48

• Rundle et al (2021) – investigated whether public stigma differs between alcohol use disorder and other health conditions
  
  • Alcohol use disorder (AUD)
  • Major depressive disorder (MDD)
  • Co-occurring AUD and MDD
  • Diabetes
  • Also looked at whether people’s beliefs of the cause of addiction moderates this effect.
• Vignette
  
  • For the past several months, John/Jane has been suffering from tiredness, low energy and difficulty carrying out his daily routines. Several times, he/she has tried to motivate himself/herself but continues to have difficulty keeping up with his/her work and family obligations. Recently, the only thing that has John/Jane feel better is drinking alcohol. John’s/Jane’s wife/husband has noticed his/her behaviour becoming worse over the last few months and urges him/her to go to a doctor. At his/her doctor’s visit, John/Jane is diagnosed with an alcohol use disorder (a dependence on alcohol). The doctor tells John/Jane that this is potentially a long-term condition that could get worse over time, but that John’s/Jane’s condition could also improve if he/her starts treatment now.
• Personal and Perceived Public Stigma Measure
  
  • Measures public stigma, consisting of four subscales:
  • Perceived public stigma – belief that an individual should be embarrassed about their condition, whether an individual should be accepted into a community.
  • Perceived treatment stigma – belief that treatment would increase stigma within an individual
  • Personal stereotypical stigma – stereotypical behaviour of an individual (greater violence, lower intelligence, less trustworthy)
    Personal discriminatory stigma – willingness to socialise/interact with an individual
• Public stigma highest for diagnosis of AUD, followed by AUD/MDD
• Endorsement of psychological model and nature model of addiction associated with lower levels of public stigma
• Endorsement of moral model was related to greater levels of public stigma
• However, and against the authors prediction, endorsement of disease model wasn’t associated with public stigma.
  This does not support the mixed-blessing model

Question 49

differences between Kelly and Rundle

Answer 49

• First difference: manipulation of aetiological labels with the vignette.
  
  • Kelly et al – manipulated labels to describe SUD (e.g., disease, problem, etc)
  • Rundle et al – no aetiological label manipulation. Instead, participants model of addiction beliefs were recorded.
  • Providing a clear explanation of the aetiology (as in Kelly et al.) may directly influence perceptions of stigma
• Second difference: differences in treatment seeking/outcome
  
  • Kelly et al. – person described as high likelihood of success following treatment (high treatment stability)
  • “Alex is committed to doing all that they can to ensure success following treatment”
  • Rundle et al. – person described as seeking treatment with variable likelihood of success (low treatment stability).
  • “The doctor tells John/Jane that this is potentially a long-term condition that could get worse over time, but that John’s/Jane’s condition could also improve if he/her starts treatment now”
    Someone who has high likelihood of success in treatment may be perceived as having greater volitional control (i.e., being able to change through their own will). This may affect stigma levels.