Psychological Treatments Flashcards
Aims
Mitigating barriers eg craving. Increasing control and reducing stress. Deal with trauma and underlying issues. Provide alternatives and environments, rewards and incentives for abstinence.
COM-B
Michie, stralen and West
Capability, motivation and opportunity. All interact to lead to behaviour, need all three for behaviour to change. Motivation can be reflective or automatic, capability is psychological or physical, opportunity is physical or social
CBT
Explores consequence of drug use, teaches cognitive strategies to recognise cravings address psyc C and M. Very effective but very rigid don’t address underlying issues. Needs a clinical practioner and lots of time. Lack of funding means a long wait which can demotivate.
Magill 2013
Meta of 53 studies. CBT with alcohol and drug disorders. When combined with other psyc support is better then when is combined with pharmacological.
Contingency management
Uses operant conditioning. gives addicts a tangible reward to reinforce positive behaviour, often biochemically clarified with a drugs test
Value of reward increases with the number of consecutive drug free samples.
Very very effective as replace drug reward.
Cessation for pregnant smokers
11% are smokers at delivery in the UK. Cochrane review of 9 trials. CM was very very effective, it had a huge success rate. 2.8x more likely to quit. Compared to psyc interventions and OST har higher adherence, abstinence and use of medications.
Brief advice
Proactively raise awareness and assess willingness to discuss lifestyle. Used opportunistically in medical settings. Often used for smoking by GPs. Targets so many people’s it is effective even thought it’s not very successful on an individual level.
Karner (2009)
BA/alcohol interventions in primary care. Most effective for least dependant and those seeking treatment. Reduced intake by 6 units per week after BA.
Mutual aid
Social, emotional and informational support provided by and to a group of addicts at every stage of recovery. Most well-known treatment. Recommended by UK gov despite no scientific evidence.
12 steps of AA
Admit are powerless Believe a higher power can help recovery Give lives to higher power Searching and moral inventory of self. Admit nature of wrongs Be ready to have god remove all defects Ask him to remove shortcomings List people harmed Make amends Make direct amends Continued personal inventory and admit wrongs Improve contact with higher power Spiritual awakening
Mechanisms of change of AA
1-3 demoralisation and abstinence
4-9 remediation and sobriety
10-12 rehab and sobriety
Addresses lots of mechanisms of action from COM-B
Evaluation of AA
No more or less effective than other treatments.
Spiritual focus
Claims addiction is a disease but also a moral failing.
Highly variable between groups
Rejects moderation and OST
Treatment without addiction
600,000 dependant drinkers, 81% don’t access treatment. 24% of adults drink over low risk guidelines. Alcohol is a causal factor in over 60 medical conditions. Misuse is biggest factor in morbidity and mortality age 15-49
Drink less app
Involves goal setting, normative feedback, cognitive bias retraining, self monitoring, feedback, action planning and identity change. Targets capability, motivation and opportunity.
Issues with heterogeneity
Causes and symptoms of dependence differ no consensus on nature, goals and effectiveness of treatments. Most countries have a mix of services to meet diverse needs but may be an issue as spread too thin for any to be effective.
