Reducing Addiction

Question 1

How is Drug Therapy used?

Answer 1

Drugs are used to treat various addictions such as smoking, drinking and heroin abuse. More recently, they have also been used to treat sex and gambling addictions.

Question 2

What is drug therapy for nicotine A

Answer 2

Nicotine Replacement Therapy (NRT)

agonist substiution

Question 3

What is the aim for NRT?

Answer 3

to provide less harmful source of nicotine eg patches, gum , nasal spray rather than cigarette 🚬

Question 4

How does NRT work?

Answer 4

1. stimulates nicotine receptors + activates brains reward pathway
2. releasing dopamine into mesolimibic system
3. stimulating nucleus accumbens creating same pleasurable feeling as smoking 🚬 does
4. Leads to reduction in nicotine withdrawal symptoms and stops cravings
5. reduction in w drawal symptoms eg of negative reinforcement as NRT removes unpleasant consequences of quitting smoking

Question 5

How does NRT desensitise nicotine receptors

Answer 5

1. releases small amounts of nicotine so only some receptors are full w nicotine but not all
2. overtime amount of nicotine receptors reduce meaning cigs less rewarding to smoke = relapse less likely to occur
3. Addict gradually reduce dosage of nicotine tolerance as their tolerance to nicotine is reduced

Question 6

What drug therapy is used for gambling A ?

Answer 6

• No specific drug treatment for gambling has been approved in the UK. There is ongoing R into several candidates the most promising being an opiod antagonist such as naltrexone, which is conventionally used to treat heroin addiction.

This has come about because of the similarities between gambling addictions and substance addictions.

Question 7

What is the aim for opiod antagonist?

Answer 7

Reduce the pleasurable feeling associated with gambling.

Question 8

How does opiod antagonist (naltrexone) work?

Answer 8

enhance the the release of the neurotransmitter GABA in the mesolimbic pathway.

The increased GABA activity reduces the release of dopamine in the nucleus accumbens (and ultimately pre-frontal cortex. Some research (e.g. Kim et al) has linked this with reductions in gambling behaviour.

Question 9

Whats RTS for NRT

Answer 9

P - Stead RTS effectiveness of NRT

E - reviewed 150 high quality R studies that compared use of NRT w placebo

E - all forms of NRT sig more effective in helping smokers quit than placebos and no treatment at all

L - ✅ drug therapy as way reducing A found to be v effective

Question 10

Whats Limitation for both NRT and Opiod antagonists

Answer 10

P - Side effects

E - common side effects include sleep disturbance, stomach problems dizziness and headaches unlike CBT which is non invasive challenge irrational thoughts lead to A

L - side effects may cause I to relapse of symptoms therefore drug therapy wud be ineffective at reducing I’s A

Question 11

What is a Strength of Drug therapy

Answer 11

P - req little motivation and commitment

E - patient just had to wear patch/chew gum in order to reduce A

E - unlike CBT reqs more effort attend sessions over time and do hwk must be motivated to quit

L - drug therapy seen to be more appropriate reducing A than others such as CBT

Question 12

What is behavioural interventions

Answer 12

include aversion therapy and covert sensitisation. Both work on the principles of CC and aim to replace the pleasurable association with the addictive substance/behaviour with an unpleasant association. (Counterconditioning) 😍 > 😥

Question 13

What is the aim for aversion therapy

Answer 13

The idea of the therapy is to use the principles of classical conditioning in order to change the pleasurable association with the addictive substance/behaviour and replace it with an unpleasant association in a vivo experience.

Question 14

How does aversion therapy work for nicotine addiction?

Answer 14

One specific technique used is ‘Rapid Smoking.’

Individuals will sit alone in a room taking a puff of a 🚬 every 6 secs they will begin to feel nauseous and sick 🤢 and start to associate this feeling to smoking (principles of CC). This is repeated until the individual develops an aversion to smoking, thus reducing their addiction.

Question 15

How does Aversion Therapy Work for Gambling A

Answer 15

Electric shocks have been used for some behavioural addictions such as gambling.

shocks used do not cause permanent damage, but they are meant to avert people from gambling and therefore do cause pain 🤬 (they are pre-selected by participants at the start of treatment). The addicted gambler thinks of phrases that relate to his or her gambling behaviour and write them down on cards, for example ‘lottery’, ‘casino’ Some non-gambling behaviours are also included e.g. ‘went straight home’. The participant is asked to read out each card and when they get to a gambling related phrase they are given a two second electric shock. ⚡️The participant should then associate (CC) gambling with the painful shock, rather than pleasure and develop an aversion to gambling, reducing their addiction.

Question 16

How does Aversion Therapy Work for Alcohol Addiction ?

Answer 16

A client is given an aversive drug such as disulfiram (Antabuse).

This interferes with the bodily process of metabolising alcohol into harmless chemicals. This means a person who drinks alcohol whilst taking disulfiram will experience severe nausea and vomiting.

The aim of this is for the individual to associate the 🍷 with the nausea and develop an aversion to drinking alcohol as it would cause a conditioned response of nausea, reducing their addiction.

Question 17

What is the aim for covert sensitastion

Answer 17

The idea of the therapy is that the pleasurable association with the addictive substance/behaviour has to be broken down and replaced with an unpleasant association in
a vitro expertence.

Question 18

How does Covert Sensitastion work for Nicotine Addiction?

Answer 18

Client is encouraged to relax.

Therapist then reads from a script asking the client to imagine an aversive situation. eg the client may imagine themself smoking a cigarette followed by the most unpleasant consequences e.g. the experience of 🤢or imagine themselves smoking a cigarette covered in 💩The more vivid the Imaginary scene is the better the treatment works.

the therapist will go into graphic detail about certain elements of the scene (smell, sounds, physical movements).
Towards the end of the session, the client imagines turning their back on the addiction and experience the resulting feelings of relief
The participant should then associate the addiction with the unpleasant scenario, rather than pleasure, reducing their addiction.

Question 19

Give RTS for effectiveness of behavioural interventions

Answer 19

P - McConagehy

E - compred ⚡️aversion therapy w CS in treating gambling A

E - found that 1 yr follow up those who received CS sig more likely to ⬇️ gambling activities

L - suggest CS>Aversion therapy more effective to treating gambling A

Question 20

Whats a strength of CS

Answer 20

P - suitable for most I non invasive treatment

E - I pregnant 🤰 CS unlikely harm foetus

E - unlike aversion therapy as stress + pain can lead to - + emotional effects on baby

L - CS more appropriate compared to AT

Question 21

Whats a weakness of CT and AT

Answer 21

P - req motivation and commitment from patient

E - patient has to commit to attending sessions and work w therapist to unlearn A bh whilst placing themselves in adversive sits such as feeling 🤢 or recieving ⚡️

E - unlike drug therapy which res less comitmwnt only take one tablet

L - I drop out ⬇️ effectiveness

Question 22

What is the aim of CBT

Answer 22

To identify and challenge cognitive distortions that are causing an A as a way of coping and replace with more adaptive ways of thinking via cognitive restructuring

Question 23

What is the first stage of CBT

Answer 23

• functional analysis

therapist ask client to identify high risk situations/triggers to their A

eg 🚶‍♂️past betting shop ask them to report what they are 🤔 during and acter the A

rs is critical shud be warm and responsive but not cosy

therapist must challege clinets biased cognitions not merely accept them

Question 24

What is the second stage for cognitive CBT?

Answer 24

• cognitive restructuring

after analysis cognitive restructuring (disputing) used to challenge irrational/maladaptive thoughts 💭 into rational/adaptive ones

eg I has A to gambling have irrational beliefs that they win more than they lose (selective recall) 🏆>❌

> challenged by empirical disputing eg
‘where is evidence that u 🏆>❌?’

Question 25

What is third stage of Behavioural CBT?

Answer 25

• Social Skills

Moreover, the addicted person will be taught social skills, eg an I will learn how to refuse the addictive behaviour gambling/substance without embarrassment and fuss in social situations.

This is done by the therapist teaching the patient how to act within a social situation, eg making 👀contact and being firm in the refusal to gamble, in a safe and secure environment (role play).

Moreover, the client would be taught avoidance strategies, where the client would learn to avoid situations that are likely to produce addictive behaviours (high risk situations identified in functional analysis) i.e. driving a different way home to avoid driving past a betting shop. 🚗🏠

Question 26

What is the final stage for behavioural CBT

Answer 26

• Homework

patient practices social skills within real world 🌍 on their own + reports back to therapist until they feel confident within social situations where addictive bh/substance is available

> leads to relapse prevention

Question 27

Give a Strength into CBT reducing Addiction

Answer 27

P - sutiable for all I as it is a non invasive treatment

E - I is pregnant CBT unlikely to harm foetus unlike drug therapy where chemicals within drug such as nic in NRT may cause physcial damage to 👶

L - CBT more appropriate treatment for depression as not limiting to who can take part in sessions

Question 28

Give a weakness of CBT reduce Addition

Answer 28

P - reqs motivation from patient

E - patient has to attend sessions over months

E - challenge irrational A and turn into rational thoughts and turn into avoidance strategies
unlike drug therapy where patient takes tablet/nicotine patch/gum to reduce A

L - CBT less apro treatment for reducing A than others such as drug therapy as patients drop out treatment and therefore relapse

Question 29

Give another strength of CBT reducing A

Answer 29

P - uses a wide variety of techniques to reduce addictions.

E - Some of these can be combined with other treatments such as drug therapies.

E - In recent years CBT has expanded its delivery methods and can now be conducted online or telephone support without the physical presence of a therapist.

E - This allows the treatment to be readily available from an I own home, reducing amount of motivation required by each individual.

L - This makes CBT an effective intervention in reducing A for all individuals no matter what their circumstances and severity of their addiction.