Reducing Addiction Flashcards
What are the different types of treatments for addiction???
- drug therapy
- aversion therapy
- covert sensitisation
- CBT
What does drug therapy assume??
If we work on the assumption that addiction may have a biological cause, then a natural extension of this is to assume that biological treatments may be effective in reducing addictive behaviours.
What can we treat with drug therapy and how??
Whilst drug therapies may sometimes be used to treat gambling addiction, this is not common and there is limited research to support its use so we will not consider them here.
Instead, we will look at 2 different types of drug therapy to treat smoking addiction:
Agonist substitution – Nicotine Replacement Therapy
Antagonist – Bupropion
Before we can look at each of these, we need to understand what the terms AGONIST and ANTAGONIST mean, given that these terms link directly to each of the drug therapies.
Explain nicotine replacement therapy??
For drug therapy
This therapy works by delivering therapeutic doses of nicotine (without the undesirable parts of tobacco) in the early stages of stopping smoking. This release of nicotine is absorbed much more slowly and steadily than in tobacco.
NRT can come in many forms that include: Research and add to booklet
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However, _____________________ can be seen as the most effective as they also resemble the activity of smoking like handling and inhaling
- Nicotine replacement therapy works by releasing a clean controlled dose of nicotine into bloodstream
- Nicotine binds to nicotine acetylcholine receptors in the Mesolithic pathway simulating the release of dopamine
- Using NRT means that the amount of nicotine can be gradually reduced over time reducing the severity of withdrawal symptoms
Explain bupropion mode of action??
For drug therapy
Meta-analyses of research suggest that this antidepressant drug can be an effective treatment in smoking cessation
Bupropion MODE OF ACTION:
Bupropion appears to be an antagonist at nicotinic receptors and may work – in part - by blocking nicotine effects so there is no rise in dopamine levels when you smoke a cigarette.
In addition, Bupropion is also a weak inhibitor of dopamine and noradrenaline reuptake, which leads to an overall increase in dopamine whilst taking the drug This may help to relieve withdrawal symptoms and/or reduce depressed mood which could help reduce the chances of relapse.
The treatment generally lasts 7 to 12 weeks with a week of treatment before the smoker attempts to stop smoking.
What is an agonist and antagonist drugs?? For drug therapy
- Agonist :
Agonists INITIATE a physiological response by binding to neuron receptor sites and ACTIVATING them.
In terms of drug treatments for addiction, agonist drugs act as a REPLACEMENT for the addictive drug and PRODUCE A SIMILAR EFFECT to the drug itself.
Examples include METHODONE to treat heroin addiction and NICOTINE REPLACEMENT to treat smoking addiction.
- Antagonist:
Antagonists INHIBIT a physiological response by binding to neuron receptor sites and BLOCKING them.
In terms of drug treatments for addiction, antagonist drugs act as an OBSTRUCTION for the addictive drug and PREVENT IT FROM CAUSING ITS USUAL EFFECT.
Examples include NALTREXONE – an opiate antagonist used to treat heroin addiction and BUPROPRION to treat smoking addiction.
What are the positive evaluations of drug therapy??
- There is evidence to support the long term effectiveness of Bupropion in smoking cessation.
Hughes et al (2014) carried out a meta- analysis that included 44 trials of Bupropion as the sole treatment for smoking addiction and found that those taking the drug had significantly higher chance of a quit attempt being successful after at least six months compared to control groups.
This implies that the use of drug therapy can help people QUIT smoking, reducing the strain on the NHS by reducing health related illnesses. - In addition NRT has massive economic benefits as well. For example, by reducing the number of people who smoke will mean there are less people suffering from smoking related disorders. Therefore if less of the population suffer from smoking related disorders, it will mean less strain on the NHS.
To elaborate, economically, this means there will be more money available within the NHS if less people are using if for diseases which could be avoided by quitting smoking.
What are the negative evaluations for drug therapy??
- However, there are clearly ethical problems with drug therapy in the form of side effects.
NRT can have side effects such as headaches, dizziness, nausea and vomiting. Some patients may find these side effects difficult to deal with and therefore stop taking it, reducing its effectiveness.
This means NRT may not be an ideal treatment, particularly for people who suffer from severe side effects. - BUT does drug therapy really helping smokers to quit?
In NRT, nicotine is still released into the body, which increases heart rate, constricts blood vessels, temporarily raises blood pressure and can lead to reproductive disorders, as well as potential complications with pregnancies. In this way, particularly if an individual stays on NRT therapy for a long time rather than gradually weaning themselves off, it may be a case of replacing one addiction for another (much like heroin being swapped for methadone)
This implies that the therapy may not be helping the individual to actually quit their addictive substance completely.
What is aversion therapy??
Give an example
Works on the principle of ‘what can be learnt can be unlearnt’. In this case, this process is done through counterconditioning.
Instead of the drug being associated with a pleasant feeling, it is slowly conditioned to be associated with a universally unpleasant sensation (e.g. vomiting).
Alcohol
The user takes the emetic, waits about 10 minutes, drinks alcohol and is subsequently sick. Treatments continues several times until an association may be made.
Another approach is for the user to take the drug Antabuse, which results in immediately being sick upon the ingestion of alcohol as it adapts the way alcohol is broken down in the body. This instant ‘punishment’ improves the contiguity of the treatment, giving an immediate hangover.
What are the positive evaluations for aversion therapy??
- Aversion therapy has been shown to be an effective treatment in helping reduce addictions. For example, Howard (2001) found that by pairing alcohol with vomit through the use of Antabuse, participants recordings of positive alcohol experiences dropped significantly. To elaborate, this research provides an element of credibility to aversion therapy, as it can significantly impact an addicts experience with the addiction. Healthcare providers should consider ways to maximise access to this treatment in the face of this research support. Therefore, aversion therapy should be considered as a viable and a frontline treatment in tackling addictions such as alcohol.
- In addition to this research support, aversion therapy also has massive economic benefits as well. For example, research in the US found that alcohol addiction alone was responsible for 232 million lost working days in a year.
To elaborate, this successful treatment can be used to ensure those with an alcohol addiction are treated and can support themselves financially by keeping their jobs. Economically, this ensures that taxes collected from these more secure jobs can be put back into other areas of healthcare. Therefore, aversion therapy plays its role in boosting the economy by ensuring sufferers of addiction can still contribute to society.
What are the negative evaluations for aversion therapy??
- However, there are clearly ethical problems with aversion therapy.
In the short term, there is potential distress and harm to the patient. For instance, using antabuse with alcohol to cause sickness could be dangerous, i.e., choking and psychological distress.
In the long term, the most common, albeit still rare, side effect of antabuse is liver damage.
This means aversion therapy may not be an ideal treatment, particularly for vulnerable addicts for whom the negative impact of the treatment could be damaging. - Aversion therapy (much like drug treatments) may eliminate the behaviour but not the underlying problem.
For instance, these treatments cannot change a personality traits, like neuroticism (like hardiness training may). They also fail to modify any genetic faults (like A1DRD2), or challenge and replace faulty cognitions or reduce sensitivity to cues associated with smoking.
THIS MEANS ‘RELAPSE’ IS OFTEN INEVITABLE with AVERSION THERAPY. - A further problem with the therapy is its questionable LONG TERM effectiveness.
When a person is exposed to an environment associated with drug taking for instance, after the completion of therapy, some of the mental and physical changes associated with cravings are reactivated and the person may likely relapse (Siegal et al 1987).
This means the long term EFFECTIVENESS of aversion therapy must be questioned.
What is covert sensitisation??
Give an example
The rising ethical issues and pressures during the 1970’s forced aversion therapy out of the therapeutic limelight. It was replaced by covert sensitisation.
In place of an actual stimulus-response (e.g. vomiting), clients are tasked with imagining how it would feel.
It requires the client to be effective in using their imagination and the therapist needs to be skilled in getting the client to picture all elements of the imagined environment they are in.
Phobias are often incorporated to elicit the necessary reactions. So a gambling addict could be asked to imagine playing a slot machine that is covered in spiders or snakes. It is hoped that with consecutive sessions, the client will associate the slot machines with the phobia.
What are the positive evaluations for covert sensitisation???
- There is evidence to support the EFFECTIVENESS of COVERT SENSITISATION to treat addiction. McCONAGHY et al (1983) compared aversion therapy with covert sensitisation to treat gambling addiction. Although both were effective in removing the urge to gamble, covert sensitisation was more so. A follow-up at 1 year found 90% of those receiving covert sensitisation had reduced their gambling activity compared to only 30% of those who received aversion therapy. They also reported experiencing fewer and less intense gambling cravings. This suggests that in the long-term covert sensitisation is more effective in reducing gambling addiction.
- In addition to the research support, aversion therapy also has massive economic benefits as well. For example, research in the US found that alcohol addiction alone was responsible for 232 million lost working days in a year.
To elaborate, this successful treatment can be used to ensure those with an alcohol addiction are treated and can support themselves financially by keeping their jobs. Economically, this ensures that taxes collected from these more secure jobs can be put back into other areas of healthcare. Therefore, covert sensitisation plays its role in boosting the economy by ensuring sufferers of addiction can still contribute to society.
What are the negative evaluations for covert sensitisation???
- Covert sensitisation deals with some of the ethical issues raised by aversion therapy.
There are minimal issues with psychological and physical distress as this technique is simply in vivo. As such, individuals are likely to be protected from harm, creating less of an ethical dilemma. Whereas, aversion therapy such as using antabuse to pair alcohol with nausea has several issues, such as links to liver damage.
This means covert sensitisation can be considered a more ethical form of treatment for those suffering from a variety of addictions. - Covert sensitisation, along with aversion therapy, can be seen as limited because it only addresses the behavioural aspect of addictions and may not resolve the underlying problem.
For instance, these treatments cannot change a personality traits, like neuroticism (like hardiness training may). They also fail to modify any genetic faults (like A1DRD2), or challenge and replace faulty cognitions or reduce sensitivity to cues associated with smoking.
THIS MEANS that whilst the addiction being treated may be addressed, the individual may simply transfer their addictive tendencies to another substance or behaviour. - Another weakness is the UNSCIENTIFIC nature of covert sensitisation therapy to combat addictions.
As a behavioural technique it focuses largely on UN-OBSERVABLE cognitions - like the power of imagination (this relies on inferences).
This DOES NOT help promote psychology towards a prove scientific discipline, like other techniques for treating addiction (e.g. aversion therapy).
What is CBT??
CBT is mainly used to identify and challenge the irrational thoughts of an individual. The client is taught to be self-sufficient in tackling these irrationalities.
Skills training is also employed to train the client in developing coping strategies to deal with sudden onsets of episodes or (in this case) temptations to relapse into addictive behaviours again.
What are the different CBT skills???
Cognitive reframing is performed whereby the therapist may teach the client about addictions, how they work, how they can be overcome and specific things about the clients addictions
e.g. teaching about the nature of chance in gambling.
Functional analysis focuses on understanding the thought process when clients find themselves in high-risk situations. The therapist tries to understand where thoughts can be challenged so the client is able to rescue themselves from the situations.
EG, identifying triggers and what causes them to smoke or drink.
Relapse prevention- Use relaxation techniques when feeling stressed/ when they feel they are going to partake in addictive behaviour instead.
E.G, instead of smoking when stressed, they could do something relaxing such as reading or listening to music
Give an example for the different CBT skills???
Cognitive reframing -the therapist may teach the client about addictions, how they work.
Functional analysis -understanding the thought process when clients find themselves in high-risk situations
Relapse prevention- Use relaxation techniques when feeling stressed/ when they feel they are going to partake in addictive behaviour instead.
What are the positive evaluations for CBT??
- CBT has been shown to be an effective treatment in helping reduce addictions. For example, Ladoucer, et al (2001) randomly allocated 66 pathological gamblers to either CBT or a waiting list. The CBT involved both cognitive correction and relapse prevention. Of those that completed the CBT course, 86% were no longer classified by DSM criteria as pathological gamblers.
Also, it was found that after treatment gamblers had a better perception of control over their gambling problem, and increased self-efficacy. These effects were long lasting and remained after 6 months and a 1 year follow up.
This suggests that CBT is an effective treatment for addiction. - In addition to this research support, CBT also has massive economic benefits as well. It is one of the most effective treatments for addiction and therefore can help people return to work, increase the amount of tax they pay.
To elaborate, this successful treatment can be used to ensure those with an addiction are treated and can support themselves financially by keeping their jobs. Therefore, CBT plays its role in boosting the economy by ensuring sufferers of addiction can still contribute to society. - CBT can be said to have long term effectiveness, which is advantageous for the treatment.
For example, as it is known that addictions such as gambling is caused by cognitive biases, CBT aims to challenge these biases and change them so gamblers view their gambling addiction in a more rational way. By addressing these biases it means that the patient will not relapse back to gambling as their cognitions have changed.
This means the long term EFFECTIVENESS of CBT can be praised.
What are the negative evaluations for CBT???
- CBT can be considered more ethical than other treatments such as aversion therapy.
As CBT is essentially a talking therapy there is little distress involved, unlike the use of drugs such as antabuse with alcohol to cause sickness which could be dangerous, i.e., choking and psychological distress.
This means CBT may be an ideal treatment, particularly for vulnerable addicts for whom the negative impact of the treatment could be damaging.
- CBT has been praised for addressing the root cause of the addiction.
For instance, these treatments challenge and replace faulty cognitions which are thought to be one of the reasons for why people develop addictions. For example, it can tackle faulty cognitions such as cognitive biases such as gambers fallacy.
THIS MEANS that CBT is an effective treatment and is long lasting.
