Theories of addiction Flashcards
What makes a good theory?
> Unifies and gives explanation
> It is consistent with observations
> Not too many constructs
-> parsimonious and simple
> Testable
> Guides practice
Why interventions that seek to address motivation and/or self-control often do not increase the chances of recovery?
When someone with addiction attempts to recover, momentary risk of relapse is greatest in first few days, then fades
-> necessary natural process of recovery
What is the other name for the Trans-Theoretical Model (TTM) of addiction?
Stages of change theory
What does the Transtheoretical Model (TTM) of addiction (Prochaska and DiClemente, 1990s) propose?
People with addictive behaviour are in 1 of 5 stages:
- Precontemplation
- Contemplation
- Preparation
- Action
- Maintenance
- there is a momentum
What characterises the precontemplation stage in the TTM?
- Person is unwilling to change behaviour
- They don’t believe there’s a problem to address
What characterises the contemplation stage of the TTM?
- Person is considering changing behaviour in the next 6 months
- Dissonant state
What characterises the preparation stage of the TTM?
Person is getting ready to make a change within next month
What characterises the action stage of the TTM?
Person is actively changing a negative behaviour or adopting a new healthy behaviour
What characterises the maintenance stage of the TTM?
Person maintains behavioural change for up to 5 years
What characterises the termination/adoption stage of the TTM?
Person has eliminated undesirable behaviour
OR maintained positive behaviour for over 5 years
What characterises the relapse stage of the TTM?
Person slips/falls back into unhealthy behaviours or fails to maintain them
- can happen at any point
What are the 4 TTM principles?
- Motivation exists along continuum of readiness
- People progress through stages (not linear)
- cycle going through time
- it’s possible the person moves out and drops back in at any time - If clinicians use strategies in a stage other than the one the person is in, result usually negative
- If people are pushed at a faster pace than they are ready to take, ‘therapeutic alliance’ may break down
Which motivational strategies should the clinician adopt for a client in the precontemplation stage of the TTM?
- Establish rapport, ask permission, build trust
- Raise doubts/concerns about drug use
- Express concern, keep the door open
- > arguing and giving people advice might not be productive at this stage
Which motivational strategies should the clinician adopt for a client in the contemplation stage of the TTM?
- Normalize ambivalence
- Help tip the decisional balance scales toward change
- > self-motivated change
- Elicit and summarise self-motivational statements of intent, commitment from client
- Elicit ideas regarding client’s perceived self-efficacy and expectations regarding treatment
- > how confident are they? How to support this?
Which motivational strategies should the clinician adopt for a client in the preparation stage of the TTM?
- Explore treatment expectancies and client’s role
- Clarify client’s goals
- Negotiate a change/treatment plan, behaviour contract
(i. e. specific tasks, measurable goals) - Consider and lower barriers to change
- Help client enlist social support
Which motivational strategies should the clinician adopt for a client in the action stage of the TTM?
- Engage client in treatment, reinforce importance of remaining in recovery
- > focus on the value of change
- Acknowledge client’s difficulties in early stages of change
- Help client identify high risk situations
- > functional analysis, develop appropriate coping strategies
Which motivational strategies should the clinician adopt for a client in the maintenance stage of the TTM?
- Support lifestyle changes
- Affirm client’s resolve and self-efficacy
- Help client practice and use new coping strategies to avoid return to use
- Develop “relapse plan” (fires escape plan) if client resumes to substance use
- Review long-term goals with client
What does the COM-B model of behaviour consist of?
> Capability and Opportunity influence Motivation
> Behaviour has mutual influences with Capability, Motivation and Opportunity
What does capability refer to in the COM-B model of behaviour?
Physical and psychological capability
- knowledge, skill, strength, stamina (in commitment)
What does motivation refer to in the COM-B model of behaviour?
Reflective and automatic motivation
- plans, evaluations, desires, impulses
- > more craving-based than TTM
What does opportunity refer to in the COM-B model of behaviour?
Physical and social opportunity
- availability, prompts, reminders, cues (for success)
What does the PRIME theory of addiction consist of?
Plans, Responses, Impulses, Motives, Evaluations
> External environment
- stimuli, information
> Internal environment
- percepts, drives, emotional states, arousal, ideas, frame of mind
Plans (intentions) Evaluations (beliefs) Motives -> Impulses -> Responses
What is the PRIME theory of addiction based on?
5 laws of motivation
What is the first law of motivation in the PRIME theory of addiction?
At every moment we act in pursuit of our strongest motives (wants, needs) at that moment
What is a want according to the PRIME theory of addiction?
Anticipated pleasure or satisfaction
What is a need according to the PRIME theory of addiction?
Anticipated relief / avoidance from mental or physical discomfort
What is the second law of motivation in the PRIME theory of addiction?
Evaluations and plans can control our actions only if they create motives at the appropriate moments that are stronger than competing motives (from other sources)
What are evaluations in the PRIME theory of addiction?
Beliefs about what is good or bad
What are plans in the PRIME theory of addiction?
Self-conscious intentions to do or not do things
What is the third law of motivation in the PRIME theory of addiction?
Self-control requires mental energy and depletes resources of that energy
- we can be overruled by implicit processes
- > self-control isn’t without cost
What is self-control according to the PRIME theory of addiction?
Acting in accordance with plans despite opposing motives
What is the fourth law of motivation in the PRIME theory of addiction?
Our identities can be a powerful source of motives
- I do something that reflect who I am
What constitutes identities according to the PRIME theory of addiction?
- Labels
- Attributes
- Personal rules
What are labels in the PRIME theory of addiction?
Categories we think we belong to
What are attributes in the PRIME theory of addiction?
Features we ascribe to ourselves
What are personal rules in the PRIME theory of addiction?
Imperatives about what we do or don’t do
How can the fourth law of motivation of the PRIME theory of addiction be used clinically?
Identities can be a powerful sources of motives
-> create a “recovery” identity perhaps with support from others, to live one’s life as a person in recovery would live their life
What can happen if the identity of a client is one of a drug addict?
May cause problems with finding strong motives for change
What is the fifth law of motivation in the PRIME theory of addiction?
Actions are initiated by impulses and inhibitions
- which are generated by motives, AND habitual and instinctive associations
- behaviour is controlled by the strongest momentary impulses and inhibitions
Why are actions and behaviour a function of exposure?
The more you use, the more automatic, impulsive, implicit the underpinning thoughts (motive) are, which initiate actions
In the literature, what does the synthesis of the COM-B and PRIME theories aim to provide?
> Comprehensive model of behaviour in which existing models can be understood and compared
> Basis for improving existing models
> Rational basis for design of interventions to change behaviour
> Enable people to see and select from different change methods that capture where the person is in relation to their capability and opportunity
