Addiction

Question 1

Discuss CBT as a method for reducing addiction

Answer 1

-CBT helps addicts recognise the triggers for their behaviour and challenge irrational thoughts that reinforce their addiction. Patients are often unaware of their cognitive biases so therapists educate them on these and how gambling outcomes are determined by chance.
-The ABCDEF framework helps patients to understand how their beliefs , not activating events, lead to emotional consequences.
- A= activating events e.g. walking past a gambling shop
- B=belief about event
- C= consequence
- D= disputing irrational belief
- E=effects of disputing irrational belief
- F= feelings produced after restructuring thought patterns.
-cognitive restructuring helps patients to replace irrational beliefs (e.g. I’m bound to win this time’) with rational alternatives (e.g. the outcome is random so ill likely lose).
-therapists can use 3 disputing techniques: logical, empirical or pragmatic, to help clients replace irrational thoughts with rational beliefs, reducing their addictive behaviours and lowering risk of relapse.
-they can also use behavioural techniques so patients apply their learning to handle real-life stressful situations through either assertiveness training or social skills training.
- By addressingfaulty beliefs, CBT empowers individuals to regain control, ultimately reducing addiction and preventing relapse

Question 2

Evaluate CBT as a treatment for addiction

Answer 2

• a strength of the cognitive behavioural therapy for reducing addiction is that it has supporting research evidence. Petri recruited gambling addicts and allocated them to either a control group (a gamblers anonymous meeting) or a treatment group (gamblers anonymous meetings and 8 weekly CBT sessions). They found that the treatment group were gambling significantly less than the control group up to 12 months after the therapy. This suggests CBT is successful at reducing gambling behaviours.

-a limitation of CBT is treatment adherence. Cuiijppers et al found that drop-out rates in CBT treatment groups can be up to 5 times more than for other forms of therapy, perhaps because withdrawal symptoms can make engagement difficult. Even when clients continue in treatment, it was found that commitment to homework tasks also reduces over time. This suggests that combing CBT with biological interventions such as methadone for drug addiction, may be more effective in improving engagement and managing withdrawal.

-another strength of CBT is that it’s particularly effective in addressing the root causes of addictions, rather than just managing the symptoms. Many addicts report psychological issues such as low self-esteem, lack of confidence, and poor problem solving skills, which often trigger addictive behaviours. CBT helps individuals identify and address these underlying psychological issues (i.e increased confidence following disputing techniques), allowing them to tackle the root causes of their addiction. This suggests that by addressing the psychological triggers of addiction, CBT facilitates deeper, more lasting recovery, offering a more comprehensive solution than other methods of reducing addiction.

Question 3

Explain the types of disputing techniques and behavioural techniques involved in CBT.

Answer 3

-the therapist aims to challenge the clients irrational beliefs by using disputing techniques:
->logical disputing: asking the patient to consider ‘does it make sense for me to think like this?’
->empirical disputing: asking the patient to consider ‘ is there any evidence to justify my thoughts?’
->pragmatic disputing: asking the patient to consider ‘how useful is it for me to think like this?’

-these disputing techniques are used to replace these irrational thoughts with effective, rational beliefs which will in turn help to greatly reduce the patients addictive behaviours.
-by addressing faulty beliefs clients regain a sense of control, reducing relapse risk (relapse prevention)

-behavioural tecniques are then used. The addict is encouraged to carry out trial experiments to reduce their addiction by continuing to identify ‘risky’ situations and times in the real world.
->assertiveness training whereby an addict is encouraged to confront situations that cause stress or unpleasantness in a rational way e.g. gamblers may be asked to visit a casino and refrain from betting following an interpersonal conflict.
->social skills training helps clients navigate social setting e.g. weddings, were temptation might arise. For instance, practicing firm refusals and maintaining eye contact to avoid embarrassment. Therapists may role-model these skills before a client tries them.

Question 4

Discuss the three types of drug therapy

Answer 4

-aversives:
->pairs addictive behaviour with unpleasant consequences like vomiting via classical conditioning.
->e.g. Disulfiram which results in unpleasant symptoms such as nausea, vomiting , headaches, and flushing, deterring alcohol consumption

-agonists:
-> drug substitutes that bind to neurone receptors, activating them to produce similar effects as the addictive drug and controlling withdrawal symptoms.
->e.g. methadone which mimics some effects of heroine by activating opioid receptors, reducing cravings and withdrawal symptoms. It has a slower onset and longer-lasting effects, minimising harm.

-antagonists:
-> block the effects of the addictive drug by binding to receptor sites , preventing the drug from producing its usual addictive effect.
->e.g. Naltrexone which blocks opioid receptors, preventing the euphoric and sedative effects of opioids. It reduces cravings and discourages drug use.

Question 5

What does drug therapy refer to?

Answer 5

The use of medication to treat addiction

Question 6

Discuss aversion therapy as a behavioural intervention for addiction

Answer 6

• aversion therapy is a behavioural intervention based on classical conditioning. It’s mainly been used for alcohol, smoking and gambling addiction. aversion therapy is based on the principle that when two stimuli are frequently presented together they’ll become associated. The addictive behaviour becomes associated with an aversive outcome such as vomiting. The idea is that the aversive outcome will have higher contiguity and will overpower any reward that the addiction produces. E.g. smoking produces a small nicotine-induced reward but the aversive outcome such as an electric shock will either be faster or stronger which will discourage the addict from repeating the smoking behaviour. In this way, eventually the addiction will be extinguished

Question 7

Discuss covert sensitisation as a type of aversion therapy.

Answer 7

-this therapy is a type of aversion therapy and has mainly been used for alcohol, smoking and gambling addiction. Covert sensitisation is based on classical conditioning, and the principle that when two stimuli are frequently presented together they’ll become associated. Covert sensitisation occurs in-vitro (they imagine the aversive stimulus). Firstly the client is taught to relax using techniques like deep breathing. The therapist will then instruct them to imagine the aversive situation e.g. the addict will imagine themselves gambling followed by unpleasant consequences like a partner finding out and leaving them. The more vivid the imaginary scene the better, which is why the therapist encourages the patient to go into graphic detail including sounds and smells. In this way, the behaviour and eventually the addiction will be extinguished.

Question 8

Evaluate behavioural interventions in reducing addiction

Answer 8

• a strength of aversion therapies is that there is strong supporting research evidence. Smith and Frawley studied 600 patients being treated through aversion therapy for alcoholism. After 12 months, 65% of patients were still resisting alcohol. This suggests aversion therapy is successful and effective at reducing addictive behaviours such as alcohol consumption. And these effects are long lasting, increasing the treatments usefulness.
  -however, Hajek and Stead reviewed 25 studies of aversion therapy for nicotine addiction and found the majority lacked blind procedures. As researchers know who received placebo / treatment, they may over exaggerate the effectiveness of aversion therapies. This suggests results from these studies need to be treated with caution, which challenges the validity of the findings.
• a strength of covert sensitisation is that it has received supporting research evidence. Mc Conaghy compared conventional aversion therapy with covert sensitisation in treating gambling addiction. At a one-year follow up, those who had received covert sensitisation were significantly more likely to have reduced their gambling activities (90% of participants) compared to aversion therapy (30%). They also reported experiencing fewer and less intense gambling cravings than the aversion-treated group. This suggests covert sensitisation may be more effective than traditional aversion therapies in reducing gambling behaviours.
• a limitation of behavioural interventions at reducing addictive behaviours is that there are serious ethical issues. This is because patients are subjected to psychological and physical harm, which they have the right not to experience. For example, aversion therapies which use drugs cause extremely uncomfortable consequences, e.g. nausea and vomiting. Also, covert sensitisation also emends the patient to imagine shameful situations, e.g. smoking cigarettes covered in faeces. These ethical issues can lead to poor compliance with treatment and high dropout rates, which decreases the usefulness of behavioural treatments for addiction.

Question 9

Evaluate drug therapies

Answer 9

• one strength of drug therapies in reducing addiction is that there is supporting research evidence. Stead et al concluded that NRT is more effective in helping smokers quit than either placebo or no treatment. NRT users were up to 70% more likely to have still abstained from smoking after 6 months. Research also indicates two extra benefits of NRT: it’s safer than cigarette smoking because it eliminates the harmful effects of tobacco smoke, and it doesn’t seem to raise dependence. This suggests that drug therapies like NRT, are useful in reducing addiction.
  -Chung et al suggest alcoholics with one gene variant respond better to naltrexone treatment than those with a different version of the gene, suggesting there are individual differences to the success of drug treatments, making the evidence mixed.

-one limitation of drug therapies is that they can cause side effects. This is because common side effects are nausea and headaches. For example, in relation to gambling, naltrexone leads to significant side effects which means there is a risk that the patient will discontinue the therapy, especially when they have lost the pleasurable effects of the addiction. This means the risk of side effects should be carefully weighed up against the benefits of the drug therapy and psychological therapies which do not alter brain chemistry.

-a final strength of drug therapies from reducing addiction is that they help remove the stigma associated with addiction. This is because drug therapies suggest that addiction has a neurochemical or genetic basis, which helps to minimise the harm and judgement placed on the patient. This shift in understanding challenges the view that addiction is a form of psychological or moral failure. As a result, the reduced stigma may encourage individuals with addiction to seek treatment more willingly, as they may feel less judged or ashamed.
-however despite blame, some would argue patients may not be of sound mind to give informed consent for treatments that alter their brain chemistry due to the nature of their addiction; raising ethical concerns.