Addiction Therapy Flashcards
What do antagonist drugs do
Inhibit a physiological response by binding to neurone receptor sites + blocking them
- preventing the addictive drug from having its normal effect
- antagonist drug acts as an OBSTRUCTION for the addictive drug + prevent it from causing its usual effect
- eg the antidepressant bupropion reduces the DA hit that follows nicotine inhalation
- GAMMA VINYL GABBA
What do agonist drugs do
Initiate a physiological response by binding to neurone receptor sites and activating them
- act as a substitute for the addictive substance + produce a similar effect to the drug itself
- EG nicotine replacement to treat smoking addiction and methodine to treat heroin addiction
- irritators
What does Nicotine Replacement Therapy do
Works by delivering therapeutic doses of nicotine (w/o desirable effects of tobacco) in EARLY STAGES of stopping smoking
- this release of nicotine is absorbed much more slowly + steadily than in tobacco
- HOWEVER ultimately it still causes action on NAcR + DA
- inhalers/ e cigarettes most effective as they resemble the activity of smoking (handling and inhaling)
What is the mode of action of NRT
- works by releasing a clean controlled dose of nicotine into bloodstream
- nicotine binds to nicotine acetylcholine receptors in mesolimbic pathway, stimulating DA release
- using NRT means that amount of nicotine can be gradually reduced over time, reducing the severity of withdrawal symptoms
What is the bupropion mode of action
- appears to be an antagonist at nicotine receptors and works by blocking nicotine effects so there isn’t a rise in DA levels when smoke a cig
- also a weak inhibitor of DA + noradrenaline re uptake = overall increase in DA whilst taking drug
- helps relieve withdrawal symptoms and/ reduce depressed mood (helps reduce chances of relapse)
- treatment generally lasts 7-12 weeks with weeks of treatment before the smoker attempts to stop smoking
Positive EV drug therapy
Evidence - STEAD, meta analysis into effectiveness of NRT and found its more effective than placebo treatments
- NRT users up to 70% more likely to still be abstaining from smoking 6 months after quitting than other groups
= use of drug therapy can help wu it smoking addiction
Requires less effort from the indv than cognitive therapies
- very little time is taken up when taking NRT in comparison to CBT where for the more time + resources required
= more people engage with them + they may contribute more to the cessation of addictive behaviours (ST)
Negative EV DRUG THERAPY
Questionable - does therapy really help smokers quit?
- NRT, nicotine still relapsed into the body, which increases heart rate, constricts blood vessels, temporarily raising blood pressure and lead to reproductive disorders
- if stays on NRT for long time than gradually weaning themselves off, may be a case of replacing one addiction for another (heroine swapped for methodine)
= may not help indv quit completely
Biological interventions (NRT + bupropion) ignore UNDERLYING REASONS for why people smoke in first place, masks the real cause
- does nothing about faulty conditions/ learnt associations addicts may have/ faulty genes that have predisposed them to addiction
= once therapy stops many will relapse to their old smoking habits - drug therapies one are ineffective LT
What is Aversion Therapy
- learning through association
- replaces positive associations to addiction (smoking relives stress) with aversive/ negative associations (smoking = sick feeling)
- designed for alcohol problems but applied to many addictions (especially drug based addictions)
- alcohol paired with EMETIC drug ANTABUSE (induces severe nausea + vomiting when combined with booze)
- indv encouraged to drink alcohol (create negative association)
- process repeated to strengthen association
- SEVERAL repetitions after, effectiveness tested, completing an OLFACTORY TEST (examines overt behavioural responses, questionnaires to assess alcohol related expectations)
Rapid smoking - aversion therapy
SPIEGLER
- client required to sit in closed room
- take puffs of cig every 6 seconds ( faster than normal)
- rapid inhalation and constant exposure to fumes = nausea
- newly formed negative feelings will now be associated with nicotine
Positive EV Averison Therapy
Evidence - Howard, used AT for treating 82 alcoholic pts across 5 sessions in a 10 day treatment trial
- given emetic drug (Antabuse)
- given their PAD to smell + taste
- vomiting 5-8 mins after taking drug
- instructed to drinks alcohol (immediately regurgitated)
- repeated with diff alcoholic drinks
- its reported positive alcohol - related expectancies had decreased following treatment
= AT effective in treating alcohol addic
fairly scientific - most aspects open to careful observation + replication (pts carefully observed during + after treatment, their responses to OLFACTORY tests clear for all to see)
- standardised procedures (generalisation with various flavours of alcohol) procedure can be checked for consistency
= AT has its own roots in scientific approach, seen as credible theory
Negative EV aversion therapy
Ethical problems - in ST, indv exposed to physical + psychological harm ( although consented) in LT protects from cirrhosis of liver
= AT may not be ideal treatment, esp for vulnerable addicts for whom the negative impact could be damaging
May eliminate behaviour but NOT UNDERLYING PROBLEM
- does nothing for faulty cognitions, risky personality factors, vulnerable genes
- ultimately results in once addiction replaced with another
= ‘relapse’ is often inevitable with AT
What is covert sensitisation
Variation of AT
- principles of learning through association (CC) in which positive associations (smoking relives stress) replaced with aversive associations (smoking = sick)
- unlike AT, indv experiences IMAGINED (in vitro) negative associations between previous CS (smoking/ gambling) and new UCS(vomiting) = new NEG association + new CRA (nausea) to the CS
Lung damage - imagined unpleasant consequence that indv can learn to associate with smoking
Positive EV covert sensitisation
Evidence - McConaghy compared AT with CovS to treat gambling addiction
- both effective in removing urge to gamble, CovS more
- follow up at 1 year = 90% receiving CovS had reduced their gambling compared to 30%received AT
- also reported experiencing fewer + less intense gambling cravings
= LT CovS is more effective
CovS deals with some ethical issues raised by AT - minimal exposure to psychological harm in both ST
- LT increases suitability for many
- no potential harmful drugs
= CovS considered more ethical form of treatment for treating addictions
Neg EV for Covert sensitisation
Limited - only addresses behavioural aspect of addictions + not resolve underlying problems like AT
- does nothing for faulty cognitions/ genes, risky personality factors
- one addiction replaced by another
= idv may transfer addictive tendencies to another substance/ beh
Relies on imagination + inferences
- although client carefully observed before and after treatment, relies upon cognition + therapist assuming client is actively taking part
- lack of empirical basis can be seen to limit credibility of therapy
= doesn’t have trust + objectivity that’s found in other therapies (AT)
What happens the first 2 stages of CBT for addiction
Cognitive reframing (for all CBT)
- works on principle that changing addict’s thoughts about addictive behaviours = successful abstinence
- therapists work with indv to address some cognitive biases that fed their addiction
Functional Analysis
- therapist works collaboratively with indv up to 5 sessions - indv focuses on identifying their behavioural patterns + thoughts relating the addiction
- therapist encourages to come up with own reasons for attempting to change their addictive behaviour (focusing on problems they face as a results of dependency + personal adv of abstinence) ——— ‘focusing on improvements on my breathing will help me give up smoking’
- together, build plan for change + future sessions monitor this plan
