Addictive behaviours 2 Flashcards

Question

Social Psychologial Explanation 1 : peer influence

Answer 1

Social Influences on Addictive Behavior: Social influences play a significant role in the development and maintenance of addictive behaviors, such as smoking, drinking alcohol, and other forms of substance abuse. One of the most prominent influences comes from peers, whose behaviors and attitudes can strongly affect an individual's decisions to engage in addictive behaviors. Social Psychological Processes: Several social psychological processes can influence addictive behaviors, including: Social Learning Theory: Social learning theory (developed by Albert Bandura) emphasizes that people learn behaviors through observation and imitation of others, particularly role models. In the context of addiction, individuals may adopt addictive behaviors by observing and imitating peers or family members who engage in such behaviors. Perceived Social Norms: Perceived social norms refer to an individual's beliefs about what behaviors are accepted or expected in their social group. For example, if a person perceives that smoking or drinking alcohol is common or acceptable within their social circle, they may be more likely to engage in these behaviors themselves, even if they might not have otherwise considered them. Reinforcement and Modelling: Reinforcement occurs when an addictive behavior is followed by positive outcomes, such as social approval or a temporary sense of relief, which can encourage the individual to repeat the behavior. Modeling involves observing others (often peers or significant others) engaging in addictive behaviors and seeing the rewards or benefits they receive, which can lead the individual to mimic the behavior. Conclusion: Social influences—including peer pressure, social learning, and the reinforcement of addictive behaviors—can play a significant role in the onset and continuation of addiction. These factors highlight the importance of social context in understanding and adressing addictive behaviours

Answer 2

Peer Influences on Addictive Behavior: Peer influence often goes beyond direct pressure (e.g., someone offering a drink or cigarette) and can be much more subtle in shaping an individual's behavior. This subtle influence can manifest in various ways, such as social learning and perceived social norms, which can significantly impact an individual’s likelihood of engaging in addictive behaviors.

Answer 3

ial Learning Theory (SLT): Developed by Albert Bandura (1977, 1986), Social Learning Theory explains that behavior is learned through observing and modeling the behavior of others, especially if those individuals are seen as role models or have status. People are more likely to imitate a behavior when they see it being reinforced (vicarious reinforcement) and less likely when they see it being punished. For addictive behavior to take place, the observer must: Pay attention to the role model. Remember the behavior. Be motivated to imitate the behavior. Be capable of reproducing it. Applying SLT to Addictive Behaviors: If someone in a peer group is seen enjoying the effects of drinking, smoking, or taking drugs, and if the individual identifies with that person, they are more likely to imitate those behaviors. People who are low in confidence or have low self-esteem are also more likely to imitate these behaviors because they might be seeking approval or trying to fit in. Perceived Social Norms: Perceived social norms refer to the expectations of behavior within a specific group—how people think they should think, feel, and behave. People often overestimate the extent to which their peers engage in risky behaviors, such as smoking or drinking. This misperception can lead to increased addictive behavior. Descriptive vs. Injunctive Norms: Descriptive norms are perceptions about how much others are engaging in a certain behavior (e.g., drinking or smoking). Injunctive norms are perceptions about what behaviors are considered acceptable or expected within a group. Example: If an adolescent believes their friends are heavily drinking (descriptive norm) and they also believe their friends approve of it (injunctive norm), they are more likely to start drinking. Applying Social Norms to Addictive Behaviors: Perkins and Berkowitz (1986) found that students often overestimate how much their peers drink. This misperception leads them to drink more themselves, creating a cycle of risky behavior. Many young people report drinking because they think "everyone else is doing it." In reality, only a minority may be drinking, but the perception of how common the behavior is in the group is enough to influence an individual’s behavior. Conclusion: Peer influence and social learning play a crucial role in the development of addictive behaviors. People are often influenced by their peers through subtle processes such as observing their behaviors and adopting perceived social norms. By understanding how social influence works, interventions can be developed to reduce addictive behaviors.

Answer 4

Social Norms Marketing (Interventions): Social norms interventions aim to correct misperceptions about addictive behaviors, particularly drinking. These campaigns are designed to change perceptions about what is considered "normal" behavior, making responsible behavior seem more typical. Example: The University of Rhode Island ran a campaign targeting students' misperceptions about drinking. They used messages like “Most of us have fewer than four drinks when we party” to highlight that the majority of students actually drink responsibly, challenging the belief that heavy drinking is the norm. Effectiveness of Social Norms Campaigns: Why they work: These campaigns target the misperception that "everyone is doing it"—often, students believe their peers drink more than they actually do. When this false belief is corrected, drinking behavior tends to become more moderate. Wesley Perkins (2007) found that in a study of 14,000 students, a social norms intervention reduced both misperceptions and actual drinking behavior, proving the effectiveness of the approach in some contexts. Limitations: Mixed results: While some studies show positive results, other research suggests these interventions do not always lead to long-term behavior change. Some campaigns fail to make a significant impact, especially if the message isn't believed or if the intervention isn't widely accepted. The effectiveness can also depend on how the message is received. If the target audience doesn't trust or believe in the information, the desired behavior change may not occur. "Correcting the Misperception": A key component of social norms marketing is to challenge students' beliefs about peer behavior. Many students overestimate how much their peers drink, and campaigns aim to correct this misunderstanding by showing that most students drink in moderation. By doing so, the hope is to reduce excessive drinking among students by shifting the norm towards more responsible behavior. Conclusion: Social norms marketing can be a useful tool in modifying addictive behaviors by correcting misperceptions and promoting healthier norms. However, its success is not guaranteed, and its long-term effectiveness may require careful messaging, consistent reinforcement, and consideration of the audience's receptivity.

Answer 5

Research evidence Borsari and Carey (2001) reviewed 40 prospective studies to examine the link between peer influence and addictive behaviors. Findings: The review found clear evidence of an association between peer influence and individual addictive behaviors. Most studies showed that peer use (i.e., the behavior of one's peers) is a strong predictor of the individual’s own substance use, particularly in relation to: Alcohol Tobacco Cannabis Key Role of Peer Behavior: The studies provide evidence that peer behavior and group norms are crucial in both the initiation and maintenance of addictive behaviors. This suggests that peer groups are highly influential in shaping individual patterns of substance use.

Answer 6

Peer Influence vs. Peer Selection: A major issue in research on peer influence and addictive behavior is distinguishing whether peer groups actually influence the individual into engaging in the addictive behavior (peer influence) or whether the individual selects friends who are already engaging in the behavior (peer selection). This is often referred to as a "chicken and egg" problem, where it's difficult to determine which comes first. Kobus and Henry (2010): Their study found that individuals who were already engaging in risky behaviors (e.g., substance use) were more likely to form associations with peers who also engaged in those same behaviors. Implication: This suggests that peer influence and peer selection are often intertwined and hard to distinguish in practice, as individuals may both influence each other and select peers with similar behaviors.

Answer 7

Clayton Neighbors et al. (2007): This research focused on alcohol consumption and examined perceived and injunctive norms. Their work explored how individuals perceive the drinking habits of their peers and how these perceptions influence their own behavior. Unconscious Influence: A key challenge in studying peer influence is that individuals are often unaware of how their peers influence their behavior. The influence is typically subconscious, which makes it difficult to study directly. Methodological Issues: Since people may not be conscious of peer influence, it’s challenging to investigate using standard methods. Most research relies on retrospective questionnaires, which have limitations, such as the risk of bias or inaccuracies in participants' recall of past behavior. This means that while peer influence is significant, it's hard to capture and measure effectively in studies.

Answer 8

Broader Social Context: While peers play a significant role in influencing addictive behavior, Kobus (2003) argues that focusing solely on peers is overly simplistic. Other factors, such as family and neighborhood environments, also contribute to the onset of addiction. Additionally, media influences can play a significant role, especially in shaping perceptions of addictive behaviors. Multiple Mechanisms: Social learning theory and perceived social norms often act simultaneously, meaning they can work together to influence behavior. However, this overlap makes it difficult to identify and separate the exact mechanisms at play. Research Challenges: The complexity of these interacting influences makes it challenging for researchers to untangle the specific roles of each factor. Since multiple psychosocial elements contribute to addiction, it becomes difficult to pinpoint one singular cause, further complicating efforts to study and intervene in addictive behaviors.

Answer 9

METHODOLOGICAL ISSUES The majority of studies in this area involve self-report methods, which are prone to social desirability bias, both when measuring peer influence and self-reported addictive behaviour. Prospective studies offer a clearer view of the causes of addictive behaviour than retrospective designs. It is difficult to conduct experimental studies in this area due to ethical issues, so many are correlational. This makes it difficult to establish cause and effect. There is also the issue of animal studies, which are often used to test the effects of peer influence. For example, Smith (2012) found that rats were more likely to self-administer cocaine when they were with a rat who had access to cocaine, compared to when they were with a rat that didn’t have access to cocaine.

Answer 10

Social Learning Theory and Media Influence: Social learning theory suggests that people can learn new behaviors by observing role models. The media plays a significant role as a potential source of these role models. If addictive behaviors like smoking, drinking, or drug use are depicted in media, individuals might imitate these behaviors, especially if the behaviors are shown in a glamorous or socially rewarding light. Media Portrayals of Addiction: Research indicates that addictive behaviors are frequently portrayed in the media, often without emphasizing the negative consequences. For example: A study by Primack et al. (2008) found that 23% of the top 200 music videos in 2005 showed tobacco or alcohol use. Hanewinkel et al. (2007) found that 89% of successful films in both the U.S. and Germany depicted alcohol use, and 22% showed drug use. Only 11% of films included any anti-drug messaging. Effects of Exposure: Research on how exposure to addictive behavior in the media influences actual behavior is still mixed: Robert Wellman et al. (2006) found that exposure to tobacco advertising and promotion was strongly linked to a positive attitude towards smoking and an increased likelihood of adolescents beginning to smoke. A longitudinal study by Hanewinkel et al. (2011) found that teenagers exposed to alcohol use in films were more likely to have drunk alcohol and engage in binge drinking. Sargent and Hanewinkel (2009) confirmed this in a study of 6,522 teenagers across Europe, showing that exposure to alcohol use in films, especially American films, was associated with an increased likelihood of alcohol consumption. While these studies suggest a significant role of media exposure in shaping attitudes and behaviors toward addiction, the overall effect is complex, as it depends on numerous other factors such as peer influence, family environment, and individual characteristics.

Answer 11

Difficulty in Establishing Causal Links: Correlational Research: Most studies examining the media's effect on addictive behavior are correlational, meaning that they only identify a relationship between media exposure and addictive behavior but do not establish cause and effect. For example, people who are already engaged in addictive behaviors may be more likely to watch media that portrays these behaviors. This makes it hard to conclude whether the media exposure leads to addiction or if the addiction drives media consumption. Longitudinal Studies: Although longitudinal studies, like those by Sargent and Hanewinkel (2009), track participants over time, they still cannot definitively establish causality. As Patrick Glenn (2005) argues, even longitudinal studies don't resolve the issue of cause and effect. For instance, while seeing alcohol use in films might encourage teenagers to drink, it might also be the case that teenagers who drink alcohol are simply more inclined to watch films that depict alcohol use. Lack of Population Validity: Many studies focus on specific groups, such as adolescents or university students, making it difficult to generalize findings to the broader population. Adults, who may also be exposed to similar media content, may be less susceptible to its effects. This limits the external validity of these studies, as they may not reflect how the media influences other age groups or demographics. Adolescents' Views on Media Influence: Self-Reported Influence: Adolescents themselves acknowledge the role of the media in encouraging them to engage in addictive behaviors. For example, Sargent and Hanewinkel (2009) found that over a third of adolescents had watched popular films that depicted smoking, and many viewed the characters who smoked as glamorous, which could influence their own behavior. However, adolescents, like others, may not be fully aware of the media's influence on their thoughts and behaviors. Positive Effects of the Media: Discouraging Addictive Behaviors: While much of the research focuses on how the media can promote addictive behaviors, it's important to note that the media can also have positive effects. For example, anti-smoking campaigns have been shown to reduce smoking behaviors among adolescents. Pechmann and Shih (1999) found that adolescents who saw anti-smoking ads had more negative attitudes toward smoking. Vicarious Punishment: In some cases, media portrayals of the negative consequences of addiction—such as the harm or death of public figures (e.g., Amy Winehouse)—can serve as a form of vicarious punishment, discouraging viewers from engaging in similar behaviors. Conclusion: While the media can play a significant role in shaping attitudes toward addiction, its influence is not one-dimensional. Research highlights both the negative effects of media exposure, such as the glamorization of addiction, and the potential positive impact, such as through anti-addiction campaigns. However, methodological issues like the difficulty of establishing causality and the challenge of generalizing findings across populations need to be considered when evaluating the overall influence of media on addictive behaviors.

Answer 12

Agonist Substitution: Methadone Definition: An agonist is a substance that binds to a receptor in the brain and activates it to produce a response. Methadone, for instance, is a synthetic opioid that acts as an agonist by mimicking the effects of heroin but in a less intense manner. Mechanism: Methadone satisfies the body’s craving for heroin or other opioids, preventing withdrawal symptoms and reducing cravings without producing the same euphoric high. This helps individuals gradually stabilize, making it easier for them to reduce or cease their drug use over time. Uses: Heroin Addiction: Methadone is commonly used as part of a harm reduction approach for people addicted to heroin. It reduces the risk of withdrawal symptoms, infection from needle use, and criminal behavior related to drug-seeking. It also improves the chances of obtaining stable employment. Criticisms: The main criticism of methadone substitution is that it replaces one addictive substance with another. Methadone itself can be addictive, and there is a risk of overdose if it is not properly administered. However, methadone is generally considered safer than heroin when used in a controlled manner, especially in a clinical setting. NICE Guidance: The National Institute for Health and Care Excellence (NICE) has provided guidelines for methadone treatment, which include it being part of a detoxification program combined with psychosocial interventions to improve long-term outcomes. Antagonist Substitution: Naltrexone Definition: An antagonist is a substance that binds to a receptor but does not activate it, blocking the effects of other substances. Naltrexone is a drug that blocks opioid receptors in the brain, preventing the euphoric and pleasurable effects of heroin or other opioids. Mechanism: Naltrexone works by preventing the rewarding effects of opioids, which helps reduce the motivation to continue using them. It is typically used after a person has detoxified and is no longer using the drug. Uses: Heroin Addiction: Naltrexone is primarily used for individuals who have already stopped using opioids and are highly motivated to stay sober. It is prescribed after detoxification and is often combined with psychological therapy. Alcohol Addiction: Naltrexone is also used in alcohol addiction treatment, where it helps reduce cravings and the rewarding effects of alcohol. In the UK, Nalmefene (Selincro), a similar drug, has been approved for alcohol dependence treatment. Gambling Addiction: Naltrexone has been found to be useful in the treatment of gambling addiction, though it is not licensed for this use in the UK. NICE Guidance: According to NICE, naltrexone is recommended for those who have already detoxified from opioids and are committed to remaining drug-free. It is not recommended for individuals still using opioids. Limitations: While naltrexone has been shown to be effective in some cases, a Cochrane review in 2013 found inconsistent results across trials. The variable effectiveness has led to debate over its widespread use, particularly as a first-line treatment. Comparison of Agonist and Antagonist Substitution Agonist Substitution (e.g., Methadone): Mimics the effects of the addictive drug (e.g., heroin) to reduce cravings and withdrawal symptoms. Typically used during the early stages of recovery and often in combination with other treatments. Main criticism is that it may replace one addiction with another, though it is safer than the original drug when managed properly. Antagonist Substitution (e.g., Naltrexone): Blocks the euphoric effects of addictive substances, reducing the reinforcement of drug use. Best for individuals who have already stopped using the drug and are committed to staying sober. May not be suitable for everyone, especially those who are still actively using the addictive substance. Both substitution therapies are commonly used in addiction treatment programs, each with its benefits and limitations. Methadone helps stabilize individuals during early recovery by preventing withdrawal, while naltrexone is effective for maintaining sobriety in those who are already clean and highly motivated.

Answer 13

Evaluation: Effectiveness of Substitution Treatments for Addiction Effectiveness of Methadone Research Findings: NICE assessed the effectiveness of methadone through 31 reviews of published research. Of these studies: 17 studies found that methadone was more effective than a placebo in retaining individuals in treatment and reducing heroin use. A meta-analysis of controlled trials showed that methadone significantly increased treatment retention compared to a placebo. Other studies found that methadone helped reduce criminal activity and the spread of HIV, along with a decrease in injecting drug behavior. Limitations: Overestimation of Effectiveness: One issue with the reviews and meta-analyses is that they often include the same primary studies, raising the risk of overestimating the effectiveness of methadone. Confounding Factors: While methadone has been shown to reduce drug use and criminal behavior, these effects might also be due to other concurrent treatments, such as psychological therapy or social support. Comparing Methadone and Buprenorphine Buprenorphine is another agonist treatment used for opioid addiction. It is milder than methadone and has a lower risk of overdose. Buprenorphine is typically administered as a sublingual tablet. Study Comparison: A study by Mattick et al. (2014) compared methadone and buprenorphine, reviewing findings from 31 studies involving over 5,000 participants. The results indicated: Both methadone and buprenorphine were effective in retaining individuals in treatment. Methadone was found to be slightly more effective than buprenorphine for treatment retention, although both treatments were associated with positive outcomes. Conclusion: Both treatments are effective, but methadone is marginally more effective, while buprenorphine might be preferred due to its lower risk of overdose. Effectiveness of Naltrexone Heroin Addiction: A review by NICE of 17 studies examining naltrexone’s effectiveness for heroin addiction revealed: Conflicting Evidence: 11 studies produced mixed results regarding its ability to reduce heroin use. This inconsistency suggests that naltrexone’s effectiveness may vary depending on individual circumstances, such as motivation and level of detoxification. Effectiveness in Relapse Prevention: There is stronger evidence that naltrexone reduces relapse rates in highly motivated individuals who are already detoxified and wish to remain drug-free. This makes naltrexone particularly suitable for individuals in probation programs or those who are committed to long-term abstinence. Gambling Addiction: Research by Grant et al. (2006) tested naltrexone on a small group of 45 gamblers and found that it was more effective than a placebo in reducing gambling activity. While the findings suggest naltrexone’s potential for treating gambling addiction, further research with placebo-controlled comparisons is needed to confirm its effectiveness in this area. Overall Evaluation: Methadone: Pros: Well-supported by research, especially for retention in treatment and reduction in heroin use, criminal activity, and the spread of HIV. Cons: Potential for overestimation of effectiveness due to overlap in study populations. The treatment also substitutes one addiction for another, although it is generally safer than heroin. Buprenorphine: Pros: Lower risk of overdose compared to methadone, effective in retaining individuals in treatment. Cons: Slightly less effective than methadone for treatment retention, though this might be an acceptable trade-off for its safety profile. Naltrexone: Pros: Effective for relapse prevention in motivated individuals who have detoxified, and useful for treating gambling addiction. Cons: Mixed results in the treatment of heroin addiction, limited by inconsistent research findings. Further research is needed to confirm its long-term effectiveness. Additional Issues: Self-report and Urine Tests: Many studies rely on self-report methods to measure drug-taking behavior, which can be unreliable. Some studies use urine tests, which can be manipulated. Sample Attrition: A significant problem in addiction treatment research is the high dropout rate from programs, which can affect the representativeness of the sample and lead to biased results. Many studies follow participants for only a short period, making it difficult to assess long-term outcomes, such as relapse. Conclusion: While all three treatments (methadone, buprenorphine, and naltrexone) have demonstrated effectiveness in addiction treatment, their success may depend on factors such as the individual’s motivation, the type of addiction being treated, and the presence of additional psychosocial interventions. Further research is needed to address the methodological challenges and improve the understanding of these treatments’ long-term effects.

Answer 14

Evaluation: Ethical Implications Ethical Criticisms of the Use of Methadone From an ethical standpoint, there are several important concerns regarding the use of methadone as a treatment for opioid addiction: Addictiveness of Methadone: Methadone is itself an addictive drug, and there is a risk of overdose, especially if it is taken in excessive amounts or combined with other substances. Critics argue that while methadone helps to reduce the harms associated with heroin use, it may simply replace one addiction with another. Overdose is a significant concern. Methadone can cause death if too much is consumed, particularly when mixed with other drugs. Additionally, methadone-related deaths have occurred due to accidental consumption, especially in homes where children might ingest it unintentionally. NICE (2014) reported 429 methadone-related deaths between 1993 and 2008. Accidental Consumption: The accidental ingestion of methadone, particularly by children, is a serious risk. Since methadone is commonly stored at home, this presents an ethical dilemma regarding how to balance its benefits in treatment against its potential dangers in a domestic setting. Long-Term Dependency: The ethical concern arises from the fact that methadone does not eliminate addiction but merely alters the nature of it. Critics argue that methadone maintenance can be seen as a form of prolonged dependency, which could be viewed as morally problematic if the ultimate goal is to fully eliminate addiction. Some proponents of methadone treatment suggest pairing it with additional rehabilitation efforts to address the root causes of addiction and promote detoxification. However, this dual approach raises questions about the sufficiency and ethics of methadone as a standalone treatment. Ethical Concerns with Naltrexone Naltrexone, as an opioid antagonist, has its own set of ethical concerns: Withdrawal Symptoms and Side Effects: A major issue with naltrexone is that it can cause withdrawal symptoms such as nausea and headaches, especially when first administered. These side effects can lead to non-compliance, as individuals may discontinue the drug due to discomfort. The inability to experience euphoric feelings, which individuals with addiction often seek, is another factor leading to discontinuation. Risk of Overdose After Relapse: Naltrexone works by blocking the opioid receptors in the brain, preventing the euphoric effects of heroin. However, if an individual relapses while on naltrexone, they may take a higher dose of heroin to overcome the blockade. This increases the risk of overdose, as the usual dose might now be potent enough to overwhelm the system and cause fatal consequences. From an ethical perspective, the potential for this dangerous relapse behavior poses a challenge in using naltrexone as a treatment. The risk of overdose following relapse raises questions about the safety and responsibility of prescribing naltrexone, especially for individuals who may not have full control over their addiction.

Answer 15

Evaluation: Social Implications Financial Cost of Methadone to Society The financial implications of methadone treatment have sparked debates about the effectiveness of its funding: Costs and Criticism: A report by the Centre for Policy Studies (Gingell, 2011) argued that prescribing methadone was an inefficient use of public funds. The report pointed out that nearly £3 billion was spent on methadone programs, yet 327,000 individuals remained dependent on the drug. This led the report’s author to suggest that the money would be better allocated to abstinence-based treatments. Counterarguments and Economic Benefits: However, these criticisms have been contested by other studies. Research by Durrance et al. (2011) indicated that the economic benefits of methadone treatment outweighed its costs. Methadone is associated with reducing the spread of HIV and hepatitis, and it helps improve the functioning of users within society. NICE guidelines also support methadone as a cost-effective treatment, suggesting that it helps reduce costs related to crime and unemployment. Methadone and Criminality Methadone treatment has been shown to have significant social benefits, particularly in reducing criminal behavior: Reduction in Crime: A report by the National Treatment Agency (2009) found that methadone treatment led to a reduction in criminal activity. Heroin addicts often commit crimes to fund their drug use, and when methadone replaces heroin, the need for criminal activity diminishes. The report concluded that those who had been in treatment the longest saw the greatest reductions in criminal behavior. Concerns About Antisocial Behavior Near Treatment Centres: A potential issue raised by critics is the establishment of methadone treatment centers, which could lead to an influx of addicts congregating in specific areas. This could raise concerns about antisocial behavior in the vicinity of these centers. Research Findings: However, research in the USA, specifically a study by Boyd et al. (2012) on methadone treatment centers in Baltimore, found no evidence of an increase in crime around these centers. The study concluded that crime rates in areas with methadone centers were similar to those in the surrounding regions, challenging the concern that methadone clinics contribute to higher local crime rates.

Answer 16

Aversion Therapy Aversion therapy is based on classical conditioning principles and aims to reduce undesirable behaviors by associating them with unpleasant consequences. The process of classical conditioning involves pairing a neutral stimulus (NS), which would not naturally provoke a response, with an unconditioned stimulus (UCS) that naturally leads to an unconditioned response (UCR). Over time, the neutral stimulus becomes a conditioned stimulus (CS), capable of eliciting the same response as the UCS. Antabuse (Disulfiram) Antabuse (disulfiram) is used to treat alcohol addiction by interfering with the body's ability to metabolize alcohol. Normally, alcohol is broken down in the liver by an enzyme, but Antabuse blocks this enzyme. When a person who has taken Antabuse drinks alcohol, they experience intense symptoms such as nausea, vomiting, and headaches. The goal is for the person to associate alcohol with these unpleasant side effects, reducing the desire to drink in the future. This method is an example of classical conditioning: During learning: Antabuse (UCS) → Vomiting (UCR) Alcohol (NS) + Antabuse (UCS) → Vomiting (UCR) After learning: Alcohol (CS) → Vomiting (CR) Rapid Smoking Rapid smoking is another form of aversion therapy designed to help individuals quit smoking. The procedure involves the smoker sitting in a closed room and taking a puff of a cigarette every 6 seconds until they feel ill or nauseous. The goal is for the person to associate the unpleasant physical sensation with smoking, leading them to avoid the behavior in the future. Like Antabuse, rapid smoking is grounded in classical conditioning, where the smoker associates nicotine with the negative feelings of nausea. However, this method has fallen out of favor, particularly in the UK. The National Institute for Health and Care Excellence (NICE) no longer recommends rapid smoking as a treatment for nicotine addiction due to the health risks it poses and because more effective alternatives have since been developed. Antabuse Implants Antabuse implants offer a solution to the problem of patient compliance. One major issue with Antabuse is that people often stop taking it due to side effects or forgetting to take the medication regularly. The Unistik Antabuse implant is a pellet inserted under the skin, typically in the lower abdomen. This pellet releases the drug slowly over up to 12 months, ensuring that the unpleasant reaction with alcohol continues during that period. Ethical Concerns Regarding Antabuse Implants While the use of Antabuse implants may improve treatment adherence, ethical concerns have been raised about their use, particularly regarding coercion. In 2007, former Conservative Minister Iain Duncan Smith suggested that persistent alcoholics, including homeless individuals, should be required to receive an Antabuse implant to qualify for state benefits. His proposal was meant to encourage individuals to seek help for their addiction. However, critics argue that the use of the implant in exchange for state benefits raises significant ethical issues: Coercion and Autonomy: Forcing individuals to undergo a treatment that causes an unpleasant reaction if they drink alcohol may be viewed as a violation of their autonomy. Critics argue that the choice should be left to the individual. Ethical Concerns of State Intervention: Some believe that requiring the implant as a condition for receiving benefits is a form of coercion that limits an individual's ability to freely choose their treatment options. The argument here is that individuals should not be forced into medical procedures, even if those procedures aim to improve their health. Justification in Extreme Cases: Others argue that in cases where the person's addiction is severely harming their life and the lives of others (e.g., contributing to homelessness, crime, or severe health problems), the state's intervention through measures like Antabuse implants could be justified. They propose that such decisions should be made only after thorough consideration and with additional steps, like a detoxification program, to ensure that the individual is not coerced or subjected to harm.

Answer 17

Several studies have shown that Antabuse can be effective in promoting long-term abstinence from alcohol. A study by Neidershof and Wilfong-Saefen (2003) compared individuals who were treated with Antabuse to those who received a placebo. The results showed that those treated with Antabuse had significantly greater abstinence for up to 12 months following the treatment. This suggests that Antabuse is effective in helping people reduce their alcohol consumption and addictive behavior. However, some researchers have questioned the validity of abstinence as a sole measure of success. Just because an individual stops drinking or smoking during treatment does not necessarily mean they are cured of their addiction. Abstinence may be a temporary result, and relapse can occur once the treatment ends. Furthermore, many studies on Antabuse are conducted on volunteers who are often already motivated to quit. This could mean that they are more likely to succeed with or without the treatment, raising concerns about the generalizability of these findings. Effectiveness of Rapid Smoking Rapid smoking is a technique in which smokers take a puff of a cigarette every 6 seconds until they feel ill, with the goal of associating the unpleasant physical sensations with smoking. A study by Lowe et al. (2000) on 100 smokers found that after a single session of rapid smoking, there was a significant reduction in cigarette intake compared to a control group. However, the effectiveness of this method diminished over time. Short-Term Effects: The improvements in cigarette consumption were notable initially, with participants consuming fewer cigarettes within the first four weeks. Long-Term Effects: When a follow-up study was conducted after six months, the improvements were not sustained. Many participants no longer experienced the same negative physical effects from smoking, causing the negative associations to dissipate. This suggests that rapid smoking may be effective in the short term but lacks lasting impact, especially if not paired with other interventions like Cognitive Behavioral Therapy (CBT). Eliminates the Behavior, Not the Problem A significant limitation of aversion therapy, and similar behavioral treatments, is that they often focus solely on eliminating the undesirable behavior rather than addressing the underlying causes of the addiction. For example, if a person drinks alcohol to cope with stress or depression, stopping the drinking behavior alone does not solve the root issue. The individual may still experience the psychological distress that led to the addiction in the first place. This highlights a key concern: while the addictive behavior may be suppressed, the underlying emotional or psychological issues (e.g., stress, trauma, depression) may remain unaddressed, leading to potential relapse or the displacement of the behavior. The person might find another harmful coping mechanism to replace the one that was removed. Therefore, aversion therapy may be less effective in the long term unless combined with other therapeutic approaches that focus on addressing the cognitive and emotional aspects of addiction, such as CBT or counseling. Conclusion While Antabuse and rapid smoking have shown some effectiveness in helping individuals reduce their addictive behaviors, both methods have limitations. Antabuse can promote abstinence, but it may not offer a cure for addiction and could result in relapse once the treatment is discontinued. Rapid smoking is effective in the short term, but its effects are not sustained over time. Both therapies fail to address the underlying psychological causes of addiction, making it essential for individuals to undergo comprehensive treatment plans that incorporate CBT or other therapeutic methods for long-term success.

Answer 18

Risk of Harm The use of Antabuse poses significant ethical concerns due to the risk of harm associated with its side effects. The drug causes severe physical reactions when alcohol is consumed, including symptoms like nausea, vomiting, headaches, and in extreme cases, even life-threatening consequences. This raises a critical ethical issue: informed consent. Individuals must be made fully aware of the potential dangers before starting treatment to ensure they are giving valid and informed consent. Failure to adequately communicate the severity of the side effects may lead to ethical issues around whether patients truly understand what they are agreeing to. Additionally, there is the concern of non-compliance. Some patients may initially take Antabuse but stop once they experience the unpleasant side effects. This behavior may undermine the effectiveness of the treatment and raises concerns about the autonomy of the individual. Patients may choose to stop treatment, which leads to the question of whether they are being ethically coerced into continuing treatment when they are experiencing significant discomfort. To mitigate these issues, Antabuse implants have been suggested as a way to ensure that the drug is continuously administered. While implants may improve compliance, they introduce another ethical dilemma: the possibility of coercion. In some cases, Antabuse implants may be used on individuals who are not motivated to seek treatment, potentially without their full consent. This leads to concerns about the autonomy and freedom of choice of individuals receiving the implants, especially in situations where they are pressured into treatment. More Ethical Alternatives There are alternative, less harmful, and more ethical methods for achieving the same goal of reducing addictive behaviors. One such alternative is covert sensitisation, which relies on mental imagery rather than physical discomfort. In covert sensitisation, individuals are asked to imagine an unpleasant experience while thinking about their addictive behavior (e.g., smoking or drinking). This approach creates a negative association with the behavior without the person actually having to endure any unpleasant physical reactions. Research by Kraft and Kraft (2005) found that individuals who were hypnotized and asked to imagine unpleasant consequences of smoking and drinking were less likely to relapse. This method avoids the physical harm associated with Antabuse and eliminates the coercion that can come with its use. Covert sensitisation may be considered more ethical because it avoids the risks of using a drug like Antabuse to induce an unpleasant reaction, making it a potentially safer and more respectful treatment for individuals dealing with addiction. Conclusion While Antabuse and similar treatments may be effective in addressing addiction, the ethical implications are significant. The risk of harm associated with Antabuse, especially in the form of unpleasant and potentially life-threatening side effects, raises questions about informed consent and the potential for coercion in cases where implants are used. The ethical concerns surrounding these issues could be alleviated by considering alternative treatments like covert sensitisation, which avoids physical harm and respects the autonomy of the individual. This analysis shows that while Antabuse can help some individuals overcome addiction, its ethical implications need careful consideration. Alternative approaches should be explored to ensure the safety, autonomy, and well-being of individuals undergoing treatment.

Answer 19

Financial Implications The financial cost of treating addiction with medications like methadone has been a subject of debate. In the UK, the NHS's expenditure on methadone and other addiction treatments has increased significantly over the years. For example, in 2008, the NHS spent over £2.25 million on these medications, a significant rise from £1.08 million in 1998 (Devlin, 2008). While this represents a relatively small portion of the NHS’s overall budget, there are arguments suggesting that such spending may save money in the long run. Supporters of addiction treatment programs argue that the financial investment in such treatments may be justified because, in the long term, these programs help individuals overcome addiction, potentially leading to reduced healthcare costs, lower crime rates, and improved productivity in the workforce. By treating addiction effectively, the NHS could ultimately reduce future medical and societal costs associated with long-term addiction, such as hospitalizations, crime-related expenses, and welfare support for those unable to work. The Social Cost of Not Treating Addictions The Centre for Social Justice (2013) in their No Quick Fix report highlighted the economic and social costs of addiction to society. They estimated that addiction in the UK costs over £21 billion annually due to crime, unemployment, family breakdown, and poor health. The report also stated that the total cost to the NHS alone could be as high as £3.5 billion when considering the effects of alcohol and drug misuse. These figures underscore the importance of addressing addiction and providing adequate treatment, even if some treatments may be controversial or costly in the short term. If addiction treatment is not prioritized, the social consequences may escalate. Families are torn apart, individuals lose their jobs, and crime rates increase as people seek to fund their addictions. These problems contribute to a vicious cycle that places a heavy burden on society. Treating addiction can help break this cycle, which benefits not only the individuals affected but also the broader community. Weighing Costs vs. Benefits While financial concerns and ethical issues related to treatments like aversion therapy or Antabuse implants exist, the long-term societal benefits may outweigh these drawbacks. Investments in addiction treatments can ultimately reduce the financial burden on social services, healthcare, and the criminal justice system. Furthermore, successful treatment programs can lead to healthier families, stable employment, and a reduction in crime. The decision to allocate resources for addiction treatments, even if controversial, can be viewed as a socially responsible choice. By addressing addiction early and effectively, society may save considerable resources that would otherwise be spent on tackling the fallout from untreated addiction. Conclusion While there are clear financial costs to treating addiction, the social benefits of addressing addiction—such as reducing crime, improving health outcomes, and stabilizing families—may justify these costs. The long-term savings in healthcare, crime prevention, and social services could far exceed the initial financial outlay. As such, the societal value of investing in addiction treatment, even with controversial methods, may be substantial. In this context, treatments like methadone, Antabuse, and other therapeutic interventions can be viewed as essential tools in mitigating the broader social costs of addiction.