Reducing addiction Flashcards
(20 cards)
What are the three ways of reducing addiction?
1) Drug therapy
2) Behavioural interventions
3) CBT
AO1: Drug therapy for nicotine addiction
Nicotine replacement therapy is an agonist substitution. Nicotine is provided from less harmful sources e.g. patches, gum and nasal sprays rather than a cigarette. NRT stimulates the nicotine receptors by activating the brain rewards pathways through the release of dopamine which stimulates nicotine receptors in the nucleus accumbent creating the same pleasurable feeling from a cigarette. This reduces withdrawal syndrome and stops cravings. The reduction of withdrawal syndrome removes the unpleasant consequence of quitting smoking so continuing with NRT is negatively reinforced.
Nicotine receptors are also desensitised by releasing small amounts of nicotine so not all nicotine receptors are full. Over time this reduces the nicotine receptors which reduces cravings and reduces the chances of relapse. The addict can lower the dosage as their tolerance has been reduced.
AO1: Drug therapy for gambling addiction
No specific drug treatment has been approved yet in the UK. There have been several candidates with the most promising being an opioid antagonist, naltrexone, which is typically used to treat heroine addiction. This is because of the similarity green gambling and substance addiction. The aim of opined antagonists is to reduce the pleasurable feelings associated with gambling. naltrexone enhances the release of the NT GABA in the mesolimbic pathway. The increase GABA activity reduces the release of dopamine in the nucleus accumbent which reduces the urge to gamble.
AO3: NRT - RTS Stead - placebo
RTS the effectiveness of NRT in reducing nicotine addiction comes from Stead et al. He reviewed 150 high quality studies where NRT was compared to placebos. They found all forms of NRT (gums, patches and inhalers) were more effective for quitting smoking than placebos and having no treatment at all. This supports drug therapy as it shows by reducing withdrawal syndrome and desensitising nicotine receptors it reduces smoking addiction. Increases the validity.
AO3: NRT - little motivation
A strength of NRT is that it requires little motivation. This is because the patient only has to wear a patch or reduce gum in order to reduce their addiction. This oil unlike CBT where addicts must attend sessions for month and complete homework which requires time and effort leading to increased attrition rates. More appropriate.
AO3: NRT - side effects
A weakness of NRT and opiod antagonists is that they may have negative side effects. These include headaches, sleep disturbance, dizziness and stomach problems. This is unlike CBT which is non invasive where they have to identify and challenge irrational thoughts around addictive behaviour. Side effects may stops them taking drugs so they may relapse. Ineffective
What are the evaluations for drug therapy? (3)
1) RTS Stead - placebo
2) Side effects
3) Little motivation
AO1: Aversion therapy
The aim of AT is to use the principles of classical conditioning to change pleasurable association of addictive substance/behaviour and replace it with unpleasurable association in an in vivo experience.
Nicotine addiction:
One specific technique used is ca;;ed rapid smoking. Individuals will sit in a room alone and have a puff of their cigarette every 6 seconds. This causes nausea and sickness and they will start to associate these feelings with smoking. This is repeated until they have created an aversion to smoking reducing nicotine addiction
Gambling addiction:
Electric shocks are delivered in behavioural interventions for smoking. The electric shocks don’t cause permanent damage but do cause pain to avert gambling addiction. Addicts write down gambling behaviours on card such as “lottery’ and ‘casino’. They also write some non gambling behaviours ‘going straight home’. They are presented with these cards and every time a gambling related card is presented a two second electric shock is delivered. The individual then associates gambling with a painful shock rather than please causing version to gambling, reducing the addiction.
AO1: Covert sensitisation
The aim of CS is that the pleasurable association is broken down into unpleasant association in an in vitro experience.
Nicotine addiction:
The client is encouraged to relax. The therapist then reads a script asking the client to imagine an aversive situation. For example they imagine themselves smoking followed by an unpleasant consequence e.g. vomiting after smoking or smoking a cigarette covered with faeces. The more vivid the imagery scene is the better it will work. Therefore the therapist goes into graphic details about the elements of the scene. Towards the end the client should turn their back on their nicotine addiction feeling relief. They then associate their addiction with the unpleasant scenario rather than pleasure, reducing the addiction.
What are the equations for behavioural interventions (4)
1) RTS McConaghy - CS v AT
2) Ethical issues
3) Motivation commitment
4) Non invasive
AO3: BI - RTS - CS vs AT
RTS CS comes from McConaghy who studied reductions in gambling addictions. He compared electric shock aversion therapy with CS to treating gambling addiction. He funds that one year like those who had CS were more likely to have a reduction in their gambling addiction with CV 90% reduction and AT 30% reduction. This shows that imagination is more effective than aversion therapy and as it uses imagination it is a much safer treatment. Increasing the appropriateness.
AO3: Non - invasive
A strength of CS is that it is suitable for all types of people as it is non invasive. For example if an individual is pregnant CS is less likely to harm the foetus. This is unlike AT where the stress, pain and committing caused from the mother could lead to negative physical and psychological effects on the baby. CV more appropriate that AT.
AO3: BI - Motivation and committment
A weakness of both is that it requires the addicts motivation and commitment. This is because they are expected to attend sessions and work with therapist to unlearn their pleasure response to the addictive behaviour whilst putting them in aversive situations such as feeling sick or getting electric shocked. This is unlike drug therapy as they are only required to take a tablet or wear nicotine patch or gum to reduce addiction. They may drop out reducing effectiveness
AO3: BI - ethical issues
A weakness of AS is that it has ethical issues. This is because AT techniques such as feeling sick or receiving shocks could cause physical or psychological harm. For this reasons CS may be more appropriate as it is carried out in a vitro experience reducing physical and psychological harm. CS may be more appropriate.
AO1: CBT
The aim of CBT is to identify and challenge maladaptive thoughts that cause an addiction and replace the with more adaptive ways of thinking and coping behaviours that help them cope with high risk situations which may trigger relapse.
The first stage is functional analysis where the therapist asks the client to identify high risk situations that will cause them to engage in addiction for example walking past a betting shop. The therapist asks the client how they feel before, during and after these high risk situations. This is so the therapist can identify any cognitive biases and work with the client to challenge faulty thinking.
After analysis, it is cognitive restructuring. This is where maladaptive, irrational thoughts are changed into adaptive rational ones by disputing. For example, someone with a gambling addiction may have irrational beliefs that they win more than they lose. However by disputing the therapists asks for evidence for this “Where is the evidence that you win more than you lose?’.
The addicted person is then taught social skills to help them cope with high risk situations which may cause them to engage in addiction. They teach the client how to refuse addiction without causing embarrassment. The client practice these with therapist in role playing scenarios before it is implemented in the real world.
They are also taught avoidance strategies were they are taught to avoid addiction. For example driving home a different day to avoid a betting shop.
The client then puts into place these social skills in the real world on their own and reports back to client until they feel confident in situations with their addiction. This leads to preventing relapse
What are the evaluations for CBT (4)
1) RTS Perty et al - treatment vs control condition
2) Motivation and commitment
3) Chemical dependence
4) Non invasive
AO3: CBT - RTS Perty
RTS CBT comes from Perty et al. He randomly allocated a group of gamblers to one of two conditions. The control group received Gamblers Anonymous meetings. The treatment condition received GA meetings and an 8 session Cut programme. They found that the treatment condition was much less likely to gamble compared to the control group. This shows by identifying and challenging cognitive biases it reduces addictive behaviour. Increasing validity.
AO3: CBT - motivation
A weakness of CBT is that it requires commitment. This is because patients must attend sessions over a period of times where they identify and challenge maladaptive thoughts that cause an addiction and change them into adaptive ways of thinking. They must also complete homework such as avoidance strategies of addiction. This is unlike drug therapies where they only have to take a drug such as nicotine patch or gum to reduce gambling addiction. Therefore this reduces appropriateness as they may quit and drop out.
AO3: CBT - Chemical dependence
A strength is that it avoids chemical dependence. This is because in CBT clients are taught the skills to identify and challenge their own cognitive distortions which cause there addiction e.g feeling like they cant cope without addictive substance. This is unlike drug therapy which relies on drug to regulate their levels of nicotine/dopamine. CBT may be more appropriate
AO3: CBT - Non invasive
A strength of CBT is that it is non invasive which makes it more suitable for a broader range of people. For example CBT is less likely to cause harm to a foetus of someone who is pregnant as they are taught social skills to identify and challenge maladaptive thoughts. This is unlike drug therapy which as chemicals in the drugs such as nicotine in Not may cause physical damage to the baby. Increases appropriateness.
