What is substance use?
People do not experience harm from taking a substance. Eg. Coffee
What is substance misuse?
Substance results in some form of problem. Eg a person who drinks 5 cups of coffee in the morning
What is substance abuse?
The person (& indirectly others) will be harmed in some way from taking the drug.
How do substance abuse,misuse and use vary in countries?
In Muslim countries it is illegal to sell and drink alcohol whereas in the UK it is only illegal under the age of 18.
What is addiction defined as?
A substance has been repeatedly used resulting with the user being preoccupied with the substance maintaining supply & is likely to relapse if they attempt to stop taking drugs.
What is physical dependence defined as?
Where the body has got used to the substance & continued usage is needed to maintain the body in what is now its normal state. ‘Normal’ - being no withdrawal symptoms or unpleasant feelings
What were Olds & Milner the 1st to do in 1954?
Research the role of certain areas of the brain being ‘pleasure centres’.
Outline Olds & Milner’s research in (1954).
A- Investigated the role of the septal area of the brain in addictive behaviour.
M- Electrodes were implanted into septal brain area of rats. The electrode supplied a small electric current when the rat pressed the lever (self stimulation)
R - rats pressed the bar v. rapidly & for long periods of time. Some rats pressed until exhausted & unable to press anymore.
C - Stimulation of the septal area of the brain was highly rewarding for rats & may be seen as pleasurable
What did research from Phillips et al find in 2002?
Self stimulation of this area of the brain increases levels of dopamine.
State the two types of dependency.
Physical dependence & psychological dependence
List the 6 main components of addictive behaviour
- Activity associated with the addiction is central & of high importance
- Experience of addictive behaviour results in a rush & a pleasant feeling ‘high’
- Physical tolerance to the drug means high levels have to be taken to maintain the pleasant feeling
- Withdrawal symptoms occur when the drug has not been taken for long periods
- Relationships with other people are often subject to hostility & conflict
- Risk of relapse after having come off the drug is high
What 3 main factors did Sarafino list as part of health promotion in 2006?
- Individual factors - habits behaviours beliefs incentives
- Interpersonal factors - social factors family & friends models for behaviour
- Community factors - health promotion & education which takes place during their community
Health promotion can be sued for prevention & reduction of substance abuse by using 4 methods.
List the 4 methods
- Information giving - healthy diet exercise medical conditions
- Information to motivate - motivate a person to be healthy
- Motivational Interviewing - one to one basis motives & resistances of individual are explored
- Behavioural techniques - aimed at changing unhealthy behaviours
When can health promotion campaigns take place?
Schools work & communities
Outline Moher et al 2005 study
A - effectiveness work-based attempts to help employees to stop smoking
M - effectiveness of programme analysed - some focussed on individuals others on the work force
R - group therapy counselling & nicotine replacement therapy increased cessation rates in comparison to controls. Self-help materials had little effect whole workforce programmes did not reduce smoking. Competitive & incentive schemes increased attempts to stop. Bans increased consumption during the working day but little at home
C - most effective workplace programme which help employees are ones that focus on the individual
Outline the 6 stages in the Prochaska model of behaviour change.
- Pre-contemplation: person is not aware that have a substance abuse problem & have no intention of changing
- Contemplation: the person has become aware of their substance abuse
- Preparation: the person has made the decision to change their behaviour in the near future - substance abuse may be reduced
- Action; behaviour begins to change at least for one day
- Maintenance: the behaviour change is maintained
- Termination: new behaviour has become established & is now normal
What is a strength of substance abuse programmes?
High completion rates with high success
What is the comparison between smokers who stop during the early stages compared to those in the action stage?
Early stage - less successful
If they tried to stop smoking during preparation then to the action stage periods of abstinence was much longer
What do health promotion & prochaska’s model of behaviour change present people with?
Structure programme that they can manage & tackle each stage
What is aversion therapy?
Based on classical conditioning
The abused substance is paired with an unpleasant stimulus such as electric shock or a drug that makes you sick
Outline Wiens & Menustik study into the effectiveness of aversion therapy in 1983 on alcohol abusers.
M- hundreds of people with a drink problem were treated using an emetic
R- 60% of men & women ceased taking alcohol altogether over 12 month period 1/2 them remained alcohol free for 2 years
C- aversion therapy is effective in alcohol abuse treatment success trade is not very high as many relapse after treatment programme
What is a ethical evaluation of aversion therapy
Fails to protect participants from harm
What is aversion therapy known to be good for?
Alcohol & smoking abuse less evidence for other types of substance abuse
What research suggests other alternatives are more successful that aversion therapy
Higgins et al.
M- Cocaine abusers given contingency training of 6 months
R- 68% completed the programme & achieved 8 weeks without drugs
C - Incentives can be effective when treating cocaine abusers
What other aversion therapy did Danaher research in 1977?
What is another type of aversion therapy CS?
What is the aim of covert sensitisation?
Associate unpleasant & negative thoughts with substance abuse
When did Emmelkamp suggest CS is most effective in 1996?
What is contingency training based on?
Operant conditioning involves giving incentives
What is self management?
Helping an individual help themselves to overcome their addictive habit & manage their substance abuse
What do self-management programmes involve?
- monitoring - record of substance intake
- awareness - insight into what causes the person to abuse the substance
- consequences - of the substance abuse for individual family & friends
What is most well known form of self-management?
AA (Alcohol Anonymous)
What are the 2 basic principles of AA?
People who abuse alcohol are alcoholics for life
1 drink after a period of abstinence will cause an individual to backslide
What does Moos and Moos research in 2004?
The more regularly a person attends AA the more likely they are to stop abusing alcohol & the better relationships they have.
What are the limitations of AA?
Those who do not believe in God are less likely to attend AA groups
How can self management programmes be assisted?
Community base programmes
Outline Botvin et al research into community based programmes in 2001.
A- Community programme about binge drinking with teenagers in New York City
M- 1700 teens programme about negative effects of binge drinking . Control group of 1300 did not receive the programme
R- Binge drinking was 50% lower in those who received the programme
C- Community based programmes provided information & practical advice on how to stop binge drinking
What is the difficulty with verifying self-management groups?
They do not record or disclose information so it is hard to verify scientifically
When is self management most successful?
When it is built on a structured programme
What is the biggest problem with self management?
Relapse Budney & Higgins (1998) due to peer pressure & external factors
What is the most successful form of self management?
Cognitive Behavioural Therapy - which helps the individual deal with their behaviour in everyday life
Give an example of behavioural therapy
Miller et al 1992 - people monitor their alcohol abuse & the therapist teaches them coping strategies
What did research show using the behavioural technique?
70% improvement from clients
Outline the 3 types of prevention techniques
What is primary prevention?
Concerned when the substance is about to start & to prevent abusing in the first place
What is secondary prevention?
Aimed at target groups who may be at risk of abusing a substance
What is tertiary prevention?
People who are already abusing substances & to prevent them from developing
What did Naidoo & Will identify in 1998 as the 3 factors to consider in risk assessment
- Psychological factors - employment status level of social support
- Cultural factors - certain ethnic groups
- Biological factors - parents or both parents have a history of substance abuse
What did Gray et al find in 2000 about Aboriginal Australians
Drink excess - genetic predisposed & vulnerability
What is a medical way of identifying those who abuse substances?
Through their GP Anderson 1993 & Wallace 1988 GPs were effective
Outline Drummond’s study in 2002
A- effectiveness of helping people identified at A&E who abuse alcohol
M- people with alcohol problem identified a A&E & were invited to clinics
R- 50% of identified attended the clinic the next day to discuss alcohol abuse with health professional
C- identifying substance abusers in medical settings can treat substance abuse
What is a limitation of high risk groups?
Focus too much on the individual not enough on the social & cultural factors of the risk group
What is necessary in treating high risk groups?
Culturally sensitive treatments
What are fear arousing appeals?
Appeals used to create fear in a person about the side effects of substance abuse causing upsetting scenes for the user & others
What did Janis & Hovland state are the 3 key factors?
Source factors (expertise), Message factors(type of appeal) , Audience factors (persuadable the audience is)
Outline Janis & Feshbach’s 1953 study
A- effect of different levels of fear appeals on health behaviour
M- 3 lectures on tooth decay varied in level strong medium & weak
R- strong appeal = highest level of anxiety but least change low fear appeal = least anxiety more change
C- High fear arousals create high anxiety but little change
Outline Festinger Cognitive Dissonance theory 1957
Uncomfortable feelings of conflict motivate people to change their behaviour & attitudes
What are the problems with Festinger’s theory?
Cannot test cognitive processes
Subjective to individuals
Outline Witte (1992) findings from the extended parallel process model
Levels of self efficacy & the message effect whether or not an individual accepts or rejects the message
What is social inoculation
Making people resistant to social pressures
What 4 factors in Flay (1985) identify as key in SI.
- Knowledge - facts & info about negative effects of substance abuse
- Discussion - how does the person feel about substance abuse
- Skill development - communication skills how to resist others
- Public commitment - publicly that they will not accept abuse
What did McAlister et al (1980) use social inoculation techniques to do?
To deal with the social pressures of smoking
Outline Cujipers et al 2002 study into social inoculation
A- effectiveness of SI
M- Schools were delivered SI and others were not. Pupils had to report on their behaviour towards substance abuse. Reports were compared
R- Pupils that received SI drank less alcohol than those who did not as well as higher rates of cannabis use
C- SI programmes can influence levels of substance abuse in school aged teenagers
What are some problems with fear arousing appeals?
Ignore the reasons why
Wide audience & not targeted
What is the inverted U theory?
Moderate fear arousal/appeals are the most effective at encouraging change