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Reducing factors in addiction

vesara Unit4-Addiction A-Level English 21 cards

Cards in this deck (21)

  1. 1Ao1- The TPB can be used as an explanation/model for understanding the process of addiction but also as a way to understand prevention and treatment. Firstly, it can do so by changing behavioural attitude. The US office of National Drug Control Policy launches as anti-marijuana campaign in as trying to create the attitude that marijuana uses is inconsistent to achievement. The campaign was effective due to success in changing attitudes. Also, changing subjective norms is another important factor of TPB, anti-drug campaigns seek to give adolescents actual data about people engaging in risky behaviour in an attempt to change subject norms, e.g. adolescents who smoke are usually part of a peer group who smoke and therefore might believe that smoking’s the norm for teens but exposure to accurate statistics should correct subjective norms and form part of an effective campaign. Thus, this theory TPB could be used to help develop long lasting changes in addictive behaviour.Ao2- TPB model has been criticised for ignoring other factors such as biology as it’s limited to how cognitive processes only influence our behaviour and as such doesn’t include the role of other factors, such as emotions and motivation. The underlying idea behind this model is that people behave in conscious, thought-through, deliberate ways when in fact we often act on impulse. TPB therefore doesn’t predict well behaviours that aren’t thought0through which often include addictive behaviours. Apart from cognitive context, behaviour may also be influenced by motivation. Klag found that recovery was more successful if it was decided by the addicts themselves. It could be concluded that the TPB is reductionist as a model for addiction prevention.
  2. 2Ao1-SAMEAo2- Odgen conducted a literature review and pointed out that not all parts of TPB have been consistently validated and behaviour was measured by self-report rather than in an objective way. Some studies reported no role of subjective norms while others showed no predictive role for perceived behaviour control and some showed no role for behavioural attitudes. TPB may be able to predict behavioural intention but intention doesn’t always result in actual behaviour even if perceived behavioural control is high. An individual may intend to give up smoking but doesn’t mean they will even if they believe they can do it. As such TPB’s model construct validity is relatively low as the theoretical components aren’t seen in real life as suggested by Odgen et al.
  3. 3Ao1- TBP claims that perceived control was the most important predictor of ultimate behaviour, so we could reinforce people’s perceived control which leads to a change in behaviour. Godin et al used questionnaires and interviews with adults who intended to quit smoking and found perceived control was the most important predictor of ultimate behaviour so, prevention programmes should concentrate on willpower and effort. This can be done by creating/building up people’s sense of self-control because higher sense of control leads to a lower chance of starting addictive behaviour. We can change/raise peoples sense of control which could lower the chance of them starting addictive behaviours.Ao2- Evidence collected by Godin et al has been questioned due to replicability issues found by conflictive evidence from other researchers. One early intervention programme was trialled by Gaboury and LaCoucheur in a classroom setting with school students in Canada. It consisted of general information about gambling, it’s possible negative consequences and strategies to control gambling behaviour. The results show that while the programme improved knowledge about gambling both immediately after the sessions and at 6 month follow up, no influence was demonstrated on actual gambling behaviour. This suggests that some components of TPB such as changing long term behavioural attitudes and perceived behavioural control haven’t been consistently found to directly influence behaviour.
  4. 4Ao1- SAMEAo2- TPB model has been found successful in predicting intention to change rather than actual behaviour to change (Armitage and Conner). This pattern in results is typically found in prediction in health behaviours that are difficult to change e.g. complete withdrawal from drugs. This suggests the TPB is primarily an account of intention formation rather than specifying he process involved in translating intention into action. As such, TPB model is faulty because it doesn't make a distinction between a motivational phase and post-decisional phase.
  5. 5Ao1: One method of treatment of substance addiction is called agonist substitution. This involves giving an addict a safer drug that’s chemically similar. This method is commonly used to treat heroin addicts but can also be used for nicotine addicts. Methadone is an influential drug in a liquid form which patients must drink once being watched by the supervisor/clinicians. The opiate levels in the brain rises slowly and doesn’t produce a high like heroin. It’s a long lasting drug meaning that if the addict injects heroin it won’t have an effect.Ao2: Effectiveness of agonistic drugs is disputed due to the risk of relapse. When the substitute drug is gradually reduced, the addict may relapse. This is because the addict will have unpleasant physical withdrawal effects. This suggests that replacement drugs can be effectively used in safe and legal environment as well as short-term fix but specialists should be able to consider more effective treatments such as combined therapy. As such the effectiveness of replacement drugs is relatively low as it leads to high risk of relapse but would be improved when combined with psychological therapies.
  6. 6Ao1- SAMEThere’s a risk that the ex-addict will become dependent on the agonist drug itself. As the therapy progresses, the addict can become as reliant on the methadone as they were on the heroin. This shows the effectiveness of replacement drugs is unclear as the addict may easily replace their addiction to heroin with a dependency of methadone. It may be more effective to offer psychological therapies. Drugs therefore cannot be seen as an effective long-term treatment as it could lead to dependency.
  7. 7Ao1-Another biological method used in the treatment of substance addiction involves antagonist treatment where drugs are given that close off the effects of the addictive substance. One example wold be naltrexone which works by barricading the movement of neurochemicals that give the addict the positive feeling. They’ve been used to treat nicotine dependency as well as a radius of other behaviour.There is supporting research for the effectiveness of antagonists. O’Brien reported conclusions of a programmes using naltrexone as well as traditional behavioural treatments. In both it was found that the distribution of naltrexone greatly improved the likelihood of accomplishment, decreased craving and increased abstinence. Similar, Hollander found that naltrexone has been shown to be effective in reducing the gambling behaviour of problem gamblers. Overall, antagonist treatments can be seen as effective form of substance treatment.
  8. 8Ao1-SAMEAo2: Drug treatments may ignore the underlying cause of addiction. Biological interventions may ignore underlying reasons for addiction e.g. risk factors such as age or peer pressure, cognitive biases or the negative effects of drug use. So, although the symptoms may be treated, the underlying reasons being ignores may lead to symptom substitution meaning the addiction may re-surface in another way or the may still be permanent change in the addict’s brain which cannot be fixed by drugs Overall, drug therapies aren’t very effective as they’re palliative not curative.
  9. 9Ao1-According to learning theory we can unlearn inappropriate behaviours such as addictions. Higgins et al investigated how voucher therapy changed the behaviour of people with a cocaine addiction. They used 28 cocaine addicts had their urine tested several times a week, every time it was clear they were given vouchers starting with $2.50 and going up $1.50 increments. It was also backed up with counselling directed at employment, recreation, relationships, skill training etc. It was also compared with a more traditional out-patient counselling programme over a 12-week period. They found that patients in the voucher-based programme had significantly longer periods with cocaine-free urine compare to those in the traditional counselling programme. Therefore the voucher-based system builds coping skills and strengthens social relationships.Ao2- Behavioural interventions are ineffective as they ignore the underlying causes and reasons that led to the addiction in the first place. Just treating the system (i.e. addictive behaviour) means that the underlying problem is still present and that any treatment benefits are short-lived. Even if one addiction has ceased, other addictive behaviours can become replacement. For example, there’s evidence that gambling addicts being treated with psychological therapy give gambling, only to become addicted to alcohol (Griffiths). This is a problem as addict substitute’s one addiction for another. This suggests that some behavioural treatment e.g. voucher therapy alone may not be effective and should be supported by psychological methods/therapies e.g. counselling.
  10. 10Ao1- SAMEAo2- Combining psychological and biological therapies can bring greater improvements for addicts as you’re helping the patient on both a psychological and physiological level. CBT has been shown to be reasonably effective treatment, but it’s often more effective when used in combination with medications. For example, in a study of people with alcohol-related problems Feeney et al reported that 14% of pps who received CBT alone abstained from drinking, compared to 38% of pps in a group who’d received both CBT and medication. This shows that the effectiveness of combined treatment (CBT+ medication) was higher for the alcoholics than just CBT. In conclusion, addicts should be offered combined with treatments from the beginning.
  11. 11Ao1-CBT aims to change addictive behaviour by changing the faulty cognitions, promoting positive cognitions among addicts and increasing motivation to change behaviour. Motivational interviewing is a new form of cognitive therapy which focuses on helping people develop the motivation to change their habits by reviewing their own behaviour and the positive and negative effect it has. Prochaska built the stages of change model identifying the addict’s readiness for change and getting them motivated. 1) Pre-contemplation; the addict had no intention of change. 2) Contemplations and commitment; persons aware of a problem and need to change, once they commit to changing a plan is formed. 3) Action; person follows their plan and is in action if they’ve successfully altered their behaviour. 4) Maintenance; the person needs self-monitoring strategies to prevent relapse.Ao2-There is research that supports the effectiveness of effectiveness of many psychological interventions, such as cognitive therapy for pathological gamblers. Ladouceur et al (2001) randomly allocated 66 pathological gamblers either to a cognitive group or a waiting list group. They found 86% no longer fulfilled DSM criteria for pathological gambling. They had higher perception of control, and higher self-efficacy even after 1 year. However, it’s difficult to assess the effectiveness of psychological treatments because they’re often used alongside other treatments and help e.g. self-help groups, counselling, family. It’s therefore hard to establish whether success is due to the psychological therapy alone, some other treatment intervention or an interaction between different therapies. As such, despite evidence from Ladoucer et al supporting the effectiveness of psychological interventions, it’s very difficult to distinguish whether the positive outcomes directly due to the therapy alone as the patients aren't treated in isolation.
  12. 12Ao1-SAMEAo2-One study comparing the effectiveness of three different types of psychological therapy found no significant differences in their effectiveness either at one-year or three year follow up. However, it was found that certain types of client did better with one treatment as opposed to another (Project MATCH Research Group 98). For example, people with lower levels of dependence responded most favourably to CBT. Similarly, the effectiveness of different interventions depends on the types of addiction. For example, biological interventions might be more likely to work with chemical addictions than with behavioural addictions. These findings have important implications for the choice of therapy for individual clients. Therefore, the individual should be matched to the right kind of therapy for them in order to maximise the effectiveness and positive outcomes for the patient.
  13. 13Ao1-Psychologists could help intervene in the cycle of personal and social problems associated with drug abuse. The US National Institute on Drug Abuse Collaborative Cocaine Treatment study enrolled 487 patients randomly assigned to one of 4 interventions, 1) group drug counselling alone (learning about stages of recovery; group problem-solving). 2) CBT/GSC (recognise and change distorted thinking about drug use) 3) supportive expression psychotherapy/GDC (learn how addiction affect relationships and how to improve interpersonal relations) 4) individual drug counselling/GDC (earn how to avoid drug trigger and adopt more positive behaviours). This study found that a combination of group and individual drug counselling significantly reduce cocaine use with an associated reduction in other behaviours (e.g. unprotected sex among addicts). This shows that intervention in the form of counselling reduced addictions.Ao2- It could be argues that government sponsored intervention programmes can bring positive benefits to addicts. Crits-Christoph found a marked reduction in HIV risk associated with reduction of cocaine use. This could be due to a reduce in frequency of unprotected sex that was otherwise associated with high cocaine use. Therefore, the NIDA study can be seen as effective as it not only lowers amount of cocaine use but also the negative effects/behaviours aswell
  14. 14Ao1- Psychologists proposed a prevention model based on research into pathological gambling as there’s a concern for adolescents and young adults. This framework applies de-normalisation, protection, prevention and harm reduction principle. E.g. programmes based on prevention to avert at risk youth from escalating towards pathological gambling. Also, programmes founded on a harm-reduction approach inform youth of the risks and dangers associated with gambling and help them develop the skills to remain in control. This demonstrates the importance of prevention to reduce youth gambling.Ao2- Research suggests that a public health intervention's important. This is because it is a proactive approach to a potentially devastating social issue. Research has demonstrated that problem gambling during adolescence can lead to adverse outcomes Derenvensky and Gupta (04) found that such adverse outcomes are strained relationships, delinquency and criminal behaviour, depression and even suicide. In conclusion, this research highlights the need for gambling intervention to stop younger ages becoming pathological gamblers.
  15. 15Ao1- Legislation is one way of controlling access to addictive activities, governments must take economic considerations into account when making their decisions. Addictive behaviour produce billions of pounds in revenue there is also the issue of urban regeneration to consider-building casinos in an economically deprived areas creates jobs and attracts people. One prevention government initiated measure could be to control addictive behaviours through legislation. E.g. there are age restrictions in place on the sales of alcohol, cigarettes, lottery cards etc. There are also age controls on who can sell alcohol/cigarettes i.e. licensed sellers.Ao2-
    However, some people argue that alcohol is too widely available an easy to buy even for those who are under-aged. Legislation has been relaxed so that supermarkets and licensed pubs can now sell alcohol 24/7. Similarly, although the Gambling Act 07 states that gambling is only allowed in the UK is specifically permitted by licence, there's nothing to stop private gambling. Therefore the controls of addictive behaviour by government legislation is not always effective.
  16. 16Government interventions- legislation. Ao1- complete ban In the UK it's currently illegal to possess consume produce or sell certain types of drugs e.g. cannabis and cocaine. As new drugs are produces classification is updated by the government pharmaceutical advisory body. Drugs whether class A-C, are designated as controlled substances under the Misuse of Drugs act 71 and are illegal. Classification is related to how addictive the drug is and how dangerous it is, whether it is socially acceptable or not also plays a part. Nicotine is extremely addictive and has extreme health implications but is not illegal because it is so ingrained in our culture as it alcohol.The legal ban on the recreational use of such substances has obviously not got rid of the problem of drug use or addictions. In fact, many libertarians organisations and prominent members of society are lobbying for the partial legalisation of some drugs (cannabis) as a way of making them more controllable and taxable. A complete ban on cigarettes and alcohol consumption seems to be highly unlikely for political reasons. There are two reasons 1) economic reasons e.g. taxes 2) cultural factors e.g. ingrained.
  17. 17Ao1- restricting/banning advertisement We know that advertising can have a negative effect on addictive behaviours. During 1989-2000 there was raising annual expenditure and there was a strong positive correlation between advertising expenditure and alcohol consumption by children 11-15years old. Snyder found a strong correlation between number of adverts for alcohol watched by young people and amount of alcohol consumed. A ban on advertising should help reduce addictions. Cigarette advertisements have been banned from TV internet and cinema adverts and in 2012 even from shelves in supermarkets. Alcohol's been restricted as effects of advertising isn't clear.Ao2-
    Studies on the relationship between advertising and consumption are useful for making predictions but they only provide correlational data so we cannot be sure that there is a causal link between money in alcohol adverts and amount of alcohol consumption.
  18. 18Ao1- increasing the costs There does seem to be a negative relationship between the cost of cigarettes/alcohol and the amount that is bought. So perhaps a possible strategy is to substantially raise the price of these products by increasing taxes so that financial attractiveness of these products drops in the eye of uses. It may encourage people to stop buying the products and deter children from starting.Ao2-
    However, for political reasons increasing taxes is not as straight forward. If they raise taxes too much they lose buyers and thus lose money.
  19. 19Ao1- ban on smoking in public Public smoking has become less acceptable, 2007 it became against the law to smoke in any enclosed public places in England. Banning people from smoking in public seems to have had a positive impact on health and nicotine use. Such legislation should reduce environmental cues because situations are no long associated with smoking and therefore help smokers to quit and prevent relapse.Ao2-
    University of Dundee found significant improvements in the health of bar staff in 2 months following the ban. They tested bar workers lung function a month before the ban came and 2 months after. Symptoms fell from 80% to less than 50% with reduced levels of nicotine in bloodstream and lung function of as much as 10%.
    NHS stats 2007 found a 12% increase in the number of people able to quit for at least 4 weeks in 3 months before the ban compared to the same 3 months in 2006. The number setting a quitting date was also higher.
  20. 20Ao2- Legislation has been shown to have some effects on the level of smoking and drinking. E.g. after 2007 ban on smoking University of Dundee found significant improvements in the health of bar staff in 2 months following the ban. They tested bar workers lung function a month before the ban came and 2 months after. Symptoms fell from 80% to less than 50% with reduced levels of nicotine in bloodstream and lung function of as much as 10%. However, it's difficult to assess the precise effect of a single intervention as so many factors are involved in addictive behaviour e.g. biological model suggests people have genetic vulnerabilities or there are many risk factors. As such, evidence for the effectiveness of these interventions is not as clear as we might hope as the research has been inconclusive, as there are many confounding variables which may have affected results.Ao2-
    Research suggests that whilst public health interventions and legislation can be effective at stopping/reducing behaviour, people may change their behaviour to compensate for the intervention. Gomel et al showed that a workplace ban on smoking was effective in stopping that specific behaviour but it had other more negative effects. Smokers in Australia were questioned over 6 weeks following the smoke ban. Results showed that pps reported smoking less during work and home but blood tests revealed they were compensating for not smoking at work by smoking more outside work hours. These results suggests that there's not effectiveness in stopping smoking in the ST.
  21. 21Ao3- Effective government legislation about the use of drugs such as smoking cigarettes should be based on peer review and scientific research evidence rather than anecdotal evidence and opinion. Firstly, the government must only take into account research which has gone through the high scrutiny of the peer review process to make sure knowledge isn’t plagiarised. Secondly, the research should be scientific data. One important characteristic is objectivity; this means making sure that results are from a standardised studies/experiments which give a cause and effect relationship. Also, replicability is important so the results of one cigarette study can be shown elsewhere and in a wider context. In conclusion, it’s important that government legislation should be based on professionals.

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A-Level Unit4-Addiction Flashcards on Reducing factors in addiction, created by vesara on 18/05/2016.
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vesara · May 2016
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Mar 7, 2018
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