Types of Intervention

Types of Intervention

1. Biological

   • Heroin addiction and methadone
     • Methadone mimics the effect of heroin and produces feelings of euphoria, but is less addictive
     • It is prescribed slowly, increasing amounts to increase tolerance. The dose is then slowly decreased until the addict no longer needs either methadone or heroin.
     • Substituting one addiction for another.
     • 300+ deaths due to methadone in 2007.
   • Drug treatment for gambling
     • No drug treatment as of yet.
     • Hollander (2000)
       • Gamblers treated with SSRI's to increase serotonin levels showed significant improvements compared to a control group.
         • Blanco et al, 2002
           • Larger and longer study involving 32 gamblers over a 6 month period, failed to demonstrate any superiority of SSRI treatment over a placebo.
       • Sample was very small (10) and only over a 16 week period.
     • Naltrexone - dopamine receptor agonist. Reduces the rewarding and reinforcing properties of gambling behaviour.
       • Kim and Grant, 2001
         • Found significant decreases in gambling thoughts and behaviour after 6 weeks of treatment.

2. Psychological

   • Reinforcement
     • Giving people rewards for not engaging in the behaviour.
       • Sindelar (2007)
         • Investigated whether money rewards were better than methadone treatment. There were two conditions, no reward and reward. Both groups received counselling and methadone treatment. The reward group drew prizes for monetary rewards when they tested negative. Drug use dropped significantly for the 'reward' participants. (urine samples tested negative 60% more often).
     • Although research such as SIndelar et als study have shown effectiveness of reinforcement therapies for reducing addictive behaviour, such interventions do not address the problem which led to the addiction in the first place.
   • CBT
     • The main goal of CBT is to change the way people think about their addiction and to learn coping mechanisms for the situations that lead them to carry out the addictive behaviour.
     • Ladouceur et al (2001)
       • Randomly assigned 66 pathological gamblers either to CBT or a waiting list control group. Of those who completed treatment 86% no longer fulfilled the DSM criteria for pathological gambling. They also found they had more self efficacy, improvements that were maintained in a 1 year follow up.
     • Sylvain et al (1997)
       • Evaluated the effectiveness of CBT in a sample of male pathological gamblers. Treatments included CBT, social skills training and relapse prevention. They found significant improvements after treatment, which was maintained 1 year later.

3. Public health

   • Nida study
     • Collaborative Cocaine Treatment study. 487 patients randomly assigned;
       • 1. Group Drug Counselling alone
         • 52%
       • 2. CBT & GDC
         • 57%
       • 3. Supportive-expressive psychotherapy & GDC
         • 49%
       • 4. Individual drug counselling & GDC.
         • 39%
       • Percentages refer to...6 months later, reported using cocaine in the previous month...
     • (Chrits-Christoph et al, 2003).
       • A reduction in HIV risk was also reported. This appeared to be primarily due to a reduction in the frequency of unprotected sex that was otherwise associated with high levels of cocaine use.
   • Telephone smoking quitline services
     • Stead et al (2006)
       • Meta-analysis of 18,000 participants. Those who received repeated telephone calls from a counsellor increased their chances of stopping smoking by 50%. This was compared to smokers who only received self-help materials over brief conselling. they concluded that callback counselling improves long term cessation for smokers who contact Quitline services.
     • West (2009)
       • Shows that although there was a decline in the % of people in the UK who smoked prior to the smoking ban on smoking, this was followed by a rebound effect. Attempts to stop smoking were actually greater in the 9 months before the ban than 17 months afterwards.
   • Prevention of youth gambling
     • Messerlian et al (2005)
       • Proposed a prevention model based on research into pathological gambling. THe framework applied denormalisation, protection, prevention and harm-reduction principles
         • Programmes based upon prevention attempt to avert at risk youths from escalating towards pathological gambling and included identification strategies.