Types of Intervention and their Effectiveness

Types of Intervention and their Effectiveness

1. BIOLOGICAL INTERVENTIONS

   • Agonist Substitution e.g. (NRT)
     • Safer drug - chemically similar.
     • Gum, patches deliver nicotine, controlled doses via skin - bloodstream - brain
     • Reduce with/d/ symp/s + desensitising nic/ receptors, smoke = less satisfying
     • Silagy et al (2002) - meta analyses - NRT eff/. x2 likely quit at least 6 months / control
     • More eff/ than placebos initially but +70% return when treatment stops. 9 months - difference bet/w placebo + NRT disappeared
     • Readily available from... BUT EXPENSIVE
     • Low nic/ = not satisfying = give up
     • Controversy NRT harmful BUT cost-benefit analysis NRT better option
   • Antagonist treatments e.g. Bupropion
     • Block eff/s nic/ - block nic/ receptors.
     • Reduce pleasurable eff/s + cravings + with/d symp/s
     • Sustained-release bupropion, 150mg, x2 daily - equivalent/superior in efficacy to NRT (Jorenby, 2002). Over x2 eff/ / control.
     • Well tolerated, few side eff/s. Eff/ for depressive symptoms
     • Risk seizures for diminished seizure thresholds
     • Available on prescription - lack availability = less likely continue treatment
   • Short-term, cessation low, +70% return 6-12months
   • Biol/ therapies - combination w/ psych/ cessation rates enhanced
   • Ethical Issues - med/ interventions takes responsibility away = less motivated
   • Isolating effectiveness difficult - often several inf/s e.g. TV

2. PSYCHOLOGICAL INTERVENTIONS

   • Aversion Therapy
     • Class/ cond/: Abused substance paired unpleasant response so no longer enjoyed
     • Smith (1988) - 327 ppts - electric shocks self administered wristband when smoking related beh/. Later support = elastic band to stimulate when urge
     • Long-term - 52% 12 months
     • Relapse: smoking household- 70%, smoke-free- 40%
     • Ethical conern
       • Less unpleasant than talking therapy
     • Expensive, time-consuming, not available
     • High relapse - many factors inf/ beh/ e.g. cues
   • CBT
     • Avoid high-risk situations, recognising lure, developing alternatives (recreational activities)
     • Pos/ Neg/ consequences + self monitoring to recognise cravings early.
     • Identify triggers, inc/ coping skills, inc/ non drug use related activities
     • Ladouceur et al (2001) - random allocate - 66 G's, a) CBT group irrational thoughts questioned + training in relapse prevention OR b) Control G (waiting list). 86% CBT no longer pathological (DMS-IV). CBT - higher self efficacy + coping better 1 yr.
     • Morgenstern et al (2001) - CBT/12-step approach (AA) little difference
     • Difficult evaluate effectiveness - used simultaneously other treatments e.g... assess which component beneficial
     • Definition of successful varies - abstinence clear, more measurable. Gaining control, improving lifestyle beneficial too

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