Reducing addictive behaviour

Reducing addictive behaviour

1. Theory of planned behaviour

   • Main assumptions
     • Behavioural beliefs - individuals views on the behaviour and the outcomes of their actions - alcohol pleasurable & relaxing, can cause a hangover
     • Subjective norms - what we think others view of the behaviour is - family/friends view on alcohol
     • Perceived behavioural control - the level of control an individual believes they have over their own behaviour
     • TPB too critical, does not consider emotions - behaviour may be in response to a negative situation
     • Topa et al - other factors such as peer groups influences addictive behavior
     • Intention of behaviour - made up of behavioural beliefs, subjective norms & perceived behavioural control - combined with actual behavioural control to produce behaviour
   • Preventing addictive behaviour
     • Changing behvaioural attitudes - US drug campaign said success was due to creating a change in attitude to drug use
       • TPB does not consider the difference between intention (plans for the future) & expectation (likelihood of performing behaviour)
     • Changing subjective norms - giving accurate statistical information on drug use can correct subjective norm
       • Armitage & Conner - meta-analysis found TPB successful in predicting intention to change than actual change
         • Explains formation of intention, not formation of behaviour
     • Godin et al - perceived behavioural control most important predictor
       • Shows there are two different parts to addictive behaviour - motivational phase formation of intention, & post decisional phase initiation and maintenance of behaviour
     • Self efficacy - belief in one's own ability to complete tasks and reach goals, greater self efficacy - increase chance of behavioural change
     • Webb et al - internet interventions based on TPB most successful
     • White et al - examined sun protection intentions of Australian young people. TPB predictors significant predictors of actual sun protection behaviour
   • TPB does not consider motivation
     • Klag - addicts more likely to quit addiction if stopping is their own idea
   • Attitudes & intentions normally measured sober, risky behaviour actually performed under the influence of drugs/alcohol
     • MacDonald et al - increased intention for unprotected sex & risk behaviours in intoxicated individuals - alcohol decreases cognitive ability, only obvious characteristics attended to

2. Types of intervention

   • Biological interventions
     • Methadone - used for heroin addicts, similar compound to heroin mimicking effects but less addictive. Given slowly decreasing doses to improve tolerance
       • Addicts can become dependent on methodone
       • Methadone use controversial - 300 related deaths & use is unsupervised leading to black-market selling
       • Alternative treatment, the use of Narcotic antagonists NATs - blocking the effects of opiates removing the euphoria felt
     • Aversion drugs such as disulfiram used to provide sickness when combined with alcohol
       • Smith et al - 12 months after 6 months of treatment many individuals had relapsed
     • NRT - used to reduce the symptoms of cigarette withdrawal, nicotine still provided. Reduces stress, withdrawal & curbs nicotine cravings
       • Nicotine patches desensitise nicotine receptors as it's released slowly, some relapse because of this
       • Bupropion - antidepressant increasing dopamine levels in the brain reducing nicotine receptors & removing cravings
     • Hollander et al - SSRIs used to treat gamblers showed improvement compared to control
       • Naltrexone (dopamine antagonist) decreases rewarding effects of gambling
       • Hollander study only 10 individuals. Blanco et al - 32 gamblers over 6 months had no improvement against placebo
   • Psychological interventions
     • Contingency management - rewarding individuals for not engaging in behaviour based on ideas of operant conditioning
       • Sindelar et al - methadone treatment individuals in 2 groups. One rewarded for negative drug tests. At the end, reward group had 60% more negative tests
       • Does not treat the root of the addictive behaviour. Another addiction may be substituted in place of the original
     • CBT - used to alter the fault cognitions that lead to addiction
       • Ladoucer et a - 66 pathological gamblers either in treatment group or waiting list. 86% treatment group no longer pathological gamblers & had increased self efficacy
       • Relapse prevented by identifying times of relapse risk, coping techniques taught to prevent relapse
       • Motivational interviewing used to give client information on problems of dependence & advantages of abstinence provoking contradictory argument. Client then made to give reasons for wanting to change behaviour
     • In vivo desensitisation - associating feelings of boredom with addiction - taking gamblers to a casino & only standing for an extended time period
     • No single psychological intervention better than the other, further improvement when including drug treatment
   • Public health interventions
     • Intervention projects such as NIDA used to intervene in the cycle of personal & social drug use
       • Crits-Christoph et al - NIDA lead to decrease in cocaine use - also caused decrease in associated behaviours (unprotected sex) reduce in HIV
     • Telephone smoking quitlines - Stead et al 50% more effective than self help material alone
       • Multiple callbacks most effective method
       • Boos & Croft - increase in smoking in military personnel abroad
         • Beckham et al - quitline, counselling & NRT highly effective in US veterans
     • Workplace interventions - smoking ban can decrease behaviour - all employees in it together, offering emotional support - may only lead to increase in home smoking
       • Australian workplace smoking ban - only 2% stopped completely
     • Government interventions - banning/restricting goods/advertising and increasing prices by tax
       • Public cigarette smoking banned in 2007, advertising before than, high tax to put off smoking behaviour
       • Alcohol advertising banned from being linked to sexual performance or consumption appear attractive - adverts usually comedy
     • Preventing youth gambling - Messerlian et al - prevention model using denormalisation, protection & prevention principles. Attempt to avert at risk use from pathological behaviour
       • Gupta - problem gambling in adolescence can lead to strained relationships, criminal behaviour, depression & suicide
   • Clinicians illusion - addictions thought to be hard to treat as most treated have advanced issues