Interventions for addiction (Key: - = negative criticism/limitations + = positive criticism/support Biological interventions Methadone for heroin: Heroin addicts are given Methadone, which gives similar effects but is less addictive. Their dose is slowly increased to build up tolerance, then slowly decreased to wean the addict of it until the addict need neither substance. Some people just switch from being heroin addicts to Meth addicts - Statistics show more than 300 methadone related deaths in the UK in 2007 - Methadone consumption is often unsupervised, which has created a black market, where addicts can sell their doses for only ? 2 Potential drug treatments for gambling: not approved in the UK yet, but there is evidence that SSRI’s (selective serotonin re-uptake inhibitors which increase serotonin= good mood) or Naltrexone (a dopamine receptor antagonist, which reduces the reward of gambling by reducing dopamine) may be effective. Hollander found that gamblers treated with SSRI’s showed improvements compared to a control group - BUT Hollander’s study only had 10 participants; a larger, longer study by Blanco et al (32 gamblers over 6 months) showed SSRI was no more effective than a placebo + Kim and Grant showed that naltrexone led to decrease in gambling thoughts and behaviours after 6 weeks of treatment - Intervention bias of doctors: Cohen and Cohen suggest that clinicians don’t believe addictions are too difficult to treat, because they only come across them when the addiction is too advanced to respond to treatment Psychological interventions:
Reinforcement: Sindelar did a study with addicts on methadone therapy (+ counselling). One group was rewarded every time they tested negative for drugs. By the end, the reward group had 60% more negative urine tests than the control (who weren’t offered rewards). + Sindelar showed it to be effective at reducing the addictive behaviour - BUT Reinforcement doesn’t address the underlying problems that caused the addiction in the first place, so as soon as the rewards are removed, addicts may just go back to engaging in the same, or another addictive behaviour again (eg an alcoholic may go back to alcohol, or develop an new addiction for sex). The rewards would have to be paid for by the NHS, which is a public service funded by taxes. The general public wouldn’t want their taxes being spent on giving addicts rewards CBT: CBT helps people change the way they think about their addiction and learn ways of coping effectively. (eg. in gambling addiction, the addict has a cognitive error in believing they can influence the outcome of the game, CBT would correct this wrong thinking by showing them that the belief is irrational) + Effective: Ladoceur et al randomly allocated 66 pathological gamblers to either a CBT group or waiting list.
At the end, 86% of the treatment group were no longer classed as pathological gamblers, and had increased self-efficacy. + ALSO Sylvian et al looked at treatments that targeted both cognition and behaviour. Pathological gamblers were given cognitive therapy, social skills training and relapse prevention, resulting in improvements which were maintained at a 1yr follow-up. Research has tended to show that no psychological treatment to be superior, but that they are most effective when combined with pharmacological treatments. Public health interventions The NIDA (National Institute on Drug Abuse) Study:
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US government sponsored interventions such as the NIDA Collaborative Cocaine Treatment (CCT) study are designed to intervene in the cycle of drug-related personal and social problems. + The NIDA intervention led to a reduction in cocaine use, and subsequent reductions in related behaviours (eg. unprotected sex, which led to a reduction in HIV transmission) Telephone smoking ‘Quitline’: Stead et al found that smokers who received repeated Quitline counselling telephone calls were 50% more likely to quit than a control who only received brief counselling. Has real-world applications: Military personnel deployed overseas often take up, or increase smoking habits. Beckham et al found that combining Quitline services with nicotine replacement therapy was highly effective in treating US military veterans. Prevention of youth gambling: Messerlian et al proposed a prevention model based on research into teenage pathological gambling using denormalisation, protection, prevention and harm reduction principles. (eg. programme based on prevention would include early identification of ‘at risk’ youths, and attempt to avert them from escalating towards pathological gambling. + Public health intervention in gambling is proactive and addresses a potentially devastating social issue. Research shows that problem gambling as a teen can lead to subsequently adverse outcomes, (eg. strained relationships, criminal behaviour, depression and even suicide) so early prevention is essential. (Derevensky and Gupta)
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