1. Addiction UNIT 4: PSYA4 lcb@beauchamp.org.uk

2. Content The Psychology of Addictive Behaviour Models of Addictive Behaviour  Biological, cognitive and learning approaches to explaining initiation, maintenance and relapse, and their applications to smoking and gambling. Vulnerability to Addiction  Risk factors in the development of addiction, including stress, peers, age and personality.  Media influences on addictive behaviour. Reducing Addictive Behaviour  The theory of planned behaviour as a model for addiction prevention.  Types of intervention and their effectiveness, including biological, psychological and public health interventions.

3. Starter: Pair discussion In pairs, list as many public health interventions as you can think of that may have an impact on addictive behaviour i.e. smoking or gambling.

4. Public Health Interventions Public health interventions are put into place by governments and voluntary organisations and are designed to prevent or treat addictive behaviours. These are not targeted at individuals but at large groups of people – i.e. the population! These include legislation (e.g. voluntary workplace smoking ban and price increase) and health education (e.g. advertising, leaflets, and telephone ‘Quitline’).

5. Mass media strategies Mass media strategies are public health interventions put into place by the government and health departments to target large groups of people. These interventions aim to prevent or treat addictive behaviour, with the main focus being on smoking behaviour.

6. The NHS website Offers free help and support for people wanting to quit smoking. www.smokefree.nhs.uk – order a free ‘Quit Kit’ online 0800 022 4332 – SMOKEFREE helpline - free support and guidance www.nhs.uk/Service- Search/Smoking%20cessation%20clinic/.../636 - free NHS smoking cessation clinics

7. Effectiveness of PHI: ‘Quitline’ Stead et al (2006) Meta-analysis of over 18,000 PTs. Found that people who received repeated telephone calls from a counsellor increased their odds of stopping smoking by 50% compared to smokers who only received self-help materials and/or brief counselling. Concluded that multiple call-back counselling improves the LT probability of giving up smoking for smokers who contact the Quitline services. Real-world applications – effective in reducing nicotine dependence.

8. Use of advertising TV advertisements, radio advertisements, leaflets, and posters. 1. ‘No Smoking Day,’ 2. ‘Stoptober,’ 3. The ‘NHS Scared and Worried Campaigns.’

9. ‘No smoking’ day www.nosmokingday.org.uk – Wednesday 12 th March 2014 This is an annual event in March aimed at promoting ‘no smoking’ across the UK.

10. Effectiveness of ‘NSD’ Elton and Campbell (2008) Investigated the impact of ‘NSD’ in the English town of Bury. Distributed a postal questionnaire before the day was introduced to establish how many people smoked, and how much. Repeated the survey 3 months after ‘NSD’ was introduced and compared the level of smoking behaviour.

11. Effectiveness of ‘NSD’ Elton and Campbell (2008) Response rates of smokers were similar – 22.4% smoked in the first questionnaire and 22.6% in the second questionnaire. However the number of cigarettes smoked a day fell significantly from 27.6 to 21.8. This shows that, although the same amount of people smoked, they had reduced their daily intake of cigarettes following the ‘NSD’ indicating some level of effectiveness of ‘NSD’ in reducing addictive behaviour.

12. ‘Stoptober’ www.stoptober.smokefree.nhs.uk - 28 day challenge to stop smoking ‘Stoptober’ is an NHS campaign that runs for 28 days in October every year. The aim behind the campaign is that if smokers can give up smoking for 28 days then they are more likely to quit full stop.

13. NHS ‘Scared and Worried’ Campaigns Part of the smoking is ‘the enemy of the family’ strategy and aimed to reinforce motivation for smokers to quit. The campaigns looked at smoking from the perspective of a concerned son or daughter. The TV adverts showed children openly dismissing things that would normally be perceived as scary or worrying. What they actually viewed as scary or worrying was their parent’s smoking. Both campaigns successfully made 6 in 10 smokers think they should stop smoking for their family and made almost 50% of smokers think they should quit now and made them feel uncomfortable about smoking.

14. NHS ‘Scared and Worried’ Campaigns http://www.youtube.com/watch?v=TXMwP3nK2_o http://www.youtube.com/watch?v=P7L4LVfHCSE http://www.youtube.com/watch?v=TYah-yv646Q

15. Practical applications Public health interventions that increase the cost of addictive substances (e.g. cigarettes) could promote smoking cessation and even discourage people from starting smoking in the first place. An increase in the expense of smoking may make the perceived cost of the addictive behaviour greater than the perceived benefits.

16. Strengths: Self-report techniques + Can be easily repeated so that data can be collected from large numbers of people relatively cheaply and quickly. + Respondents may be more willing to reveal personal or confidential information than in an interview – anonymous.

17. Weaknesses: Self-report techniques - Answers may not be truthful – social desirability bias. - Sample may be biased as only certain kinds of people fill in questionnaires e.g. those willing to spend time completing and returning.

18. Problem of cause and effect  Many public health interventions may occur at the same time. Therefore it is difficult to establish which one has been most effective.

19. General Evaluation Defining ‘success’ in treatment can be difficult. In addiction treatment there are many problems when evaluating the effectiveness of an intervention – is ‘success’ defined as complete abstinence or is ‘success’ simply reducing the addictive behaviour? E.g. if someone reduces their smoking by 50% is that effective treatment?

20. General Evaluation Effectiveness may depend on the addiction. It could be that biological interventions (e.g. drugs) work better for chemical addictions, and psychological interventions (e.g. CBT) for behavioural addictions. Therefore further research is needed.

21. General Evaluation Which treatment is most effective? It doesn’t seem to matter which treatment an addict engages in, as no single treatment has been shown to be demonstrably better than any other. Addiction interventions are often used in combination – therefore it is difficult to establish the effectiveness of each one individually.

22. General Evaluation Undergoing a variety of treatments simultaneously appears to be beneficial in treating addictive behaviours. E.g. Biological and psychological in combination. Research evidence to support effectiveness of all types of intervention.

23. END OF TOPIC!!!