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 Quiz on biological interventions for addictive behaviour. 10 questions. Work independently!

4. Psychological Interventions Combination of behavioural and cognitive approaches. They are based on the assumption that if we are able to learn addictive behaviours, such as smoking and gambling, then we are also able to unlearn them.

5. Role of operant conditioning The principles of operant conditioning have been applied in the treatment of addictive behaviours. The idea behind this treatment is that by giving people rewards for not engaging in the addictive behaviour, this will actually reduce the addcitive behaviour.

6. Supporting research: OC Sindelar et al (2007) Aim: investigated whether the provision of money as rewards would produce better patient outcome for people on a methadone treatment programme. Procedure  PTs randomly allocated - 2 conditions.  Condition 1: reward (experimental group).  Condition 2: no-reward (control group).  Also received their usual care = daily dose of methadone and individual and group counselling sessions.  PTs in the reward condition drew for prizes of various monetary value every time they tested negative for drugs (urine sample).

7. Supporting research: OC Sindelar et al (2007) Findings: It was found that drug use dropped significantly in the reward condition, with the number of negative urine samples being 66% higher than in the control condition. Conclusion: this suggests that the principles of operant conditioning, in particular positive reinforcement, led to the reduction of addictive behaviour. I.e. if rewarded for not engaging in addiction, then behaviour was reduced.

8. CBT CBT is based on the idea that addictive behaviours are maintained by the person’s thoughts about these behaviours. The main goal of CBT is to help people change the way that they think about their addiction (cognition), and to learn new ways of coping more effectively with the circumstances that led to these behaviours in the past (behavioural), e.g. stressful situations.

9. Relapse Prevention (CBT) Relapse prevention involves several cognitive and behavioural strategies to help the individual stay away from the addictive behaviour and also to provide support for people who do relapse. Therapists help to identify situations that present a risk for relapse for the individual. They also provide the addict with techniques to learn how to cope with temptation (positive self- statements and distracting activities) combined with the use of covert modelling (e.g. practice the coping skills in one’s imagination).

10. Evaluation Behavioural therapy may eliminate the behaviour but not the problem The addiction could be due to an underlying psychological problem rather than a learned maladaptive behaviour (i.e. a behaviour that causes an individual harm). Behavioural therapies eliminate the addictive behaviour but not the problem, may simply start to engage in another addictive behaviour instead.

11. Evaluation Behavioural therapies often used in conjunction with other addictive treatments. It is difficult to evaluate the effectiveness of behavioural therapies as often combined with other techniques e.g. drugs.

12. Evaluation The effectiveness of CBT. Reasonably effective but more effective when in combination with medication. Feeney et al (2002) found that only 14% remained abstinent on CBT alone compared to 38% who received medication and CBT.

13. Exam focus Apply your psychological knowledge of biological and psychological interventions to the past-exam question (June 2012). In pairs, read the scenario and bullet point ideas in your booklets. 10 marks = 10 minutes.

14. 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’).

15. 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.

16. 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

17. 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.

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

19. ‘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.

20. 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.

21. 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.

22. ‘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.

23. 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.

24. 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

25. 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.

26. 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.

27. 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.

28. 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.

29. 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?

30. 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.

31. 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.

32. 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.

33. END OF TOPIC!!!