Part 1. Psychological Models Part 2.Treatments in Addiction

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Part 1. Psychological Models Part 2.Treatments
in Addiction
Psychology PS 3013

• Dr Marilyn M Christie
• School of Psychology
• (Clinical Section)

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Addiction Belief Inventory (Luke et al
(2002) (1)
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Addiction Belief Inventory (Luke et al (2002)
(2)
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Addiction Belief Inventory (Luke et al (2002)
(3)
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Main Sources of attitudes

• The mass media and other public information
  systems (e.g. newspaper headlines, health
  promotion leaflets, Government poster campaigns,
  etc.)

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Main Sources of attitudes

• The mass media and other public information
  systems (e.g. newspaper headlines)
• The education system and/or cultural teachings

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Main Sources of attitudes

• The mass media and other public information
  systems (e.g. newspaper headlines)
• The education system and/or cultural teachings
• Personal contacts (e.g. friends, family)

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4 Main Sources of attitudes

• The mass media and other public information
  systems (e.g. newspaper headlines)
• The education system and/or cultural teachings
• Personal contacts (e.g. friends, family)
• Personal experience ( positive and negative).
• Macdonald and Patterson (1991)

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What do you think influences YOU the most?

• Media?
• Cultural attitudes?
• Friends or family?
• Personal experience?
• Anything else?
• Lets look at our own behaviour

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Sources of Our own Beliefs and Attitudes re
addictive behaviours

• 2 mins
• Pick a substance (e.g. nicotine, chocolate,
  alcohol) or a behaviour (e.g. shopping, T.V.
  soaps,) that you have decided NOT to use/engage
  in

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Sources of Our own Beliefs and Attitudes re
addictive behaviours

• Pick a substance (e.g. nicotine, chocolate) or
  behaviour (e.g. shopping, T.V. soaps,) that you
  have decided NOT to use/engage in
• Jot down what information led you to make that
  decision?

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Sources of Our own Beliefs and Attitudes re
addictive behaviours

• Pick a substance (e.g. nicotine, chocolate) or
  behaviour (e.g. shopping, T.V. soaps,) that you
  have decided NOT to use/engage in
• Jot down what information led you to make that
  decision?
• Think where did that information come from to
  help you make the decision to cut down/stop?

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What influenced YOU the most?

• Media?
• Cultural attitudes?
• Friends or family?
• Personal experience?
• Anything else?

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Popular Models of Addiction

• Moral/Weak Will
• Medical/Disease/Genetic
• Social Learning/Free will
• Bio/psycho/social

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Moral Model of Addiction- Basic Beliefs

• Using alcohol or drugs is a sign of moral
  weakness, low standards, bad character
• It is a transgression from acceptable social
  norms and deserves punishment
• Addicts are to blame and choose to do it
• Addicts are responsible for their own recovery
  and have a choice

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Disease Model of Addiction - Basic Beliefs

• Alcoholism/drug addiction is a unitary disease
  entity, an illness
• Its causes are primarily/solely biological
• Its primary symptom is the inability to control
  consumption. Abstinence is the only option.
• Professionals can only treat it medically
• It is irreversible and cannot be cured

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Free Will/Learning Theory Model of Addiction -
Basic Beliefs

• Drug/alcohol use is volitional and functional
  behaviour it is learned behaviour.
• People use substances to help them cope with
  life. Influence of environmental factors,
  thoughts and beliefs.
• People go in out of problems with substances.
  Labelling is detrimental.
• Reasons for use are the subject for treatment
  (e.g. depression, anxiety) active part for
  individual in treatment

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Summary of Common Models of Addiction
Moral Weak will, Transgressor, Sinner,
Bad Criminal, Active Individual
Social/Learning Normal, coping Faulty
thinking, Faulty beliefs, Active Victim
Medical/Disease Ill, sick, passive Loss of
Control Passive Victim
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But we know that the Effects Of A Substance
Depends On

• The drug per se
• Amount, strength, mode of use, pharmacology
  (stimulant, depressant etc.)

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The Effects Of A Substance Depends On

• The drug per se
• Amount, strength, mode of use, pharmacology
  (stimulant, depressant etc.)
• The person
• Personality, characteristics (age, weight,
  gender), past experiences, expectations

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The Effects Of A Substance Depends On

• The drug per se
• Amount, strength, mode of use, pharmacology
  (stimulant, depressant etc.)
• The person
• Personality, characteristics (age, weight,
  gender), past experiences, expectations
• The situation
• Social context (party, alone), other people
  (reactions, attitudes), availability, legality,
  cost, etc)

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• So how best to make sense of addictions?
• From a psychological point of view

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Bio/pscyho/social Model - Basic Beliefs

• There is no one single explanation for addiction
  they all have merits.
• Biological, social and psychological factors
  interact to influence behaviour.
• There is a continuum of levels of involvement of
  different influences across the lifespan. They
  fluctuate.
• Effective treatment involves e.g. controlled
  drinking/drug taking.

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Part 2. Treatments for Drug Alcohol Problems

• What Works?

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Treatments for Addiction - What Works?

• Alcohol vs. Drug fields are very different
• Why? Our beliefs!
• Government moral panic over drug use.
• Majority of people drink alcohol, but do not take
  illicit drugs.
• Drug use per se is deemed wrong by society.
  Misuse needs treatment/prison.
• Drunkenness is viewed as part of growing up. More
  available.

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Consider Spontaneous Remission

• 80 of addiction problems are sorted out without
  treatment.
• Knowing how to do it (e.g. weightwatchers) has
  short-term gains.
• Knowing that you can do it (self efficacy)
  maintains that change a little.
• Social support for new behaviour is all
  important (abstinence,control etc.) for long term
  gain.

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However, for those who seek help, treatment
works
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What works for Alcohol Problems?

• NOT Drug treatments alone
• NOT educational films/lectures/leaflets
• AA/12 Step Approach
• v Motivational Enhancement/Brief Intervtn
• v Social Behavioural Network Therapy
• v Cognitive Behaviour Therapy (CBT)
• Self-Help Manuals
• v Relapse Prevention

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Drug Treatments for Alcohol Problems

• Work only as additional to psychosocial
  treatments, not as an alternative.
• Tranquillisers work for detoxification (5-10
  days)
• Antabuse works to prevent drinking but compliance
  is a huge problem.
• Opioid Antagonists (e.g. acamprosate) have mixed
  results (36 success rate)

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Alcoholics Anonymous/12 Step

• Have to admit to being powerless and give in to
  a higher being, hit rock bottom, work in
  groups/meetings, 24 hr buddy system.
• Not consistent evidence of effectiveness
  research not good quality (except Project MATCH).
  
• Effective ingredient the social network that
  supports abstinence.
• Not for everyone. Will not work if client is
  forced to attend.

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Motivational Enhancement Therapy Brief
Interventions

• Deals with peoples ambivalence about changing
  their behaviour. It is a style of interviewing
  encourages commitment to change looks at
  pros/cons etc.
• Excellent evidence of effectiveness for risky
  drinkers (e.g. in primary care)
• Not enough on its own for serious problem
  drinkers.
• Needs well trained, self confident workers who
  like the client group.

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Social Behavioural Network Therapy (SBNT)

• New therapy from UKATT that involves key people
  in the client's social network.
• Client names the key people (e.g. family,
  friends) who agree to be part of treatment
  programme.
• Carries therapy into the clients life, beyond
  treatment setting.
• Needs attendance at multiple sessions

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Cognitive Behaviour Therapy (CBT)

• Views drinking/drug taking as learned responses
  mediating thoughts as key.
• Modification of them is through rehearsal of new
  behaviours to triggers.
• Antecedent thoughts, critical analyses and
  reactions are part of the change process.
• There is also a social element to changing
  substance use.

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Self-Help Manuals

• Skills work to start the change process
• Self- efficacy (belief in yourself) works to
  maintain change and most people need extra social
  support for this.
• Practice in real life situations works to develop
  skills, self efficacy and social support for the
  new you.
• Manuals alone may be only half the solution.

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Key to successful Interventions for alcohol
problems

• Motivational work to engage in treatmnt
• Behavioural Cognitive skills training
• Practice in real life situations (rehearsal)
• Involvement of social/family networks to maintain
  changes over time
• Practical help (e.g. housing, debts, loneliness)
  to prevent relapse.

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What works for Drug Problems? Staged Treatment
Programmes

• Substitute opiate prescribing in the short term
• Help with practical life problems
• Behavioural relapse prevention with rehearsals
• Treatment for comorbid mental health problems
• Involvement of the (appropriate) social network

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What does not work for Drug Users?

• Any one approach by itself
• prescribed drugs
• group therapy
• Narcotics Anonymous (NA/AA)
• Family/Social Therapy
• Relapse prevention
• Motivational work
• It HAS to be an integrated, staged programme.

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Conclusions

• There is no one model that explains addictive
  problems.
• There are biological, psychological and social
  factors that lie behind an addiction and
  most/all of them need to be involved in the
  change process - whether by self-help or by
  formal treatment services.
• Relapse is the most common outcome but it
  should be a learning opportunity.

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Have you changed your beliefs in the last 2 hrs?

• Look again at your Addiction Beliefs Scale
  (Handout 1)
• Complete it again
• Compare your answers
• How have your beliefs changed?

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Message from room bookings services

• Clean up after yourselves and leave the room
  tidy!
• THANK YOU