Title: Part 1. Psychological Models Part 2.Treatments in Addiction
1Part 1. Psychological Models Part 2.Treatments
in Addiction
Psychology PS 3013
- Dr Marilyn M Christie
- School of Psychology
- (Clinical Section)
2Addiction Belief Inventory (Luke et al
(2002) (1)
3Addiction Belief Inventory (Luke et al (2002)
(2)
4Addiction Belief Inventory (Luke et al (2002)
(3)
5Main Sources of attitudes
- The mass media and other public information
systems (e.g. newspaper headlines, health
promotion leaflets, Government poster campaigns,
etc.)
6Main Sources of attitudes
- The mass media and other public information
systems (e.g. newspaper headlines) - The education system and/or cultural teachings
7Main 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)
84 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)
9What do you think influences YOU the most?
- Media?
- Cultural attitudes?
- Friends or family?
- Personal experience?
- Anything else?
- Lets look at our own behaviour
10Sources 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
11Sources 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?
12Sources 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?
13What influenced YOU the most?
- Media?
- Cultural attitudes?
- Friends or family?
- Personal experience?
- Anything else?
14Popular Models of Addiction
- Moral/Weak Will
- Medical/Disease/Genetic
- Social Learning/Free will
- Bio/psycho/social
15Moral 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
16Disease 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
17Free 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
18Summary 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
19But we know that the Effects Of A Substance
Depends On
- The drug per se
- Amount, strength, mode of use, pharmacology
(stimulant, depressant etc.)
20The 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
21The 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)
22- So how best to make sense of addictions?
- From a psychological point of view
23Bio/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.
24Part 2. Treatments for Drug Alcohol Problems
25Treatments 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.
26Consider 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.
27However, for those who seek help, treatment
works
28What 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
29Drug 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)
30Alcoholics 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.
31Motivational 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.
32Social 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
33Cognitive 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.
34Self-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.
35Key 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.
36What 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
37What 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.
38Conclusions
- 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.
39Have 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?
40Message from room bookings services
- Clean up after yourselves and leave the room
tidy! - THANK YOU