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Part 1. Psychological Models Part 2.Treatments in Addiction

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Title: Part 1. Psychological Models Part 2.Treatments in Addiction


1
Part 1. Psychological Models Part 2.Treatments
in Addiction
Psychology PS 3013
  • Dr Marilyn M Christie
  • School of Psychology
  • (Clinical Section)

2
Addiction Belief Inventory (Luke et al
(2002) (1)
3
Addiction Belief Inventory (Luke et al (2002)
(2)
4
Addiction Belief Inventory (Luke et al (2002)
(3)
5
Main Sources of attitudes
  • The mass media and other public information
    systems (e.g. newspaper headlines, health
    promotion leaflets, Government poster campaigns,
    etc.)

6
Main Sources of attitudes
  • The mass media and other public information
    systems (e.g. newspaper headlines)
  • The education system and/or cultural teachings

7
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)

8
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)

9
What do you think influences YOU the most?
  • Media?
  • Cultural attitudes?
  • Friends or family?
  • Personal experience?
  • Anything else?
  • Lets look at our own behaviour

10
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

11
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?

12
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?

13
What influenced YOU the most?
  • Media?
  • Cultural attitudes?
  • Friends or family?
  • Personal experience?
  • Anything else?

14
Popular Models of Addiction
  • Moral/Weak Will
  • Medical/Disease/Genetic
  • Social Learning/Free will
  • Bio/psycho/social

15
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

16
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

17
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

18
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
19
But we know that the Effects Of A Substance
Depends On
  • The drug per se
  • Amount, strength, mode of use, pharmacology
    (stimulant, depressant etc.)

20
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

21
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)

22
  • So how best to make sense of addictions?
  • From a psychological point of view

23
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.

24
Part 2. Treatments for Drug Alcohol Problems
  • What Works?

25
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.

26
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.

27
However, for those who seek help, treatment
works
28
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

29
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)

30
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.

31
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.

32
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

33
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.

34
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.

35
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.

36
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

37
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.

38
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.

39
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?

40
Message from room bookings services
  • Clean up after yourselves and leave the room
    tidy!
  • THANK YOU
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