Reducing addiction - Behavioural interventions

Question 1

Describe behavioural interventions?

Answer 1

Work on the assumptions that addictive behaviours are learned and so can be reduced
by changing the consequences from pleasant to
unpleasant.

Question 2

How do behavioural interventions try to reduce addction?

Answer 2

try to change a person’s motivation to engage in these
behaviours.

• operate by reducing the time lag between the desired effects of a drug and
  its negative consequences so that they occur more-or-less simultaneously

Question 3

What is aversion therapy?

Answer 3

Aims to decrease the undesirable behaviours associated with addiction by
associating them with unpleasant sensations.

counterconditioning - associating the drug with an unpleasant state

Question 4

What is convert sensitisation?

Answer 4

eliminating an unwanted behaviour by creating an imaginary association
between the behaviour and an unpleasant stimulus/consequence.

Question 5

Outline counterconditioning in aversion therapy

Answer 5

replaces +ve reinforcement with punishment

• individual learns to associate an aversive stimulus (UCS) with an action they had previously enjoyed (NS)
• During therapy patient engages in the behaviour while being exposed to
  something unpleasant (e.g a drug that makes them nauseous)
• The behaviour becomes associated with the unpleasant stimulus & becomes the CS. It begins to decrease in
  frequency and eventually stop

Question 6

What addiction can aversion therapy treat?

Answer 6

alcohol abuse
drug abuse
pathological gambling
smoking

Question 7

Give an example for aversion therapy for treating gambling

Answer 7

Patient keeps a behavioural diary to measure whether change is occurring

• the electric device is placed on the patients wrist, and patient must select an uncomfortable shock level
• the shock is repeatedly paired with the stimuli (picture of betting shop poker images, etc) the person has chosen for gambling
• discomfort becomes associated with gambling hebaviour

Question 8

Give an example for aversion therapy for treating drinking using an emetic

Answer 8

Client is given an aversive drug that causes vomiting

• they experience nausea and 5-10 mins later they vomit, before they vomit they’re given an alcoholic drink and vomiting begins immediately after
• treatment continues with several repetitions with stronger doses and different types of alcohol

Question 9

Give an example for aversion therapy treating drinking using disulfiram

Answer 9

Disulfiram interferes with the normal bodily process of
metabolising alcohol into harmless chemicals

• Drinking alcohol while taking this drug results in severe nausea and
  vomiting (an instant hangover).
• client associates alcohol with unpleasant
  symptoms. Fear of experiencing the symptoms may be enough to prevent the client drinking alcohol.

Question 10

What is a limitation of the use of the aversion drug disulfiram?

Answer 10

client may end up vomiting in social situations where alcohol is available.

• The loss of dignity, and the risk of
  harm – raises ethical issues which led to a reduction in the use

Question 11

How is convert sensitisation carried out?

Answer 11

creates an association between the behaviour and an
unpleasant stimulus, but unpleasant stimulus is only imagined

• Rather than experiencing actual physical consequences (pain) they are pictured.
• Must be vivid enough so they experience feelings of
  discomfort/anxiety when they imagine themselves engaging in the addictive behaviour.

Question 12

Give an example of covert sensitisation used to treat drinking

Answer 12

Patients would imagine themselves engaging in the various behaviours associated with drinking (opening a bottle, going pub etc) then as vividly as possible imagine an unpleasant
consequence (vomiting & humiliation)

• eventually lose the desire to drink

Question 13

Give an example of covert sensitisation used to treat nicotine addiction

Answer 13

the Client is first encouraged to relax, and therapist reads a script instructing the client to imagine an aversive situation - e.g client imagines themselves smoking followed by vomiting -

• the more vivid the imagery, the better, therapist goes into graphic detail about the elements of the imagery, sights and smells, etc
• towards the end of the session client imagines a scene where they ‘turn their back’ on cigarettes resulting in feelings of relief.

Question 14

What is a strength for behavioural interventions for reducing addiction

Answer 14

• Supported by research

Question 15

What are limitations behavioural interventions for reducing addiction

Answer 15

• Methodological problems
• Deterministic
• A.T may not be effective

Question 16

Evaluate research support from McConaghy as a strength for covert sensitisation

Answer 16

P: There is research support

E: McConaghy et.al. directly compared conventional electric shock aversion therapy with covert sensitisation in treating gambling addiction. At a one-year follow-up, **those who had received covert sensitisation were significantly
more likely to have reduced their gambling ** activities (90% of covert sensitisation participants compared with just
30% undergoing aversion therapy). Also reported experiencing fewer & less intense gambling cravings than
the aversion-treated participants.

Also found that aversion therapy was much more effective in reducing gambling
behaviour and cravings after one month than after one year.
In a long-term follow-up he found that after 2-9 years, aversion therapy was no more effective than a placebo.
Covert sensitisation was more beneficial.

E: Suggests that covert desensitisation is a promising behavioural intervention for a
range of addictions.

Question 17

Evaluate methodological problems as a limitation of aversion therapy

Answer 17

P: Methodological problems with studies of aversion therapy.

E: Stead reviewed 25 studies of aversion therapy used to treat nicotine addiction. Found it was
impossible to judge the effectiveness of these therapies because all but one suffered from methodological problems. Procedures were not ‘blind’ so the researchers who evaluated the outcomes of the studies knew which participants received therapy or placebo. This creates bias, which makes therapy appear more successful than it is. Most research studies into the effectiveness of aversion therapy are quite dated.

E: Limitation because such research may not be valid.

Question 18

Evaluate determinism as a limitation of aversion therapy

Answer 18

P: Aversion therapy does not encourage the individual to use their freewill to overcome their
addiction.

E: Antabuse only requires a patient to take a pill. This may lead the individual to believe that they have no control over their addiction and no free will to change their behaviour. So they might not be motivated to cease the addictive behaviour, preventing it from being effective.

E: This is a determinist standpoint which may take responsibility away from the person concerned.

Question 19

Evaluate how aversion therapy might not be effective as a limitation

Answer 19

P: Might not be the most effective treatment for all addicts as some may struggle to adhere to the treatment.

E: Aversion therapy uses unpleasant and even traumatising stimuli. Induced vomiting and electric shocks are things most people wish to avoid. So it’s no surprise that many patients drop out of treatment before it is completed. This lack of treatment adherence makes it difficult for researchers to assess the effectiveness of aversion therapy.

E: This is a problem bc there may be a systematic pattern to which patients drop out. Those less likely to respond to treatment may be the ones who leave early. If sample size reduces due to attrition, this would lower any confidence in the conclusions of research. If this is the case, then research is probably overoptimistic about the effect of aversion therapy.

L: This highlights another advantage of covert sensitisation, that it’s less traumatic compared to aversion therapy.