Reducing Addiction

9 Key excerpts on "Reducing Addiction"

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  Seminars in Addiction Psychiatry

  • Ed Day(Author)
  • 2021(Publication Date)
  • RCPsych Publications

    (Publisher)

  Chapter 8 Psychological Approaches to Addiction Rob Hill and Jennifer Harris Introduction Psychological theory and practice have a lot to offer in terms of understanding addictive patterns of behaviour, yet despite the theoretical advances that have occurred over the years, change at the individual level often remains slow and precarious. Motivation to change sometimes appears as a magical moment seemingly unrelated to the severity of symptoms, and when change does occur it often follows what Marlatt and his colleagues have called ‘the rocky road to recovery’. White has acknowledged this problem and notes that while there have been many advances in our knowledge and treatment of addictions, not least in the field of cognitive behavioural therapy (CBT), there are still limitations in the efficacy of addictions treatment [1]. Thus, some clients, generally those whose substance use is part of a broader cluster of problems, quickly relapse after treatment. This finding has led to a call for a reorientation of treatment away from an acute care model to a recovery management model or what White calls ‘focusing on the lived solution’. Put simply, tackling dependency, while an important first step in the process of change, is rarely sufficient to maintain change over time or indeed to necessarily create a better life. Thus, many self-help groups are increasingly focusing on what is known as ‘recovery capital’, which refers to the sum of resources necessary to initiate and sustain recovery from substance misuse. As such it conveys a more positive way of conveying to clients the reasons for ensuring a robust relapse prevention strategy. Theories and Interventions for Addictive Behaviour Psychoanalytic Theories of Addiction Psychoanalysis, as conceived by Freud, is both a theory and a treatment which seeks to understand conflicting elements or parts that often remain hidden or inaccessible (uncon- scious) to an individual without treatment.

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  Understanding Drug Misuse

  Models of Care and Control

  • Jan Keene(Author)
  • 2010(Publication Date)
  • Bloomsbury Academic

    (Publisher)

  (2009a), Heather et al . (2002), Stockwell (2006), Witkiewitz and Marlatt (2006), Babor et al. (1999) and Morgenstern and McKay (2007). This work on the psychological interpretation dependence has to a greater or lesser extent adapted cognitive psychol-ogy to the particular problems of dependence generally. This approach is also particularly useful for after-care and relapse prevention. The behavioural approach can be criticized because of the limita-tions of its theoretical base and cognitive psychology can be criticized for its lack of scientific testing but there seems little doubt from the accumulated evidence that psychology has a good deal to offer in the field of dependence. The most severe criticism is that while psychologi-cal theories and methods of treatment are useful in dealing with psy-chological dependencies, they have not yet been shown to be effective in serious cases of physiological dependence. Behavioural interventions Behavioural interventions are concerned with the accurate description of behavioural problems and change in the specific behaviours identi-fied. The approach usually involves close monitoring of concrete changes in behaviour. Initial assessment: Drug use behaviour is likely to have been strongly reinforced over long periods of time. It is necessary in any assessment to identify which variables are important in continuing this reinforce-ment for each individual. Positive and negative reinforcement: The aim is then to change the reinforcing properties of drug use behaviour, either by offering positive reinforcement for non-drug-using behaviours or negative reinforcement for drug use. For example, it is possible to use prescribed drugs (e.g. Naltrexone) to block the physiologically reinforcing effects of opiates (although there is little evidence for effective long term, post-treatment results). Reducing Dependence 45 Cue exposure or extinction: The typical cues for drug use are pro-duced without the reinforcing antecedents.

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  Psychology of Addictive Behaviour

  • Antony C. Moss, Kyle R. Dyer(Authors)
  • 2010(Publication Date)
  • Bloomsbury Academic

    (Publisher)

  The continued use of cocaine and other stimulant drugs is motivated both by a craving for the high (positive reinforcement) and to relieve the depression and anxiety associated with chronic stimulant use (negative reinforcement) (Dyer and Cruickshank, 2005). The withdrawal syndrome from psychostimulants often involves depression and sadness, fatigue, hypersomnia followed by insomnia, drug craving and vivid, unpleasant dreams. In general, there is a lack of pharmacological treatment options for psychostimulants. To date, the most effective approach has been to medicate the troublesome symptoms and provide supportive care. Recently, researchers have examined the use of antidepressants to assist withdrawal with mixed results (Cruickshank et al., 2008). Hopefully, effective treatment options will be discovered in the near future.

  Summary

  In this book we have shown how addictive behaviour is a complex process, involving the interplay of pharmacology, learned factors and social setting. An understanding of the complex interrelationships of these factors is essential to successful treatment. Pharmacological treatments have been proved to be very successful in treating drug dependence, and this is especially true of the replacement treatments (that is, nicotine replacement therapy and heroin substitution treatment). However, it is rarely sufficient to provide only pharmacological treatment, and including a form of psychosocial therapy is often essential to address the psychosocial reasons for abusing a drug and the factors maintaining that drug abuse.

  Psychosocial interventions

  Psychosocial therapies focus on the psychological, behavioural and social aspects of drug use. They may be offered as a standalone treatment or they may be offered with a pharmacological treatment. We will now briefly look at some of the available psychosocial interventions for drug dependence.

  Counselling

  Many people, particularly those who need assistance to get some order back into their lives, can benefit from counselling and support on an individual basis. A counsellor will build a trusting relationship without judgement, help the person develop a sense of responsibility and self-confidence, and assist the person to develop and implement their own solutions to their drug problems.

  Counselling may be offered on an individual or group basis. Group counselling sessions give the opportunity to feel supported by other people experiencing similar problems and to practise skills in effective listening and communicating with others. As social factors play a significant role in the initiation and maintenance of drug use, counselling sessions may also help find solutions to problems in living conditions, relationships, job training and so forth. Counselling is rarely sufficient by itself to treat drug dependence but it is a vital addition to other forms of treatment (Gowing et al., 2001; Jarvis et al., 1995).

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  Interventions for Addiction

  Comprehensive Addictive Behaviors and Disorders, Volume 3

  • (Author)
  • 2013(Publication Date)
  • Academic Press

    (Publisher)

  While the majority of this section has focused on interventions for alcohol use, it is important to note that harm reduction with college students spans a wide range of problematic behaviors including tobacco, marijuana, and other drug use, sex-related behaviors, gambling, and eating disorders. The techniques used for reducing harm subsequent to alcohol consumption also may reduce harm subsequent to other addictive behaviors, enhance personal reasons for change, provide tools to support that change, and educate students on norms and expectancies while respecting the autonomy and individuality of students. In addition, these programs are potentially helpful for use with adolescents and with young adults not attending colleges and universities. However, it is still somewhat controversial to suggest the use of harm reduction programs with adolescents since addictive behaviors are mostly illegal activities for minors. Some treatment professionals and policy makers see harm reduction programs as condoning illegal activities, whereas harm reduction professionals would argue that reducing risk to adolescents outweighs concerns about legal issues.

  Summary and Future Directions

  Harm reduction approaches have been found to be helpful for clients who are not willing or able to cease addictive behaviors. The biopsychosocial model of addictive behaviors suggests that effective harm reduction interventions may need to target client physiology, client’s cognitions and behavior, or the client’s environment. Harm reduction approaches have been empirically supported and have demonstrated efficacy to help people reduce aversive consequences of addictive behaviors as well as reach moderation goals that may eventually lead to cessation (although not necessarily). Harm reduction differs from traditional treatment in that it operates under the assumption that client goals for treatment may vary and may not include cessation of the addictive behaviors. The harm reduction professional defers to the client in establishing the goals for therapy, and serves as an advisor to the client on how to best reach these goals. Harm reduction programs have great appeal to specific demographics of clients, such as to those with cooccurring problems that make behavior change difficult, to youth and young adults who may not see the need for cessation, to older adults who also do not desire cessation, and to groups where moderation may be a culturally relevant value. Researchers continue to test and refine pharmacological and psychological harm reduction methods, and the research they generate contributes to reevaluating and redesigning prevention and treatment methods and to challenge the policies that suggest one size that fits all treatment is appropriate or effective for all clients.

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  The SAGE Handbook of Drug & Alcohol Studies

  Social Science Approaches

  • Torsten Kolind, Betsy Thom, Geoffrey Hunt, Torsten Kolind, Betsy Thom, Geoffrey Hunt, Author(Authors)
  • 2016(Publication Date)
  • SAGE Publications Ltd

    (Publisher)

  4 Psychological Explanations of Addiction

  Robert Hill and Jennifer Harris

  Introduction

  Terms such as ‘addiction’, ‘dependence’ and ‘excessive appetites’ are used to describe an individual’s overwhelming, intense desire to engage in a particular behaviour, despite the negative consequences of doing so. Addiction is typically thought of as relating to psychoactive substances but encompasses other behaviours that can become compulsive such as eating, gambling, sexual activity, exercising and shopping. While these behaviours are thought to share similar psychological processes, psychoactive substances exert an additional unique neurobiological impact on the brain, psyche and body. With repeated use, the body and mind can adapt to the substance so that, if prevented from taking the substance, they can enter a withdrawal state. This triggers the urge to use in order to gain relief and regain equilibrium. Tolerance develops so that the individual experiences the need for increasingly frequent doses of the substance to maintain biological, neurological and psychological homeostasis. Alongside the typical cycle of craving, substance-seeking and use, relief and withdrawal, there is a concomitant narrowing of interests, social contact and lifestyle in order to focus on the substance. It may seem perplexing that the behaviour continues despite the dwindling positive effects of substance use over time, together with the considerable negative impact on physical and mental health, social, financial and legal aspects of life. Moreover, substance dependence has historically been viewed in terms of a chronic relapsing condition with periods of remission and relapse. The two major psychiatric diagnostic systems, the World Health Organisation's International Classification of Mental and Behavioural Disorders (ICD-10; WHO, 1992) and the American Diagnostic and Statistical Manual of Mental Disorders, Version 5 (DSM-5; APA, 2014), clearly describe the above physiological, behavioural, cognitive and social features of excessive and dependent substance use.

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  Drugs and Crime

  Theories and Practices

  • Richard Hammersley(Author)
  • 2015(Publication Date)
  • Polity

    (Publisher)

  8

  Treatment of Drug Dependence

  Happily, I know of no adequately evaluated treatment for drug dependence that has managed to reduce substance use while failing to reduce the associated offending. Furthermore, coerced treatment is no less effective than treatment that is self-referred (Stevens et al., 2005). Treatment rarely eliminates either activity for everyone.

  What is substance dependence or addiction?

  Over the past hundred years or so a highly influential myth has evolved which assumes that addicted substance use is qualitatively different from non-addicted substance use. Consequently, addicts lack adequate control over their substance use or other related misbehaviours. Over the past thirty-five years, the concept of ‘dependence’ has become used more widely than ‘addiction’. ‘Dependence’ was designed to acknowledge the diversity and complexity of the syndrome or disorder, including diversity in the extent to which people lost control, and to make fewer assumptions about there being a biologically distinct state underlying it (Edwards and Gross, 1976). Nonetheless, theoretical controversy remains over whether ‘dependence’ is a distinct syndrome or a descriptive summary of what can happen when someone uses drugs or alcohol heavily for a long time (Hasin et al., 1997; Finagarette, 1988; Hammersley and Reid, 2002). The form and outcomes of dependence can be complex and varied. Indeed, it may be more helpful to consider ‘dependence’ as a process rather than a state (Mullen and Hammersley, 2006). Here, ‘addiction’ will refer to theory that regards it as a state with some biological underpinning and ‘dependence’ as something more descriptive, diffuse and elusive.

  The addiction view has been predominant in the USA because it fits well with the twelve-steps self-help movement that began there, though compared with other countries the twelve-steps philosophy in the USA is also highly influential in the area of treatment that has to be paid for (Sobell and Sobell, 2006). Because most treatment in the USA is paid for via private medical insurance, there is a lot of money to be made treating addiction. It is also simpler for insurers to cover, and so to treat, a distinct condition like ‘addiction’ than to tackle the complexities of paying for help with complicated but subtle social and psychological difficulties. Relatively speaking, in other countries addiction services tend to run on a shoestring. The USA is also dominant in research and influential national bodies such as the National Institute on Drug Abuse officially endorse the view of addiction as a brain disease. This helps to support an enormous biomedical research programme that hopes to find treatments and cures for addictions.

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  Choice, Behavioural Economics and Addiction

  • Nick Heather, Rudy E. Vuchinich(Authors)
  • 2003(Publication Date)
  • Pergamon

    (Publisher)

  Thus, for example, an explanation of physical dependence that invoked adaptive regulation of drug receptors in the brain (e.g. Littleton 2001) cannot be a sufficient explanation of drug craving. This is the case because persons showing high levels of physical dependence do not always report experiencing craving. Similarly, no theory of drug craving, whether based on classical conditioning, cognitive processes, or some other mechanism (see Drummond 2001), can be a sufficient explanation of the addicted person's failure to control their behaviour. This is the case because, again, relapse to that behaviour often occurs in the absence of reported feelings of abnormal desire for the substance or activity in question. Moreover, people do sometimes escape from addictive behaviour despite continuing to experience occasional craving. A full discussion of the insufficiencies of reductionism is beyond our present scope, but suffice it to say that, with specific regard to addiction, the above reasoning demonstrates that reductive theories can never offer a fully adequate explanation of addictive behaviour. This is not to say, of course, that explanations of neuroadaptation or of abnormal desires or motivations cannot illuminate or add to our understanding of addictive behaviour, which is implicit in the proposed framework of three levels of analysis. For example, important Concluding Comments 411 contributions to an understanding of addiction from neuroanatomy, neurochemistry, and learning theory are made by Cardinal and colleagues (Chapter 7, this volume). However, our rejection of reductionism has two implications. First, addictive behaviour is the final common pathway that must be the explanatory aim of any adequate theory, and, second, to be useful a theory need not aim to explain anything other than addictive behaviour itself. From this viewpoint, behavioural choice theories are potentially adequate and useful theories of addiction.

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  Cognitive-Behavioural Therapy in the Treatment of Addiction

  A Treatment Planner for Clinicians

  • Christos Kouimtsidis, Paul Davis, Martine Reynolds, Colin Drummond, Nicholas Tarrier(Authors)
  • 2007(Publication Date)
  • Wiley-Interscience

    (Publisher)

  26 COGNITIVE-BEHAVIOURAL THERAPY IN THE TREATMENT OF ADDICTION is linked with taking responsibility for treatment, and finally gaining control over one’s thinking, decision-making and coping behaviour. This CBT treatment model has three critical components: (i) case formulation based on functional analysis and developmental history; (ii) cognitive restructuring and (iii) skills training. Use of the proposed model with different substances and treatment populations The rest of this chapter will focus on the application of the model described in this book across different substances and client groups, and offer advice on when, how and what to modify, in an explicit way. Substances of misuse differ from each other mainly in three domains: 1. Psychopharmacological properties : pharmacological properties are related to the psychotropic effect of the substance, and therefore influence the user’s expectan-cies from the use of the substance. These expectancies are specific to the substance, and to a degree, are common to all users of the substance, that is all stimulant users expect enhancement of physical energy. However, expectancies are shaped by the user’s individual experience of the substance, and will therefore depend on individual needs, that is for some users, stimulants improve social skills, for others this might not be so important. 2. Legal status : the legal status of a drug is related to its social acceptance. This has a direct impact on its availability, and therefore the type of risky situations en-countered in the cycle of use (see Beck model). Legal status is also associated with lifestyle changes that the client is required to undertake to maintain abstinence. For example, the use of alcohol is culturally accepted and alcohol is widely avail-able in the community. Reminders are widespread and therefore difficult to avoid, even for an individual with a stable family and social background.

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  The Reduction of Drug-Related Harm

  • E. C. Buning, E. Drucker, A. Matthews, R. Newcombe, P. A. O'Hare, E. C. Buning, E. Drucker, A. Matthews, R. Newcombe, P. A. O'Hare(Authors)
  • 2013(Publication Date)
  • Routledge

    (Publisher)

  Chapter 1

  The reduction of drug-related harm A conceptual framework for theory, practice and research

  Russell Newcombe

  INTRODUCTION

  Harm reduction – also called damage limitation, risk reduction, and harm minimization – is a social policy which prioritizes the aim of decreasing the negative effects of drug use. Harm reduction is becoming the major alternative drug policy to abstentionism, which prioritizes the aim of decreasing the prevalence or incidence of drug use. Harm reduction has its main roots in the scientific public health model, with deeper roots in humanitarianism and libertarianism. It therefore contrasts with abstentionism, which is rooted more in the punitive law enforcement model, and in medical and religious paternalism.

  Health care, criminal justice and educational services can specialize in either strategy (e.g. syringe exchange compared with rehabilitation) or can combine elements of both approaches (e.g. flexible prescribing clinics which offer detoxification and maintenance). However, in some fields (e.g. school drug education), abstentionism has an almost total monopoly. Rather than use either strategy out of faith, policy makers and service providers should monitor and evaluate how effective they are at achieving their aims and objectives. However, whereas abstentionist interventions are relatively easy to evaluate (i.e. how many people are prevented from starting or continuing to use drugs), harm reduction interventions require the selection of a subset of desired goals from a matrix of potential harm reduction options.

  Harm reduction goals are also hierarchical – that is, they vary in their propensity for decreasing negative effects of drug use. The most well-known goal sequence is that endorsed by the British Government’s Advisory Council on the Misuse of Drugs (1988, 1989) as a strategy for reducing the transmission of HIV infection among and from injecting drug users. Namely: the cessation of sharing of injection equipment; a move from injectable to oral drug use; a reduction in the quantity of drugs consumed; and, finally, abstinence. Other sub-goals can also be added at various points in the hierarchy: for example, cleaning injection equipment before sharing it, reducing the number of people with whom equipment is shared, and switching from illicit to prescribed injectable drugs. An analogy can be made with an acrobat’s safety-net system: if one net fails, there is another net underneath.

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