2. The disease model – the role of dopamine in addiction Initiation The reward centre of the brain(mesolimbic pathway) contains lots of dopamine receptors. Rewarding experiences e.g. Drug taking, stimulate the mesolimbic pathway releasing dopamine telling the brain that it’s good A lasting link is established linking the activity to the pleasurable award. Some people have a variant of a gene(A1) coding for a different dopamine receptor DRD2 The A1 variants results in fewer DRD2 receptors. People with this variant are more likely to become addicted to drugs which cause a large release of dopamine thus compensating for their genetically caused deficit. Repeated exposure = the brain is increasingly sensitive to their desirability. Potenza F: the neurotransmitter liked mostly to additive behaviour is dopamine although there are others which have a similar effect Noble et al F: the A1 variant was present in 2/3 of deceased alcoholics : 1/5 of deceased non-alcoholics Blum et al F: there was an increased prevalence of the A1 variant in children of the alcoholics : non-alcoholics Volkow et al F: gave a group of adult volunteers a drug which gently lifts dopamine lvls. Some liked it others hated it. Those who liked it had fewer A1 DRD2 receptors : those who didn’t. This was found by using brain scans. Caine et al F: when mice were engineered to lack a particular dopamine receptors they do not develop a liking for cocaine : controls Bostwick et al F: when treating a patient with a dopamine antagonist the compulsion for the addictive behaviour decreased rapidly and the patient dramatically improved Comings et al F: the A1 variant was present in several other psychological, biological disorders as well as the general population

3. Maintenance Chronic use of the addictive behaviour leads to downregulation(reduction in the activity of the mesolimbic pathway) This leads to stress characterised by withdrawal symptoms This negative state is the dominant force in the maintenance through negative reinforcement(engaging in the addictive behaviour to avoid the negative feelings) Due to downregulation(tolerance) the lvl of the addictive behaviour increases Relapse Due to drug use The frontal cortex is less effective at making decisions and judging the consequences of actions Addicts have learned to expect rewarding experiences from the drug. In the context of relapse: The frontal cortex impairment means that there is a higher risk of relapse due to their lack/non-existence of self control Other stimuli e.g. Cues such as the room the addict use to take the drug act as secondary reinforces for the drug. When the addict experiences them dopamine is released and they expect a reward, even if they know it isn’t coming. Reductionist – reduces a complex issue such as addiction down to a simple explanation of a neurochemical imbalance. Where these factors have been shown to play an important part, the studies also show that not everyone is addicted due to dopamine, and it may be that other factors e.g. Irrational thought processes are more influential. Practical implications – as shown by the study by Bostwick et al, there are possibilities for the development of pharmaceuticals to treat addiction, such an approach is more progressive that just simply punishing the addict Banks et al F: used monkeys to test the feasibility of substituting cocaine for a less addictive replacement drug that mimics the feeling but without the risk of abuse. Not all biological – Grant et al F: in a study with monkeys it was found that there was a correlation to amount of dopamine receptors and social interactions. The less social interaction the lass DRD2 receptors. Interaction between biology and stimuli – Volcow F: people who grow up in stimulation environments are more protected from developing addiction = naturally responsive to dopamine therefore will not need to use an artificial stimuli e.g. Drugs Extrapolation – Hackman et al F: even high quality animal research fails to compare to the human research

4. Expectancy Theories – addicts differ : non-addicts in terms of their expectations about the +ve/-ve effects of the behaviour Initiation A behaviour would turn into an addiction as a result of the expectations the individual has about the costs and benefits of the activity E.g. Alcohol consumption would be directly related to how much the individual believes it will deliver the desired effect. Heavier drinkers are associated with drinking having more positive effects Southwick et al F: Heavier drinkers have been shown to have more positive expectations about the effects of alcohol consumption compared to light drinkers. Brown et al F: among heavier drinkers, drinking has been associated with expectations of social and physical pleasure, tension reduction, and more sociability. Maintenance/Relapse As addiction continues it is governed less by conscious expectations but more by the unconsciousness and addiction becomes an automated process Explaining the loss of control and difficulty of abstain from the addictive behaviour Therefore we should be able to prevent relapse by altering the persons expectations consciously thus affecting the unconscious. Tate et al F: Smokers experiences fewer somatic and psychological symptoms of withdrawal from smoking when told to not expect any negative effects compared to the control group Tate et al F: When smokers are told that they are going to experience more somatic negative effects of withdrawal and no psychological, smokers reported more severe and numerous somatic complaints Men hold stronger positive and weaker negative effects of alcohol consumption than women which could be a factor in maintenance of the alcohol dependence Sher et al F: men reported more positive expectations in tension reduction, social lubrication and performance enhancement Carey et al F: no gender differenced between positive expectations of alcohol consumption Research tends to focus on consumption rather than the addiction itself, it rarely considers the loss of control pinnacle of the behaviour being classified as an addiction

5. Rational choice theory – addiction is a rational choice based upon cost and benefit. It only becomes and addiction once the behaviour is unusually frequent/the costs are v. high Initiation Addiction is based upon ‘utility’ – the measure of satisfaction gained from consumption of a particular good. ‘utility’ = cost - benefit Addiction is experienced as an increase in consumption = they have made a rational choice based on the ‘utility’ of their addictive behaviour Maintenance/Relapse Addiction is rational, and those addicted look ahead in a rational way and then behave in a way which is likely to max. What they like doing An exception is gambling Griffith’s study – Gamblers use cognitive bias’ when gambling – a variety of heuristics e.g. Hindsight bias, flexible attributions, erroneous perceptions, and personification, all which distort the gamblers reasoning of their addiction This theory can explain why some addicts despite the ‘out of control’ view of addiction actually just stop! In utility terms when the costs are abnormally high e.g. A person’s life becomes really unpleasant they decide to stop and do. West F: when the harmful health effects of smoking/ actual expenditure of smoking outweighs the benefits they quit smoking Utility offers itself practical implications West F: by changing the utility e.g. Making them more expensive the costs outweigh the benefits and initiation is less likely to occur. It cannot explain all addictions e.g. Gambling in which the behaviour itself is contradictory to the rational choice theory Support by Griffiths

6. Operant conditioning(addiction is the result of maladaptive learning) Initiation Behaviour - reward = dopamine(mesolimbic pathway) = positive reinforcement Stimulus – natural/artificial e.g. Drugs/gambling White F: addictive drugs e.g. Cocaine, amphetamine, opiates and nicotine can act as reinforces Griffiths F: Gamblers may become addicted due to a number of reinforces(physiological, psychological, social and financial) Maintenance/Relapse Chronic exposure to the addiction(drugs) – short periods of absence can lead to withdrawal effects(anxiety, stress, shakes) Withdrawal effects are reduced by engaging in the addictive behaviour Any reduction in the behaviour = negative reinforcement therefore explaining the high likelihood of relapse after stopping the addictive behaviour West F: the process of maintenance of the addictive behaviour doesn’t require conscious thought, therefore can explain the conflict between the conscious want to stop and the motivational forces that impel them to continue This suggests that the person’s addiction is out of their control and therefore they are absolved of any negative impact the addiction may have on their lives, possibly decreasing their motivational force for treatment. Reductionist – simplifies addiction as to only the act of reinforces therefore ignoring other psychological and biological factors which can lead to initiation and maintenance/relapse of the addictive behaviour e.g. Genes and cognitive bias Relevant studies from either to support Griffiths F: operant conditioning is more useful explaining maintenance/relapse, but is less useful at explaining initiation : the that of classical conditioning It has limited application to other addictions e.g. Gambling - Winefield et al F: Gamblers loose more than they win, so there is little reinforcement however they continue to gamble, this is contradictory to the operant theory explaining addiction

7. Individual differences – it fails to explain why some people become addicted and others don’t Robinson et al F: at some point in a person’s life they will take a potentially addictive drug, however only a small portion become addicted, suggesting that other psychological and possibly biological factors may play a part in the development and maintenance of addiction Classical conditioning Initiation Unconditioned stimulus – unconditioned response Unconditioned stimulus + conditioned stimulus = unconditioned response Conditioned stimulus = conditioned response The conditioned stimulus acts like a secondary reinforcers The secondary reinforcers and produce the same physiological effects and the unconditioned one Glutier et al F: alcohol related stimuli, produced many of the same physiological responses to the alcohol itself e.g. Increased heart rate Maintenance/relapse Conditioned response in the absence of the drug due to the presence of the secondary reinforcers e.g. Environment but the body in a stage of disequilibrium. The disequilibrium = withdrawal symptoms Withdrawal symptoms motivate to person to take the drug again = alleviate the symptoms Robins et al F: Veterans who had become addicted to heroin whilst in Vietnam, where less likely to relapse when they returned back home compared to civilians who returned to the same place that they developed their addiction Implications for treatment bases upon the secondary reinforcers. Drummond et al F: developed a treatment called cue exposure – the patient is exposed to the secondary reinforcers without taking the drug = stimulus discrimination = without taking the drug the bond between the secondary reinforcers and the drug goes away reducing cravings for the drug Skinner F: most behaviour is voluntary and isn’t passive/involuntary unlike that suggested by the classical theory, therefore it cant explain initiated by it can explain maintenance/relapse

8. Social learning theory Initiation Brings together both classical and operant and extends them looking at observation and communication Addiction starts with operant conditioning Any positive effects experienced by using the drug directly/observed by others leads to repeated drug use Any negative effects directly experience/observed = decreased likelihood of taking the drug again Maintenance/ Relapse Most drugs have positive and negative effects The person is motivated to take the drug = positive, but wants to avoid it = no negative effects Wests F: creates and approach-avoidance conflict – take the drug and stop taking the drug Through classical conditioning secondary reinforcers are associated with the drug After stopping these cues = higher risk of relapse George et al F: the presence of multiple cues raises the ‘positive outcome expectations’ = motivation to use to drug again = positive effect Explains initiation better than the other 2 Benda et al F: peer group influences are the primary influence for adolescents taking up smoking/ drug taking Takes aboard cognitive factors as well – self efficacy(a persons belief in his/her’s ability to succeed) Lawrance F: self-efficacy predicts the onset of smoking and progression of experimental to regular drug use.

9. Initiation Smoking during pregnancy = risk factor for child later on in life Buka et al F: women who smoked during pregnancy doubled the risk of their child becoming addicted to tobacco Usually during adolescents Psychosocial motives – symbolic act conveying messages McAllister et al F: peer group conveyed messages = smoking is enjoyable promoting popularity Mayeux et al F: for boys only there was a link to smoking at age 16 and popularity 2yrs later Suggests that awareness of effects before hand may reduce this risk as people wont associate smoking with popularity but health risks instead. Adolescents who believe this are somehow linked to smoking Jarvis F: children who approve this motive usually come from backgrounds where smoking is common/approved of Jarvis F: this image is sufficient for them to push through the initial unpleasant first few tabs, after which the physical effects take over. Socioeconomic status and nicotine addiction Nicotine addiction has been associated with social disadvantage Fidler et al F: In the UK smoking was linked to social and economic disadvantage. Poorer = higher nicotine intake Peretti-Watel et al F: in a French study, neighbourhood, poor housing socioeconomic status are all correlated to smoking and nicotine addiction Suggest practical implications to reduce nicotine addiction to improve living conditions and other factors

10. Maintenance/Relapse Physical and psychological effects of nicotine Nicotine – activates the nicotinic acetylcholine receptors(nAchRs) Releases dopamine in the nucleus accumbens = pleasure(temp) Nicotine lvls drop = withdrawal effects e.g. Impaired mood and conc. Smokers have another tab, and the cycle continues(operant conditioning) Khaled F: In a Canadian study, long term smoking had an adverse effect on mood – the incidence of depression was highest in long term smokers trying to quit Gender bias Jane et al F: there is much gender bias related to research on smoking addiction The onset and development of smoking differs in males and females Lopez et al F: women start smoking later : men. There are gender diff. In context and stages of smoking

11. General info: DSM-IV-TR = loss of control of gambling behaviour, increased frequency in gambling and time spent thinking about it, continue to gamble despite negative effects on life. Initiation Pathological gambling runs in families Shah et al F: in a twin study, evidence for genetic transmission in males Black F: first degree relative were at increased risk of developing pathological gambling : distant relative Petry F: genetic predisposition may act indirectly through the trait of impulsivity. The trait for impulsivity is a strong predictor of pathological gambling It may not be genetics instead it may be due to social modelling influences Slutske F: 64% of the variation in risk for pathological gambling is down to genetics the other 36% down to family Sensation seeking and boredom avoidance There are individual differences in the amount of stimulation a person needs Gamblers are higher sensation seekers = little consideration for risk and they anticipate arousal more positively : low sensation seekers Pathological gamblers need intense stimulation and excitement Blaszczynski F: poor tolerance for boredom = repetitive gambling behaviour. Higher boredom proneness : non-gamblers. There was no difference between the diff. Types of gambling Bonnaire F : French study of pathological gambling involving passive games and active games suggest that there are 2 distinct sub-groups to addiction. Those who played active games = more sensation seeking : those who played passive games = avoid negative emotional states e.g. Boredom Coventry and Brown F: that casino gamblers were higher sensation seekers : gen. Pop. Supporting the view that gambling isn’t a homogenous activity. Little supportive research Coventry and Brown F: gamblers who engaged in active gambling e.g. Horse racing were lower on sensation seeking : non-gamblers

12. Self esteem Link to self esteem and general health behaviour Abood F: a significant relationship to self esteem and general health behaviour account for a significant % of the variance in health behaviours amongst adolescents Baumiester F: low self esteem may cause people to behave in ways that are self-defeating(harmful) to avoid self-awareness Taylor F: a 9 year study of 872 boys showed that those with low self esteem were at higher risk of developing an addiction by the age of 20 Phillips et al F: adolescents with low self esteem had excessive phone use – used phones as a way of escaping from unpleasant situations(self-awareness) Armstrong F: that pathological internet use was linked to individuals which has low self esteem Niemz F: 18% of British students analysed = pathological internet users with low self esteem(measured using Rosenburg self-esteem scale) Confounding evidence suggesting no link Hull et al F: no difference in lvls of self-esteem of adolescent substance abusers and control Self esteem may be a contributing factor but not the most important Bentler et al F: in a list of risk factors for substance abuse amongst adolescents, self esteem ranked behind 9 others, in order of importance self esteem was the least. Low self esteem may not contribute to addiction directly, but rather indirectly, influencing other factors which contribute more McMurran F: the most important factors are culture, family, lifestyle, social group, behavioural skills, thoughts, feelings and physical factors

13. Attributions to addiction Attributions - explanations about the cause of one’s behaviour E.g. Smokers would attribute their behaviour to forces outside their control to ease their discomfort caused by their conflicting cognitions about their behaviour Being addicted to nicotine provided the explanation they needed to continue on smoking despite the health risks McAlister et al F: smokers who were labelled as heavy smokers shifted their attributions to be consistent with ‘addiction’ thus absolving them of any personal responsibility Attributions may lead to major behavioural obstacles Eiser et al F: if smokers perceive themselves as addicted the ‘addict’ label acts as a self-fulfilling prophecy whereby they feel that they are not in control, are not responsible for their actions or their failure to change their behaviour Attributions differ across substance type Hatgis et al F: college students attributed greater responsibility to marijuana : alcohol, crack cocaine and heroin = of their perception of it being less addictive : to the others Hammersley F: drug users in prison blamed their drug use for their crimes of theft, when in fact the best predictor of crimes of theft was criminal behaviour prior to drugs

14. Social contexts of addition Smoking We only tend to interact with those with similar beliefs to out own Eiser F: smokers tend to befriend smokers and non-smokers tend to befriend non-smokers Increased levels of smoking are associated with positive encouragement and outcomes such as popularity around your peers McAlister F: increase lvls of smoking are linked to peer encouragement and approval, and the view that smoking leads to popularity Smoking behaviour = 2 theories Social learning theory – learning by observation and mimicry of other peoples behaviour Initiation into a behaviour is determined by those who you spend the most social contact with Experiences with the new behaviour determine whether or not it will persist Duncan et al F: exposure to peer models increases the likelihood that teenagers will become smoking Eiser F: there is evidence to show that rewards such as popularity, and peer approval increase the likelihood of smoking and why they continue Reliability and applicability – people do continue on after a negative effect Social identity theory – there is a social identity of the group with its own individual norms and people in the group adhere to those norms Where smoking/non-smoking is central to the group norm, individuals are likely to follow that norm. Brown F : the influence of peers on attitudes to substances decreases as adolescents goes on, with ageing friends and romantic partners are more important upon influencing behaviours and attitudes especially those related to health Therefore the social identity changes throughout a person’s life and there are practical implications Michell F: adolescents are encouraged to start smoking by the stereotypes that they hold of specific social crowds

15. Film representations Most films represent addiction in a positive way Sulkunen F: 140 scenes from 47 films representing various addiction. Only analysed scenes which directly represented addiction(61 scenes left). Addiction represented as a way of relieving a particular problem, contrasted with the dullness of ordinary life, and protesting against parental hypocrisy. Gunasekera F: 87 most pop. Films over the last 20yrs. Films with drugs were less common: alcohol and smoking. Most addictive behaviours shown positively with no negative consequences. Only 1/87 films was free from negative health behaviours. Sargent F: analysing 4000+ adolescents to the effects of smoking in the media assessed a year later. Of those who hadn’t smoked proir to exposure, a year later this was a significant and strong predictor of whether or not they had started Films do represent the negative consequences Boyd F: films do represent the negative consequences of addiction e.g. Violence and crime, sexual degredation. In the US they are offered script to screen advice and given incentives(money) if they do portray the negative consequences. Films are good for their widespread appeal providing info on stereotypes which may offer a deterrent Byrne F: the Film industry is an important information tool e.g. The image of ECT comes not from the royal college of psychiatrist but from the film ‘One flew over the cuckoo’s nest’

16. The role of media in changing addictive behaviour Treatment to addiction is often hindered by their being too few professionals, and the expense to the addict therefore a more communal approach may be better suited as it has been shown that the media is influential(see above) Bennet F: when comparing viewers of a series related to alcohol : controls, there was an improvement in the lvl of alcohol related knowledge but no change in behaviour(consumption)/attitude to alcohol. Kramer F: assessed the effectiveness of a self-help tv show to problem drinking. The intervention group was more successful at achieving low risk : control and this was maintained after 3 months In the UK an anti-drug campaign was launched to warn teenagers about the negative effects of drugs, but the evidence so far has been inconclusive to its effectiveness Hornik F: anti-drug campaigns often fail to accomplish goals and may also have led to delayed unfavourable effects e.g. Increase in drug use Hornik F: the reason for its low effect = youths already exposed to lots of negatives about drugs therefore = little effect. It implies that drug use is commonplace If drug use is seen to be common more people will do it Johnston F: youths who saw campaign ads were more likely to think that their peers were using, therefore more likely to use themselves

17. The key to changing behaviours is to understand the factors which contribute to the persons intention to change their behaviour and how this intended behaviour may be transformed into an actual behaviour 2 theories TRA TPB TRA – cognitive theory Concerns the decision to engage in a particular behaviour This is predicted by their intention – if they intend to give up the behaviour they will Intention = 2 factors Social norms – beliefs about what we think significant others thinks is right(injunctive norm), and out perceptions of what we think people are actually doing(descriptive norm) Behavioural attitudes – based on beliefs about the consequences and whether they will have a +ve/-ve value Behavioural attitude Subjective norms IntentionBehaviour Applications Safe sex(Terry) F:targeted behaviour such as sex with no penetration, with a condom, monogamous relationships – link between intention and behaviour = problematic = p. Not fully confident in controlling their behaviour/wished of partner Gambling(Moore) F: in a sample of adolescents and adults TRA predicted gambling frequency and problem gambling

18. There are problems with determining intention therefore limiting its predictive power Albarracin F: The intentions and attitudes assessed in Q. = poor representations of the actual intentions and attitudes involved in the actual behaviour The TRA developed in the US involves western constructs therefore may not be able to be applied to non-western cultures Bagozzi F: the effects of attitudes to subjective norms were greater in determining intention to eat fast food in the US students : Chinese Supported by research evidence Predicting a wide range of behaviour such as blood donation, family planning and dental hygiene It fails to take into account past behaviour despite it known to be a successful predictor of future behaviour Therefore reductionist Ignored other behaviours such as involuntary and irrational Therefore limiting its applicability TPB Takes into account perceived behavioural control(the extent to which the person beliefs they will be able to perform the behaviour) Perceived behavioural control acts on either, intention or the behaviour itself Stronger control = stronger intention Stronger control = persevere longer Behavioural attitude Subjective control Perceived behavioural control IntentionBehaviour

19. Applications Intention to change unhealthy behaviours(Rise) found that affective attitude and descriptive norm = better predictors : other aspects of the TPB in predicting whether or not people actually quit smoking When does perceived behaviour control come into predicting intentions Perceived behavioural control is more important when issues of control are associated with performance of a task Netemeyer F: good predictor of the intention to loose weight : consuming convenience food Better predictive power Conner F: meta analysis = perceived behavioural control added 6% in the variance of intention : TRA Takes into account individual differences = better predictor Conner F: meta analysis = TPB accounts for 60% variability in peoples intentions Cognitive explanation = behaviour is of rational thought = TPB ignores emotions and other irrational components Albarracin F: by ignoring emotions the predictive power weakens = emotions explain why people act irrationally against their intended behaviour even when the intended behaviour is rational Much cited and influential model therefore shows some scientific validity Walker F: TPB is the most widely used and popular cognitive model used in health psychology Empirical support = reliable model Wickersham F: components in testicular self examination e.g. Attitude, subjective norm and PBC all correlated with intention Schifter F: weight loss was predicted by the models components mostly PBC Dunn F: PBC main component in predicting smoking, alcohol consumption and exercise

20. Classical conditioning Aversion therapy = undesirable response to a stimulus is removed by associating it with another aversive stimulus e.g. Alcohol paired with an emetic drug(antabuse/apomorphine) – nausea and vomiting become the conditioned response to alcohol Patients given a warm salin solution containing the emetic. Before vomiting given a 4 ounce glass of whiskey – told to smell swill and taste before swallowing If no vomiting has occurred then another straight whiskey and a pint of beer with more emetic in it Over time = lengthened treatment, higher doses of emetic, broadening hard liquor. Patients encouraged to drink soft drinks between treatment to prevent generalisation to all drinks Meyer F: aversion therapy is better than no therapy at all, and half their patients abstained at least one year after treatment Roth and Fonagy F: when using random control trials to test emetics and electric shocks, the results weren’t consistent but it appeared to be only a ST impact in both techniques Smith F: Aversion therapy(drugs/electric shocks) – higher rates of abstinence but low sustainability over 12 months : counselling Covert sensitisation(another form of aversion therapy) = the conditioned stimulus and response are imagined Patients visualise the initiation of the undesirable behaviour and the conditioned response Ethics – less physiological and psychological harm experienced by the patient Gelder F: no more effective : aversion therapy Roth and Fonagy F: no more effective : aversion therapy and alternative interventions

21. Operant conditioning Contingency management(CM) = environmental contingencies play an important role in encouraging/discouraging behaviour Teaching patients and those close to them to reinforce behaviour which is inconsistent with the undesirable behaviour e.g. Avoiding situations associated with gambling Reward = tokens = money = goods Also includes teaching job finding, and socail skills as well as assertiveness training to refuse engaging in the behaviour Azrin F: consistent findings show that CM is cost effective and one of the most effective treatments available Petry F: Less % of relapse when treating alcoholics with CM : standard outpatient treatments Davison F: CM had general effectiveness when the patients weren’t under constant external supervision

22. Psychological treatments are better when there is a high dependence on the behaviour Carrol F: drug treatment : placebo was better at treating patients with a low degree of cocaine dependence and cognitive treatment better at treating patients with a high degree of dependence Cognitive treatment CBT Learned how to avoid high risk situations/strategies to cope with cravings and resisting the regard to call a “slip” a catastrophe Alternatives to engaging in the behaviour so to find new ways of coping more effectively with the circumstance that led to the addiction in the past e.g. In gambling CBT tries to correct the errors in thinking reducing the urge to gamble Carrol F: after 12 months cognitive treatment still showed to be more effective at reducing drug addictions : drug treatment Morgenstern F: no difference in effectiveness of CBT : counselling CBT associated with increased coping skills but not sure if this helps Morgenstern F: association to increased coping skills and better outcome : alternative intervention but results not consistent = 9/10 studies showed increase in coping skills but no change in behaviour Bennett F: small no of studies involving pathological gambler = positive results Sylvain F: male pathological gamblers treated with CBT = improvement, maintained after a year Ladouceur F: 66 pathological gamblers assigned to either cognitive therapy/waiting list, 86% no longer fitted the DSM criteria of a gambler, had better self control and efficacy maintained after 1yr(cognitive therapy) Ladouceur F :pathological gamblers - 54% of patients in CBT groups improved : 7% control Ladouceur F: pathological gamblers - improvements in patients were cited at 6, 12, and 24 months follow- ups

23. Gambling and SSRI Hollander F: small study of 15 people first treated with a placebo then the SSRI showed that with SSRI = reduction in gambling and urge to gamble(10/15 competed the study) Bennet F: replicated these findings using other SSRI’s Small study limited generalisability Findings replicated = reliable Blanco F: involving 32 gamblers = no superiority of SSRI’s to placebo Kim and Grant F: SSRI’s = significant decrease in gambling thoughts and behaviours after 6 weeks Medication to maintain abstinence = not approved in the UK yet Disulfiram – blocks the metabolism of alcohol at a specific point = negative effects Patient has to be strongly committed = has to be taken every day Davison F: no specific benefit : placebo Davison F: high drop out rates 80% Ethics – physiological harm Gelder F: cardio irregularities/ cardiovascular colapse, constant metallic taste in the mouth, dermatitis, peripheral neuropathy and impotence Therefore shouldn’t be administered until at least 12 hours after their last drink = constant detoxifications Malcolm F: repeated detoxifications associated with a poorer response to treatment Due to constant detoxification = highly dependant alcoholics = inpatient = expensive High drop out rates, harm and little benefit = decrease cost-effectiveness Antagonists – block activity of endorphins released on consumption of alcohol = reducing cravings Inconsistent findings when used alone but more effective when combined with CBT Davison F: only effective when using the drug, but long lasting compliance = difficult therefore long lasting effectiveness cant be established

24. Medication = substitute Heroin = Methadone Less addictive chemical similar to heroin Acts more slowly : heroin(no “rush”) The patient is given increasing doses of methadone so that the patient becomes cross dependant The drug is slowly decreased(less severe withdrawal) until s/he is no longer on either drug Patients substitute one addiction for another, UK stat auth F: methadone = responsible for 300+ deaths Strain F: the effectiveness of methadone is improved if the dose is high : low Little effective = doesn’t produce expected “rush”, unpleasant side effects e.g. Insomnia and reduced sexual functioning

25. Doctors Advice Doctors are credible sources of information, 70% of smokers will visit the doctors at some point, and doctors can be successful in promoting cessation in smoking Russel F: when doctors gave advice to stop smoking, a leaflet on stopping smoking and follow up there were 5.1% of the group not smoking : 3 other similar conditions = 500,000 ex smokers in the UK 1yr Worksite intervention Workplace’s adopting non-smoking policies – reach many people who dont consider going to a clinic Large no = group motivation and social support Evidence F: overall reduction in no of tabs smoked for up to 12 months Ogden F: although smoking in work may be reduced the level of smoking out of work compensates for the loss Ogden F: Australian study ban smoking the in workplace, smokers did see the benefits but only 2% gave up Community – based programmes Same aim as above = reach large groups of people use group motivation and social support Stanford 5 city project F: 13% reduction in smoking rates : control North Karelia Project F: 10% reduction in smoking rates of males : control. 24% reduction in cardiovascular deaths = x2 : USA Australia North coast study F: 15% reduction in smoking over 3yrs Swiss national research programme F: 8% reduction in smoking over 3 yrs Government Interventions Anti – smoking legislation = July 2007 = illegal to smoke in public places = more supportive environment Information centre for health and social care F: 250000 quit smoking between April and December West F: attempts to stop smoking were greater before the ban : after