Health Psychology S Spring 2013

Health Psychology
Spring 2013
S
Objective 2.2 (EQ):
Examine prevention strategies and treatments
for substance abuse and addictive behavior.
S
Prologue Notes:
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Define the multi-faceted aspects of addictive behavior (to assist you
in developing your essay)
It is your aim to present one or more prevention or treatment
strategy.
Evaluate the strategies that you have presented.
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S Addictive behavior is any activity, substance, object, or behavior that
becomes the major focus of a person's life resulting in a physical,
mental, and/or social withdrawal from their normal day to day
obligations.
S There are biopsychosocial origins of addictions and virtually any
activity or substance has the potential to become addictive (this can be
explained in your introduction).
S Scientists are now poised to capitalize on recent advances in genetics,
neuroscience, and developmental biology to create targeted sciencebased prevention programs that reflect the complexities underlying
drug abuse and addiction.
S Multiple factors must be considered (as we know neurochemistry,
perception, and environment are all factors that cause addictions) in
effective treatments for addictive behavior.
Effective treatment strategies take the following assumptions into
account:
S Addiction is a complex disease.
S No single factor can predict who will become addicted to drugs.
Addiction is influenced by a tangle of factors involving genes, chemistry,
environment, and age of first use.
S For example, recent advances in genetic research have enabled researchers
to begin to uncover which genes make a person more vulnerable (D2
Receptors), which protect a person against addiction (higher levels of d2),
and how genes and environment interact (having an addictive personality in a
negative environment).
Effective treatment strategies take the following assumptions into
account:
S Addiction is a developmental disease.
S It usually begins in adolescence or even childhood (which explains why
some programs begin this early) when the brain continues to undergo
changes.
S The prefrontal cortex governs judgment and decision-making functions
and is the last part of the brain to develop.
S This may help explain why teens are prone to risk-taking, are
particularly vulnerable to drug abuse, and why exposure to drugs at this
critical time may affect propensity for future addiction.
Effective treatment strategies take the following assumptions into
account:
S Prevention and early intervention work best.
S The developmental years might also present opportunities for resiliency
and for receptivity to intervention that can alter the course of addiction.
S We already know many of the risk factors that lead to drug abuse and
addiction– mental illness, physical or sexual abuse, aggressive behavior,
academic problems, poor social skills, and poor parent-child relations.
S This knowledge, combined with better understanding of the motivational
processes at work in the young brain, can be applied to prevent drug
abuse from starting
S Things we should consider…
S One should ALWAYS be critical of strategies that are reductionist (one
single approach).
S The most effective strategies will usually combine multiple factors and
treatment options.
S All strategies have their strengths and limitations.
Alcoholism is a broad term for problems with alcohol, and is
generally used to mean compulsive and uncontrolled consumption
of alcoholic beverages, usually to the detriment of the drinker's
health, personal relationships, and social standing.
It is medically considered a disease, specifically an addictive illness,
and in psychiatry several other terms are used, specifically "alcohol
abuse" and "alcohol dependence," which have slightly different
definitions.
S Several ongoing national surveys, including the Monitoring the
Future study, the National Household Survey on Drug Abuse,
and the Youth Risk Behavior Survey, are investigating the
drinking behaviors of adolescents in the United States.
S These studies have found that the majority of adolescents under
the age of 18 have consumed alcohol, although the minimum
legal drinking age in the U.S. is 21.
S Drinking rates may even have increased in recent years in some
age groups. Why have we seen an increase in drinking in recent years?
S No substantial differences exist among various
sociodemographic subgroups with respect to drinking rates,
although alcohol consumption generally is lowest among
African- Americans and highest among whites. Moreover,
alcohol consumption increases sharply throughout
adolescence.
S Several ongoing national surveys, including the Monitoring the
Future study, the National Household Survey on Drug Abuse,
and the Youth Risk Behavior Survey, are investigating the
drinking behaviors of adolescents in the United States.
S These studies have found that the majority of adolescents under
the age of 18 have consumed alcohol, although the minimum
legal drinking age in the U.S. is 21. Moreover, alcohol
consumption increases sharply throughout adolescence.
S The following empirically based strategies are currently in place
for the treatment of alcoholism:
S Alcoholics Anonymous
S Drug Treatment
S Biopsychosocial Treatments
S Alcoholics Anonymous (AA) is an
international mutual aid movement
founded in 1935 by Bill Wilson and
Dr. Bob Smith in Akron, Ohio.
S AA states that its "primary purpose is
to stay sober and help other alcoholics
achieve sobriety".
S Thus, AA is considered a treatment
strategy for alcoholism.
S With other early members Wilson and Smith developed AA's
Twelve Step program of spiritual and character development.
AA's Twelve Traditions were introduced in 1946 to help AA
stabilize and grow.
S The Traditions recommend that members and groups remain
anonymous in public media, altruistically help other alcoholics,
including all who wish to stop drinking, and do not affiliate AA
with any other organization.
S AA is centred around ‘the twelve steps and twelve traditions’.
The twelve steps are guidelines for self-improvement (Alcoholics
Anonymous, 2001).
S They can be altered to suit different personal, cultural and
religious needs – although there is a heavy emphasis on
spirituality and a surrendering of free will, first to the power of
the addiction and secondly “a power beyond the self ”.
According to VandenBos (2007) they can be summarized:
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An acceptance that one cannot control one’s addiction or compulsion (a cognitive
component)
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a recognition of a greater power as a source of strength (a cognitive component)
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a need to examine past errors in one’s history with the help of a supportive sponsor
(a cognitive component)
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an attempt to make amends for these errors (a cognitive approach)
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an attempt to commit to a new life with a new code of behaviour (a cognitive
approach)
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a commitment to helping others who suffer from the same addictions or
compulsions (a social approach).
S As implicitly mentioned previously, A.A. is largely a cognitive
based treatment strategy. It focuses on “thoughts, feelings,
perception, and schemas” of the person suffering from
alcoholism.
S This can seen as strength and a limitation to the treatment strategy.
S As implicitly mentioned previously, A.A. is largely a cognitive
based treatment strategy. It focuses on “thoughts, feelings,
perception, and schemas” of the person suffering from
alcoholism. How can this be a benefit?
S It also includes a social identity component where the person
suffering from alcoholism looks to positively identify with others
who are sober and dissociate themselves from “alcoholics”. How
can this be a benefit?
S Research as recently compared A.A. treatment to other
reductionist programs (such as cognitive behavioral therapy).
S A 2007 study by the National Council on Alcoholism’s medical
journal reported that people attending 12-step treatment
programs had a 49.5% abstinence rate after a single year.
S Those who were in CBT programs were less successful,
maintaining a 37% abstinence rate. It almost seems too close to
call. However, the moderate social component of A.A. may
account for the difference in effectiveness (explain why this
would be the case).
S Twelve-step literature routinely stresses the importance of
service, encouraging its members to give of themselves to others
through sponsoring of fellow alcoholics or even making coffee
(this is a social component that increases the effectiveness of the
program).
S In a 2004 survey published in the Journal of Drug and Alcohol
Abuse, alcohol addiction researcher Sarah Zenmore reported that
giving support helped recovering alcoholics and addicts to
maintain their sobriety.
S “Studies have shown that AA involvement is a strong predictor
of sustained recovery,” she reported. That included “meeting
attendance as well as helping activities such as doing service in
the AA fellowship and being a sponsor.”
S This aspect of A.A. seems to speak to the sociocultural origins of
addictions (this can be explained in your response).
S Positives
S AA has stood the test of time and has empirical support for its
effectiveness.
S It involves a cognitive based approach that seeks to change ones
perspective and mind-set about alcoholism.
S It offers a social, community-based support in a well-meaning
atmosphere by former addicts. This includes certain social
components such as social learning, social identity, and cultural
schemas.
S Negatives
S AA can not and does not address certain biological aspects of addiction (such as
D2 receptors, brain centers, etc.). Some addicts have a biological cause of their
addictive that cognitive and social treatments cannot address (explain
biological factors and their influence on addiction in your response).
S It is difficult to quantify the effectiveness of AA. Any research group will be
self-selecting because people chose to attend AA and any comparison between
AA attendees and non-AA alcoholics is inherently flawed. Also, the term
“effectiveness” in subjective, thus measuring effectiveness is inherently
subjective as well.
S Environmental factors (factors inherent within the culture) can sometimes not be
controlled by the program and must be addressed through state and local public
policies that influence certain aspects of addictions (this can be explained in
your response).
Treatment Strategies
S Biological methods:
S Drug Treatment: Disulfram: considered the most effective drug for
dealing with alcoholism; it creates an intense sensitivity in the user
to the effects of alcohol. This drug causes an instant and intense
‘hangover’ in anyone who drinks alcohol while taking the drug.
S Dopamine Treatment: Researchers are finding that drug treatments
that increase productivity in D2 receptors have been shown to slow
down “cravings” for alcohol. This has been paired with many
cognitive behavioral treatments to provide an effective strategy for
treatment of alcoholism and other addictive behaviors.
Treatment Strategies
S Cognitive methods:
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Cognitive Behavioral Therapy: Cognitive behavior therapy is mostly
used to treat depression, anxiety disorders, phobias, and other mental
disorders, but it has also been shown to be valuable in treating
alcoholism and drug addiction, especially as part of an overall program
of recovery.
S Cognitive-behavioral coping skills treatment is a short-term,
focused therapeutic approach to helping drug-dependent people
become abstinent by using the same learning processes the person
used to develop alcohol and drug dependence initially.
Treatment Strategies
S Cognitive methods:
S
Cognitive Behavioral Therapy: Cognitive behavior therapy is mostly
used to treat depression, anxiety disorders, phobias, and other mental
disorders, but it has also been shown to be valuable in treating
alcoholism and drug addiction, especially as part of an overall program
of recovery.
S Cognitive-behavioral coping skills treatment is a short-term,
focused therapeutic approach to helping drug-dependent people
become abstinent by using the same learning processes the person
used to develop alcohol and drug dependence initially.
Treatment Strategies
S Biopsychosocial Treatment: This represents an eclectic (various)
approach to treatment. The approach assumes biological,
psychological and social factors play a significant role in alcoholism
and therefore they should be represented in treatment.
S Separating the illness into constituent elements allows the clinician
to distinguish between volition (e.g. personal need, desires,
motivation) and biological deterministic elements (e.g. genetic
predisposition and brain chemistry) which can often remove
responsibility from the paradigm of understanding a person’s illness.
Done correctly, this treatment is the most effective of all
strategies (this will need to be explained and discussed in the
portfolio objective)
S Critical Thinking things to consider:
S Should there be a cultural difference in treatment and prevention strategies
(does culture play a role in ?
S What are the limitations to only taking ONE approach to treatment?