Health Psychology

Health Psychology Spring 2013

Objective 2.2 (EQ): Examine prevention strategies and treatments for substance abuse and addictive behavior.

Prologue Notes: 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.

Addictive Behavior • 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. • 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).

Prevention Strategies • Scientists are now poised to capitalize on recent advances in genetics, neuroscience, and developmental biology to create targeted science-based prevention programs that reflect the complexities underlying drug abuse and addiction. • Multiple factors must be considered (as we know neurochemistry, perception, and environment are all factors that cause addictions) in effective treatments for addictive behavior.

Prevention Strategies Effective treatment strategies take the following assumptions into account: • Addiction is a complex disease. • 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. • 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).

Prevention Strategies Effective treatment strategies take the following assumptions into account: • Addiction is a developmental disease. • It usually begins in adolescence or even childhood (which explains why some programs begin this early) when the brain continues to undergo changes. • The prefrontal cortex governs judgment and decision-making functions and is the last part of the brain to develop. • 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.

Prevention Strategies Effective treatment strategies take the following assumptions into account: • Prevention and early intervention work best. • The developmental years might also present opportunities for resiliency and for receptivity to intervention that can alter the course of addiction. • 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. • 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

Things to consider… • Things we should consider… • One should ALWAYS be critical of strategies that are reductionist (one single approach). • The most effective strategies will usually combine multiple factors and treatment options. • All strategies have their strengths and limitations.

Alcoholism Treatment 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.

Why is this an issue? • 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. • 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.

Why is this an issue? • Drinking rates may even have increased in recent years in some age groups. Why have we seen an increase in drinking in recent years? • No substantial differences exist among various sociodemographicsubgroups 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.

Why is this an issue? • 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. • 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.

Alcoholism Prevention • The following empirically based strategies are currently in place for the treatment of alcoholism: • Alcoholics Anonymous • Drug Treatment • Biopsychosocial Treatments

Alcoholics Anonymous • Alcoholics Anonymous (AA) is an international mutual aid movement founded in 1935 by Bill Wilson and Dr. Bob Smithin Akron, Ohio. • AA states that its "primary purpose is to stay sober and help other alcoholics achieve sobriety". • Thus, AA is considered a treatment strategy for alcoholism.

Alcoholics Anonymous • With other early members Wilson and Smithdeveloped AA's Twelve Step program of spiritual and character development. AA's Twelve Traditions were introduced in 1946 to help AA stabilize and grow. • 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.

Alcoholics Anonymous • AA is centred around ‘the twelve steps and twelve traditions’. The twelve steps are guidelines for self-improvement (Alcoholics Anonymous, 2001). • 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”.

Alcoholics Anonymous According to VandenBos (2007) they can be summarized: • An acceptance that one cannot control one’s addiction or compulsion (a cognitive component) • a recognition of a greater power as a source of strength (a cognitive component) • a need to examine past errors in one’s history with the help of a supportive sponsor (a cognitive component) • an attempt to make amends for these errors (a cognitive approach) • an attempt to commit to a new life with a new code of behaviour (a cognitive approach) • a commitment to helping others who suffer from the same addictions or compulsions(a social approach).

Alcoholics Anonymous • 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. • This can seen as strength and a limitation to the treatment strategy.

Alcoholics Anonymous • 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? • 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?

Empirical support? • Research as recently compared A.A. treatment to other reductionist programs (such as cognitive behavioral therapy). • 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. • 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).

Empirical support? • 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).

Empirical support? • In a 2004 survey published in the Journal of Drug and Alcohol Abuse, alcohol addiction researcher Sarah Zenmorereported that giving support helped recovering alcoholics and addicts to maintain their sobriety. • “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.” • This aspect of A.A. seems to speak to the sociocultural origins of addictions (this can be explained in your response).

Evaluation of AA (you portfolio evaluation will need to more personal and in depth) • Positives • AA has stood the test of time and has empirical support for its effectiveness. • It involves a cognitive based approach that seeks to change ones perspective and mind-set about alcoholism. • 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.

Evaluation of AA (you portfolio evaluation will need to more personal and in depth) • Negatives • 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). • 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. • 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).

Other treatment strategies Treatment Strategies • Biological methods: • 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. • 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.

Other treatment strategies Treatment Strategies • Cognitive methods: • 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. • 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.

Other treatment strategies Treatment Strategies • 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. • 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)

Conclusion • Critical Thinking things to consider: • Should there be a cultural difference in treatment and prevention strategies (does culture play a role in ? • What are the limitations to only taking ONE approach to treatment?

Health Psychology