Psya4 - A - Types Of Intervention And Their Effectiveness, Including Biological, Psychological And Public Health

Front 1

Types of intervention and their effectiveness
Biological
Smoking
Description of Nicotine Replacement Therapy (NRT)

Back 1

NICOTINE REPLACEMENT THERAPY (NRT) is an agonist substitute. Nicotine is addictive, but much less damaging to the body than the other components of cigarettes (such as tars). One strategy for reducing smoking is therefore to replace the nicotine obtained through smoking with a safer nicotine source. Nicotine replacement therapy is available in a number of forms including patches, gum, nasal spray and inhalers.

Front 2

Types of intervention and their effectiveness
Biological
Smoking
Effectiveness research of NRT

Back 2

SELBY (2012) found that a 21.4% who called a helpline to receive a free 5 week course of NRT were still non-smokers after six months, compared to 11.6% of the control group.
(+) large sample – 14000
(-) high drop out rate – only 2600 completed all follow up materials
(-) Canadian study so may not be generalisable
(+) but studies in other countries have found similar success rates with NRT
(-) only follows up for 6 months so doesn’t monitor long term effectiveness

Front 3

Types of intervention and their effectiveness
Biological
Smoking
Evaluative Comments of NRT

Back 3

(-) Side effects – common side effects of NRT include disturbed sleep, dizziness and headaches.
(+) Availability – can be bought over the counter or on prescription from the smoker’s GP.
(-) May not be effective in long term – 1/3 of smokers relapse after a period of abstinence. No difference in relapse rates amongst those who used NRT.
(-) The individual may become dependent on the NRT
(+) However, the risk of dependence on NRT is small, and only a small minority of patients (about 5%) who quit successfully continue to use NRT regularly in the longer term.
(-) Doesn’t address the CAUSE of addiction – People may smoke to relieve life stress. NRT does not treat this, so relapse may be more likely than with psychological therapies.
(+) Can be combined with psychological therapies – such as cognitive behavioural therapy to improve long term effectiveness.

Front 4

Types of intervention and their effectiveness
Psychological
Smoking
Description of Aversion Therapy

Back 4

AVERSION THERAPY is based on the principles of classical conditioning. It creates a negative association with the addictive behaviour. This may be achieved by administering drugs which cause nausea when the substance (e.g. alcohol) is consumed or by means of painful (but relatively mild) electric shocks when the behaviour is carried out.

Front 5

Types of intervention and their effectiveness
Psychological
Smoking
Effectiveness Research of Aversion Therapy

Back 5

SMITH (1988) gave 327 smokers a five day course of treatment involving aversion therapy and therapy sessions. The participants self-administered shocks though a wristband when taking part in smoking behaviour, such as opening a pack of cigarettes or placing one in the mouth. They were asked not to inhale any of the smoke so that there were no positive associations with the behaviour.

A telephone interview checked on progress 13 months later. 52% had abstained from smoking for 12 months.
(-) self-report method – prone to social desirability bias, although this may have been reduced because it was a telephone interview rather than face to face
(-) difficult to separate the effects of the therapy and the aversion therapy – may have been that the combination of the two was most effective

Front 6

Types of intervention and their effectiveness
Psychological
Smoking
Evaluative Comments of Aversion Therapy

Back 6

(-) Ethical issues – the patient is being subjected to a unpleasant substance or shock – psychological harm?
(+) Client perceptions – drop-out rates are low; many addicts report they find aversion therapy less unpleasant than psychological ‘talking’ therapies.
(-) Relapse rates are high – aversive link weakens over time, meaning that the patient may relapse.
(-) Other factors – Smith (1988) found that relapse was much more likely when reformed smokers returned to a household where others smoked. This suggests that learning and environmental factors are also important considerations in the success of interventions for addiction.

Front 7

Types of intervention and their effectiveness
Public Health
Smoking
Description of Legislation

Back 7

LEGISLATION such as ‘Smoking in public places’ was banned in the UK in July 2007. Although the primary objective of this legislation was to protect workers and the general public from the harmful effects of second-hand smoke, evidence suggests that smokers have also found that the law has created a more supportive environment for them to quit smoking.

Front 8

Types of intervention and their effectiveness
Public Health
Smoking
Effectiveness Research of Legislation

Back 8

Information Centre for Health & Social Care statistics show that nearly a quarter of million people quit smoking with the help of local NHS Stop Smoking Services between April and December 2007.

(-) Social desirability bias – participants may not want to admit to their smoking behaviours as they are not generally socially acceptable traits.

Front 9

Types of intervention and their effectiveness
Public Health
Smoking
Evaluative Comments of Legislation

Back 9

(-) Rebound effect - West (2009) found that there was a decline in the percentage of people smoking in the UK following the ban on smoking, but attempts to stop smoking were actually greater in the nine months before the ban.
(-) Organisations have found ways around the smoking ban, such as creating areas outside of pubs for people to smoke.
(-) Not really helping the indivdiual quit; just making it more difficult to smoke.

Front 10

Types of intervention and their effectiveness
Biological
Gambling
Description of Naltrexone

Back 10

NALTREXONE is an opium antagonist – meaning that it blocks the action of endorphins in the brain, thus reducing the rush of pleasure felt by the addict when they indulge in the addictive behaviour. The drug has been used for some time to treat chemical addictions such as alcoholism, but is now also being used to treat behavioural addictions such as gambling. Grant and Kim (2006) suggest that gamblers experience a rush of excitement akin to that of heroin users.

Front 11

Types of intervention and their effectiveness
Biological
Gambling
Effectiveness Research of Naltrexone

Back 11

KIM & GRANT (2001) found that naltrexone reduced thoughts about gambling, the urge to gamble and – at relatively high doses – gambling behaviour itself. In a further study, Kim et al (2001) found that, over a 12 week period, naltrexone was more effective than a placebo in controlling the frequency and intensity of urges to gamble, as well as the behaviour.
(+) used a double blind procedure to eliminate demand characteristics and investigator effects
(-) only measures over 12 weeks, so doesn’t monitor long term effectiveness

Front 12

Types of intervention and their effectiveness
Biological
Gambling
Evaluative Comments about Naltrexone

Back 12

(-) Side effects – possible side effects include nausea, headaches, constipation and insomnia.
(-) Doesn’t address the cause of addiction – treatment does not treat the underlying causes of addiction, so relapse may be more likely than with psychological therapies.
(+) Can be combined with psychological therapies – biological therapies can be combined with psychological treatments such as CBT to improve long term effectiveness.
(-) Ethical issues – there may be ethical issues involved in using treatments which interfere with bodily chemicals, particularly for non-chemical addictions.

Front 13

Types of intervention and their effectiveness
Psychological
Gambling
Description of Cognitive Behaviour Therapy (CBT)

Back 13

COGNITIVE BEHAVIOUR THERAPY (CBT) is based on the idea that addictive behaviours are maintained by the person's thoughts about these behaviours. The main goal of CBT is to help people change the way they think about their addiction, and to learn new ways of coping more effectively with the circumstances that led to these behaviours in the past (e.g. coping with difficult situations or when exposed to peer pressure). In gambling addiction for example,cognitive errors, such as the belief that the individual can control and predict outcomes, play a key part in the maintenance of gambling. CBT attempts to correct these errors in thinking, thus reducing the urge to gamble.

Front 14

Types of intervention and their effectiveness
Psychological
Gambling
Effectiveness Research of CBT

Back 14

LADOUCER (2001) randomly allocated 66 pathological gamblers either to a cognitive therapy group or to a waiting list control group. Of those who completed treatment, 86% no longer fulfilled the DSM criteria for pathological gambling. They also found that after treatment, gamblers had a better perception of control over their gambling problem and increased self-efficacy, improvements that were maintained at a one-year follow-up.
(-) no evidence that the gambling behaviour disappeared.
(+) indicates a higher effectiveness rate than biological treatments.

Front 15

Types of intervention and their effectiveness
Psychological
Gambling
Evaluative Comments about CBT

Back 15

(+) Increases self-efficacy – makes the individual feel more responsible and in control of their own behaviour, which may be very important for gamblers and other addicts, as they may traditionally feel ‘helpless’ when faced with their addiction.
(-) Requires insight – the addict needs to be able understand their own thought processes and recognise that their thoughts are wrong. This may be difficult for some individuals to understand or acknowledge.
(-) Therapist competency – much success may rely on the skill and experience of the therapist.

Front 16

Types of intervention and their effectiveness
Public Health
Gambling
Description of Legislation

Back 16

LEGISLATION like the Gambling Act (2005) restricts gambling activities. It offers limitations on who, where and what gambling can occur in the UK. Its primary objectives were to prevent gambling being a source of crime; that gambling is conducted fairly and openly and that vulnerable people like children are not harmed or exploited. The aim is therefore not to overtly stop gambling addiction, but one of its impacts is that it might make gambling behaviour less accessible, especially for children.

Front 17

Types of intervention and their effectiveness
Public Health
Gambling
Effectiveness Research about Legislation

Back 17

Health Survey England (2013) reported that 68% of men and 61% of women in the ‘16-24 year old’ category had gambled in the last 12 months (including lottery), without the lottery these numbers dropped to 54% and 45% respectively.

(-) Social desirability bias – participants may not want to admit to their gambling behaviours as they are not generally socially acceptable traits.

Front 18

Types of intervention and their effectiveness
Public Health
Gambling
Evaluative Comments about Legislation.

Back 18

(-) easier access to gambling such as on-line sites mean problem may be regulated, but it is actually more widespread.
(-) could stricter regulation on gambling lead to it going 'underground' and those with gambling addictions finding it more difficult to get help?
(-) Other factors may be responsible for decrease – Soaps may offer storylines with characters with Gambling addictions (e.g. Anthony Moon in Eastenders) and these may have a more wide spread influence with regard to gambling.