What is the key issue?
- Whether or not drug abuse can be treated
Why is the topic a key issue?
- Drug misuse and addiction have so many underlying dimensions and disrupt so many aspects of an individual’s life
- Treatments must help the individual stop using drugs and maintain a drug free lifestyle
- Addiction is typically a chronic disease
- Addicts have to overcome both physical and psychological dependence whilst coping with withdrawal
- Different treatments for drug abuse and many rest on the medical model of illness which suggests that biological drug treatments will work when treating biological problems
- Treatments also rest on the social learning theory model – suggests that misuse comes from observational learning
- To be successful, treatments need to look at the underlying reasons why misuse started and deal with this first
- The effectiveness of treatments are affected by individual differences – all addicts have different reasons for starting and continuing
- Drug abuse needs to be treated to reduce crime e.g. stealing to fund drugs
- Needs to be treated to reduce deaths – overdoses, needle sharing
- NHS is investing money and it is being wasted
- Most people need long term repeated treatment to overcome both physiological and psychological dependence, and withdrawal
Biological explanation for misuse
- Neurochemical explanation explains that substance misuse changes neurotransmitter action in the brain
- Drug – stimulant and depressant alters neurotransmitters balance by acting at the synapse
- Repeated use leads to changes in chemical balance in the brain resulting in physical dependency
- Leads to tolerance – harder to overcome
- Individual will continue to take the drug to function correctly – otherwise, they would experience harsh withdrawal symptoms
- When they believe they need the drug to function properly – psychological dependency
How can we treat physical dependency?
- Drug therapy such as methadone maintenance therapy
- Methadone given to a patient every day in a clinical setting as a liquid (orally)
- Methadone blocks the effects of heroin at the synapse, suppressing withdrawal symptoms and reducing cravings without experiencing euphoria
- Methadone doses are given depending on the level of addiction
- Urine test and health checks conducted at least every 3 months
- Evidence to show that heroin addiction can be treated – treatments for physical dependency are effective
Evidence that treatments used to tackle physical dependency are effective
- Blattler et al found that giving a daily dose, prescribed dose of heroin reduced cocaine use and caused behavioural changes that are linked with abstinence
However – the issues;
- Methadone is continued to be used without detox – 85% of users stay on methadone for 1 -2 years
- Self-administration mean users sell methadone on black market – defeats objective of treatment
- Users can overdose on methadone if mixed in a cocktail of other drugs
- Shows that drug abuse can be treated if the addict is willing to commit to treatment – needs motivation and consent
- Doesn’t explain psychological dependency
- Costing tax payers a lot of money – methadone is very expensive
Learning explanation of substance misuse
- Based on social learning theory – individual observes a role model e.g. a celebrity misusing a substance
- Identify with the role model e.g. due to administration, making modelling of the misuse more likely
- Individual’s motivation to begin misuse comes from vicarious reinforcement – observing role model in a positive state
- Imitate by taking the drug – motivation from positive reinforcement from drug to take it again
- This explanation could be used to treat drug misuse by extinguishing the learnt behaviour of taking the drug
Evidence that abuse may be psychological;
- Bandura, Ross & Ross found aggression was imitated more if the role model was the same sex
- Difficult to generalise findings for aggression to substance misuse
- Bahr et al found peer drug use had a strong effect and social learning between peers is important
- Moolchan et al found 75% of teenagers who smoked had at least one parent who smoked – they stated they smoked to fit in with their peer group
- These provide evidence for cases of substance misuse meaning treatment should include addressing the cause when treating substance abuse
How can we treat misuse if it is learned behaviour?
- Aversion therapy – used to treat learned behaviour – treats psychological problems
- Uses the principles of classical conditioning to remove the response of consuming a drug such as alcohol
- Disulfiram is paired with alcohol consumption to produce one unconditioned response of an unpleasant expectation accompanying vomiting
- Conditioned stimulus of alcohol will cause the conditioned response of an unpleasant expectation
- Response stops alcohol consumption showing drug misuse could be treated by pairing the drug with an adverse stimulus
Problems with aversion therapy;
- High relapse rates – doesn’t treat physical dependence
- Extinction – Pavlov’s dog – link becomes extinct
- Expensive
- Stimulus generalisation
- Some may be more motivated
Preventative measures;
- Anti-drugs campaigns have been used to treat drug misuse e.g. NHS Scared campaign which exploits parental conscience by playing emotions
- Protective over the child, due to their distress, which heightens the parent’s responsibility to stop smoking
- Mechanic et al found that smoking fell by half due to anti-smoking campaigns – however, this is hard to determine a cause and effect relationship for quitting smoking
- Extraneous variables such as the smoking ban or prices of cigarettes may have impacted in people’s decision to stop smoking
- Preventative measures supports the prevention of drug misuse, rather than the treatment of drug misuse
- Education should be given in schools
Problems with aversion therapy;
- High relapse rates – doesn’t treat physical dependence
- Extinction – Pavlov’s dog – the link becomes extinct
- Expensive
- Stimulus generalisation
- Some may be more motivated
Social approach;
- social support is essential for successful treatment
- former addicts can be useful in providing social support – an addict can relate to them and will listen without prejudice
Cognitive approach;
- Often addicts develop a set of cognitions that suggest that taking more of the drug will help because it alleviates withdrawal symptoms
- Ignore the knowledge that the more they use the drug, the worse the symptoms become
- Addicts approaching treatment may believe the habit is too difficult to break
- Counselling can challenge and change faulty cognitions
Psychodynamic approach;
- If treatment is going to be successful, the underlying causes for the addiction need to be discovered and addressed
Biological approach;
- All treatments involve tackling dependence on an artificial boost to certain neurotransmitters
- Methadone treatment used for heroin addiction – often not successful and some addicts continue to use heroin at the same time
Learning approach;
- Aversion therapy uses classical conditioning to treat alcoholism – can be effective in the short term but long term effectiveness is less clear
- Treatment is likely to be more successful if linked to addressing the causes of addiction
- Pairing association of alcohol with having a good time with friends quickly results in the alcohol being perceived as the source of enjoyment – learning new associations is one possibility for treatment (aversion therapy)
- Social learning theory exposes the addict to appropriate role models – people who have overcome an addiction are the most effective as the addict will be able to relate to them – used by Alcoholics Anonymous