- BIOLOGICAL INTERVENTIONS
- Drug substitution is a common treatment for addiction. Methadone is commonly used a drug substitute for a heroin addiction.
- Methadone is a synthetic drug widely used in the treatment of heroin addictions. It mimics the effects of Heroin but is less addictive and much safer to use and the ingredients of the substance are wholly known unlike some forms of heroin. Initially a drug abuser will be prescribed in increasing amount, which is then decreased until the addict no longer is dependent on either heroin or methadone.
- Drug treatments for a gambling addiction:
- There are no official approved drug treatments yet in the UK but research suggests that drug treatments can be beneficial. For example George and Morali (2005) found supporting evidence for serotonin dysfunction in pathological gambling and in a study by Hollander et al (2000), gamblers treated with SSRI’s to increase serotonin levels showed significant improvements compared to a control group.
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There are problems with methadone treatments. Some drug addicts can become as reliant on methadone as they were on heroin; therefore this method is just simply substitution one substance for another. Methadone use is therefore controversial. Statistics show more than 300 methadone related deaths in the UK in 2007. As methadone is often unsupervised, this has created a black market causing even more drug related problems.
The Hollander study may not be useful in demonstrating effectiveness. The Hollander sample was very small (only 10 participants) and had a short duration of only 16 weeks. Therefore the study lacks generalisability, whereas Blanco et al (2002) who used 32 gamblers over 6 months failed to demonstrate any difference between SSRI’s and a placebo. This therefore suggests that maybe drug treatments aren’t appropriate for gambling addictions.
PSYCHOLOGICAL INTERVENTIONS
Behavioural Reinforcement
One way to reduce addictive behaviour is to give people rewards for not engaging in the object of their addiction. Sindelar et al (2007) investigated whether monetary rewards would produce better patient outcomes for people on the methadone treatment programme. Participants were randomly allocated to either a reward or no reward condition in addition to their usual care. Participants in the reward condition drew for prizes each time they tested negative for drugs. Drug use dropped significantly for participants in the rewards condition, with the number of drug samples being 60% higher in the controlled condition.
CBT (Cognitive Behavioural 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. In a gambling addiction, for example, cognitive errors such as the belief that the individual can control and predict outcomes plays a key part in the maintenance of gambling. CBT attempts to correct these errors in thinking which will in turn, reduce the urge to gamble and help cease their addiction.
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It’s possible that reinforcement may not be 100% effective at treating addictive behaviour, just one addiction. Although research, such as the Sindelar et al study, has shown the effectiveness of reinforcement therapies for reducing addictive behaviour, such as interventions do nothing to address the problem that led to the addiction in the first place. This means that although a specific addictive behaviour might have been reduced, it’s possible it may just be substituted for another behaviour. E.g. drugs for alcohol. Therefore, reinforcement doesn’t solve the problem long-term.
There is supporting evidence for the effectiveness of CBT. Ladouceur et al (2001) randomly allocated 66 pathological gamblers either to a cognitive therapy group or a control group. Of those who completed the treatment, 86% no longer fulfilled the DSM criteria for pathological gambling. They also had better perception of control and increased self-efficacy. These were improvements that were maintained after a 1-year follow up.