Drug therapy is a biological method of reducing addiction. Methadone is used to treat heroin addiction by reducing cravings while constantly lowering the amount taken. Smoking addiction is treated with nicotine replacement products, like patches and gums. Sedatives like benzodiazepines are used to reduce cravings in alcoholics and Antabuse is given to induce nausea when alcohol is drunk. Antabuse is also a behavioural intervention, used as part of aversion therapy to break down positive associations of drinking alcohol and replace them with negative associations (feeling sick when drinking). This operates on the principles of classical conditioning with alcohol acting as a conditioned stimulus to produce a conditioned response of vomiting. Another behavioural intervention is covert sensitisation, where, in a relaxed state, an alcoholic has to imagine feeling ill while drinking, then to imagine actually being sick in public. The greater the negative emotion produced, the greater chance the therapy has of working. Cognitive behavioural therapy on the other hand aims to alter the irrational thought processes associated with addiction. Addicts learn to recognise and challenge their irrational thinking and are taught substance-refusal and relapse-prevention skills, such as how to deal with everyday problems that could act as a gateway back into addiction.
Fig 17.4 Using Antabuse to treat alcohol addiction
Curtiss et al. (1976) assessed the effectiveness of aversion therapy in treating nicotine addiction. The participants were all nicotine addicts who had expressed a desire to quit their smoking behaviour. The experiment had two conditions: one condition involved being part of a discussion group and rapid and continual smoking (in order to induce nausea and vomiting) and the second condition, which only involved participation in the discussion group. Five months after the treatment finished, the researchers measured the degree of smoking behaviour of the participants in both conditions. It was found that both groups had decreased the amount they smoked, but there was no significant difference in the effectiveness of the treatment for participants who had additionally received the aversion therapy. It was concluded that aversion therapy as a treatment for nicotine addiction is not effective as a treatment that produces long-term smoking cessation.
• McLellan et al. (1993) found that 69 per cent of participants receiving treatment of methadone only had to be withdrawn from the study, as they had eight consecutive positive urine samples indicating they were taking heroin again. Other treatment groups who received methadone plus other interventions, such as psychotherapy, responded far better, which suggests combination treatments are more effective.
• Ashem & Donner (1968) looked at the efficacy of covert sensitisation, finding that 40 per cent of patients receiving covert sensitisation for alcohol addiction, were still abstinent 6 months after treatment, whereas none of the control group remained alcohol free in that time. This suggests that covert sensitisation is an effective treatment for alcoholism.
• Young (2007) used self-report measures on 114 participants to assess the effectiveness of cognitive behavioural therapy in treating addiction to the internet. Over 6 months, 12 sessions of CBT were given, with most clients maintaining reductions in addictive behaviour 6 months later, demonstrating the effectiveness of the therapy.
Research indicates that drug treatments work best when combined with psychological treatments, which suggests that an holistic amalgamation of biological and psychological theories provides the most valid explanation of addiction and means of treating it.
Covert sensitisation is adaptable to all addictions and undesirable behaviours. It also does not incur the ethical problems of aversion therapy, as the negative consequences are only imagined and are never actually experienced.
There is a wealth of research evidence to suggest CBT is effective in treating addiction, which gives support to the cognitive explanation upon which it is based. However, it can often be even more effective if combined with drug treatment.
Research has indicated that aversion therapy does not work with everyone, which indicates that there are individual differences in how applicable this therapy is. Classical conditioning would argue the treatment should work equally with all, which evidently isn’t so.
CBT is not effective for clients who have problems forming a trusting relationship with their therapist and/or have problems perceiving and challenging their irrational thinking in regards to their addictive behaviour.
Covert sensitisation only really works in treating addiction with those individuals possessing vivid enough imaginations to create sufficient degrees of negative emotions.
Research into treatments of addiction allows clinicians to learn which treatments are most effective for dealing with different sorts of individuals, who are suffering different types and degrees of addiction. This allows treatments to be more specifically targeted.