Unit 3
Health Psychology
Definitions
• Health psychology considers the reasons for
behaviour that is detrimental to health, such as
substance misuse. The emphasis then is on how to
promote healthy living.
– Understanding what causes good and bad health, using
psychology to promote good health
– For example, it looks at biological causes of substance
abuse and how drug treatments might work
– Understand health from a cognitive, social and biological
perspective
– The study of how our mental and physical health can be
assessed
Key Terms
–Synapse
–Substance misuse
–Tolerance
–Physical dependence
–Psychological dependence
–withdrawal
Methodology
LAB STUDIES USING ANIMALS
Animal laboratory experiments can be used to show a cause and effect
relationship between the drug administered and the behaviour resulting
Mice can be used to comparatively study the effects of drugs on the brain or
vital organs as they can be sacrificed to examine physiological damage
Monkeys, for example, can be studied to investigate the reinforcing effects of a
drug on behaviour to understand what schedule of reinforcement or type of
drug causes addictive behaviour
Meisch (2001) used monkeys research to show that they would be more likely
to drink a drug solution than water, demonstrating its reinforcing effects
Animals can be used to test substitute biological drugs/replacement drugs for
addicts
The findings of animal research are used to judge possible influences on
human behaviour or physiology
Rat Park was developed to understand whether drugs are biologically addictive
or reinforced behaviour
Rats were used to examine the effects of chronic stress on ethanol (aka ethyl
alcohol!) intake by Nagaraja & Jeganathan (2003)
Methodology
Evaluating use of animal research – practical issues
(nb you don’t need to know all of these, just pick 2-3 that you could expand on,
and use examples from animal studies to demonstrate the point)
• Animals are more practical to use than humans as their behaviour can be
monitored closely in confined situations over long periods of time
• Relatively cheap and can be used in large numbers/relatively small and easy to
handle/easier to house and cage
• Animal research as a whole is expensive as it involves specialist
equipment/facilities
• In drug trials animals are cheaper/more cost effective in terms of fee/cost and
amount of drug – than humans
• The knowledge gained from animal research can benefit humans, making it
important in improving the quality of human life
• Human behaviour is very different from animal behaviour, so the results of such
study may not be generalisable to humans
• The nervous system (neural transmission) is the same in animals as it is in
humans, so the results of drug research on neural transmission should be
generalisable to humans
• Animals breed quickly, so the heritability of conditions caused by drug use can
be studied conveniently
Methodology
Evaluating ethics of animals research to study drugs
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Animal research is subject to strict regulation that can be costly to set up as special
housing, equipment and a licence is required
Guidelines are enforced with animal research such as housing, number, endangered
species, painful procedures
Animals can suffer during experimentation which may be seen as morally
objectionable/pro-species argument
Animals respond differently from humans to drugs, so suffering may be more extreme
Animals can be used where suffering may be unacceptable to inflict upon humans
The least number of animals should be used in animal research to minimise suffering to
the least amount of animals
If procedures cause pain to the animal an anaesthetic can be used to alleviate the pain
The benefits of the research should outweigh the costs to the animals involved –
Bateson’s cube
During drug experimentation animals may suffer pain and discomfort – this would be a
basic mark and you would need to elaborate to get more than 1 mark
Methodology
Human Research method 1 – Interviews
• Can be used to generate quantitative and qualitative information
about the effects of drug use and effectiveness of
prevention/rehabilitation programmes
• Interviews can gather essential information about the individuals
experience of drug use, social conditions and rehab/relapse
conditions
• Qualitative information can be gathered about the experiences of
drug use/lifestyle
• Quantitative information can be gathered about amount of
substance abuse, age of commencement etc
• Blattler et al (2002) used interviews to find out amount of drug taken
and other patterns, looking at heroin and cocaine use - elaborate
• Different styles - Structured and unstructured interviews +
open/closed ended questions + face to face between researcher
and interviewee – elaborate
Methodology
Human research– Questionnaires
• Blattler et al used questionnaires to assess the
effectiveness of prescription heroin
• Questionnaires can be used to gather a lot of
information about the prevalence, experiences and
causes of drug use
• Questionnaires can gather qualitative and
quantitative information based on type of question
asked (closed or open)
Methodology - Human research 1
evaluation
+ Strengths
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Can provide qualitative data about feelings
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Long terms effects can be studied
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Longitudinal research can be conducted into the long term effects of drug use or rehabilitation/eq; so that
more robust conclusion can be drawn over time/eq;
Can generalise to humans, unlike animal studies
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Human participants can provide qualitative data that cannot be measured in animal studies in the same
way/eq;
Such as how drugs make the person feel/subjective experiences/eq;
In depth research into factors associated with drug use can be investigated so that vulnerability can be
predicted in humans/eq;
Human studies do not have generalisability issues associated with animal research - animals may not
respond in the same way to drugs/eq;
animals may not respond in the same way to drugs because of cognitive/physiological/behavioural
differences between us/eq;
They test drugs on humans that other humans will use so the findings will show exactly what effects the
drugs will have on humans because we share the same central nervous system
Validity
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Human research conducted in real life is more valid than artificial situations used to study animals
Which means findings can be applied to real life situations such as to help drug users
Methodology - Human research 1
evaluation
- Weaknesses
• Ps may not tell the truth about their drug use so distort the
results, this is because drug taking is a sensitive topic so Ps may
cover up or exaggerate the extent of their drug misuse
• Ps may give socially desirable answers and say what they believe
they should say which would affect the validity of the findings as
all responses will be skewed to social norms values
• Closed questions may not offer the opportunity to give the
detailed response or actual response the P would want to give
• Open questions are open to interpretation by the researchers –
such subjectivity will elad to bias and could affect the validity of
the research
Methodology
Human research method 2 – PET SCANS
• PET scans can be used on human participants
to understand the effects of drug use on the
brain structure and functioning
• Blood flow to a particular area of the brain can
be detected/imaged to show the active parts of
the brain during/following drug use
• Scott (2004) found that smokers brains were
less active in memory, emotion and pleasure
regions after smoking cigarettes
Methodology – evaluate one study
using humans as participants
Blatter et al (2002)
• Cross checking using biological and self report measures of drug use to
ensure the findings were valid
• They followed up reasons for drop out from the programme to ensure
that the findings were not biased by the remaining participants
• The study was ethically correct and authorised by an ethics committee
for offering of drugs
• A full right to withdraw was offered and often taken up
• As participants maintained their normal routines the findings of the
study in terms of its effect on social behaviour should have good
ecological validity
• The study could be criticised for having a cohort effect, the findings
could be due to conditions of the cohort and time
• The sample size of drug users was high offering generalisable findings
in the drug user population in Switzerland
• Urine tests were used and cross checked against drug use claims
increasing reliability? Validity?
Methodology
Why use humans not animals?
• Animals are behaviourally/genetically/physiologically
different to humans so findings may not be generalisable
• Drugs affect the brain and as humans have a more
complex nervous system/cognitive abilities comparisons
are harder to make
• Qualitative information can be gathered from human Ps
which is much more difficult to gather from animals
• Humans have subjective experiences especially when high
that can be studied that animals cannot report
• Animals may react differently to some drugs compared to
humans. The effect of the drugs are different because of
the differences in the nervous systems of humans and
animals so the findings may not apply
How Drugs Work
Heroin – mode of action, withdrawal, tolerance, dependency
Mode of action:
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Increases the level of dopamine in the brain
Acts upon the opioid receptor sites
Trigger release of neurotransmitter at receptor sites
Mimics endorphins to stimulate dopamine reward system
Morphine produced by taking heroin is a depressant and painkiller
GABA activity is inhibited
Withdrawal
– Symptoms begin within 12 hours following last fix of heroin and involve
agitation/restless (or any other symptom)
– The severity of withdrawal is dependent upon the level of addiction
– Hot and cold flushes and restlessness
– Skin crawl and often sleeps a lot
– Cramps and vomiting, diarrhoea, sweating, twitching and shaking, depression,
sensitivity in groin area, ‘itchy blood’ frustration, confusion.
– Psychological response – feel they can’t cope without heroin, cannot function
without the drug.
How Drugs Work
Tolerance
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The reward circuit becomes highly activated
Over-production of dopamine
The body has to adapt to the heroin – try and achieve homeostasis (balance)
Reduces the amount of dopamine produced
More enzymes are produced to break it down
Stifles the brain's reward circuit through inhibition- the same dose of drug is less rewarding
Heroin rapidly develops tolerance
Users very quickly need increasing amounts of it to get the “high”
Eventually just users take heroin to delay unpleasant withdrawal symptoms
Physical Dependence
– Linked to tolerance – need increasing amounts to reach high so become physically
dependent.
– Body is used to functioning with heroin – so needs it for normal functioning.
– E.g. Brain of heroin users produce less endorphins so addicts will rely on heroin for pleasure
and reduction of pain.
How Drugs Work
Alcohol - mode of action, Physical dependency, psychological dependency, tolerance
mode of action
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Acts upon GABA system
Increased GABA suppresses inhibitory behaviour
Affects ANS by suppressing sympathetic division
Results in slow reaction time
Physical dependency
– Extreme cases can lead to drink
– Irritability or shaking
– Potentially can pass out
How Drugs Work
Psychological dependency
– Sense of relief when access alcohol
– Drinking seen as a ‘coping’ strategy
– ‘first drink’ alleviates physical symptoms
Tolerance
– Blood alcohol level drops and the individual feels sober
before they actually are
– Alcohol produces enzyme
– Enzyme breaks alcohol down quickly
– In a few weeks, drinker will need to consume 50% more
to achieve the same feeling
Biological Explanation of Substance
Misuse
BIOLOGICAL - description
• Drug misuse can be explained by significant change to the neurotransmitter
action in the brain
• Stimulants or depressants alter the balance of neurotransmitters and affect
mood and behaviour
• Natural production of neurotransmitters need to be substituted with drugs to
function normally
• Drug taking results in physiological dependency which results in the need to
take the drug to feel normal
• Drugs can be taken to prevent unpleasant withdrawal effects such as sickness
• Using more of the drug may be needed because the body becomes tolerant to
lower doses
• Drugs are taken to produce pleasant effects due to the chemical action in the
brain
Biological explanation - evaluation
• The biological approach ignores the role of nurture in that addiction can be
explained by social learning, reinforcement or peer pressure
• Neurological activity in the brain of addicts have been shown to be different to
be different to non-addicts, supporting a biological basis for addiction
• Animal studies have shown biochemical changes in the brain due to drug
misuse, supporting the biochemical theory
• Withdrawal symptoms due to the biochemical crash support this explanation
• Many people try and infrequently use drugs such as alcohol, and don’t
become addicted, suggesting individual differences rather than a completely
biological explanation
• There are cultural and subcultural differences that cannot be explained by a
biological approach
• The learning explanation of addiction is closely related as it builds up on the
need for pleasure, avoidance of withdrawal effects and reinforcement
Learning explanation of substance
misuse
SOCIAL LEARNING THEORY - description
• An individual may observe a drug user and model their behaviour
• A role model who takes drugs can encourage drug misuse if they
have status and power is looked up to or respected Eg friend, family
member, media model, someone they admire or relate to, making
modelling more likely
• Drug use can be glamorised and rewarded which can be a form of
vicarious reinforcement for an observer which means the model is
seen to be enjoying themselves for example.
• The observer may identify with the drug user and wish to adopt the
same drug taking values and beliefs as a role model
• Receive direct positive reinforcement from the drug itself or gain
approval from friends as a reward
• Retain/encode the memory of models taking drugs and copy/imitate
Learning explanation - evaluation
• Vast amount of experimental evidence for the general role observational
learning so we can be fairly sure that a similar process can explain drug taking
(eg Bandura 1961)
• Drug misuse tends to run in families and this could be due to genetic factors
rather than social learning - SLT provides an alternative explanation for the fact
that addictions tend to run in families
• Culturally, different drugs are used/misused in different cultures, supporting
social learning theory as an explanation of drug taking
• studies that demonstrate the reliability of SLT support this explanation of drug
misuse through modelling (Bandura 1961)
• SLT does not explain drug use in the absence of observing a role model
• It is difficult to evidence SLT in this area as there are many other factors
involved in addiction, and it is difficult to isolate SLT as one explanation due to
other influences on behaviour eg peer pressure to take drugs to look cool
• SLT explains why people first take the drug which the biological approach fails
to explain
Comparison of 2 explanations
• Closely linked as the biological explanation builds on the need for
pleasure, avoidance of withdrawal effects, and reinforcement
• The learning explanation is the nurture side whereas the
biological explanation is the nature side of the debate
• The biological approach explains physiological dependency whilst
the learning approach explains psychological dependency.
• The learning approach can explain the cultural differences in
types of drug taken – due to reinforcement, which the biological
explanation does not address
There are other points that you could make, these are just examples
Treating Addiction
Biological method - Describe
• Biological substitute programmes, such as methadone for heroin
addiction can reduce craving and prevent heroin having its typical
euphoric effect
• Methadone is a synthetic opiate used to replace heroin
• It works to block the effects of heroin at the synapse and reduce the
withdrawal symptoms for 24 hours
• Methadone reduces heroin cravings
• If taken with heroin the heroin will not produce its euphoric effects
• Blood test are done regularly to test for illegal drug use for the
programme to be effective
• Drug replacement for class A drugs also serve to reduce drug related
behaviours and disease (crime, prostitution, HIV)
• The effects of methadone last a day (24 hours) for a daily dose is taken,
usually under supervision, and is systematically lowered to wean off
• When trusted the drug can be taken away from the pharmacy
Biological treatment of addiction - Evaluation
Blattler et al found that those give prescribed methadone reduced their general use of cocaine
and showed behavioural changes associated with abstinence
• Methadone is a synthetic opiate that can produce physical dependency
• Drug replacement therapies often have withdrawal and dependency issues themselves
• Drug replacement therapy can help take the addict away from the drug context that may
reinforce an addicts lifestyle
• Less glamour when taken orally so removes association between shooting up and high (which is
a good thing)
• Reduces the risk of other infections associated with needle sharing/taken orally
• Ball and Ross (1991) found methadone effective in reducing illicit opiate use
• Biological drug replacement therapy can be costly to the health service although this may not
be as high as the cost to the individual and family if it remains untreated
• Drug replacement can involve a dangerous cocktail that is harmful in itself
• Drug replacement therapies often have withdrawal and dependency issues themselves.
• Non-compliance can result in abuse of the methadone programme and may sell the drugs on
the black market
• It does not treat the cause of the addiction, but simply replace an illegal drug with a legal one
• Need motivation to give up drugs otherwise the treatment won’t be successful
YOU DON’T HAVE TO WRITE ABOUT ALL THESE STRENGTHS AND WEAKNESSES, PICK A COUPLE OF
EACH AND ELABORATE AND EXPLAIN WHAT THEY MEAN
•
I don’t think I need to talk about TEP!! But this is the
other treatment you could use….
Treating Addiction
Aversion therapy
• Aversion therapy can be used so that drug use is
associated with an unpleasant consequence
• Emetics can be given with a drug to force a
negative consequence
• Drugs will be avoided to prevent to conditioned
effect
Treating addiction – aversion
therapy evaluation
• Aversion therapy is considered unethical as
it forces adverse reaction
• Participants must be fully informed of the
process before undertaking treatment
• Abstinence is usually short term as
conditioning can be reversed easily
• Behavioural therapies do not successfully
treat the causes of the addiction but help to
break a habitual behaviour
Key Study: Blattler et al Swiss Heroin
programme
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P
Aimed to see if prescribed heroin
could reduce the use of cocaine
To investigate the variables
affecting cocaine misuse
To see if a drug maintenance
programme was successful on
poly-drug users
Ps were followed up after 18 months in the programme
to see if there was a reduction in illegal drug use
The Ps were selected from an existing treatment
programme and had been addicted for over 2 years
Ps were interviewed every 6 months to measure their
illegal substance use
Urine tests were used
All gave informed consent
Counselling made compulsory for all patients
Standardised questionnaire – same questions
Independent interviewers to prevent researcher bias
Approved by an ethical committee
R
the treatment resulted in more than
half reducing their cocaine use
Urine analysis confirmed the huge
reduction in regular cocaine use of Ps
on the programme
C
Conclusion: There was a reduction in drug related
behaviour and offences as a result of the programme.
Key Study: Blattler et al - Evaluation points
G - The study omitted data from participants excluded for dealing or dropped out of the programme, so the results are
limited to the most dedicated patients
Low population validity if generalised to the wider population (e.g. mild drug users)
Participants may have taken part in the programme with the intention of getting free heroin not to give up their drug
habit/eq;large sample of 266 Ps is a sample from which generalisations can be made to the target population for
specific drug users
R - Independent researchers conducted the interviews and analysed the findings to ensure there was no researcher
A - The applications of this study are far reaching in terms of economic and individual cost of drug use
V - The validity of the findings are established through triangulation of biological and self report measures
The participants were naturally undertaking the clinical trials, so participants were not carefully selected or matched to
a control group
As participants were followed up over 18 months the long term effects of the programme could be established
Ecological validity as they were drug users on a drug programme
High population validity as they were extreme drug users/polydrug users and findings were related to them
Cause and effect is hard to show as there are many other factors to take into account
bias
The findings were compared to baseline measures to ensure a reliable change in drug usage was established
E - Participants of the study were fully informed about the nature and extent of the research, so it was ethical in that
sense
Ps gave full consent to take part as they were part of the rehab programme
There was a right to withdraw from the programme
Approved by ethics committee
A few did withdraw so right to withdraw was enforced
Petry: Contingency management
programme
A
P
R
C
Petry evaluation: Contingency
management programme
G
R
A
V
E
Evidence in Practice
Content Analysis
• Give aims of your content analysis
• How you sourced the material, planned and carried it out, themes and
categories, coding decisions, bias, procedure, sampling, apparatus, controls,
how you might have got round bias in the source (editing)
• Give a range of procedural issues – eg sampling, how data was summarised
into categories
• Analysing your data
– Analysing data, qualitative and quantitative, refers to how data was scored,
tallied, totalled, themes analysed, conclusions drawn from the summaries (can
include theory as relevant).
• Results
– Accurate and detailed links made between the findings and two or more
concepts, theories and/or research drawn from health psychology.
– Detailed explanation of findings with accurate and detailed links made between
the findings and at least two concepts drawn from health psychology
• Conclusions
– In depth description of conclusions drawn from practical and/or showing some
supporting ideas, evidence, concepts and/or justification.
If asked to design a study using
humans eg asking about legal highs:
Questionnaire/interview/survey
– Design a questionnaire designed to administer to users and
non-users of the drug
– Ask users of the drug to report psychological and physical
effects
– Use open ended questions to gather qualitative data on how
the P feels when taking the drug
– Use closed ended questions to gather quantitative info on
how many times the P uses the drug etc.
You have already answered this as an exam question…
again please dig this out!
Anti Drug Campaigns
Talk to Frank
• Uses openness as a strategy for children and parents
to seek advice
• Parents are encouraged to look for signs of drug use
• Younger people are exposed to drug user images that
are negative
• Shows peer group pressure and how this can
influence drug use
• Uses both sides of the argument to encourage choice
and consideration
Health Campaign - techniques
• Scare tactics – frighten people into not using drugs
• Role models – use a key figure that people will identify with to
show dangers of drugs
• Statistics – provide information about death/illness rates of drug
misuse as fear factor
• Openness; use as a strategy for parents and children to seek
advice
• Two-sides – present both sides of argument to encourage choice
and consideration
• Mediums – use various ways of delivering the message eg TV,
adverts, radio, internet, twitter etc
• Support – ensure suport is available like helplines, counselling
• Signs – encourage parents/guardians to look for signs of drug
use
Anti Drug Campaign Evaluation
(Remember, apply the different approaches to explain the underpinning psychological
theory behind the campaign)
Generally:
• Difficult to measure effectiveness as many factors may cause increase in health
• Quantitative measures of health related behaviour (death rate, consumption, helpline activity)
can be statistically verified
• Health programmes often go hand in hand with a change in public opinion, which may account
for reduction in un-healthiness rather than programme itself
• Health campaigns only work if people do not have barriers to health related behaviour and can
access help
• They are preventative rather than curative so stops issues before they cause
health/lifestyle/family issues
• Can be costly but cheap in comparison to curative strategies
Specifically:
• Talk to Frank is based on the Yale Model of Persuasion which has experimental support for the
effectiveness of presenting both sides of the argument
• The Talk to Frank campaigned has come under a great deal of criticism
•
Remember the describe and evaluate sheet I developed for you… please dig this out!!!
Key Issue
Description of Key Issue
– THE ISSUE OF HOW DRUG ABUSE CAN BE
TREATED
– HOW TO PREVENT DRUG ABUSE
– HOW DRUG TAKING IS PORTRAYED IN THE
MEDIA
Application of theory and research
This was the other Key Study at we didn’t look at –
you DO NOT NEED this as well as Petry: Ennet al al.
Peer groups and smoking
Description
Aim: To investigate adolescent smoking and the relationship between them and their peers and friends
Procedure:
1092 9th grade students (aged 14-15) from 5 schools in the US were questioned between August and December 1980
Mothers educational background was determined as well as a range of other possible mitigating variables
Ennett et al (1994) used questionnaires to gather information about smoking and peer group influence directly from the
source by asking/self report method
Network analyses was used to determine friendship cliques within the school they attended
Friendship reciprocation was weighted more greatly than non-reciprocated friendships
Results
Just under ½ the Ps were regarded as cliques, the remainder were clique liaisons or isolated individuals
89.9% of clique members were non smokers
2% of cliques were entirely smokers
68% of cliques were entirely non smokers
Cliques that were similar (race/sex/mother’s educational background) were either all smokers or non-smokers, and the
dissimilar cliques included both smokers and non-smokers
Conclusions:
Peer groups tend to discourage smoking, and only similar smoking groups encouraged it
Girls are more likely to be in smoking cliques than boys
The mothers educational level affected adolescent smoking
Key Study: Ennett al al
Evaluation (including comparison with Blattler)
The sample of adolescents surveyed from the 5 schools was inclusive and large, so the results should be generalisable to
this culture
The survey gathered in depth information about friendship cliques using a variety of methods to ensure validity before
examining smoking behaviour
It is supposed to measure the influence of friendship groups on smoking, but the findings were restricted to three best
friends – we are influenced by more than our closest friends
Connectedness and reciprocal friendship may have been mis-measured as one persons view of friendship may not be
reciprocated by the other person
The self report data may have been affected by the lack of social desirability with regards to smoking
The study is different to Blattler who actually administered replacement drug – this study just used self reports
Blattlers study did not investigate the role of friendship groups in the formation of a drug habit
Both Ennett and Blattler took self reports from participants
Both Ennett and Blattler cross checked self reports with tests (urine and carbon monoxide) to check for reliability of answers