REDUCING ADDICTIVE BEHAVIOUR
To read up on reducing addictive behaviour, refer to pages 628–646 of Eysenck’s A2
Level Psychology.
Ask yourself
 Can addiction be prevented?
 How do you think the biological approach would treat addiction?
 What do you think would be the most effective treatment for addiction?
What you need to know
MODELS OF PREVENTION TYPES OF
INTERVENTION



The Theory of
Reasoned Action
The Theory of
Planned Behaviour
The Stages of
Change model







Biological (medical)
Psychological
Cognitivebehavioural therapy
Psychotherapies
Self-help therapies
Public health and
legislation
Peer-based
programmes
ADDICTION
TREATMENT: OVERALL
EVALUATION

Key conclusions
The best solution to addiction is to prevent people starting in the first place. There is
a range of prevention measures but it is difficult to assess their effectiveness
because it’s impossible to ascertain how many people would have become addicted
if these measures were not in place.
Historically, there are three stages of prevention (Force, 1996, see A2 Level
Psychology page 629):
 “Primary prevention” refers to measures employed to prevent the onset of a
targeted condition.
 “Secondary prevention” refers to measures that identify and treat
asymptomatic persons who have already developed risk factors or preclinical.
 “Tertiary prevention” refers to efforts targeting individuals with identified
disease in which the goals involve restoration of function, including
minimising or preventing disease-related adverse consequences.
Primary prevention targets the general population, secondary prevention targets atrisk or vulnerable groups, and tertiary prevention targets individuals with an
identified disorder.
Primary prevention has not been particularly successful. “Just say ‘No!’” is not
enough! Studies dealing with adolescents suggest that simply giving information is
not enough to create positive effects (Edmundson et al., 1991; Donaldson et al.,
1997; Van der Pligt, 1998, see A2 Level Psychology page 630).
MODELS OF PREVENTION
A logical starting point in the history of treatment was that attitudes need to be
changed to change behaviour. However, other factors supersede attitudes in their
influence on behaviour so the simple intuitive model of attitudes and behaviour
cannot be used to predict how people will behave.
The Theory of Reasoned Action
The Theory of Reasoned Action, first proposed by Fishbein and Azjen (1975, Azjen &
Fishbein, 1980, see A2 Level Psychology page 630), attempted to improve on the
intuitive model and to explain why people make their behavioural choices.
The model suggests that our intention to behaviour (which is not the same as
behaviour) is predicted by our attitudes and by subjective norms. In this model, an
attitude is a collection of beliefs that you have about a particular behaviour. The
subjective norms are the influences around, us including other people.
This is the essence of the Theory of Reasoned Action. It has been used extensively in
a range of areas, such as health and also marketing, to predict and thereby try to
alter behaviour. Human behaviour, however, is very difficult to predict. To try to
take account of a few more of the variables involved in behaviour choice, The
Theory of Reasoned Action was modified and became The Theory of Planned
Behaviour (Ajzen, 1991, see A2 Level Psychology page 631).
The Theory of Planned Behaviour
The Theory of Planned Behaviour adds another factor to the original model. This
additional factor deals with the beliefs we have about the amount of control we have
over our behaviour. This makes it sound all so simple—to overcome the addiction,
just stop doing it! Unfortunately, it is not that easy because we don’t seem to be as in
control of our behaviour as we would like to think.
EVALUATION
 The models can predict behaviour. A strength is that these models can
make some predictions about what people will do.
 The predictions are weak. The problem is that predictions from the models
are usually quite weak.
 Ignore emotions. The models focus on cognitive processes and ignore
emotions. The underlying idea is that people behave in thoughtful and
rational ways but in fact we often act on impulse and emotion, so cognition
may be less relevant than the models suppose.
The Stages of Change Model
The Stages of Change Model (Prochaska, DiClemente, & Norcross, 1992, see A2 Level
Psychology page 632) has had some success in changing behaviour. The model
consists of a number of stages:
Pre-contemplation:
The individual has no intention of changing his/her behaviour and probably does
not even perceive or choose to accept that there is a problem (denial is a powerful
thing).
Contemplation:
In this stage, the individual is aware that there is a problem and thinks that it is up
to him/her to do something about it. However, it is not yet translated into action and
sometimes the addict stays in this stage indefinitely.
Preparation:
The individual intends to take action in the near future and may well have already
started to do something.
Action:
In this stage, the individual changes his/her behaviour, or experience, of his/her
environment so that he/she can overcome the problem. The addict is said to be in
the action stage if he/she has successfully altered his/her behaviour for a period of
between 1 day and 6 months.
Maintenance:
In this stage, the individual works to prevent a relapse and to consolidate the
changes he/she has made. The individual is said to be in this stage if he/she has
remained free from the problem behaviour for more than 6 months.
The model shown in the above figure presents change as a spiral. This is because
giving up the addiction often takes a number of attempts. Prochaska, DiClemente,
and Norcross (1992) suggest that smokers commonly make three or four action
attempts before they reach the maintenance stage.
To achieve “readiness for action” a range of techniques can be used, including
motivational techniques, behavioural self-training, skills training, stress
management training, anger management training, relaxation training, aerobic
exercise, relapse prevention, and lifestyle modification. The goal of treatment can be
either abstinence or simply to cut down.
TYPES OF INTERVENTION
Biological (medical) interventions
The main medical intervention is drugs. Certain drugs produce an unpleasant
reaction when used in combination with the drug of dependence, so the positive
effects of the drug are replaced with a negative reaction. The only aversive agent
available is disulfiram (Antabuse), which, when combined with alcohol, produces
nausea and possibly vomiting.
A different type of drug used for intervention is known as an agonist. This is a
substitute drug, such as a synthetic opiate (methadone), which is given to replace
the real drug. Methadone prevents withdrawal symptoms, blocks the effects of illicit
opiate use, and decreases cravings. Consequently, addicts are more open to
counselling and other behavioural interventions essential to recovery and
rehabilitation.
Yet another treatment is the narcotic antagonist (naltrexone), a long-acting
medication with few side effects, which blocks the effects of self-administered
opiates (e.g. euphoria). It is based on the premise that the lack of positive effects will
break the drug habit. Addicts often fail to comply with the treatment programme so
effective counselling or psychotherapy is often used alongside the medication. More
recently, antagonists have also been used in other addictions such as alcoholism and
gambling addiction.
Evaluation of biological (medical) interventions
 Treat symptoms not causes. The main criticism of biological treatments is
that, although the symptoms are being treated, the underlying reasons for
the addictions may be being ignored, so addicts often relapse once the
treatment has finished.
 Substitution therapies are effective. Methadone maintenance has been
shown to be safe and very effective on a variety of measures, including
preventing illicit drug use. Buprenorphine is probably equally effective. The
usefulness of “substitution therapies” cannot be overestimated as they allow
addicts to gain stability and so access other forms of intervention.
 Issue of compliance. Addicts often fail to comply with the treatment
programme, so effective counselling or psychotherapy is needed as well as
the medication.
Psychological interventions
Behavioural therapies
These are based on the view that addiction is a learned maladaptive behaviour and
can therefore be “unlearned”. A wide range of behavioural techniques has been
applied on this basis in the treatment of addictions.
Aversion therapy is based on classical conditioning as this therapy involves negative
associations being made with the addictive behaviour. Thus, the Antabuse given to
make alcoholics nauseous draws on the principles of classical conditioning as the
nausea is the unconditioned stimulus that produces the automatic response of
avoidance as we wish to avoid feeling sick. The alcohol becomes paired with this as
the conditioned stimulus so the avoidance of alcohol becomes a conditioned
response.
Similarly, other stimuli could be associated with the addiction thereby encouraging
it. For this reason, therapies may initially focus on the avoidance of relapse triggers
(like the sight and smell of alcohol/drugs, walking through a neighbourhood where
casinos are abundant, pay day, arguments, pressure). The next stage is to have
repeated exposure to relapse triggers in the absence of the addiction, so that the
addict learns to stay addiction free in high-risk situations.
Another behavioural method that draws on the principles of operant conditioning is
reinforcement, which refers to the shaping of behaviour through the consequences
of the behaviour. This is controversial because it involves the giving of rewards
(positive reinforcement) for not taking the substance.
A programme in the US, reported by Higgens et al. (1994, see A2 Level Psychology
page 636), tried to change the behaviour of people with a serious cocaine problem.
The participants had their urine tested several times a week for traces of cocaine,
and every time it was clear of any cocaine they were given vouchers. The vouchers
started with a value of $2.50 but every time they were clear of cocaine the value
went up by $1.50. The vouchers were backed up with counselling on how best to
spend the money, for example, sports equipment or a family meal in a restaurant to
help build-up relationships that might have been damaged by the substance use.
The voucher-therapy compares well to other interventions, as the norm for drug
treatment programmes is a drop-out rate of 70%, whereas 85% stayed in the
programme for 12 weeks and around two-thirds stayed in for 6 months.
Evaluation of behavioural therapies
 Should drug addicts be given money not to take drugs? It is a
controversial idea that drug users should be given money not to take drugs.
You can imagine that if this were introduced in the UK by public health
services (the NHS) then tax payers would object to the use of their money in
this way. But on the other hand it does have a high retention rate so perhaps
the greater good does lie in this intervention.
 Longitudinal research is needed. Retention rate on the programme is not a
good enough measure of the success of the voucher intervention. To fully
assess, the success of this longitudinal research is needed as without this we
do not know how long-lasting the intervention is, i.e. do the addicts stay
addiction free on completing the programme or do they relapse as soon as
they are not receiving the vouchers?
 May treat symptoms not causes. It could be argued that, if the addiction is
caused by some underlying psychological problem (rather than a learned


maladaptive behaviour), then the addictive behaviour is just a symptom of
this underlying problem so the behavioural therapy may eliminate the
symptom but not address the real cause.
Symptom substitution. The treatment of symptoms rather than causes
means that the addictive behaviour may well have been curtailed but the
problem is still there, so the person will perhaps engage in a different
addictive behaviour instead. For example, Griffiths (1995, see A2 Level
Psychology page 635) reports that gambling addiction may be treated only
for alcohol addiction to take its place.
Difficult to evaluate effectiveness. Behavioural therapies are usually not
used in isolation (the voucher therapy also involved counselling, aversion
therapy for alcoholism also involves a drug) and so it is hard to evaluate
treatment effectiveness because we cannot be sure which aspect of
treatment has had most effect, the behavioural therapy or the self-help
group, counselling, or pharmacotherapy.
Cognitive-behavioural therapy
A more recent development in the treatment of addictive behaviours is the use of
cognitive-behavioural therapies (CBT), which include rational emotive therapy,
motivational interviewing, and relapse prevention. Cognitive-behavioural therapy
involves techniques that focus on behaviour change and changing the person’s
thinking (cognitive change).
Motivational interviewing
There are five general principles of motivational interviewing (MI): expressing
empathy, developing discrepancy, avoiding argumentation, rolling with resistance,
and supporting self-efficacy. Miller and Rollnick (2002, see A2 Level Psychology page
637) suggest that MI is primarily about the motivational aspects of changing
people’s behaviour in the therapeutic setting, which focuses in on the addict’s
ambivalence (the mixed feelings the addict has to their behaviour), as this is a
starting point for change. Miller and Rollnick argue that motivation is not a
personality problem and that there is little evidence for an “addictive personality”.
The MI highlights incorporate the Stages of Change model and a mnemonically
structured (A–H) list of eight effective motivational strategies:
 giving Advice
 removing Barriers
 providing Choice
 decreasing Desirability
 practising Empathy
 providing Feedback
 clarifying Goals
 active Helping.
The therapist supports the individual using a non-confrontational approach to
recognise the problem and to come to a decision themselves about changing their
behaviour and, very importantly, avoids labelling.
Relapse prevention
Relapse prevention (Marlatt & Gordon, 1985, see A2 Level Psychology page 637)
involves helping the addict to identify situations that present a risk for relapse both
intrapersonal (factors within the individual, e.g. unpleasant emotions, physical
discomfort, pleasant emotions, testing personal control) and interpersonal (factors
between individuals, e.g. conflicts and social pressures). The relapse prevention
therapy provides the addict with techniques to learn how to cope with temptation
(positive self-statements, decision review, and distraction activities), coupled with
the use of covert modelling (i.e. practising coping skills in one’s imagination).
Evaluation of cognitive-behavioural therapy
 Research evidence. There is evidence for the effectiveness of motivational
interviewing (Luty, 2003, see A2 Level Psychology page 637).
 No more effective than other approaches. CBT approaches are better
researched than the other psychological methods in addiction but are
probably no more effective (Luty, 2003, see A2 Level Psychology page 638).
 Cognitions are difficult to change. The cognitive-behavioural technique
may be successful in changing the unwanted addictive behaviour initially.
However, it is a lot more difficult to change cognitions, so relapse may occur.
 Empowers the individual. This approach does try to convince people that
they are capable of changing their lives for the better, that they are in control,
because they can change their thinking, so it offers the potential for positive
psychological change.
 Blames the individual. The underlying assumptions of this approach may
be seen as blaming the individual for his or her maladaptive thinking, which
raises ethical issues.
Psychotherapies
Psychotherapy comprises a broad range of techniques, which of course begin with
Freudian psychoanalysis, and include transactional analysis, drama therapy, family
therapy, and minimalist intervention strategies.
Psychotherapy is known as the “talking cure” and this can be on an individual level,
as a couple, as a family, or in a group. The addictive behaviour is seen as the
symptom of underlying problems, which may include narcissism, manipulative
behaviour, guilt, irrational thinking, and low ego strength.
Evaluation of psychotherapies
 Difficult to separate out the effects of psychotherapy from other
therapies. It is difficult to evaluate the effectiveness of psychotherapy
because it is usually used in combination with other therapies. It is therefore
hard to establish whether “success” is due to the psychotherapy, some other
treatment intervention (e.g. pharmacotherapy or attendance at a self-help
group), or an interaction between therapies.




Lack of evidence for effectiveness. Evidence suggests that some forms of
psychodynamic psychotherapy do not appear to be particularly effective
(Luty, 2003, see A2 Level Psychology page 639).
The lack of evidence can be countered. The lack of evidence can be
countered by the fact that it is difficult to define what a “successful” outcome
is. Thus, the addiction may not be cured but there may be other
improvements in the lifestyle and well-being of the addict, which is a positive
outcome.
Lengthy and expensive. Psychotherapy is often criticised as lengthy and
expensive in comparison to other therapies; cognitive-behavioural therapy
can achieve similar outcomes in a much smaller number of sessions.
Does try to address underlying causes. Psychotherapy can counter the
claim that cognitive-behavioural therapy is similar in effectiveness but faster
with the criticism that the cognitive-behavioural technique does not really
address the underlying causes, whereas psychotherapy does, so of course it
will take longer and may not show effects as quickly, as psychotherapy is a
much more complex process.
Self-help therapies
The most popular self-help therapy is the 12-Step Programme of: Alcoholics
Anonymous, Gamblers Anonymous, Narcotics Anonymous, Overeaters Anonymous,
Sexaholics Anonymous, etc. This treatment programme uses a group therapy
technique and uses only ex-addicts as helpers (Griffiths, 1995, see A2 Level
Psychology page 639). The technique requires the addict to accept personal
responsibility and view their behaviour as an addiction that cannot be cured but
merely managed.
For the therapy to work, the 12-Step Programme requires addicts to have reached
“rock bottom”, to attend weekly meetings where they disclose their story, to develop
social networks, to focus on abstinence and loss of control, to rely on others for help,
and to develop spiritually. New members are provided with a “sponsor” to whom
they can turn whenever they get an urge to engage in the behaviour. The therapy
uses mottos, such as the famous “One day at a time” and “Fake it until you make it”.
For every year members go without engaging in the behaviour, they are awarded a
pin, which members consider as important milestones.
Find out more: The twelve steps
Evaluation of self-help therapies
 Lack of empirical support. There is little evidence for the effectiveness of
the 12-Step approach. Walker (1992 see A2 Level Psychology page 640)
explains this is due to the fact that no case records are kept and so the only
evidence is the self-report of the member, which is biased by subjectivity.
Also, these reports are only available with the permission of the individual,
meaning that there are insufficient numbers for analysis.
Sample bias. This also means that the effectiveness of the technique cannot
be tested as the ever-changing membership of any one meeting group and
the fact some attend multiple meetings means that comparisons cannot be
made with a control group.
 Criterion for success. The criterion for success in the 12-Step Programme is
complete abstention, which precludes the fact that there is no measure of the
success of those who haven’t managed complete abstention. It is also
possible that those who dropped out achieved abstention without needing to
attend further meetings.
 Economical. It is cost effective compared to other treatments (even if other
treatments have greater “success” rates) because there is no charge
whatsoever.
 Spirituality works for some but repels others. The technique involves
placing faith in a “Higher Power”, which is difficult for some and may cause
them to drop out. However, for others it offers a spiritual dimension that
helps them avoid their addiction.
Public health interventions and legislation
Harm minimisation
Public health education interventions have had little success. The message “Hey
kids, just say ‘No!’” does not work. Similarly, the use of scare tactics, such as pictures
of overdoses, has failed to bring about reductions in drug use.

An alternative approach is to encourage harm minimisation. This approach accepts
that people will engage in risky behaviour and tries to reduce the health risks by
encouraging users to take the drug safely. For example, the provision of needle
exchanges means that addicts do not share injecting equipment; this dramatically
reduces the risk of getting blood infections such as hepatitis or HIV and AIDS.
Another way of reducing the potential harm to intravenous drug users is to provide
medically controlled drugs as a substitute for street drugs. Drugs such as methadone
are less harmful than street heroin, partly because they are free from impurities.
The most dramatic public health intervention in recent years has been the ban on
smoking in all public places introduced in England in 2007 (following the
introduction in Scotland a year earlier).
Evaluation of public health interventions
 Too early to measure. It is still too early to measure the full effect of the
smoking ban but initial surveys suggest that over 400,000 people have given
up smoking as a result of the ban (BBC website 2008).
 Controversial. Harm minimisation programmes are controversial because
they appear to condone drug use.
Peer-based programmes
The peer-based health education programme is based on the fact that we prefer to
take advice from people like ourselves or from people for whom we have great
respect. Research shows that such programmes are more effective than teacher-led
sessions in reducing drug use. Bachman et al. (1988, see A2 Level Psychology page
643) looked at a health-promotion programme that asked students to talk about
their disapproval of drugs to each other to create a social norm that was against
drug taking and also give people practice in saying no. It is claimed that the
programme changed attitudes towards drugs and led to a reduction in cannabis use.
A similar programme was reported by Sussman et al. (1995, see A2 Level Psychology
page 643), who compared the effectiveness of teacher-led lessons with lessons that
required student participation. The study looked at around 1000 students from
schools in the US, and suggested that there were significant changes in attitudes to
drugs and intentions to use drugs in the active participation lessons but not in the
teacher-led lessons.
Evaluation of peer-based programmes
 Lack of research evidence. A criticism of peer-led health education is that it
does not have much evidence for effectiveness.
ADDICTION TREATMENT: OVERALL EVALUATION
For treatment to be effective a number of points must be considered:
 Treatment must be readily available.
 No single treatment is appropriate for all individuals.
 Treatment is better than no treatment.
 It does not seem to matter which treatment an addict engages in as no single








treatment has been shown to be demonstrably better than any other.
A variety of treatments simultaneously appear to be beneficial to the addict
as these can better treat the multiple needs of the addict.
Individual needs of the addict have to be met (i.e. the treatment should be
fitted to the addict, including being gender-specific and culture-specific). An
individual’s treatment plan must be assessed and updated consistently so
that the plan meets the person’s changing needs.
Clients with co-existing addiction disorders should receive services that are
integrated.
Remaining in treatment for an adequate period of time is critical for
treatment effectiveness. There is a direct association between the length of
time spent in treatment and positive outcomes. One of the challenges is
retaining clients in addiction treatment.
Medications are an important element of treatment for many patients,
especially when combined with counselling and other behavioural therapies.
These could include Antabuse, anti-anxiety, and anti-depressant medications.
Recovery from addiction can be a long-term process and frequently requires
multiple episodes of treatment.
The duration of treatment interventions is determined by individual needs,
and there are no pre-set limits to the duration of treatment.
Orford (2001, see A2 Level Psychology page 645) argues against the
effectiveness of treatment as he states that the excessive nature of the

addiction will wane in time and so people give up the addiction naturally. He
uses as evidence the fact that treatments only have limited success and that
the success occurs regardless of the treatment that is used. Consequently,
Orford concluded that people give up excessive appetites (or addictions)
without the help of experts.
A counter criticism to Orford is that his argument does not account for the
addicts that don’t recover, such as alcoholics who drink themselves to an
early grave rather than giving up. Thus, his argument doesn’t account for the
fact that the addiction doesn’t wane naturally for all. Also, his claim is
speculative rather than evidence-based as saying that treatments are equally
effective does not mean that it wasn’t the treatment that led to the positive
outcome.
So what does this mean?
A key weakness you will have noted across the treatments is the lack of systematic
research evidence for the effectiveness of the different treatments. Furthermore,
treatments are usually not used in isolation, instead a number are used to treat the
multiple needs of the addict. This makes it difficult to draw comparisons about the
different treatments as we cannot be sure which, if any, is effective. This leads to the
rather simplistic conclusion that they are all equally effective, which of course they
will not be for every individual. However, with such a wide range it is certainly
hopeful that each addict can find the right treatment that works for their particular
addiction.
Over to you
1. Outline two models of intervention. (9 marks)
2. (a) Outline two types of intervention. (9 marks)
(b) Discuss the effectiveness of the types of intervention described in (a). (16
marks)