Reducing Addiction: Interventions

A range of interventions exist for reducing addiction, spanning pharmacological (drug-based), behavioural, cognitive-behavioural, motivational, and peer-support approaches. The AQA specification requires knowledge of drug therapy, behavioural interventions, CBT, and public health approaches, with evaluation of each. Throughout this lesson, smoking, alcohol, and gambling are used as the primary examples.

Key Definition: Relapse prevention is a cognitive-behavioural approach that helps individuals anticipate and cope with high-risk situations for relapse, based on the work of Marlatt and Gordon (1985).

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Drug Therapy (Pharmacological Interventions)

Nicotine Replacement Therapy (NRT)

NRT provides nicotine without the harmful chemicals found in cigarette smoke. Available forms include patches, gum, lozenges, inhalers, and nasal sprays. NRT works by:

• Reducing withdrawal symptoms (irritability, anxiety, difficulty concentrating)
• Reducing craving by maintaining a low level of nicotine in the bloodstream
• Allowing the smoker to gradually reduce the dose over time

Evidence — Stead et al. (2012)

Stead et al. (2012) conducted a Cochrane systematic review of 150 trials involving over 50,000 participants and found that NRT approximately doubles quit rates compared to placebo. The quit rate with NRT was approximately 17% at 6 months, compared to about 10% with placebo.

Other Pharmacological Treatments for Smoking

Drug	Mechanism	Effectiveness
Bupropion (Zyban)	Dopamine and noradrenaline reuptake inhibitor — reduces craving and withdrawal	Approximately doubles quit rates (similar to NRT)
Varenicline (Champix)	Partial nicotinic receptor agonist — stimulates dopamine release (reducing withdrawal) while blocking the full effects of nicotine (reducing pleasure from smoking)	Most effective single drug — approximately triples quit rates compared to placebo

Pharmacological Treatments for Alcohol Addiction

Drug	Mechanism	Evidence
Naltrexone	Opioid antagonist — blocks opioid receptors, reducing the pleasurable effects of alcohol	Reduces heavy drinking days and increases abstinence rates (Anton et al., 2006)
Acamprosate	Modulates glutamate and GABA systems — reduces cravings in abstinent individuals	Effective in maintaining abstinence when combined with psychosocial support (Mann et al., 2004)
Disulfiram (Antabuse)	Inhibits aldehyde dehydrogenase — causes highly unpleasant symptoms (nausea, vomiting, headache) if alcohol is consumed	Based on aversion — effective only if the patient takes it consistently (compliance is a major issue)

Pharmacological Treatments for Gambling

Evidence for drug therapy in gambling addiction is limited:

• SSRIs (e.g., fluvoxamine) have shown modest effects in some studies
• Opioid antagonists (naltrexone) have shown some promise in reducing gambling urges
• There is currently no approved drug specifically for gambling disorder

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Behavioural Interventions

Aversion Therapy

Aversion therapy uses classical conditioning to create a negative association with the addictive substance or behaviour:

1. The addictive substance (CS) is repeatedly paired with an unpleasant stimulus (UCS) — e.g., an emetic drug (causes vomiting) paired with alcohol
2. Eventually, the substance alone triggers nausea and revulsion (CR)
3. This reduces the desire to use the substance

Limitations: Aversion therapy raises significant ethical concerns (deliberately causing distress), has high dropout rates, and the conditioned aversion may not transfer to real-world settings. It has also been historically misused (e.g., to "treat" homosexuality).

Covert Sensitisation

Covert sensitisation is a less invasive alternative in which the individual imagines the unpleasant consequences of the addictive behaviour rather than experiencing them physically:

• "Imagine taking a drink and then feeling extremely nauseous, sweating, and vomiting in public..."
• This creates a negative cognitive association without the ethical issues of physical aversion therapy
• Evidence for effectiveness is limited and largely based on case studies

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Cognitive-Behavioural Therapy (CBT) for Addiction

CBT for addiction is based on Beck et al.'s (1993) cognitive model and Marlatt and Gordon's (1985) relapse prevention model. It addresses the cognitive factors that maintain addiction.

Key Components

1. Identifying triggers — The client and therapist identify the situations, emotions, and cues that typically lead to substance use or addictive behaviour
2. Challenging dysfunctional beliefs — Facilitating beliefs ("Just one won't hurt") and core beliefs ("I can't cope without it") are identified and systematically challenged using evidence and rational argument
3. Developing coping strategies — The client learns alternative ways to manage stress, negative emotions, and cravings without resorting to the addictive behaviour
4. Relapse prevention — High-risk situations are anticipated and rehearsed. The client develops a plan for what to do if they experience a lapse, to prevent it from escalating into a full relapse

Marlatt and Gordon's (1985) Relapse Prevention Model

Marlatt and Gordon (1985) proposed that relapse is not a sign of treatment failure but a predictable part of the recovery process. Their model identifies:

• High-risk situations — triggers that increase vulnerability to relapse (e.g., social pressure, negative emotional states, interpersonal conflict)
• Abstinence violation effect (AVE) — the tendency to respond to a single lapse with guilt and a sense of failure, leading to a full relapse ("I've already failed, so I might as well keep using")
• CBT teaches clients to anticipate high-risk situations and reframe a lapse as a temporary setback rather than a catastrophic failure

Key Definition: The abstinence violation effect is the guilt and sense of failure experienced after breaking abstinence, which increases the risk of full relapse. CBT addresses this by teaching clients that a lapse does not have to become a relapse.

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Motivational Interviewing — Miller and Rollnick (1991)