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Health Psychology

Health Psychology. Substance Use and Abuse. Requirements. Defining Theories Prevent and Quit. Background defining. SUBSTANCE Anything ingested which alters our mood, cognition, behaviour USE OR ABUSE Some socially acceptable and acceptability changes over time MEDICAL APPROACH

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Health Psychology

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  1. Health Psychology Substance Use and Abuse

  2. Requirements • Defining • Theories • Prevent and Quit

  3. Background defining • SUBSTANCE • Anything ingested which alters our mood, cognition, behaviour • USE OR ABUSE • Some socially acceptable and acceptability changes over time • MEDICAL APPROACH • Addiction – dependence on a drug, resulting in tolerance and withdrawal when deprived • Substance dependence – continued use of drug despite problems caused by use • ADDICTIVE BEHAVIOUR • Salience (how important behaviour is), euphoria (buzz), tolerance (amount of activity required to maintain effect), withdrawal (unpleasant feelings/physical effects), conflict, relapse (reversion)

  4. Background theories • BIOLOGICAL EXPLANATIONS • Neurotransmitter substances and genetic differences • NEUROTRANSMITTERS • Chemical which moves between nerve cells • GENETICS • Nature-nurture • Twin studies • Family studies • AVAILABILITY • If readily available and seen to be used then others will use it too • SOCIAL CUES • Tobacco advertising now banned resulting in a decrease in consumption

  5. SPIRAL MODEL OF BEHAVIOUR CHANGE • PRECONTEMPLATION • No intention of changing, doesn’t perceive a problem • CONTEMPLATION • Aware of problem but no commitment to action • PREPARATION • Intending to take action • ACTION • Change behaviour • MAINTENANCE • Work to prevent a relapse

  6. Background prevent and quit • REINFORCEMENT • Reward for not taking a substance • E.g. vouchers with cumulative effect on value – backed up with counselling • HARM MINIMISATION • Accept people engage in the behaviours but try to make ‘better’. Eg ‘shoot-up houses, fresh needles, methadone • CHANGING COGNITIONS/BEHAVIOUR • Failure lowers self-efficacy • Self-efficacy enhancing information seems to help quitting smoking • NICOTINE SUBSTITUTION • Change habits without suffering withdrawal symptoms

  7. 3 Short Summaries • Addiction and substance abuse are difficult to define. A medical approach tends to see these behaviours as a disease, whereas a psychological approach may well see them as extreme examples of everyday behaviour. The behaviours can also be seen as lapses in moral strength • There are a number of factors that are believed to have an effect on addictive behaviours, including neurotransmitters, genetics, environmental and social influences. The jury is still out on the relative importance of these factors. • There are more treatments for giving up smoking, alcohol and the rest than you can wave a hypodermic at. Many individuals are able to use these treatments to bring about a desired change in their behaviour. There is no particular treatment or theory that appears to offer the definitive answer to the problems of addictive behaviours. The puzzle is why people cannot stop doing behaviours that damage their health. It can’t be that difficult ca it? Don’t go to the shop, don’t buy the cigarettes, don’t open the packet, don’t put one in your mouth, and don’t set fire to it. You only have to achieve one of these to kick the habit. If only it was that simple.

  8. Study 1 • Lerman • Who • 1999 • Quasi-experiment • Role of genetics in cigarette smoking • 289 smokers + 233 non-smokers. 18-80y, 58% female, 85% Caucasian. No cancer history, no alcohol or drug dependency, no psychological problems. Informed consent. Newspaper adverts – paid $25 • What • Blood sample – DNA extracted and genotypes identified as present or absent. Dopamine transporter SLC6A3-9 & dopamine receptor (DRD2-A2) • Questionnaire – demographic features, smoking history, weight, height, medicines, alcohol. + questionnaire for nicotine dependence • Results • 56% non-smokers have SLC gene; 47% smokers have it – more noticeable in the Caucasians • No difference in relation to presence of DRD2 • 62% non-smoking Caucasians possess both genes (46% smokers) • Smokers without SLC started smoking earlier, had attempted quitting less often and for shorter periods • No association between nicotine dependence and genes

  9. Study 2 • Shoal • Who • 2001 • Family history of substance abuse and negative emotions • Quasi-experiment, 118 male teenagers with history, 158 no history. 15-17y. Via substance use clinics, adverts and telephone listings. Paid $150. psychological disorders, physical disability, reduced IQ excluded. Family history via interview with fathers. • What • Questionnaires. • CTI (constructive thinking) – ability to have constructive/destructive thoughts • CNCEQ (cognitive distortions) – rate extent of thinking in a particular way • MPQ (negative emotions) – describe state of mind – vulnerable, worried, angry etc • DUSI (drug use frequency) – number of times substances used in each month over 12 • DUSI sub section – how much substance use was related to problems, attitudes, thoughts, behaviours • ALL questionnaires previously used and validity, reliability established • Results • Family history of substance abuse had significantly higher destructive thinking skills, cognitive distortions, negative emotions, use frequencies and use problems. • Destructive thinking and negative emotions correlate with frequency of substance use and problems related.

  10. Study 3 • Adams • Who • 2003 • Personality and preferred substance • Correlation • 200 adolescents 13-19y informed consent/assent in treatment for substance abuse and delinquency + 200 matched from community (ethnic spread matched also) • What • Psychological and demographic assessments via interview and questionnaires • DISC (conduct disorder) • CIDI (substance use) – use of alcohol, nicotine, illegal substances • TPQ (personality) – novelty seeking NS, harm avoidance HA, reward dependence RD • Preferred substance via interview • Motivation for use measured by why chosen preferred over other substances • Results • Low score on NS prefer alcohol and marijuana – high NS wide range substances • High NS associated with greater stimulant use and motivations for positive rewards. Low NS associated with sedative use and motivated by avoiding negative emotions/life experiences • HA and RD do not correlate with preference or motivation • Treatment centre group scored more highly on NS and HA than community and had a wider substance preference

  11. Study 4 • Wechsler • Who • 2003 • Social norms and alcohol among students • Quasi-experiment • 25000+ students and staff 98 colleges. Questionnaire, return implied consent • What • CAS (alcohol study) – 37 colleges use social norms marketing campaigns to reduce alcohol consumption – 61 colleges do not. • Social norms campaigns highlight latent healthy norms instead of negative aspects • Data on drinking behaviour and familiarity with social norms marketing messages analysed • Results • No significant decrease where social norms marketing used • In two categories – frequency of drinking and amount consumed – increases were observed !

  12. Study 5 • Moolchan • Who • 2000 • Review research on tobacco smoking • What • Risk factors, characteristics, treatment intervention for adolescent smoking • Results • 42.7% grade 9 students used tobacco • 75% teenager smokers will smoke as adults • Instantly appear independent and mature, fit in with peers • Adolescent smokers more depressed, more likely to have ADHD • Females more confident, outgoing, rebellious, socially skilled than male smokers (who are socially insecure) • Females pre-occupied with dieting/weight more likely to become smokers • Influenced by range of environmental and biological factors, and treatments thus far have not been effective.

  13. Study 6 • Robinson • Who • 1997 • Predictors for stages of adolescent smoking • 6967 7th graders 39 schools • What • Questionnaire • Results • 37.8% tried smoking, 4.1% regular smokers influenced by cost • Social value of cigarettes rated as low but if friends smoke then they were likely to. Girls likely to smoke if parents do. 39% believe smoking reduces weight 4% actively use as dietary strategy. • Range of social influences contribute to both experimental and regular smoking and this has implications for smoking prevention programmes

  14. Study 7 • Lando • Who • 1997 • Successful treatment with broad spectrum approach • 16 men, 18 women, advert, 31.2y, smoking 12.4y avg ~28.7 per day • What • Diary kept for one week prior to experiment (baseline) • Random assign (2 groups) • Experimental group – 6x45min sessions over 1 week. Smoking is a learned activity (not addiction). Urged to smoke as much as possible (twice normal amount) and sent to labs to smoke continuously for 25 minutes. Expected to abstain after that week and attended 7 follow-up sessions over 2 months. Discussed difficulties, paid a fine for each once smoked, rewarded for abstinence. • Control group – one weeks aversive training and then maintain alone • Results • 76% experimental (35% control) not smoking after 6 months • Broad spectrum approach a successful way to help quit

  15. General Review • Ecological validity • Shoal includes father’s in the study so could have higher ecological validity • Adams deliberately avoided nicotine use – lowering EV further • Quantitative/qualitative data • Use of quantitative data adds to EV and can be statistically analysed but tells us nothing about using these substances • Wechsler tells us there was an increase rather than a decrease in drinking • Numbers do not provide explanations • Reliability questionable as self reports used in all studies which are subjective • Determinism/free will • Many of the studies imply a link between substance use and underlying physiological processes over which we have no control. • Wechsler found people can choose (free will) whether to follow advice • Implications/usefulness • Wechsler suggests other methods for health promotion needed • Shoal suggests training in constructive thinking could lead to reduction in substance abuse • Adams suggests that novelty seeking increases variety of drugs, so alternative novel experiences are needed • Lerman – if we have a genetic inheritance for nicotine then genetic engineering can cut it down

  16. Questions • Describe one theory of substance abuse (6) • Discuss the validity of theories of substance abuse (10) • Describe one method of preventing substance abuse (6) • Discuss the problems of researching methods of preventing substance abuse (10) • Describe one method of quitting substance abuse (6) • Contrast one method of quitting with other methods of quitting substance abuse (10) • Describe what psychologists have found out about the use and abuse of substances • Discuss the psychological evidence on substance use and abuse • Suggest one technique to prevent people starting the use of a substance, give reasons for your choice.

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