Transcript social - NPTC Moodle

Social Perspectives
Psychology of Addiction
Aims

To examine the influence of social
roles and relationships in
contributing to the development of,
and recovery from, drug and
alcohol problems.
Cultural Influences on drug
use
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Substance use varies across countries
and across social groups.
As well as formal legal controls,
informal social norms specify what
drugs are acceptable and when and
how they are used.
Distinguish normative social influence
and informational social influence.
Social influence
Peer influences

Association with drug-using peers could reflect selection or
influence.
Family influences

Via toleration of drug use, modeling & poor bonding
Different influences?

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Parents influence early smoking, peers more important to later
smoking
Peers important for both initiation and maintenance of illicit
drug use?
Social influences on
expectancies

Use of, and perceived approval of,
substances by parents & peers
correlates with positive expectancies
regarding use
Relationships and substance
use
Reduction in drinking in adulthood may reflect changes in
roles

Single & Divorced people drink more than married ones
 May be selection or causality
Power Rodgers & Hope, 1999
 sample interviewed at 23 and 33.

Only one effect of drinking on subsequent status, heavy
drinking single men were more likely to marry.

Drinking increased following divorce and reduced (not
significant for women) after marriage.

Recently divorced people drank more than those divorced
before 31

Addicts’ families
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Families of alcoholics report greater
disruption, including lower levels of family
cohesion, expressiveness, independence and
higher conflict (Sher, 1993).
Men in treatment for alcoholism were four
times more likely to physically abuse their
wives (O’Farrell & Murphy, 1995)
Families of recovered alcoholics may not
differ from controls (Moos & Billings, 1982)
suggesting these features are related to
current drinking.
Alcohol and the family


Steinglass (1981) argued that alcohol may
serve a function for some families.
Interactions may differ when problem
drinkers are drunk or sober, though there is
no universal pattern.
In the 1980s the concept of codependency
borrowed ideas from family systems theory
and disease perspectives to locate problems
in those around addicts. However there is
little real support for the claims made.
Alcoholics Anonymous
Numerous imitators, including groups for relatives
Al-Anon, Alateen, etc.
and groups for other addictions
Narcotics Anonymous, Gamblers Anonymous, etc.
Provides
 A clear view of alcoholism
 Regular support meetings
Possible problems
 Dogmatic Viewpoint?
 As a self help group experience can vary
Is it effective?


Involvement in AA correlates with
improvement (Humphreys et al., 1996).
Very few randomised controlled studies,
these typically don’t show AA
attendance to be superior to other
approaches. All used clients required to
attend treatment, who are likely to be
poorly motivated.
Social factors in treatment
Community Reinforcement (Azrin, 1976, Hunt & Azrin, 1973)
Aims to produce lifestyle change, focuses on
Family relationships & social networks
Vocation
Recreational activities
Often combined with vouchers, direct reinforcement of
abstinence
May also be combined with Antabuse (Disulfiram)
Higgins et al. (1993) compared CRA to 12-step participation with
cocaine users. They found greater engagement with the full 24week programme (58% vs 11%) and greater abstinence 16
weeks later (42% vs 5%).
Social behaviour and network
therapy

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Social behaviour and network therapy (Coppello et
al., 2002) recruits members of the clients social
network to support change.
Isolated clients are assisted to develop new social
networks.
Social behaviour and network therapy was evaluated
in a randomized controlled trial in comparison to
motivational enhancement therapy (UKATT research
team, 2005). Both led to significant improvements in
a number of outcome measures.
Therapeutic Communities
Typically include

Structured Lifestyle

Confrontational & Group therapies

May emphasise a twelve-step approach

Many staff are former addicts, Emphasis on self-help

Often provide social and occupational skills
NIDA review (Simpson & Sells, 1981)

Are effective, better outcome with longer stay.

20% of residents were using narcotics at ten year follow-up, 30%
of controls were. difference only significant for those staying 90+
days.
Dekel, Benbenishty & Amran (2004) 95% of those completing the 13month programme were drug free 15 months later, as opposed to
36% of those who dropped out.
Does treatment have to produce
social change?
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Gifford et al. (2006) argue that treatment outcome depends on
 Treatment program alliance (the social climate of treatment)
 Acceptance based responding (acknowledging internal
experiences such as craving)
 Social Relationship Quality
Acceptance based-responding (ABR) predicted
outcome five years after residential treatment.
ABR was in turn influenced by treatment programme
alliance and Social Relationship Quality
Conclusion

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Social roles and relationships influence drug
use.
The provision of social support can facilitate
behaviour change. Treatments which don’t
change the social environment may be unlikely
to produce lasting change.
Recommended Reading
Chapter 5 in
Sussman, S. & Ames S.L (2001). The Social Psychology of Drug
Abuse. Open University Press.
Later chapters also cover relevant material
Chapter 13 in the following discusses drug use and the family.
Jung, J. (2001). Psychology of alcohol and other drugs : a research
perspective. London: Sage Publications.
Teeson et al. briefly discuss the community reinforcement approach,
under the heading of family & marital therapy, on pages 65-66.
For a more detailed review see
Miller, R.M., Meyers, R.J. & Hiller-Sturmhöfel, S. (1999). The
community reinforcement approach. Alcohol Research & Health,
23, 116-121 available online at
http://pubs.niaaa.nih.gov/publications/arh23-2/116-121.pdf
Further Reading
Predicting use
West, P., Sweeting, H. and Ecob, R. (1999). Family and friends'
influence on the uptake of regular smoking from mid-adolescence
to early adulthood. Addiction, 94, 9, 1397-1412.
Adult drinking
Power, C., Rodgers, B. and Hope, S. (1999). Heavy alcohol
consumption and marital status: disentangling the relationship in a
national study of adults. Addiction, 94, 10, 1477-1487.
Interventions targeting social influences
Copello, A., Orford, J., Hodgson, R., Tober, G., Barrett, C. (2002).
Social behaviour and network therapy: Basic principles and early
experiences. Addictive Behaviours, 27, 345-366.
Gifford, E.V., Ritsher, J.B., McKellar, J.D. & Moos, R.h. (2006).
Acceptance and relationship context: A model of substance use
disorder treatment outcome. Addiction, 101, 1167-1177.
UKATT research team (2005). Effectiveness of treatment for alcohol
problems: Findings of the randomized UK alcohol treatment trial
(UKATT). British Medical Journal, 331, 541-548.