4.3.10 - Reducing addiction
Treatments for addiction can reduce withdrawal, change learned associations or challenge the thoughts and coping routines maintaining use. You will compare drug therapy, aversion therapy, covert sensitisation and cognitive behaviour therapy, linking each procedure to its proposed mechanism. Evidence on relapse, side effects, adherence, ethics and motivation will help you judge effectiveness and explain why treatment often works best when matched to the person and context.
Treatment targets
Once an addiction is established, the person may keep repeating the behaviour even when the long-term consequences are severe: illness, debt, relationship conflict, work problems or shame. AQA asks for three ways of reducing addiction:
- Drug therapy: changes the biological effects of the addictive substance or behaviour.
- Behavioural interventions: use learning principles to change behaviour. This lesson focuses on aversion therapy and covert sensitisation, which aim to form unpleasant associations.
- Cognitive behaviour therapy (CBT): changes the thoughts and coping behaviours that keep the addiction going.
Drug therapy
A biological treatment that uses chemicals to alter brain or body processes, reducing cravings, reducing withdrawal, blocking reward or creating unpleasant effects when the addictive substance is used.
Drug therapy is therefore the most biological route in this lesson.
Behavioural intervention
A treatment based on learning principles, including classical and operant conditioning. Aversion therapy and covert sensitisation specifically aim to change learned associations with addiction cues; other behavioural methods may change the consequences of the behaviour.
Behavioural interventions focus on what the person has learned to associate with the addictive behaviour.
Cognitive behaviour therapy
A psychological therapy that combines cognitive techniques, such as identifying and challenging unhelpful or inaccurate beliefs, with behavioural techniques, such as skills training and relapse prevention.
The three routes target different parts of the addiction cycle.
| Treatment route | Main target | Illustrative examples | Core exam phrase |
|---|---|---|---|
| Drug therapy | Neurochemical reward, craving or withdrawal | Nicotine replacement therapy, disulfiram, methadone, naltrexone | "Changes the biological effect of the addictive substance or behaviour." |
| Behavioural interventions | Learned associations between addiction and pleasure/relief | Aversion therapy, covert sensitisation | "Uses classical conditioning to form an unpleasant association." |
| CBT | Faulty thoughts, triggers and poor coping skills | Functional analysis, cognitive restructuring, skills training | "Identifies triggers and changes thinking and behaviour." |
For example, gambling linked to loneliness calls for investigation of triggers and coping as well as the rewarding effects of gambling. A treatment name is not yet an explanation: show what changes, why that could reduce the behaviour, and which maintaining influence may remain.
For exams, keep the word reducing in mind. These treatments do not magically "cure" addiction. Strong answers explain the mechanism, then evaluate suitability, side effects, ethics, motivation and relapse.
Drug therapy
Drug therapies are based on the idea that addiction is partly maintained by brain chemistry. If cravings, withdrawal and reward keep the addiction going, then a drug may reduce addiction by changing those processes.
There are three useful categories.
| Type | How it works | Addiction example | Why it may reduce addiction |
|---|---|---|---|
| Aversive drug | Creates an unpleasant reaction if the substance is taken | Disulfiram for alcohol dependence | Drinking becomes linked with nausea or sickness rather than pleasure |
| Agonist | Activates similar receptors to the addictive substance, but in a safer or controlled way | Nicotine replacement therapy; methadone | Reduces cravings and withdrawal while the dose is stabilised or reduced |
| Antagonist | Blocks receptor sites so the addictive substance or behaviour produces less reward | Naltrexone for opioid dependence; considered for gambling harms | Reduces the rewarding effect, making relapse less reinforcing |
Disulfiram is an aversive drug used in alcohol dependence. It interferes with alcohol metabolism, so drinking alcohol after taking disulfiram can produce very unpleasant physical effects such as flushing, nausea and vomiting. In learning terms, alcohol-related cues become associated with an expected aversive reaction, which can reduce drinking.
Nicotine replacement therapy (NRT) is an agonist approach for nicotine addiction. Patches, gum, lozenges, sprays or inhalers provide nicotine without the tar, carbon monoxide and many other harmful substances in tobacco smoke. Nicotine activates nicotinic acetylcholine receptors, supporting dopamine activity enough to reduce withdrawal and cravings. The dose can then be reduced gradually, or a slow-acting patch can be combined with a fast-acting product for sudden cravings.
Methadone is an opioid agonist used for heroin addiction. It can reduce withdrawal and cravings in a medically controlled way. This may stabilise the person's life, reduce risky street-drug use and make psychological or social support more possible.
Naltrexone is an opioid antagonist. For opioid dependence, it blocks opioid receptors so opioid use produces less reward. It has also been investigated for gambling addiction because gambling can activate reward pathways involved in dopamine. NICE guidance for gambling harms treats naltrexone as something to consider after psychological therapy has not worked well enough or when relapse is repeated, not as a simple first-line cure.
Hartmann-Boyce et al. (2018) identified 136 studies; 133 studies with 64,640 participants contributed to the main NRT-versus-control comparison. NRT increased longer-term quitting rates by about 50–60% relative to placebo or no-NRT controls. This is a relative improvement, not a guarantee of success for most users.
Worked interpretation: a relative benefit
If 10 of every 100 people quit in a hypothetical control group, a 50% relative increase would mean 15 of every 100 quit with treatment: 10 plus half of 10. That is an increase of 5 percentage points, not 50 percentage points. The review supports NRT for smoking cessation; it does not establish that NRT treats gambling or that all nicotine use has ended, since NRT itself contains nicotine.
AO3: limitations. Drug therapies can have side effects and adherence problems. NRT can cause headaches, sleep disturbance or local irritation, depending on the product. Methadone can maintain physical dependence on a controlled substitute opioid. Dependence is a cost to consider alongside reduced exposure to unpredictable street drugs and improved stability, rather than proof the treatment has failed. Naltrexone needs specialist monitoring for some uses, especially because liver function and opioid use matter. Drug therapy can also be reductionist if used alone, because it may reduce craving while leaving social stress, faulty beliefs or coping problems untouched.
Aversion therapy
Aversion therapy aims to change what a person has learned to associate with addictive behaviour.
Aversion therapy
A behavioural treatment based on classical conditioning in which an addictive substance or behaviour is paired with an unpleasant stimulus, so the person learns to associate the addiction with discomfort rather than pleasure.
The learning process behind aversion therapy is called counterconditioning.
Counterconditioning
Counterconditioning means replacing an existing learned association with a new one. In aversion therapy, a pleasurable addiction-related association is replaced with an unpleasant association.
Aversion therapy assumes that addiction is partly maintained by learned associations. Nicotine, alcohol or gambling may become linked with pleasure, stress relief, confidence or excitement. Aversion therapy tries to reverse that learning.
Alcohol addiction: Historical aversion procedures paired alcohol-related cues with an emetic-induced nausea response. The emetic is an unconditioned stimulus and nausea an unconditioned response; after repeated pairing, alcohol cues may elicit conditioned nausea or avoidance. Distinguish this conditioning procedure from modern disulfiram treatment: disulfiram deters drinking through the expected alcohol reaction. Patients are advised to avoid alcohol, not repeatedly provoke the potentially dangerous reaction.
Gambling addiction: Historical behavioural procedures used an aversive stimulus such as a brief electric shock rather than a drug. The client might read cards containing gambling-related phrases and neutral phrases. When they read a gambling phrase, they receive a short shock from a wrist device. The proposed mechanism depends on an unpleasant association; these historical procedures raise ethical and acceptability concerns and are not a description of routine contemporary gambling care. With repeated pairings, gambling-related thoughts become associated with discomfort.
The key AO1 chain is:
| Stage | Addiction example |
|---|---|
| Before treatment | Gambling cues are associated with excitement and reward. |
| During treatment | Gambling cues are repeatedly paired with an unpleasant stimulus, such as a shock. |
| After treatment | Gambling cues become conditioned stimuli that trigger discomfort or avoidance. |
| Intended outcome | Cravings reduce and the person is less likely to gamble. |
Evidence must match the actual procedure. An alcohol-deterrent drug is not the same intervention as repeatedly pairing gambling cues with a shock. A poor outcome from one does not establish failure of the other. To evaluate aversion therapy, ask whether a learned avoidance response persists outside the clinic and after the aversive stimulus is absent. If cues in daily life differ from those used in treatment, the association may not transfer well.
Continue this lesson.
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