Substance+abuse+and+addiction

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 * Constant Craving: Addiction and Substance Abuse **

Additional introductory resources:

1. Explain factors related to the development of substance abuse

 * Cocaine **

In 1957, the World Health Organisation (WHO) defined drug addiction as:Drug addiction is a state of periodic or chronic intoxication produced by the repeated consumption of a drug (natural or synthetic). Its characteristics include: (i) an overpowering desire or need (compulsion) to continue taking the drug and to obtain it by any means; (ii) a tendency to increase the dose; (iii) a psychic (psychological) and generally a physical dependence on the effects of the drug; and (iv) detrimental effects on the individual and on society.


 * What is cocaine? **

Cocaine is a highly addictive drug, it works by tapping into the brains natural reward (dopamine) pathways

The drug binds itself to the proteins in the brain that are responsible for transporting the dopamine, as a result, the dopamine builds up in the synapse to create a “high”

People who take cocaine experience pleasure every time they take the drug, and a distinct lack of pleasure once it wears off, thus reinforcing the compulsion to take more.

Cocaine is so attractive to users because it provides an instant sense of euphoria.

Cocaine is a captivating drug that makes one feel confident, talkative and alert. This is often desired by people who find it difficult to feel that way normally.

COCAINE EFFECTS **Higher doses** A high dose of cocaine can cause a person to overdose. This means that a person has taken more cocaine than their body can cope with. Not knowing the strength or purity of the cocaine increases the risk of overdose. Injecting cocaine increases the risk of overdose due to large amounts of the drug entering the blood stream and quickly travelling to the brain. Higher doses of cocaine can produce symptoms, including: Many of these can lead to coma and death. High doses and frequent heavy use can also cause a “cocaine psychosis”, characterised by paranoid delusions, hallucinations and bizarre, aggressive or violent behaviour. These symptoms usually disappear a few days after the person stops using cocaine. **Withdrawal** After taking cocaine on a regular basis, the user will almost inevitably become addicted. When the drug is discontinued immediately, the user will experience what has come to be known as a "crash" along with a number of other cocaine withdrawal symptoms, including: More serious withdrawal symptoms include: These symptoms can last for weeks or, in some cases, months. Even after most withdrawal symptoms dissipate most users feel the need to continue using the drug; this feeling can last for years. About 30-40% of cocaine addicts will turn to other substances such as medication and alcohol after giving up cocaine. Long-term effects Some of the effects that may be experienced after taking cocaine for a very long time include:
 * Anxiety
 * Sleep disorders
 * Paranoia
 * Tremors and muscle twitches
 * Nausea and vomiting
 * Rapid and weak pulse
 * Chest pain
 * Heart attack
 * Kidney failure
 * Hypothermia (low body temperature)
 * Seizures
 * Increased heart rate and body temperature
 * Brain haemorrhage
 * Stroke and convulsions
 * Paranoia
 * Depression
 * Total exhaustion
 * Tension and Anxiety
 * Itching
 * Radical mood swings
 * Irritability
 * Fatigue
 * Insomnia
 * An intense craving for more cocaine
 * Nausea and vomiting.
 * Schizophrenia
 * A feeling of a crawling sensation on the skin also known as "coke bugs".
 * Depression
 * Anxiety, paranoia and psychosis
 * Eating disorders and weight loss
 * Sexual dysfunction
 * Hypertension and irregular heart beat
 * Sensitivity to light and sound
 * Hallucinations
 * Cerebral atrophy (wasting of the brain) and impaired thinking.
 * Damage to the nasal lining and the structure separating the nostrils (the nasal septum).
 * Breathing difficulties, chronic cough, bronchitis and other respiratory problems.

= Cocaine - Etiology = **Social** Study found that subordinate monkeys who are on the lower social ladder than dominant monkeys, are more likely to administer cocaine than higher ranking monkeys. Groups of monkeys were housed together to determine which were dominant and which were subordinate. Being the dominant monkey means receiving social benefits like being groomed more often etc. They are also more aggressive towards subordinate monkeys. Researchers then took PET Scans of the monkeys' brains and examined how their reward pathways differed by measuring dopamine acitivty in the brain. It was found that the dominant monkeys had more active dopamine activity/reward pathway (20% more dopamine receptor function) than the subordinate monkeys. The dominant monkey's reward pathway was only very active when it was socially housed, confirming that it is the result of the group/social activity. When the scientists gave the option for the monkeys to inject themelves with cocaine, more of the subordinate monkeys injected themselves than the dominant monkeys. Thus, social circumstance plays a crucial part in determining addiction. Wake Forest University Baptist Medical Center (2008, April 6). Subordinate Monkeys More Likely To Choose Cocaine Over Food. Same study, with rats: Schenk et al (1987) Cocaine self-administration in rats influenced by environmental conditions: implications for the etiology of drug abuse. **Cognitive** Addictive personality An addictive personality refers to a particuar set of personality traits that make an individual predisposed to addictions. People who are substance dependent are characterized by: a physical or psychological dependency that negatively impacts the quality of life. It is a mental dependence or addiction to a substance but not a physical addiction although it can lead to a physical addiction in the end. Cocaine users who have an addictive personality are more likely to abuse cocaine: (Brutlag, 2010) **Biological** Genetic predisposition A genetic predisposition is a genetic affectation which influences the phenotype of an individual organism within a species or population but by definition that phenotype can also be modified by the environmental conditions. In the rest of the population, conditions cannot have that effect. Genetic testing is able to identify individuals who are genetically predisposed to certain health problems. Cocaine users who are genetically predisposed to addiction are more likely to abuse cocaine: (Brutlag, 2010)


 * __Gavin & Kleber Model__**

-Within 15-30 minutes of a final Cocaine does, dysphoria occurs (agitation, anxiety, intense craving) -The craving stops after about 1 hour of Cocaine abstinence -The user feels an intense need to sleep or rest- this may lead to hypersomnolence (sleeping for hours upon house) -The sleep may be disrupted by hyperphagia (hunger pains) -After the long rest, the cocaine cravings have totally resided -Beings with several hours/a few days of a normal mood state, normal sleeping patterns and low/no cocaine cravings -Followed by feelings of boredom, low energy, low environmental stimulation/please and anxiety -Anything in the environment that is a reminder of cocaine or has associations to the user will provoke intense cravings to use the drug again. At this point it is extremely sensitive to relapse. -If the user continues to resist the relapsing phase, there will be feelings of normality and a happy mood without the need for the drug. -The user is still sensitive to environmental cues, which may eventually trigger a relapse
 * Gavin and Kleber have suggested that symptoms of abstinence from Cocaine occur in three stages:**
 * __Crash Phase:__**
 * __Withdrawal Phase:__**
 * __Extinction Phase__**


 * Laurence (2000)** **conducted research which showed that:**
 * 1) Young people using Cocaine are increasing their chances of having fatal strokes.
 * 2) The use of Cocaine may lead to deformed blood vessels in the head. This mixed with a surge in blood pressure from using Cocaine can lead to Cerebral Aneurysms – and ultimately death.

__** Behavioural Interventions **__

-Many behavioural treatments have been found to be effective for cocaine addiction, including both residential and outpatient approaches. Indeed, behavioural therapies are often the only available, effective treatment approaches to many drug problems, including cocaine addiction. -After stabilization, treatment can take place. - Recovery begins with a learning process of breaking old habits, ties with cocaine-using friends and identifying “triggers” that increase desire to use cocaine. - [|Cognitive-behavioral] [|therapy] is another approach. Cognitive-behavioural coping skills treatment, for example, is a short-term, focused approach to helping cocaine-addicted individuals become abstinent from cocaine and other substances. The underlying assumption is that learning processes play an important role in the development and continuation of cocaine abuse and dependence. -The same learning processes can be employed to help individuals reduce drug use. This approach attempts to help patients to recognize, avoid and cope; for example, recognize the situations in which they are most likely to use cocaine, avoid these situations when appropriate and cope more effectively with a range of problems and behaviours associated with drug abuse. -Patients are encouraged to identify specific triggers and to restructure their lifestyles to avoid them. Many patients identify certain music or movies with cocaine and must learn to deal with these issues. - If you entertain the thought long enough it gains the power to impair your judgment and influence behaviour. Cocaine abusers become experts at self-deception and therefore create reasons to use more cocaine.

__** Counselling on emotional issues- therapeutic communities **__

-Perhaps the most difficult aspect of treatment and recovery from cocaine involves the guilt and intense shame felt by most users. It is true that all addicted individuals feel shame because drug-using behaviour often is in conflict with a person’s values and morals. -The guilt associated with these behaviours becomes a major reason to use more cocaine. Getting high is, in a sense, a short vacation from the intense guilt and shame associated with cocaine addiction. -Therapeutic communities, or residential programs with planned lengths of stay of six to 12 months, offer another alternative to those in need of treatment for cocaine addiction. Therapeutic communities are often comprehensive, in that they focus on the socialization of the individual to society, and can include on-site vocational rehabilitation and other supportive services. Therapeutic communities typically are used to treat patients with more severe problems, such as co-occurring mental health problems and criminal involvement.

__** Self-Help Programs **__

- Twelve-step programs offer support by helping cocaine abusers accept their problems by learning from, and helping other recovering addicts to realize that there is life after cocaine. These programs include: -Twelve-step programs emphasize taking responsibility for behaviour, making amends to others and self-forgiveness. -Individuals who successfully abstain from cocaine attend a lot of 12-step meetings for support and accountability. They often report that a part of them still looks for a good reason to use cocaine. Twelve-step meetings are daily reminders of their powerlessness over drugs.
 * Cocaine Anonymous
 * Narcotics Anonymous
 * Alcoholics Anonymous

__** Medication Approaches **__

-No [|medications] currently are available specifically to treat cocaine addiction. Consequently, the National Institute of Drug Abuse (NIDA) is aggressively pursuing the identification and testing of new cocaine treatment medications. Attempts are even being made to develop a vaccine to cocaine so that cocaine users could conceivably be made immune to its effects. -Several newly emerging compounds are being investigated to assess their safety and efficacy in treating cocaine addiction. Because of mood changes experienced during the early stages of cocaine abstinence, [|antidepressant] drugs have been shown to be of some benefit. In addition to the problems of treating addiction, cocaine overdose results in many deaths every year, and medical treatments are being developed to deal with the acute emergencies resulting from excessive cocaine abuse.

2. Explain factors related to the development of Addiction
An addiction implies that an individual cannot control his or her behaviour. It is characterised by a compulsion to use the substance continuously in order to experience the psychological and physiological effects and to avoid discomfort in its absence.

__Biological Factors __ Nicotine stimulates the release of adrenaline which increases heart rate and blood pressure. It stimulates the dopamine reward system which results in a brief feeling of pleasure that wears off after several minutes. This causes a smoker to continue smoking in order to maintain the pleasurable effects gained by smoking. Nicotine reacts on acetylcholine receptors in the brain causing it to adapt to what it believes to be a normal level of acetylcholine. A way to do this is to grow more acetylcholine receptors. Nicotine is believed to be as addictive as cocaine or heroin. The Centres for Disease Control and Prevention in the US has found that 70% of people who smoke would like to quit smoking.

__Cognitive and Socio-Cultural Factors __ Mich research has focused on the way individuals attitudes and cognitions may predict smoking behaviour, yet **Ogden (2004)** has criticised this by claiming it takes an individual out of their social context yet this is where a person's behaviour and beliefs re formed. Social learning theory is thought to play a role in smoking behaviour. In 2007 the Centres for Disease Control and Prevention found that smoking is more common in adults who live below the poverty line (30.6%) than those who live above the poverty line (20.4%).
 * Charlton (1984) ** has found that young smokers associated smoking with fun and pleasure.
 * Bauman et al. (1990) ** found that in a sample of US adolescents aged between 12 and 14 years, 80% who had parents that didn't smoke had never tried smoking themselves.
 * Lader and Matheson (1991) **<span style="font-family: Calibri,sans-serif; font-size: 11pt;"> found that children in the UK were more than twice as likely to smoke if their father smoked.
 * <span style="font-family: Calibri,sans-serif; font-size: 11pt;">Murry et al. (1984) **<span style="font-family: Calibri,sans-serif; font-size: 11pt;"> found that if parents were strongly opposed to smoking, adolescents were 7 times less likely to smoke.
 * <span style="font-family: Calibri,sans-serif; font-size: 11pt;">Unger et al. (2001) **<span style="font-family: Calibri,sans-serif; font-size: 11pt;"> surveyed 5143 Californian adolescents with a mean age of 13. it was found that European American students who had close friends who smoked were more likely to smoke compared to students who were Hispanic or Asian or American. The researchers concluded that in individualistic cultures, adolescents create their own youth culture that is characterised by rebellion, in order to set themselves apart from their parents. In collectivist cultures the bond between parent and child is stronger and rebellion is not tolerated, so they are more likely to conform to the norms their parents describe for them.


 * __ Social __**


 * APFCC: (addiction - cigarettes) DiFranza et al **


 * Theorist ** : DiFranza et al
 * Study ** **of**: Link between positive experience with cigarettes and continued addiction
 * Year ** : 2006

Study on American adolescents used psychological evaluations and interviews to investigate their use of tobacco. They found that if the child experienced a relaxation effect after consuming their first cigarette they were more likely to become addicted.
 * Summary: **

To investigate the link between a first positive experience with cigarettes and continued addiction
 * Aim: **

They conducted interviews, self-tests and the dependence to tobacco was measured based on reported cravings, time dedicated to smoking etc.
 * Procedures: **

They found that if the child experienced a relaxation effect after consuming their first cigarette they were more likely to become addicted, 70% compared to 30%. Then 90% of the 70% who reported feeling relaxation, stated that they were unable to quit.
 * Findings: **

They concluded that it takes much less to become addicted than it was previously thought. This can be both a combination of cognitive and biological factors.
 * Conclusions: **

However this study used mainly adolescents who admitted to have inhaled a cigarette at least once, and most of the data was gathered through self-reporting. Thus there are limitations to its usefulness. However it does show how quickly an addiction to cigarettes can be developed.
 * Criticisms: **


 * APFCC: (addiction - cigarettes) Charlton **


 * Theorist ** : Charlton
 * Study ** **of**: The effect of cigarette advertisements on teen smoking
 * Year ** : 1984

In this study, 258 15-year-old school pupils were interviewed about their smoking behavior and opinion of cigarette advertisements. To study the effects of advertisements and factors influencing teen smoking
 * Summary: **
 * Aim: **

The participants were interviewed regarding the feelings towards tobacco advertisements and what influenced their smoking choices this was compared to non-smokers.
 * Procedures: **

More regular smokers than non-smokers held the view that the cigarette advertisements used in this study were exciting, interesting, eye-catching, glamorous and witty. A favorable opinion of advertisements was found to be significantly associated with adolescents' smoking.
 * Findings: **

These findings provide some evidence to support the suggestion that cigarette advertisements may maintain smoking in adolescents by reinforcing a favorable attitude towards smoking.
 * Conclusions: **

Cigarette advertisements are no longer allowed in Australia and other countries, this limits the validity of this study in the modern world.
 * Criticism: **


 * APFCC: Bauman **


 * Theorist ** : Bauman et al
 * Study ** **of**: The relationship between parents smoking behavior on their child’s tobacco use
 * Year ** : 1990

Parental smoking played a huge role in the likelihood of a person trying to smoke and thus developing an addiction. The sample was of American adolescents. From the sample whose parents didn't smoke, 80% reported that they had also never tried. While half of the adolescents from the sample who did smoke had tried cigarettes.
 * Summary: **

To study the relationship between smoking behavior in a parent and their child’s exposure to cigarettes.
 * Aim: **

They studied children from 12-14 in the United States.
 * Procedures: **

From the sample whose parents didn't smoke, 80% reported that they had also never tried. While half of the adolescents from the sample who did smoke had tried. This has been confirmed by other studies in the UK. It also can be seen that parents who are strongly against smoking have children that are seven times less likely to smoke.
 * Findings: **

Thus parents have a great influence over whether their children take up smoking.
 * Conclusions: **

This doesn’t take into account peer pressure that also has a large influence.
 * Criticisms: **


 * APFCC: Bandura et al. **


 * Theorist ** : Bandura et al.
 * Study of ** : The Bobo Doll (Social Learning Theory)
 * Year ** : 1961

To see if children would imitate aggression modelled by an adult To know if children were more likely to imitate same-sex models.
 * Aim: **

Children aged 3 -6years (36 of each sex) were divided into groups. One group was exposed to adult models who showed aggression Second group observed non-aggressive behaviour (setting up toys) Third group was a control group; they did not see any model. In the first two groups, some observed same-sex models and some watched opposite-sex models
 * Procedures: **

Children who had observed the aggressive models were significantly more aggressive – both physically and verbally. Girls were more likely to imitate verbal aggression, whereas boys were more likely to imitate physical aggression.
 * Findings: **

When boys observed women bashing the Bobo doll, they made comments like “Ladies shouldn’t do that!”

Children showed signs of observational learning Children were more likely to imitate the same-sex adult.
 * Conclusions: **

Social learning theory reflects that through watching others complete activities, we will also. This contributes to people taking up smoking and other forms of substance abuse.
 * How is this relevant to smoking? **

Relating this study to smoking should be brief (talk more about the theory than study)
 * Criticisms: **

Outdated


 * Other factors and studies: **

- ** Peer pressure ** - ** Lader and Matheson ** - ** Murray et al. ** - ** Unger et al. ** - ** Social identity theory **

Addiction suggests that the individual cannot control his or her behaviour. An addiction is characterized by behavioural and other responses that always include a compulsion to use the substance continuously, in order to experience the psychological and physiological effects and to avoid discomfort associated with its absence. __Biological factors to smoking addiction__ Active ingredient in tobacco is nicotine, a psychoactive drug Average cigarette contains 1-2 milligrams of nicotine Some effects of nicotine include the stimulation of adrenaline release which increases heart rate and blood pressure. It also stimulates the release of dopamine in the brains reward centre. This means that the smoker will keep smoking in order to maintain the high levels of dopamine in the brain and avoid withdrawal symptoms. Nicotine also acts on acetylcholine receptors in the brain as if it were the natural neurotransmitter. With repeated smoking, the brain adapts to what it regards as normal acetylcholine levels in order to restore balance, usually by growing more acetylcholine receptors. __Study:__ American Lung Association - around 6,000 adolescents under the age of 18 start smoking every day. People who start smoking in childhood have increased chances of lung cancer compared to those who begin later in life. They are also more likely to become addicted, because the young brain is particularly vulnerable to nicotine's effects. __Cognitive and Social factors to smoking addiction__ According to the WHO director, the tobacco industry spends billions of dollars in effort to attract young people in developing countries to its products. Much research on smoking focuses on individual factors - for example, how attitudes or cognitions may predict smoking behaviour. According to Ogden (2004), this is a problem because it takes individuals out of their social context, and a person's behaviour and beliefs are developed through interaction with the social world. Social learning theory includes this aspect. According to SLT, smoking is learned. One of the most important factors is parental smoking. Social class has also been found to predict smoking. In most countries, there is a strong association between socio-economic class and cigarette smoking. Estimates from 2007 from the Centre for National Disease Control and Prevention in the US show that prevalence of smoking is related to socio-economic factors. Cigarette smoking is more common among adults who live below the poverty level (30.6%) than among those living at or above (20.4%). __Study:__ DiFranza et al. (2006) conducted a study with 217 European-American adolescents in America who had all reported inhaling at least one cigarette. All participants completed psychological evaluations and reported their tobacco history, as well as answering questions related to attitudes, beliefs and social environment. Eleven of them were interviewed. Results indicated that those who experienced a feeling of relaxation after the first puff were more susceptible to addiction, with 67% of those who experienced relaxation becoming dependant, compared to 29% who did not feel the relaxation. Post inhale relaxation was the biggest risk for becoming addicted. Of the particpants who experienced relaxation, 91% said they were unable to quit, and 60% felt as if they had lost control. In conclusion, it becomes apparent that it takes far less to become addicted for some, although reasons for different levels of sensitivity is unknown. Bauman et al. (1990) found that 80% of a sample of adolescents with non smoking parents had never smoked themselves. If the parents smoked, half the children had tried smoking. This is confirmed by findings in the UK. Children were twice as likely to smoke if their father smoked (Lader and Matheson 1991). In addition, parental attitude is also as important. __Prevention strategies:__ Since 1990's, most Euro countries have restricted or banned advertising WHO wants a total ban on advertising, promotion and sponsorship No Tobacco day - 31 May 2008 - WHO targeted adolescents According to WHO - 2/3 countries have no clue about tobacco use Increase in health campaigns __Treatment:__ NRT (Nicotine replacement therapy) such as patches, gum and spray can help to some extent. Gum is particularly effective as it distracts, and can prevent short term relapse. Zyban - drug in the 1990's. Was originally an antidepressant, and acts on sites in the brain affected by nicotine. Can help people to quit as it relieves withdrawal symptoms and blocks the effects of nicotine

Pisinger (2008) made a chart "the effect interventions of the individual"
 * Method || Effect || Evidence ||
 * Written materials (brochures etc) || Small || Moderate ||
 * Internet || Small || Weak ||
 * Nurse consultations || Small to Moderate || Moderate ||
 * Doctor consultations or with cessation instructor || Moderate || Moderate ||
 * Cessation treatment (group) || High || Strong ||
 * NRT || High || Strong ||
 * Zyban || High || Weak to moderate ||
 * Alternative || None || Weak ||

=**3. Examine Prevention strategies and treatments for Substance Abuse and Addictive Behaviour** **(for example, Alcoholics Anomymous, Family Therapy, Drugs and Biopsychosocial treatments).**=

<span style="font-family: Calibri,sans-serif; font-size: 11pt;">SMOKING __<span style="font-family: Calibri,sans-serif; font-size: 11pt;">Prevention strategies __ <span style="font-family: Calibri,sans-serif; font-size: 11pt;">Since the 1990's many European countries have put bans and restrictions on the advertising of tobacco as it has been found to have a significant effect on young people's smoking behaviour. **Charlton et al. (1997)** found that boys who preferred Formula One motor racing that was supported by cigarette companies were more likely to begin smoking. <span style="font-family: Calibri,sans-serif; font-size: 11pt;">According to WHO, 2 of 3 countries have no information about tobacco use and therefore do not even know about the dangers of smoking. <span style="font-family: Calibri,sans-serif; font-size: 11pt;">WHO has outlined the MPOWER strategy as a guide for anti-smoking strategies. <span style="font-family: Calibri,sans-serif; font-size: 11pt;">M - monitor tobacco use and prevention policies <span style="font-family: Calibri,sans-serif; font-size: 11pt;">P - protect people from tobacco smoke <span style="font-family: Calibri,sans-serif; font-size: 11pt;">O - offer help to quit tobacco <span style="font-family: Calibri,sans-serif; font-size: 11pt;">W - warn about the dangers of tobacco use <span style="font-family: Calibri,sans-serif; font-size: 11pt;">E - enforce bans on tobacco advertising, promotion and sponsorships <span style="font-family: Calibri,sans-serif; font-size: 11pt;">R - raise taxes on tobacco <span style="font-family: Calibri,sans-serif; font-size: 11pt;">Banning smoking in public places can motivate people to quit smoking and prevent relapse according to research in Italy **(Lemstra et al. (2008))** and Canada **(Gorini (2007)).**

__<span style="font-family: Calibri,sans-serif; font-size: 11pt;">Treatments __ //<span style="font-family: Calibri,sans-serif; font-size: 11pt;">Nicotine Replacement Therapy // <span style="font-family: Calibri,sans-serif; font-size: 11pt;">Comes in the form of gum, patches and spray. <span style="font-family: Calibri,sans-serif; font-size: 11pt;">Used to help individuals with withdrawal symptoms as they slowly reduce the number of cigarettes they smoke every day. <span style="font-family: Calibri,sans-serif; font-size: 11pt;">They administer nicotine without the dangers of other chemicals in cigarettes. <span style="font-family: Calibri,sans-serif; font-size: 11pt;">Break the physical habit of smoking without the feeling of the full effect of the reduction of nicotine. <span style="font-family: Calibri,sans-serif; font-size: 11pt;">Can prevent short-term relapse. <span style="font-family: Calibri,sans-serif; font-size: 11pt;">The drug Zyban acts on sites of the brain that are effected by nicotine. It helps people to quit by reducing withdrawal symptoms and blocks the effects of nicotine if people stop smoking.
 * <span style="font-family: Calibri,sans-serif; font-size: 11pt;">Moore et al. **<span style="font-family: Calibri,sans-serif; font-size: 11pt;"> reviewed 7 studies with over 2000 people who used different form of nicotine replacement theory. Most of the students also involved regular behavioural support and so the results may not be the same had they not been conducted without other assistance.

//<span style="font-family: Calibri,sans-serif; font-size: 11pt;">Counselling // <span style="font-family: Calibri,sans-serif; font-size: 11pt;">Individual counselling helps an individual to develop strategies to quit smoking, maintain the motivation to quit smoking and manage withdrawal symptoms. They also learn about why they smoke, the role smoking plays in their life and how to change their behaviour.
 * <span style="font-family: Calibri,sans-serif; font-size: 11pt;">Lancaster and Stead (2005) **<span style="font-family: Calibri,sans-serif; font-size: 11pt;"> reviewed the results of 21 different studies on smoking. It was found that individual counselling is more effective than other types of counselling, leading to the conclusion that individual counselling can help smoker to quit.
 * <span style="font-family: Calibri,sans-serif; font-size: 11pt;">Stead and Lancaster (2005) **<span style="font-family: Calibri,sans-serif; font-size: 11pt;"> found group therapy to help people quit smoking is more effective than being given self-help materials without being given face-to-face support. The participants' chances of quitting were doubled.
 * <span style="font-family: Calibri,sans-serif; font-size: 11pt;">Pislinger (2008) **<span style="font-family: Calibri,sans-serif; font-size: 11pt;"> concluded that the most efficient methods of quitting smoking at an individual level were consultations and participation in smoking cessation interventions alone or in groups. Nicotine replacement therapies and Zyban were also found to be effective, especially in combination with other interventions.
 * <span style="font-family: Calibri,sans-serif; font-size: 11pt;">Olsen et al. (2006) **


 * // Explaining why smokers continue to smoke once they have started // P.235 Crane
 * o **// Nicotine: //**// ingredient in tobacco, a psychoactive drug //
 * § // Stimulates release of adrenaline //
 * // Increases heart rate //
 * // Increases blood pressure //
 * § // Stimulates release of dopamine in the brain’s reward circuit //
 * // Brief feeling of pressure //
 * § // Acts on acetylcholine receptors //
 * // More acetylcholine receptors are grown as smoking is repeated to restore balance //
 * o **// Once addicted: //**
 * § // Withdrawal symptoms //
 * // Nicotine levels are not constant //
 * o // 70% of current smokers in the US (Centres for Disease Control and Prevention figures) declare that they want to quit smoking //
 * § **// STUDY //**
 * o // THEORIST: DiFranza et al. 2006 //
 * o // STUDY OF: // Link between positive experience with cigarettes and continued addiction
 * o // AIM: // To investigate the link between a first positive experience with cigarettes and continued addiction
 * § // Longitudinal study //
 * § // 217 participants (European American) //
 * § // All reported having at least inhaled cigarette once //
 * § Completed psychological evaluations, reported history of tobacco use, answered questions relating to beliefs to social environment (family and friends)
 * § 11 were interviewed
 * § Tobacco dependence assessed on reported cravings, changes in tolerance, time devoted to smoking and inability to quit
 * o RESULTS
 * § Children who experienced a relaxation effect after consuming their first cigarette
 * Were more likely to become addicted, 70% compared to 30%
 * 90% of the 70% who reported feeling relaxation, stated that they were unable to quit
 * o CONCLUSION
 * § it takes much less to become addicted than it was previously thought
 * o CRITICISMS
 * § used mainly adolescents who admitted to have inhaled a cigarette at least once
 * § Most of the data was gathered through self-reporting
 * Thus limitations to its usefulness.
 * However it does show how quickly an addiction to cigarettes can be developed.

__**NICOTINE**__