Clearly, as seen above, substance abuse and addictive behaviour are negative issues which are caused by a wide range of factors. However, there are prevention strategies, which can be put in place, in order to prevent an addiction in the first place, or alleviate the symptoms of the addiction or abuse of substances, leading to a cure. There are three main types of prevention models: primary prevention (which aims to stop the addiction from occurring in the first place), secondary prevention (which treats people at risk of the addiction, but who haven’t yet displayed the development of addictive behaviour) and tertiary prevention (which treats people who actively display the symptoms of addictive behaviour).
The Theory of Reasoned Action, presented by Ajzen and Fishbein (1975) states that behavioural intentions make one reciprocate actions from two cognitive components. These being: personal beliefs and attitudes of the individual, and subjective norms by which the individual lives. These seek to view whether the individual thinks their actions will be deemed good or bad, in terms of their own morals, and also in terms of the appropriate behaviour which their particular society deems to be acceptable. For example: if one believes that by smoking, they will be able to alleviate their stress, have a neutral outlook on smoking, and if smoking if acceptable in their society, then this makes it more likely that they will have the intention to and therefore more likely that they will follow through with the action of smoking, than if the individual believed that smoking was wrong and it was against the standard norms of their culture. Based on this theoretical model, one can prevent substance addiction by altering the way in which one views it. If one looks at purely negative aspects of the substance to which one is addicted, one will find it easier to alter their outlook and therefore their intention, which will reflect in their behaviour. Also, changing social grouping or attending places where the action is seen as a negative thing will influence the prevalence to substance addiction as it will effect the ‘subjective norm’ part of cognitive processes, telling one it is wrong and therefore making it more likely for the individual not to indulge in the action.
This Theory however, does not just have to be applied to smoking. Ohtsuka (1999), found that the TRA predicted behaviour of adolescents and adults in the field of gambling. He found that subjective norms and attitudes were good predictors of intention to gamble and that the intentions predicted well the actual behaviour.
Concerning the TRA however, there are certain critical issues. Primarily, the data collected is more often than not, by method of questionnaires. This creates issues with reliability, accuracy and validity, as individuals may lie or exaggerate intentions in order to make themselves appear more socially acceptable than truth (social desirability effect). This will therefore not represent that attitudes and behaviours that will exist in the outcome and so it creates a poor predictor of behaviour.
Similar to this, there is a large difference between the intention and expectation of the individual. Expectations are less likely to occur in real-life situations that intentions. For example: a smoker may expect to quit in a few months with the aid of social supporting. However, this type of self-help may not work for the certain individual, and therefore it may be less likely that they will quit. Their intention to quit however, could by extremely strong. The TRA measures only intentions and ignores expectations which results in the reliability of the models being called into questions. Also, addictive behaviour may occur under the influence of drugs, alcohol or other inhibition releasers, which can affect the attitude of the individuals. This would most assumedly not have been a factor at the time of the individuals being surveyed, and so this could potentially lead to the individual being more likely to undertake a behaviour that their attitudes would normally tell them they shouldn’t do. For example: they may be totally against smoking, however with the consumption of alcohol, could turn to a cigarette. This evaluative point was specifically demonstrated by McDonald who found that being drunk increased intentions of unprotected sex (due to alcohol myopia: decrease of cognitive capacity).
A distinct positive of the experiment is that it gives a strong predictive validity (Sherma, 2007). Attitudes are a good predictor of actual behaviour of individuals and therefore it is easy to assume that the attitude will directly result in the behaviour. This might not necessarily be the case however, as other external factors must be taken into account and so it could be seen that a reductionist view is being taken. However, the model does not explain the behaviour occurring.
This Theory on prevention however, has been replaced by the TPB (or Theory of Planned Behaviour), due to its lack of inclusion of expectations from the individual. Ajzen improved his first model in 1989 in order to include the fact the behaviour is most commonly under conscious intentional control. The aspect of perceived behavioural control was added to his model, in order to demonstrate the effect of how well the individual believes that they will perform. Unlike the other two cognitive components however, this can have a direct effect on the overall behaviour as well as on the intention of the individual. It has this effect due to a simple causal link found by Ajzen: the more control the individual believes that they have over a situation, the more likely they are to keep their intention - the higher the perceived control the more likely it is for the individual to try harder to keep their control. In terms of prevention, this theory can be used much alike its predecessor. However, if there is training (most commonly in the form of counselling or social coping etc.) then the perceived control could potentially be increase, aiding in resistance against a substance addiction. Rise et al. (2008) concluded using this model, that how an individual feels about something in conjunction with what other people have the tendency to do plays a more crucial role than the other aspects of the theoretical model -in the case of their study, predicting whether or not smokers would quit their substance addiction.
Supporting evidence for this theory was concluded in 1992 by Godin et al. He found that the most important predictors for potential smoking are perceived behavioural control, attitudes of the individual, and subjective norms. The most important predictors for actual smoking were: perceived behavioural control and habit. This supports the theory behind the Planned Behaviour Model of prevention. However, it finds a flaw in the model, in that it does not take into account for Habits which the individuals already display. Also, this evidence can only be extrapolated to a certain extent, due to distinct methodological issues. Results of this study were collected via a questionnaire, meaning that there was a significantly reduced level of reliability and validity due to the social desirability effect. This ‘supporting’ evidence highlights that the theory is more accurate than the previous one, however there are still adaptations which need to be made in order for it to be fully effective in all circumstances.
For the prevention theory itself, there are many research studies which provide the same results: intentions can be predicted from the three components of the model. A meta-analysis of all of the results was conducted by Armitage and Conner (2001), who found an extra 6% of variance of actions was accounted for by the new, improved model, rather than the Theory of Reasoned Action. The fact that they presented results of a meta-analysis means that there is an increased reliability as there is a mass amount of data collected, however the data is secondary and so any qualitative data presented is open to a subjective view, which can cause discrepancies due to researcher bias and incorrect interpretation. Also, the publication of these results was based on predictions of intentions, rather than the actual behaviour displayed by individuals; meaning that although addicts may have good intentions, it is difficult to change behaviour, such as giving up a substance addiction, and therefore it is harder to accomplish than originally thought. This would result a very high probability of a negative correlation occurring between actual results, and the predictors of intentions. In addition, the Theory of Perceived Behaviour does not take into account irrational behaviours. There is no scope for emotion or impulses, desires or compulsions. This is because when filling in a questionnaire, individuals generally do not take into account how they will react in certain situations which evoke a particular emotion etc. which could result in individuals not carrying out their intentional behaviour - displaying a flaw in the model.
In a more practical sense, Government agencies have had to act against substance abuse and addiction in order to improve the quality of life for their people. The World Health Organisation want a total ban on all tobacco advertising, promotion and sponsorship. Adolescents are the most prevalent to this form of media, as they are more brand-conscious and receive positive associations between the good advertising and the cigarettes, and so if they were removed, it would prevent a large percentage of the thousands of teenagers who start smoking on a daily basis. This was demonstrated by Charlton et al. (1997) who found that boys who showed a preference for Formula One Motor Car Racing, often sponsored by cigarette manufacturers, were more likely to smoke that teenagers that did not view the sporting programmes. There is a necessity for information to be provided to individuals across the globe about the dangers of smoking (which at the minute, two out of three countries do not receive) as this could ultimately change subjective norms and personal attitudes and therefore make it less likely that people would start their substance addiction.
The WHO have also published a ‘manifesto’ campaign titled ‘MPOWER’ in order to help countries find ways of reducing the amount of people who put their lives at risk due to smoking. This contains points such as: protecting young people from tobacco smoke, offering to help people quit smoking, warning people about the dangers of smoking and raising taxes on all cigarettes. Banning smoking in public places was also mainly down to their doing. The above will decrease the amount of people who can afford to smoke, help prevent people from relapsing if they have already quit smoking, and prevent the amount of teenagers and children made susceptible to the cigarette smoke, overall reducing the amount of people that are likely to start smoking. This as a form of prevention however has not been extremely successful, as only 15 of the countries handed the mandate took a reasonable amount of notice in order to make a substantial change. Also, it is approximated that less that 5% of the world’s population live in these countries and so it will have had very little overall effect in mass prevention of substance addiction to tobacco.
As for treatments, there are several different, effective forms which can be used to subside substance abuse and addiction. Nicotine Replacement Therapy such as nicotine gum, patches and sprays are very effective for short term relapse against smoking. They give the same release of neurotransmitters in the brain, without having the rest of the negative effects of a cigarette. Also, they wean the individual gradually off nicotine dependence, by decreasing the parts per million of nicotine in each sample. This means that the individual will need less and less nicotine overall than previously, until they reach a point where it is no longer a necessity and they can come off the replacement therapies as well. There is a lot of evidence, collated by both NHS and independent groups to show that these forms of treatments are extremely effective. One can take the results as more reliable due to the fact that both private and public sectors have agreed the affectivity of these drugs, rather than just one or the other, as one could have a vested interest in providing data for one direction or the other (for example: the independent collator may have been a drugs company selling the treatment). However, the fact that there is corroboration increases the reliability of the inference from the results.
Another effective form of prevention is social coping (Taylor [2002]). Social support groups have been set up in order to aid individuals to stop smoking together. NHS ‘stop smoking groups’ help prevent the likelihood of relapse and allow individuals to share their experiences, bonding them as a groups and making them feel a certain responsibility for each others actions. The theory of commitment shows that the longer one participates in such groups, the more likely one is to continue with the technique until it is effective, as otherwise one would be admitting that they had wasted a lot of time. Also, there are trained doctors and nurses who aid assess individuals techniques of stopping smoking and put them on the right path etc.
A more drastic approach to the prevention of such substance abuse is the use of emetics. This can be a simple as drugs lacing a cigarette. The drug would proceed to make the individual feel extremely ill. Continued use of this would make the individual associate smoking with being sick or sickness. This would make them more likely to quit smoking as they have extremely unpleasant feelings each time they ‘take a drag’. there is a lot of evidence for the above, from both a biological and psychological perspective. Research into this has been done by Pisinger (2008) who found that there was significant evidence for the effectively of emetic drugs against substance abuse and/or addictive behaviours.
From a purely psychological approach, the use of Cognitive Behavioural Therapy (or CBT) can also be used as a treatment to smoking. It allows the individual to see that they have a problem. It them allows them to find out how to best combat this problem for themselves and in their own way. However, there is very little evidence to suggest that such techniques have significant effect on the individual. This could in part be down to the fact that it is a relatively new technique, and so should maybe not be written off quite so quickly as a technique which does not treat addictive behaviour.
The essay has sought to outline effective forms treatment and prevention strategies as asserted by governments and health agencies world wide. It has taken stances in biological, socio-cultural and cognitive perspectives in order to assess effectively the reasons, preventions of and treatments of addictive behaviours and substance abuse, with key reference to smoking.
