Unit 3

Health Psychology

Definitions

• Health psychology considers the reasons for behaviour that is detrimental to health, such as substance misuse. The emphasis then is on how to promote healthy living. – Understanding what causes good and bad health,

using psychology to promote good health– For example, it looks at biological causes of substance

abuse and how drug treatments might work– Understand health from a cognitive, social and

biological perspective– The study of how our mental and physical health can

be assessed

Key Terms

–Synapse–Substance misuse–Tolerance–Physical dependence–Psychological dependence–withdrawal

MethodologyLAB STUDIES USING ANIMALS

Animal laboratory experiments can be used to show a cause and effect relationship between the drug administered and the behaviour resulting/eq;Mice can be used to comparatively study the effects of drugs on the brain or vital organs as they can be sacrificed to examine physiological damageMonkeys, for example, can be studied to investigate the reinforcing effects of a drug on behaviour to understand what schedule of reinforcement or type of drug causes addictive behaviour/eq;Meisch (2001) used monkeys research to show that they would be more likely to drink a drug solution than water, demonstrating its reinforcing effectsAnimals can be used to test substitute biological drugs/replacement drugs for addictsThe findings of animal research are used to judge possible influences on human behaviour or physiology Rat Park was developed to understand whether drugs are biologically addictive or reinforced behaviourRats were used to examine the effects of chronic stress on ethanol (aka ethyl alcohol!) intake by Nagaraja & Jeganathan (2003)

MethodologyEvaluating use of animal research – practical issues (nb you don’t need to know all of these, just pick 2-3 that you could expand on, and use examples from animal studies to demonstrate the point)• Animals are more practical to use than humans as their behaviour can be

monitored closely in confined situations over long periods of time• Relatively cheap and can be used in large numbers/relatively small and

easy to handle/easier to house and cage• Animal research as a whole is expensive as it involves specialist

equipment/facilities• In drug trials animals are cheaper/more cost effective in terms of fee/cost

and amount of drug – than humans• The knowledge gained from animal research can benefit humans, making

it important in improving the quality of human life• Human behaviour is very different from animal behaviour, so the results of

such study may not be generalisable to humans• The nervous system (neural transmission) is the same in animals as it is in

humans, so the results of drug research on neural transmission should be generalisable to humans

• Animals breed quickly, so the heritability of conditions caused by drug use can be studied conveniently

MethodologyEvaluating ethics of animals research to study drugs• Animal research is subject to strict regulation that can be costly to set

up as special housing, equipment and a licence is required• Guidelines are enforced with animal research such as housing,

number, endangered species, painful procedures• Animals can suffer during experimentation which may be seen as

morally objectionable/pro-species argument• Animals respond differently from humans to drugs, so suffering may be

more extreme. Aw• Animals can be used where suffering may be unacceptable to inflict

upon humans• The least number of animals should be used in animal research to

minimise suffering to the least amount of animals• If procedures cause pain to the animal an anaesthetic can be used to

alleviate the pain• The benefits of the research should outweigh the costs to the animals

involved• During drug experimentation animals may suffer pain and discomfort

(basic mark)

MethodologyHuman Research method 1 – Interviews• Can be used to generate quantitative and qualitative

information about the effects of drug use and effectiveness of prevention/rehabilitation programmes

• Interviews can gather essential information about the individuals experience of drug use, social conditions and rehab/relapse conditions

• Qualitative information can be gathered about the experiences of drug use/lifestyle

• Quantitative information can be gathered about amount of substance abuse, age of commencement etc

• Blattler et al (2002) used interviews to find out amount of drug taken and other patterns, looking at heroin and cocaine use/eq;

• Structured and unstructured interviews + open/closed ended questions + face to face between researcher and interviewee/eq;

Methodology

Human research– Questionnaires• Blattler et al used questionnaires to assess

the effectiveness of prescription heroin• Questionnaires can be used to gather a lot

of information about the prevalence, experiences and causes of drug use

• Questionnaires can gather qualitative and quantitative information based on type of question asked (closed or open)

Methodology - Human research 1 evaluation

+ Strengths• Can provide qualitative data about feelings

– Human participants can provide qualitative data that cannot be measured in animal studies in the same way/eq;

– Such as how drugs make the person feel/subjective experiences/eq;

• Long terms effects can be studied – Longitudinal research can be conducted into the long term effects of drug use or

rehabilitation/eq; so that more robust conclusion can be drawn over time/eq;

• Can generalise to humans, unlike animal studies – In depth research into factors associated with drug use can be investigated so that

vulnerability can be predicted in humans/eq; – Human studies do not have generalisability issues associated with animal research -

animals may not respond in the same way to drugs/eq; – animals may not respond in the same way to drugs because of

cognitive/physiological/behavioural differences between us/eq; – They test drugs on humans that other humans will use so the findings will show exactly

what effects the drugs will have on humans because we share the same central nervous system

• Validity– Human research conducted in real life is more valid than artificial situations used to

study animals– Which means findings can be applied to real life situations such as to help drug users

- Weaknesses• Ps may not tell the truth about their drug use so distort the

results, this is because drug taking is a sensitive topic so Ps may cover up or exaggerate the extent of their drug misuse

• Ps may give socially desirable answers and say what they believe they should say which would affect the validity of the findings as all responses will be skewed to social norms values

• Closed questions may not offer the opportunity to give the detailed response or actual response the P would want to give

• Open questions are open to interpretation by the researchers – such subjectivity will elad to bias and could affect the validity of the research

Methodology - Human research 1 evaluation

Methodology

Human research method 2 – PET SCANS• PET scans can be used on human

participants to understand the effects of drug use on the brain structure and functioning

• Blood flow to a particular area of the brain can be detected/imaged to show the active parts of the brain during/following drug use

• Scott (2004) found that smokers brains were less active in memory, emotion and pleasure regions after smoking cigarettes

Methodology – evaluate one study using humans as participants

Blatter et al (2002)• Cross checking using biological and self report measures of drug use to

ensure the findings were valid• They followed up reasons for drop out from the programme to ensure

that the findings were not biased by the remaining participants• The study was ethically correct and authorised by an ethics committee

for offering of drugs• A full right to withdraw was offered and often taken up• As participants maintained their normal routines the findings of the

study in terms of its effect on social behaviour should have good ecological validity

• The study could be criticised for having a cohort effect, the findings could be due to conditions of the cohort and time

• The sample size of drug users was high offering generalisable findings in the drug user population in Switzerland

• Urine tests were used and cross checked against drug use claims

Methodology

Why use humans not animals?• Animals are behaviourally/genetically/physiologically different

to humans so findings may not be generalisable• Drugs affect the brain and as humans have a more complex

nervous system/cognitive abilities comparisons are harder to make

• Qualitative information can be gathered from human Ps which is much more difficult to gather from animals

• Humans have subjective experiences especially when high that can be studied that animals cannot report

• Animals may react differently to some drugs compared to humans. The effect of the drugs are different because of the differences in the nervous systems of humans and animals so the findings may not apply

How Drugs WorkHeroin – mode of action, effects, tolerance. Dependency, withdrawal

Mode of action:– Increases the level of dopamine in the brain– Acts upon the opioid receptor sites – Trigger release of neurotransmitter at receptor sites– Mimics endorphins to stimulate dopamine reward system– Morphine produced by taking heroin is a depressant and painkiller – GABA activity is inhibited

Withdrawal– Symptoms begin within 12 hours following last fix of heroin and involve

agitation/restless (or any other symptom)– The severity of withdrawal is dependent upon the level of addiction– Hot and cold flushes and restlessness– Skin crawl and often sleeps a lot– Cramps and vomiting, diarrhoea, sweating, twitching and shaking, depression,

sensitivity in groin area, ‘itchy blood’ frustration, confusion.– Psychological response – feel they can’t cope without heroin, cannot function

without the drug.

Tolerance– The reward circuit becomes highly activated– Over-production of dopamine– The body has to adapt to the heroin – try and achieve homeostasis (balance)– Reduces the amount of dopamine produced– More enzymes are produced to break it down– Stifles the brain's reward circuit through inhibition- the same dose of drug is

less rewarding– Heroin rapidly develops tolerance– Users very quickly need increasing amounts of it to get the “high”– Eventually just users take heroin to delay unpleasant withdrawal symptoms

Physical Dependence– Linked to tolerance – need increasing amounts to reach high so become

physically dependent.– Body is used to functioning with heroin – so needs it for normal functioning.– E.g. Brain of heroin users produce less endorphins so addicts will rely on

heroin for pleasure and reduction of pain.

How Drugs Work

How Drugs Work

Alcohol - mode of action, effects, dependency, tolerance, withdrawal

mode of action– Acts upon GABA system – Increased GABA suppresses inhibitory behaviour– Affects ANS by suppressing sympathetic division– Results in slow reaction time

Physical dependency– Extreme cases can lead to drink – Irritability or shaking – Potentially can pass out

Psychological dependency – Sense of relief when access alcohol– Drinking seen as a ‘coping’ strategy – ‘first drink’ alleviates physical symptoms

Tolerance – Blood alcohol level drops and the individual feels

sober before they actually are – Alcohol produces enzyme– Enzyme breaks alcohol down quickly – In a few weeks, drinker will need to consume 50%

more to achieve the same feeling

How Drugs Work

Biological Explanation of Substance Misuse

BIOLOGICAL - description• Drug misuse can be explained by significant change to the

neurotransmitter action in the brain• Stimulants or depressants alter the balance of neurotransmitters

and affect mood and behaviour• Natural production of neurotransmitters need to be substituted

with drugs to function normally• Drug taking results in physiological dependency which results in

the need to take the drug to feel normal• Drugs can be taken to prevent unpleasant withdrawal effects such

as sickness• Using more of the drug may be needed because the body

becomes tolerant to lower doses• Drugs are taken to produce pleasant effects due to the chemical

action in the brain

Biological explanation - evaluation

• The biological approach ignores the role of nurture in that addiction can be explained by social learning, reinforcement or peer pressure

• Neurological activity in the brain of addicts have been shown to be different to be different to non-addicts, supporting a biological basis for addiction

• Animal studies have shown biochemical changes in the brain due to drug misuse, supporting the biochemical theory

• Withdrawal symptoms due to the biochemical crash support this explanation

• Many people try and infrequently use drugs such as alcohol, and don’t become addicted, suggesting individual differences rather than a completely biological explanation

• There are cultural and subcultural differences that cannot be explained by a biological approach

• The learning explanation of addiction is closely related as it builds up on the need for pleasure, avoidance of withdrawal effects and reinforcement

Learning explanation of substance misuse

SOCIAL LEARNING THEORY - description• An individual may observe a drug user and model their behaviour• A role model who takes drugs can encourage drug misuse if they

have status and power is looked up to or respected Eg friend, family member, media model, someone they admire or relate to, making modelling more likely

• Drug use can be glamorised and rewarded which can be a form of vicarious reinforcement for an observer which means the model is seen to be enjoying themselves for example.

• The observer may identify with the drug user and wish to adopt the same drug taking values and beliefs as a role model

• Receive direct positive reinforcement from the drug itself or gain approval from friends as a reward

• Retain/encode the memory of models taking drugs and copy/imitate

Learning explanation - evaluation

• Vast amount of experimental evidence for the general role observational learning so we can be fairly sure that a similar process can explain drug taking (eg Bandura 1961)

• Sher found that smoking tended to run in families as a consequence of imitation

• However Drug misuse tends to run in families and this could be due to genetic factors rather than social learning

• Culturally, different drugs are used/misused in different cultures, supporting social learning theory as an explanation of drug taking

• studies that demonstrate the reliability of SLT support this explanation of drug misuse through modelling (Bandura 1961)

• SLT provides an alternative explanation for the fact that addictions tend to run in families.

• SLT does not SLT does not explain drug use in the absence of observing a role model

• It is difficult to evidence SLT in this area as there are many other factors involved in addiction, and it is difficult to isolate SLT as one explanation due to other influences on behaviour eg peer pressure to take drugs to look cool

• SLT explains why people first take the drug which the biological approach fails to explain

Comparison of 2 explanations

• Closely linked as the biological explanation builds on the need for pleasure, avoidance of withdrawal effects, and reinforcement

• The learning explanation is the nurture side whereas the biological explanation is the nature side of the debate

• The biological approach explains physiological dependency whilst the learning approach explains psychological dependency.

• The learning approach can explain the cultural differences in types of drug taken – due to reinforcement, which the biological explanation does not address

There are other points that you could make, these are just examples

Treating Addiction – biological method

• Biological substitute programmes, such as methadone for heroin addiction can reduce craving and prevent heroin having its typical euphoric effect

• Methadone is a synthetic opiate used to replace heroin• It works to block the effects of heroin at the synapse and reduce the

withdrawal symptoms for 24 hours• Methadone reduces heroin cravings• If taken with heroin the heroin will not produce its euphoric effects• Blood test are done regularly to test for illegal drug use for the

programme to be effective• Drug replacement for class A drugs also serve to reduce drug related

behaviours and disease (crime, prostitution, HIV)• The effects of methadone last a day (24 hours) for a daily dose is

taken, usually under supervision, and is systematically lowered to wean off

• When trusted the drug can be taken away from the pharmacy

Biological treatment of addiction - evaluation

• Blattler et al found that those give prescribed methadone reduced their general use of cocaine and showed behavioural changes associated with abstinence

• Methadone is a synthetic opiate that can produce physical dependency• Drug replacement therapies often have withdrawal and dependency issues

themselves• Drug replacement therapy can help take the addict away from the drug context

that may reinforce an addicts lifestyle• Less glamour when taken orally so removes association between shooting up

and high (which is a good thing)• Reduces the risk of other infections associated with needle sharing/taken orally• Ball and Ross (1991) found methadone effective in reducing illicit opiate use• Biological drug replacement therapy can be costly to the health service

although this may not be as high as the cost to the individual and family if it remains untreated

• Drug replacement can involve a dangerous cocktail that is harmful in itself• Drug replacement therapies often have withdrawal and dependency issues

themselves.• Non-compliance can result in abuse of the methadone programme and may sell

the drugs on the black market• It does not treat the cause of the addiction, but simply replace an illegal drug

with a legal one• Need motivation to give up drugs otherwise the treatment won’t be successfulYOU DON’T HAVE TO WRITE ABOUT ALL THESE STRENGTHS AND WEAKNESSES, PICK A COUPLE OF EACH AND ELABORATE AND EXPLAIN WHAT THEY MEAN

Treating Addiction – Aversion therapy

• Aversion therapy can be used so that drug use is associated with an unpleasant consequence

• Emetics can be given with a drug to force a negative consequence

• Drugs will be avoided to prevent to conditioned effect

I don’t think I need to talk about TEP!! But this is the other treatment you could use….

Treating addiction – aversion therapy evaluation

• Aversion therapy is considered unethical as it forces adverse reaction

• Participants must be fully informed of the process before undertaking treatment

• Abstinence is usually short term as conditioning can be reversed easily

• Behavioural therapies do not successfully treat the causes of the addiction but help to break a habitual behaviour

Key Study: Blattler et al Swiss Heroin programme

A

Aimed to see if prescribed heroin could reduce the use of cocaineTo investigate the variables affecting cocaine misuseTo see if a drug maintenance programme was successful on poly-drug users

P

Ps were followed up after 18 months in the programme to see if there was a reduction in illegal drug useThe Ps were selected from an existing treatment programme and had been addicted for over 2 yearsPs were interviewed every 6 months to measure their illegal substance useUrine tests were usedAll gave informed consentCounselling made compulsory for all patientsStandardised questionnaire – same questionsIndependent interviewers to prevent researcher biasApproved by an ethical committee

Rthe treatment resulted in more than half reducing their cocaine useUrine analysis confirmed the huge reduction in regular cocaine use of Ps on the programme

CConclusion: There was a reduction in drug related behaviour and offences as a result of the programme.

Key Study: Blattler et al - Evaluation points

E - Participants of the study were fully informed about the nature and extent of the research, so it was ethical in that sense Ps gave full consent to take part as they were part of the rehab programmeThere was a right to withdraw from the programmeApproved by ethics committeeA few did withdraw so right to withdraw was enforced

A - The applications of this study are far reaching in terms of economic and individual cost of drug use

V - The validity of the findings are established through triangulation of biological and self report measures The participants were naturally undertaking the clinical trials, so participants were not carefully selected or matched to a control groupAs participants were followed up over 18 months the long term effects of the programme could be establishedEcological validity as they were drug users on a drug programme High population validity as they were extreme drug users/polydrug users and findings were related to them Cause and effect is hard to show as there are many other factors to take into account

R - Independent researchers conducted the interviews and analysed the findings to ensure there was no researcher bias The findings were compared to baseline measures to ensure a reliable change in drug usage was established

G - The study omitted data from participants excluded for dealing or dropped out of the programme, so the results are limited to the most dedicated patientsLow population validity if generalised to the wider population (e.g. mild drug users)Participants may have taken part in the programme with the intention of getting free heroin not to give up their drug habit/eq;large sample of 266 Ps is a sample from which generalisations can be made to the target population for specific drug users

Petry: Contingency management programme

A

P

R

C

Petry evaluation: Contingency management programme

G

R

A

V

E

Evidence in PracticeContent Analysis

• Give aims of your content analysis • How you sourced the material, planned and carried it out, themes and

categories, coding decisions, bias, procedure, sampling, apparatus, controls, how you might have got round bias in the source (editing)

• Give a range of procedural issues – eg sampling, how data was summarised into categories

• Analysing your data– Analysing data, qualitative and quantitative, refers to how data was scored,

tallied, totalled, themes analysed, conclusions drawn from the summaries (can include theory as relevant).

• Results– Accurate and detailed links made between the findings and two or more concepts,

theories and/or research drawn from health psychology.– Detailed explanation of findings with accurate and detailed links made between

the findings and at least two concepts drawn from health psychology

• Conclusions– In depth description of conclusions drawn from practical and/or showing some

supporting ideas, evidence, concepts and/or justification.

If asked to design a study using humans eg asking about legal highs:

Questionnaire/interview/survey– Design a questionnaire designed to administer to users

and non-users of the drug– Ask users of the drug to report psychological and

physical effects– Use open ended questions to gather qualitative data on

how the P feels when taking the drug– Use closed ended questions to gather quantitative info

on how many times the P uses the drug etc.

You have already answered this as an exam question… again please dig this out!

Anti Drug Campaigns

Talk to Frank• Uses openness as a strategy for children and

parents to seek advice• Parents are encouraged to look for signs of

drug use• Younger people are exposed to drug user

images that are negative• Shows peer group pressure and how this can

influence drug use• Uses both sides of the argument to encourage

choice and consideration

Health Campaign - techniques

• Scare tactics – frighten people into not using drugs• Role models – use a key figure that people will identify with to

show dangers of drugs• Statistics – provide information about death/illness rates of

drug misuse as fear factor• Openness; use as a strategy for parents and children to seek

advice• Two-sides – present both sides of argument to encourage

choice and consideration• Mediums – use various ways of delivering the message eg TV,

adverts, radio, internet, twitter etc• Support – ensure suport is available like helplines, counselling• Signs – encourage parents/guardians to look for signs of drug

use

Anti Drug Campaign Evaluation

(Remember, apply the different approaches to explain the underpinning

psychological theory behind the campaign)

Generally:• Difficult to measure effectiveness as many factors may cause increase in health• Quantitative measures of health related behaviour (death rate, consumption,

helpline activity) can be statistically verified• Health programmes often go hand in hand with a change in public opinion,

which may account for reduction in un-healthiness rather than programme itself• Health campaigns only work if people do not have barriers to health related

behaviour and can access help• They are preventative rather than curative so stops issues before they cause

health/lifestyle/family issues• Can be costly but cheap in comparison to curative strategiesSpecifically:• Talk to Frank is based on the Yale Model of Persuasion which has experimental

support for the effectiveness of presenting both sides of the argument• The Talk to Frank campaigned has come under a great deal of criticism•

Remember the describe and evaluate sheet Fran developed for you… please dig this out!!!

Key Issue

Description of Key Issue– THE ISSUE OF HOW DRUG ABUSE CAN

BE TREATED– HOW TO PREVENT DRUG ABUSE– HOW DRUG TAKING IS PORTRAYED IN

THE MEDIA

Application of theory and research

This was the other Key Study at we didn’t look at – you DO NOT NEED this as well as Petry: Ennet al al. Peer groups and smoking

Description

Aim: To investigate adolescent smoking and the relationship between them and their peers and friends

Procedure:1092 9th grade students (aged 14-15) from 5 schools in the US were questioned between August and December 1980Mothers educational background was determined as well as a range of other possible mitigating variablesEnnett et al (1994) used questionnaires to gather information about smoking and peer group influence directly from the source by asking/self report methodNetwork analyses was used to determine friendship cliques within the school they attendedFriendship reciprocation was weighted more greatly than non-reciprocated friendships

ResultsJust under ½ the Ps were regarded as cliques, the remainder were clique liaisons or isolated individuals89.9% of clique members were non smokers2% of cliques were entirely smokers68% of cliques were entirely non smokersCliques that were similar (race/sex/mother’s educational background) were either all smokers or non-smokers, and the dissimilar cliques included both smokers and non-smokers

Conclusions:Peer groups tend to discourage smoking, and only similar smoking groups encouraged itGirls are more likely to be in smoking cliques than boysThe mothers educational level affected adolescent smoking

Key Study: Ennett al alEvaluation (including comparison with Blattler)

The sample of adolescents surveyed from the 5 schools was inclusive and large, so the results should be generalisable to this culture

The survey gathered in depth information about friendship cliques using a variety of methods to ensure validity before examining smoking behaviour

It is supposed to measure the influence of friendship groups on smoking, but the findings were restricted to three best friends – we are influenced by more than our closest friends

Connectedness and reciprocal friendship may have been mis-measured as one persons view of friendship may not be reciprocated by the other person

The self report data may have been affected by the lack of social desirability with regards to smoking

The study is different to Blattler who actually administered replacement drug – this study just used self reports

Blattlers study did not investigate the role of friendship groups in the formation of a drug habit

Both Ennett and Blattler took self reports from participants

Both Ennett and Blattler cross checked self reports with tests (urine and carbon monoxide) to check for reliability of answers