Causes and Treatment of Addictions

Causes and Treatment of Addictions
The term addiction has been understood by most members of the society
from a narrow perspective where they refer to individuals’ reliance on
drugs. However, the standard meaning of the term addiction encompasses
different things (both biological and physical), which are pleasurable,
but their subsequent use becomes compulsive and impedes the normal
responsibilities (Beresin, 2013). The program for treatment of
addiction varies with institutions and the type of addiction. However,
the Brody (2013) suggested that the addiction treatment program should
be comprehensive and involve both the health professionals, relatives,
and close friends. The current research paper will provide a detailed
review of three addictions-based research works. The first research is a
systematic review of evidence based treatment of addiction resulting
from substance abuse. The study hypothesizes that adequate progress has
been put in place to enhance the attitude, adoption, and implementation
of evidence-based treatment of addiction. The second study was conducted
to assess the effect of stable housing in enhancing the treatment
program among the injection drug users. The study hypothesized that the
existence of a positive association between access to addiction
treatment and the attainment of stable housing. The third research was a
study of addiction treatment among the employed population. The research
emphasized on the understanding of the addict’s perspective about
treatment as the key to a successful treatment program. The three
research works will be reviewed under the sub-topics, methods, results,
and discussion.
Methodology
Bryan (2009) conducted a systematic review of the addiction treatment
studies published from 1998 to 2008. The study aimed at identifying the
pharmacological and psychosocial treatment approaches from the internet.
This was accomplished through key word searches and search for relevant
bibliographies. The keyword approach was conducted in three major
databases namely the Medline, PsychINFO, and Implementation Science
databases. The selected keywords directed the browser towards the
identification of evidence-based research works related to the treatment
of addiction. The study excluded the previsions study on two bases.
First, the study excluded all the training-related studies that had been
reviewed in Walters et 2005 all systematic review or were published
subsequent to the Walters et 2005 work. Secondly, studies that deviated
from the treatment of substance abuse were not reviewed. A total of 65
studies qualified to be reviewed by Bryan (2009).
The “Addiction Treatment and Stable Housing among a Cohort of
Injection Drug Users” is a cohort study that was conducted in
Vancouver to assess the effectiveness of housing in the treatment of
addiction (Palepu, Marshal, Lai & Kerr, 2012). The study respondents
were recruited through self referral and street outreach. The
recruitment criteria for the study respondents were at least a single
injection with illegal drug within a period of six months prior to the
research date. The researcher recruited a total of 992 participants.
However, the recruitment criteria are questionable because a participant
who may have injected with illegal drug one time cannot be classified as
an addict. The researcher collected data using the
interviewer-administered questionnaires. This is an effective technique
for data collection because the administrator has an opportunity to
evaluate the eminence of the data. In addition, the questionnaire
administrator can seek for clarification and win the respondents’
trust. The data was analyzed using SAS software, which determined the 2-
sided p-values. During statistical analysis, a confidence level of 95 %
was used to determine the association between stable housing and
treatment of addiction. Additionally, the use of the regression model to
assess the existence of statistical difference between stable housing
and treatment of addiction was a viable approach. The model also
assisted the researcher in filtering the participants and selection of
variables that would help in achieving the objectives of the research.
The demographic variables include I the data analysis includes age,
gender, education level, aboriginal ancestry, and legal employment
status.
Byun et al (2009) applied the meta-analysis approach to study internet
addiction in 1996-2006. The keyword was the key strategy employed in the
search for quality and completeness articles to be reviewed in the
study. In addition, researchers observed quality of the articles used in
the research by ensuring that they were complete, peer-reviewed, and
sourced from reliable academic databases, which included Google and
Yahoo. A total of 120 articles were identified where 60 of them had used
a quantitative approach on both empirical and human participants. The
research employed strict exclusion criteria, which resulted in the
elimination of articles that focused on social economic cost of internet
addiction, termination of employment, and treatment problems. This
resulted in the exclusion of 22 articles. This was a significant measure
of ensuring that the study maintains the scope and pursues the
pre-stated objectives.
Results
Bryan (2009) presented the results the 65 articles in three categories
namely the attitudes towards evidence-based treatment (EBTs), adoption
of EBTs, and implementation of EBTs. In addition, the results were
presented chronologically based on the year they were performed. The
results were further categorized into pharmacological EBTs,
psychological EBTs, and combined pharmacological and psychosocial.
Results show that 48 % of the studies that assessed the attitude towards
EBTs (25 studies) focused on pharmacological EBTs, 24 % on psychological
while 28 % focused on both pharmacological and psychological EBTs. Some
of the studies that focused on pharmacological EBTs showed a positive
response while others showed negative response. Most of the studies
reviewed under the pharmacological category assessed the participants’
response to the effectiveness of medication to prevent relapse to
alcohol addiction. A few of the reviewed studies focused on the use of a
pharmacological approach in treatment of opiate addiction.
Most of the studies that focused on psychosocial EBTs recorded a wide
acceptance of the EBTs in the treatment of addiction. For example,
Willenbring identified that 93 % positive response for adoption of
cognitive behavioral approach for prevention of relapse. Moreover, both
clinicians and addicts recruited in the research agreed on the use of
psychosocial EBTs to treat addiction and prevent relapse.
The results indicate that 31 out of 65 studies reviewed focused on the
adoption of EBTs. Eighteen percent of them focused on pharmacological
EBTs 29 % on psychosocial and 13 focused on both pharmacological and
psychosocial EBTs. The researcher identified that the preference for the
adoption of naltrexone reduced with time. However, the reduction in the
rate of adoption with time could not be monitored after approval of
buprenorphine in 2002 because there were limited research works
available. The research works that evaluated the adoption of
psychosocial EBTs identified the support of the adoption by the majority
of respondents including the addicts and professional groups. For
example, one the reviewed studies, conducted by Knudsen et al 2003, 55 %
adoption in the rural and 48 %, in the urban.
Results also indicate that 14 % of the 65 studies focused on the
implementation of EBTs. The only study (Kovas et al 2007) that met the
inclusion criteria for pharmacological EBTs indicated that addictions
that underwent medication had a prolonged life (67 %) compared to the
addicts pharmacological EBTs. Five qualitative studies that examined the
implementation of psychosocial EBTs identified the concerns about the
capacity to meet the needs addict. Similarly, the results of
quantitative research indicated a positive response for the
implementation process.
There are several limitations noticed in the research conducted by Bryan
(2009). First, the all the studies reviewed had been conducted in the
United States. The weakness with the assumption that the population of
the United States can be used to represent other parts of the world may
be misleading. This is because the adoption, implementation, and
attitude towards EBTs may vary. Secondly, the review was based on
research works that had relied on cross-sectional survey and
characterized by low rates of response. This may limit the capacity of
the study to give the reality on the ground about the effectiveness of
EBTs in treatment of addiction.
The results of the research conducted by Palepu (2012) show that 33 % of
the participants were female 32.1 % of the total participants were
aboriginal ancestry, and the median age of the study participants was
42.2 years. Mental health diagnosis was based on schizophrenia (3 %),
attention deficit (5.9 %), post traumatic stress disorder (6.1 %),
bi-polar affective disorder (7.6 %), and anxiety disorder (12.2 %), and
depression (29.3 %). The wide range of mental disorders assessed in the
study suggests that the research placed more emphasis on mental illness
than addiction.
The results for assessment of the effect of stable housing in the
treatment of addiction show that 21.3 % of the study participants had
acquired some stable housing during the study follow-up. During the
baseline study, only 38.3 % of the participants were under the addiction
treatment program. This proportion had increased by 7.5 % during the
follow-up. The increase in the number of participants with stable
housing and participants under treatment program may be a viable
indicator of the contribution made by acquisition of stable housing to
participate in addition treatment programs. However, the study failed to
capture the contribution of other factors especially the civic
education.
The result on the regression model indicated a lack of association
between attainment of stable housing and treatment of addiction. The
results presented were for the assessment of relevant factors including
income assistance, an injection of cocaine, and daily injections of
heroin. The results indicate a lack of association between crack and
cocaine injection with p = 0.38 and p = 0.95 respectively. This was an
indication of negative, but non-statically association.
Byun et al (2009) presented the result in four different sections. The
first section analyzed the methods that were used to measure internet
addiction in 1996-2006. The author noticed that the Diagnostic and
Statistical Manual of Mental Disorders (DSM) handbook is the frequently
used tool in analyzing internet addiction. Some internet users used
Internet-Related Addictive Behavior Inventory, which was developed by
Brenner. The tool uses true and false questions to assess internet
addiction. Other tools used to determine internet addiction include the
Pathological Internet User scale, Structured Clinical Interview for
Diagnostic and Statistical Manual of Mental Disorder-IV.
In the second part of the article, the author outlined the different
aspects of internet addiction that have been investigated in the
research works of 1996-2006. The author identified that the primary
aspects of internet addiction that were frequently investigated include
low interpersonal skills, level of intelligence, and the personality of
the study participant. In addition, the author managed to identify the
predictors of internet addiction such as sensation seeking, shyness,
loneliness, and depression. Other researchers aimed at establishing the
relationship between the use of internet and interpersonal skills,
attention deficit, and personality. Although the article presents
crucial aspects of internet addiction, it failed to address specific
areas within the broad topic. The study should have focused on specific
aspects of internet addiction such the association between internet
addiction and individual personalities or identification of predictors
of internet addiction.
The third and fourth sections present the results for the methods used
in the selection of respondents and methods used in data analysis
respectively. Most researchers recruited their participants through the
internet. This was an appropriate approach given that the studies
targeted the users of the internet. However, a few cases of biased
selection were noticed where some researchers (such as Armstrong et al)
used convenience sampling to recruit their participants. It is evident
that this was an intentional bias and the work should have been excluded
from the review. The researcher identified that most researchers applied
exploratory methods of data analysis, which was reasonable given that
their studies were investigating different characteristics of internet
addiction. Some of these approaches include the ANOVA, t-test,
Chi-square test, and step-wise regression analysis.
Discussion
The current research addressed the causes and treatment of different
forms of addiction. The research by Bryan (2009) supported this theme
given that the author managed to assess the effectiveness of
pharmacological EBTs, psychosocial EBTs, and the combination of
pharmacological and psychosocial EBTs in the treatment of addiction. One
of the strengths of this research includes the large number (992) of
studies that were reviewed. This offered the researcher a sufficient
ground to assess the methods of treatment in 1998-2008. The major
weakness of this review is that the research reviewed studies within a
limited geographical region that is the United States. Based on this
weakness, it will be important that the future research review research
from different parts of the world. This will help in the determination
of whether the pharmacological EBTs, psychosocial EBTs, and the
combination of the two types of EBTs are effective in all parts of the
world, which are characterized by different economic, cultural, and
religious practices.
The cohort research conducted by Palepu (2012) is a study that was based
on speech variables unlike other studies reviewed in the current
research, which considered several variables. Researcher identified lack
of significance association between addiction treatment and stable
housing among the injection drug users. However, failure of the study to
meet the statistical significance was a main weakness. This challenge
was experienced during the third trial where the clients who had been
assigned abstinent contingent housing were noted to have a higher
proportion in stable housing at 6 months (42 %) than the participants
who had the housing not contingent on abstinence (33 %). The second
weakness of the research is the limited generalizability as a result of
recruitment of participants with varying characteristics at different
levels of trial. For an example, the researcher recruited participants
of different economic status in the trials. This was a weakness because
participants with higher economic benefits had the capacity to access
and utilize health services. Based on this weakness, a future study
should recruit individuals with similar characteristics such as economic
status to allow generalizability of findings and conclusion drawn from
the research. Moreover, the future research should apply other
statistical approaches such as Chi-square test of association and
regression instead of Birmingam model.
The meta-synthesis research conducted by Byun et al (2009) addressed the
wide topic of addiction, and this reduced its capacity to offer any
effect. In addition, most of the research work reviewed had applied
inconsistent approached especially in the recruitment of study
participants, research variables, and varying definition of internet
addiction. However, one of the strengths of the study is the length of
the period covered (1996-2006), which was sufficient to study the trends
and progress in the research over time. Following these weaknesses, the
research could not establish the causal relationship between predictors
of internet addiction. Future research should review research works that
address specific topics related to internet addiction and apply standard
approach. The future research should seek to establish casual
relationship between variables instead, in addition to the degree of,
association.
Reference
Beresin, S. (2013). Addiction: What is addiction? Retrieved May 12,
2013, from http://www.psyc hologytoday.com/basics/addiction
Brody, J. (2013). Effective addiction treatment. Personal health.
Retrieved May 12, 2013, from,
http://well.blogs.nytimes.com/2013/02/04/effective-addiction-treatment/
Bryan, G. (2009). Research on the diffusion of evidence-based treatment.
Systematic review. Substance Abuse Treatment, 36 (3), 377-398. Retrieved
May 12, 2013, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2695403/
Byun, B. et al, (2009). Internet addiction: Meta-synthesis of 1996-2006
Quantitative research. Cyber Psychology & Behavior, 12 (2), 203-206.
Palepu, A., Marshal, D., Lai, C. & Kerr, T. (2012). Addiction treatment
and stable housing among a cohort of injection drug users. PloS ONE, 5
(7), Retrieved May 12, 2013, from,
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011697
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