Aim: To compare the effects of emotion regulation strategies that target smoking-related thoughts on behavioural, affective and subjective correlates of smoking. Method: Seventy-five participants were sequentially allocated to cognitive defusion (n=25), reappraisal (n=25) or suppression (n=25) conditions and applied these strategies to thoughts associated with smoking during a cue-induced craving procedure in a single experimental session. Dependent variables included smoking behaviour, behavioural approach/avoidance bias, and subjective measures of experiential avoidance, cue-induced craving, and affect. Results: Defusion and reappraisal were associated with restraint in smoking behaviour in the immediate post-session period and a reduction in smoking at seven day follow-up compared to suppression. Benefits for smoking behaviour were associated with a reduction in craving in the reappraisal condition and a greater reduction in experiential avoidance in the defusion condition. Those in the suppression condition exhibited the strongest approach bias for smoking related cues but also rating the strategy as having lower credibility and treatment expectancy relative to the two other conditions. Conclusion: Defusion and reappraisal resulted in similar benefits in terms of smoking-related behavioural outcomes. However, defusion and reappraisal were associated with distinctive experiential and affective outcomes. The results are considered in the context of lower credibility and expectancy ratings in the suppression condition and discussed with reference to the development of Cognitive Therapy and Acceptance and Commitment Therapy for addiction-related disorders.

International research has demonstrated the effectiveness of treatment for heroin abuse, yet many treatment-seekers fail to enter treatment when a place becomes available. Understanding the factors that encourage, or impede, treatment access and utilisation may help to attract more users into treatment. The waiting period prior to treatment entry is often listed among the most common barriers for those seeking treatment, yet little research has examined the motivation of substance users awaiting treatment entry or the patterns of substance use during this time. This research programme investigated the associations between treatment waiting times and motivation to change heroin use through two empirical studies. The first study examined the use of a measure of motivation - the SOCRATES - to assess changes in motivation in a sample of heroin users starting a new treatment episode. The results indicated that the measure was capable of detecting changes in motivation over a three-month period. In the second study, the SOCRATES examined changes in motivation among a sample of heroin users randomly allocated to short or prolonged waiting periods prior to treatment entry. The study found reductions in motivation over shorter waiting periods but no changes over more prolonged waits. Longer waiting periods were also associated with improvements in heroin use. Successful treatment entry was associated with motivation but not with the length of the waiting period. The research programme found motivation is subject to change over the waiting period, with many reporting reductions in their motivation, regardless of the duration of delay. These findings suggest that the waiting period represents a missed opportunity for intervention, many treatment-seekers may lose motivation for change and continue to be exposed to the risks associated with drug use at a time when they express a desire for change. With a better understanding of the waiting experience strategies such as motivational enhancements or support during the waiting period can be implemented to help encourage treatment seekers into treatment.

This research investigates the subjective experience of choice in heroin addiction. The aims were to investigate the perceived degree of control participants felt they had in relation to heroin use, and the impact this had on their lives. The idea of choice is the main aspect distinguishing the free-will model from the medical model in the field. Seven participants were interviewed for this study, two females and five males. The participants were recovering heroin addicts with length of recovery varying from 2 months to 7 years from different ethnicities and socially disadvantaged backgrounds. These were recruited and interviewed in two different 12 Step Model recovery centres. The analysis adopted Interpretative Phenomenological Analysis (IPA) as its qualitative approach as this was found to be most suitable for the experiential focus of this study’s question. The main themes were; ‘not belonging’, ‘heroin both gives and robs one’s identity’ and ‘lack of control leads to recovery.’ This research illustrates the limited choices the participants faced in their lives and how change was only possible through acknowledging one’s emotional response to a particular situation, rather than a cognitive response; whilst the participants took drugs to numb their emotions, it became impossible to make different choices in their lives. The importance of issues of identity, belonging and trauma were findings consistent with previous literature in the field of addiction. Recommendations for future research focus on a mixed methodology research showing the link between emotions and choices in reframing someone’s experience of addiction. Further recommendations would be a focused study on the impact of time in addiction and how the existential approach can contribute to enhancing treatment choices. By looking at how the existential phenomenological approach contributes to the field this research highlights possible preventative issues. The lack of choice is not attributed to disease but rather to a complex set of circumstances illustrated by the participant’s interviewed. The implication for those working in the field is to open up choices by focusing on how emotions are the primary way of changing and reinterpreting one’s life.

No description available.

We live in an environment in which alcohol is easily available and widely marketed. Alcohol advertising has been shown to increase long-term and short-term alcohol consumption. On the other hand, governments and industry use warning labels and public health campaigns to inform the public of the harmful effects of alcohol in an attempt reduce alcohol-related harm. There is not much evidence that labels and campaigns affect drinking behaviour, but evidence from other domains suggests that individual differences in attentional processing might moderate effects on behaviour. In this thesis, I tested the general hypothesis that individual differences in visual attention to alcohol cues and responsible drinking statements would underlie the effect of alcohol-related mass persuasion attempts (i.e., alcohol advertisements, warning labels and public health campaigns) on drinking behaviour and its antecedents, in young adult alcohol consumers. The secondary aim of this thesis was to examine the direct effect of alcohol-related mass persuasion attempts on drinking intentions and alcohol consumption shortly after exposure. To study this, I first conducted a cross-sectional study and a between-subjects experimental study to investigate attention to warning labels on alcohol packaging and examine whether priming participants to direct their attention to warning labels would prompt them to intend to drink less alcohol. Findings suggested that existing UK warning labels did not attract substantial attention and the amount of attention that participants directed to them did not affect their drinking intentions (Chapter 2). I subsequently conducted three experimental studies to examine to what extent novel warning labels would capture attention and affect willingness to pay for alcohol. Findings showed that novel warning labels did not attract more attention than existing warning labels, nor did they significantly influence willingness to pay for alcohol (Chapter 3). With regard to televised alcohol advertisements, I conducted a between-subjects experiment in a semi-naturalistic environment to investigate whether alcohol advertising affected proximal alcohol consumption in a brand-specific or general manner. Results suggested that alcohol advertising did not affect drinking behaviour, however methodological limitations mean that these findings should be interpreted with caution (Chapter 4). Next, I conducted two experimental studies to examine how individual differences in visual attention to alcohol cues and responsible drinking statements in alcohol-related television adverts predicted drinking intentions and proximal alcohol consumption. Findings showed that attention to responsible drinking statements did not predict drinking intentions or immediate alcohol consumption, but visual attention to alcohol portrayal (an actor sipping alcohol) in alcohol advertising predicted increased alcohol consumption in the laboratory (Chapter 5). Overall, these findings demonstrate that responsible drinking statements/labels attract limited attention and that increased attention to these labels does not prompt alcohol consumers to intend to reduce their drinking. I found no evidence that alcohol-related persuasion affected immediate alcohol consumption or drinking intentions, but attentional processing of alcohol portrayal in alcohol advertising was associated with increased alcohol consumption shortly after exposure to the adverts. Finally, I conducted a focus group study to explore subjective evaluations of current warning labels and responsible drinking adverts Findings showed that participants did not consider warning labels/adverts to be personally relevant and that they mistrusted the message source. Instead, participants suggested that warning messages focussing on alcohol-related harm (to themselves or others) might be more persuasive. Combined with the findings from the laboratory studies, these findings suggest responsible drinking statements could attract more attention if their content and format were changed. The findings reported in this thesis further our understanding of the role of attention in alcohol-related persuasion. In line with recently published evaluations of public health campaigns and warning labels, these studies suggest that warnings in alcohol advertising and on packaging in their current form have little scope for changing drinking behaviour. Instead, it might be more fruitful to increase the noticeability of warning labels and impose restrictions on alcohol marketing and/or the visual content used within alcohol marketing.

Background & Aims: The impact of an individual’s drug or alcohol use on their family members has been widely acknowledged and policy and clinical practice guidelines advise that drug and alcohol services offer family members practical and therapeutic support. However, research in this area is limited with a focus on the experiences of children affected by parental drug and alcohol use or how family members can help improve outcomes for their relatives in treatment for drug and alcohol use. Little is known about the experiences of affected adult family members in receipt of support services for themselves. The current research aimed to explore the impact that having a relative who uses drugs and/ or alcohol had on family members’ lives as well as affected family members’ experiences of seeking help for themselves. Method: Semi structured interviews were carried out with eleven adults affected by a family member’s drug and/or alcohol use and receiving support from a family, partners and friends service in London. Interviews were transcribed verbatim and analysed using thematic analysis (TA), informed by Braun and Clarke’s (2006) six-phase model of TA and underpinned by a critical realist epistemology. Results: The analysis produced five main themes across the data. Each indicated important factors in the journey of having a relative who uses drugs or alcohol. The themes were: ‘family members’ distress’; ‘ruptures in relationships’; ‘responsibility’; ‘routes to receiving help’ and ‘relieving the pressure’ Conclusion: The results of the analysis highlight the multi-faceted impact of drug and alcohol use on affected family members’ lives as well as the ways that services could help to facilitate help seeking. Findings support previous literature surrounding affected family members and drug and alcohol use and offer new insights into family members’ motivations for seeking help, as well as why many family members become isolated. The findings highlight the need for ongoing research in this area. Implications for future research, policy and clinical practice are discussed.

Substance misuse is a complex issue, fraught with many challenges for those affected. Whilst the literature suggests that pregnancy may be a ‘window of opportunity’ for substance misusing women, it also suggests that there are several barriers to women engaging with health care. One of these is the fear of being judged and stigmatised by healthcare professionals, including midwives. Previous research indicates that midwives have negative regard toward substance users and that this in turn may lead to stigmatising behaviours and consequential substandard care provision. Midwives however, stress that they do not have appropriate training to be able to effectively provide appropriate care for substance misusers. Research suggests that education (formal training) is needed in this area to improve attitudes. In this study, the role of education in changing attitude toward substance use in pregnancy was explored using case study methodology. The case was a single delivery of a university degree programme distance learning module ‘Substance Misusing Parents,’ undertaken by 48 final year student midwives across 8 NHS Trusts. The research was carried out in 3 phases, using a mixture of Likert style questionnaires (Jefferson Scale of Physician Empathy and Medical Condition Regard Scale), Virtual Learning Environment discussion board qualitative data and semi structured interviews. The findings of the questionnaires showed that whilst general empathy levels showed no significant change (p=0.539), empathy toward pregnant drug using women showed a statistically significant improvement following the module (p=0.012). Furthermore, exploration of the students’ experiences of the module demonstrated the importance of sharing and reflecting on practice with peers; the experiences of drug users, both positive and negative; and having an opportunity to make sense of these experiences, thus bridging the ‘theory-practice divide,’ as key in influencing their views. Furthermore the findings indicated value in the mode of delivery of such education, suggesting e-learning to be an effective approach, offering not only knowledge gain in terms of the content, but in wider research and critical thinking skills. This research demonstrates the potential of education in this area but also offers suggestions for effective methods of educational delivery to potentially help reduce stigma in other areas of practice.

No description available.

Background: Treatment engagement is a major factor contributing to favourable outcome of drug treatment, but high dropout rates persist. It has remained difficult to draw conclusions regarding specific predictors of engagement, but there is a clear need to identify and target clients’ major attrition vulnerabilities. Despite evidence of the association of personality with drug misuse, little is known about its role in the treatment process. Aims: This study set out to examine whether, and to what extent, personality functioning contributes to or hinders individuals’ treatment journeys. The study examined service users’ personality characteristics as potential determinants of treatment initiation, engagement and completion and whether characteristic adaptations are malleable during treatment. Methodology: A longitudinal multi-site design was utilized, examining the therapy process in a naturalistic setting in outpatient and inpatient treatment centres. The first part of the study examined whether service users’ personality traits (TPQue) and characteristic adaptations (SIPP-118) predict treatment initiation (CEST-Intake), involving n = 200 from 5 outpatient preparation treatment centres. The second part examined whether characteristic adaptations predict treatment engagement (CEST) and completion involving n = 340 participants from 6 inpatient centres. Multivariate regression analyses were applied for hypotheses testing. The final part of the study explored the malleability of characteristic adaptations and examined whether clinically significant change occurred in dysfunctional characteristic adaptations (n = 70). A series of mixed between-within subject analyses of variance were conducted to compare service users who dropped out and those who completed treatment across the two-time periods. Results: Findings indicated that certain dysfunctional characteristic adaptations are associated with treatment initiation (RQ1) and drop out (RQ3). Broad and facet level characteristic adaptation emerged as strong predictors on different segments of treatment engagement (RQ2). Dysfunctional levels on Self-control and Relational capacities significantly predicted low counselling rapport and treatment participation. The analyses at the facet level provided additional insight of the important role of Identity and Relational capacities on initiation, engagement and treatment completion. The final step shed light on the malleability of characteristic adaptations during treatment and revealed that completers had more functional characteristic adaptations at baseline and had higher levels of significant clinical improvement (RQ4). Only Social concordance remained unchanged at the second inpatient time point. This has important clinical implications considering that Social concordance and especially the Aggression regulation facet was the strongest predictor of treatment initiation, counselling rapport and treatment completion. Conclusions: These findings extend our knowledge of the predictive role of characteristic adaptations in the treatment process, and suggest it may be important to capture these individual differences early on. Delineating the role of characteristic adaptations in treatment engagement and their sensitivity to change under treatment may provide the basis for enhancing treatment specificity through individualized interventions that are scientifically-driven and empirically-validated. This is of major clinical relevance, since it provides a node-link mapping of early warning signs of individuals’ maladaptive areas that require clinical attention and may open new avenues for the scientific enquiry of personality and treatment.

Background Unlike many other psychiatric conditions, individuals with drug dependence pass through a number of intermediate stages before developing a clinical condition. Studying variation in speeds of transitions between these stages provides novel insights into Substance Use Disorder aetiology. Aims To explore: 1. Relationships between early cannabis transitions and later outcomes; 2. Relationships between individual, childhood, mental health and drug use factors and transitions; 3. The extent to which speed of early cannabis transitions are influenced by genes and environment, and the genetic correlation with dependence; 4. The relationship between early heroin transitions and later heroin outcomes, and the effect of route of administration. Design Three samples were analysed: 1) 3824 Australian twins and siblings; 2) 93 opiate substitution treatment clients; 3) 408 heroin users. Methods Cox PH Survival Analysis; Regression Analysis; Classic and Bivariate Twin Modelling. Findings Early onset of first opportunity to use (OTU) cannabis was associated with increased risks of later cannabis use outcomes, with those who reported first OTU before age 14 being twice as likely to report cannabis daily use, abuse/dependence or treatment-seeking relative to those whose first OTU occurred after age 18. Faster progression to subsequent cannabis use was associated with increased risks of later cannabis use outcomes, with those whose subsequent use was within a week of initiation being twice as likely to report cannabis daily use, and more likely to abuse/dependence, relative to those whose subsequent use was more than year after initiation. Conduct disorder, weekly tobacco use, male gender and parental drug problems were associated with faster progression to both OTU cannabis, and from opportunity to dependence. A genetic correlation of .54 was observed between age of OTU cannabis and cannabis abuse/dependence. Early OTU heroin was associated with three times likelihood of overdose and neck/groin injecting. Injecting heroin was associated with faster progression to daily use. Conclusions Considering the stage-sequential nature of drug use has identified factors associated with dependence that also influence behaviour from the earliest stage of drug involvement, and has revealed potential targets for intervention.