Outline and Evaluate the Behavioural Approach to Addiction

The Behavioural Approach Our point of departure is this: The Behaviourists knew that drugs / addictive behaviour “felt good” on a physical level. They also knew that most ADDICTS knew that their addictions are not ‘good for them’ So the question is WHY/HOW does the addictive behaviour persist despite this knowledge and wanting to stop it? The main assumption is that the addiction has become ‘conditioned’/‘learnt’/‘engrained’ to the point of being an (almost) automatic action; the question now is ‘how’.

Classical Conditioning CC is the ‘creation of associations’ in the human mind When it comes to addiction, two levels of associations occur: 1) between a pleasant environment/event and an addictive behaviour/substance 2) between that addictive behaviour/substance and environmental cues related to it. Whilst these do not account (much) for initiation, they can give an account for the maintenance/relapse of an addiction

Classical Conditioning - Process Unconditioned Stimulus (US) produces an Unconditioned Response (UR) US  UR US can become associated with a Neutral Stimulus (NS) to produce a Conditioned Stimulus (CS) US + NS  CS This CS leads to a Conditioned Response (CR) which mirrors the UR. CS (i.e. US + NS)  CR From there, the more the US and the NS co-occur to result in a CR, the more deeply engrained the NS is associate with CR NS  CR

Classical Conditioning - Smoking 1) ‘pleasant environment/event’ &‘addictive behaviour/substance’ US = sitting with friends UR = feel relaxed / happy NS = cigarettes CS (US + NS) = sitting with friends smoking CR = feel relaxed (associate cigarette with relaxation)  SO smoking becomes an ‘automatic’ way to relax when needed

Classical Conditioning - Smoking 2) Addictive behaviour/substance & related environmental cues Through CC, other associations are made between the ‘urge to smoke’ [US] leading to smoking [UR] and the environmental cues present at those times [NS], so that in time those cues become a CS to smoking (secondary reinforces). Likewise, when nicotine is lacking [US] leading to withdrawal [UR], certain cues (NS) may repeatedly be present, which in time themselves become a CS to ‘withdrawal’ symptoms

Classical Conditioning - Gambling OVER TO YOU!! 1) ‘pleasant environment/event’ &‘addictive behaviour/substance’ US = UR = NS = CS (US + NS) = CR = 2) Addictive behaviour/substance & related environmental cues

Operant Conditioning This Operant stuff an get very confusing; just remember that: Reinforcement encourages / increases a behaviour, in the context of addiction, something that reinforces the addictive behaviour  maintenance of addiction. Punishment decreases / diminishes a behaviours, in the context of addiction, something that punishes attempts to reduce / stop the addictive behaviour – relapse of addiction ‘Positive’ means giving the subject something, either a pleasant thing or an unpleasant thing. ‘Negative’ means taking away something from subject, either a pleasant thing or an unpleasant thing.

Based on the above, come up with one example for each of the categories for smoking & gambling (physiological, psychological, social and financial)

Social Learning Theory Brings together both classical and operant and extends them looking at observation and communication within the social context Explains initiation better than the other two, since reinforcement can be provided vicariously Benda et al (1997): peer group influences are the primary influence for adolescents taking up smoking/ drug taking

Intervention – Aversion therapy: Based on Classical conditioning Pairing of an aversive stimulus with a specific addiction response; e.g. Emetic+ alcohol = Sick = Free of addiction Meyer : aversion therapy is better than no therapy at all, and half their patients abstained at least one year after treatment Roth & Fonagy (1996): when using random control trials to test emetics and electric shocks, the results weren’t consistent but it appeared a short term impact in both technique Smith (1992): Aversion therapy(drugs/electric shocks) – higher rates of abstinence but low sustainability over 12 months vs counselling

Intervention – Behaviour reinforcement Based on operant conditioning Clear urine sample = voucher ($2.50). Increases by $1.50 for every consecutive clean sample [Higgins et al (1994)] Contingency management(CM) = environmental contingencies play an important role in encouraging/discouraging behaviour Teaching patients and those close to them to reinforce (reward) behaviour which is inconsistent with the undesirable behaviour e.g. Avoiding situations associated with gambling Azrin: consistent findings show that CM is cost effective and one of the most effective treatments available Petry (2010): Less % of relapse when treating alcoholics with CM vs standard outpatient treatments