1. MSc in Addiction Studies Learning Theories of Addiction Operant conditioning, social learning theory and contingency management

2. Learning objectives After you have completed this lecture you will be able to; ▫Describe the main concepts associated with operant conditioning, social learning theory and contingency management ▫Describe the relevance of operant conditioning within addiction and relapse ▫Discuss the theoretical basis for contingency management and appraise its effectiveness

3. Operant conditioning Skinner (1938) Behaviours are learnt through the process of reinforcement by punishment or reward ▫Positive reinforcement – Increases the probability of a behaviour by giving a reward ▫Negative reinforcement – increases the probability of a behaviour by taking away discomfort ▫Punishment – decreases the probability of a behaviour as the person will want to avoid it (terminate or avoid)

4. Skinner box

5. Reinforcement schedules What factors would effect strength of the reinforcer?

6. Reinforcement schedules continued… Occasional reinforcement Contiguity – reinforcements/punishments closely linked in time Different schedules of reinforcement ▫Continuous reinforcement ▫Partial reinforcement

7. Operant conditioning in drug addiction Drugs of abuse are powerful positive reinforcers Animal self-administration studies - ▫e.g. Aigner and Balster (1978), rhesus monkeys given the choice between cocaine and food, choose cocaine.

8. Contingency management (CM) Providing incentives to change behaviour and/or engage with treatment How might contingency management be used in substance misuse services?

9. CM schedules Fixed monetary incentive ▫Hep B vaccines, ConMan – one-off monetary payment ▫Adherence to TB treatment in injection drug and cocaine users (Malotte et al.2001) Escalating monetary incentive ▫Abstinence cannabis (Budney et al., 2000) ▫Naltrexone adherence in opiate dependence (Preston et al. 1999)

10. CM schedules continued… Prize based ▫Fish-bowl (Petry) ▫Alcohol – abstinence and/or attendance ▫Abstinence from methamphetamine (Roll et al., 2006), ▫Adherence to antiretroviral medication for HIV (Rosen et al., 2007) Other reinforcers ▫Methadone take-homes, dosage decrease, progression to next stage of the programme, discharge from treatment (see Prendergast 2006 for a review)

11. Effectiveness of CM What factors impact on the effectiveness of CM? What need to be considered when designing a CM protocol?

12. Summary so far Operant conditioning and Skinners experiments Contingency management ▫How it can be used in the treatment of substance misuse ▫Different schedules – what needs to be considered when designing a schedule ▫The long-term effectiveness of CM

13. Social learning theory (SLT) Behaviour is learnt through observation and experience within a social environment ▫Modelling – learn about the outcomes of a behaviour by observing others. ▫Bandura bobo doll experiments

14. Reciprocal determinism BehaviourEnvironmentPerson

15. SLT and relapse Self-efficacy – the degree to which a person feels competent or capable of performing an action ▫Predict likelihood of attempting to abstain ▫Abstinence violation effect – the effects and consequences of not remaining abstinent Marlatt and George (1984) ▫Contact with cues increases risk of relapse ▫Arouse positive outcome expectancies and trigger motivation to use drugs 4 ▫Resources available to the person to be able to abstain

16. Summary Operant conditioning and Skinner CM – what is it how can it be used in the treatment of substance abuse Important factors when developing a CM schedule Social learning theory - Bandura Social learning theory and relapse in addiction

17. Learning objectives After you have completed this lecture you will be able to; ▫Describe the main concepts associated with operant conditioning, social learning theory and contingency management ▫Describe the relevance of operant conditioning within addiction and relapse ▫Discuss the theoretical basis for contingency management and appraise its effectiveness

18. Reading Essential ▫Moss AC & Dyer KR. (2010) Psychlogy of Addictive Behaviour. Basingstoke UK: Palgrave MacMillan. Chapter 3 Recommended ▫West R. (2006). Theory of Addiction. London: Blackwell Publishing Additional ▫Prendergast M, Podus D, Finney J, Greenwell L, Roll J. (2006). Contingency management for treatment of substance use disorders: a meta-analysis. Addiction. 101, 1546-1560

19. References Aigner TG & Balster RL. (1978). Choise behaviour in rhesus monkeys: cocaine vs food. Science. 201, 534-535 Budney AJ, Higgins ST, Radonovich KJ, Novy PL. 2000). Adding voucher-based incentives to coping skills and motivational enhancement improves outcomes during treatment for marijuana dependence. Journal of Consulting and Clinical Psychology. 68, 1051-1061 Malotte CK, Hollingshead JR, Michelle L. (2001). Incentives vs. outreach workers for latent Tuberculosis treatment in drug users. American Journal of Preventative Medicine. 20, 103-107 Marlatt GA, George WH. (1984). Relapse prevention: introduction and overview of the model. Addiction. 79, 261-273 Prendergast M, Podus D, Finney J, Greenwell L, Roll J. (2006). Contingency management for treatment of substance use disorders: a meta-analysis. Addiction. 101, 1546-1560 Preston KL, Silverman K, Umbricht A, DeJesus A, Montoya ID, Schuster CR. (1999). Improvement in naltrexone treatment compliance with contingency management. Drug and Alcohol Dependence. 54, 127-135 Roll JM, Petry NM, Stitzer ML et al. (2006). Contingency management for the treatment of methamphetamine use disorders. American Journal of psychiatry. 163, 1993-1999 Rosen MI, Dieckhaus K, McHahon TJ, Valdes B, Petry NM, Cramer J, Rounsaville B. (2007). Improved adherence with contingency management. AIDSPatient care and STDs. 21:1 DOI: 10.1089/apc.2006.0028 Skinner B F. (1938). The Behavior of Organisms: An Experimental Analysis. New York: Appleton-Century