1. Moral / Temperance ModelAddiction as Sin or Crime Personal Irresponsibility Disease Model Genetic and Biological Factors ** 12-Step Framework; Abstinence Education as Treatment Behavioral Conditioning and Reinforcement Cognitive-Behavioral and Drug Expectancies; REBT Social Learning Models Cognitive Therapy; Modeling Relapse Prevention MODELS OF ADDICTION: A SUMMARY

2. Behavioral Models Classical conditioning vs. Operant learning Initiation of substance use – Primary classes of reinforcers – Behavioral tolerance

3. Rats: heroin tolerant Control rats: No heroin tolerance Received injection of heroin 15 mg/kg in familiar environment Received injection of heroin 15 mg/kg in unfamiliar environment Received injection of heroin 15 mg/kg for first time Overdose rate: 32% Overdose rate: 64% Overdose rate: 96% To some degree, drug tolerance is associated with environmental factors. Tolerance may disappear or decrease if a drug is used in an unfamiliar environment. A diagram of Siegel’s rat experiment

4. Behavioral Models Contingency contracting (begins with A-B-C) – CRA – Outpt. TX for cocaine (Higgins) – Token economies in residential settings Reciprocity contracting (e.g., Antabuse contract)

5. Social-Cognitive Models SLT’s Reciprocal Determinism: B-P-E Modeling Self-efficacy (outcome & efficacy expectations) Relapse Prevention a. Addressing ambivalence b. Reduce drug availability - physical vs. psychological availability - identify triggers and high risk situations (e.g., conditioned cues) - avoiding wrong people, places, situations - money/cash - drinking, other drugs - need for mood monitoring; craving monitoring

6. Relapse Prevention (con’t) c. Coping with High Risk Situations - social skills, assertiveness training - drink refusal skills - urge surfing d. Vigilance through knowledge about thinking -> feeling -> behavior chain (REBT) - apparently irrelevant decisions (AIDS) - abstinence violation effect (AVE) - lapse vs relapse - use as a learning opportunity, not permission to use. Object not to catastrophize the lapse, but to prevent more use