The Behavioral Perspective
From the behavioral perspective, an addiction is a maladaptive way to cope with difficulties and to satisfy unmet needs in life. Behaviorally, the person who is addicted to drugs or alcohol is experiencing a learned sequence of behaviors acquired over time in response to problems or circumstances in life.
An addiction is a learned behavior that may have resulted from observing other persons coping with stressors through the use of substances. An addiction also can develop after a person has a rewarding experience with the physiological effects of alcohol or drugs. Once a person finds that the depressive or stimulating properties of drugs or alcohol have desirable effects, that person will use the substances to cope with stressors and other negative states. Substance abuse can become a preferred coping behavior, as substances work fairly rapidly. Also, ingesting these substances usually takes little effort. Repeatedly using a substance to cope with personal or situational problems leads to an addictive pattern of abuse.
Addiction from the behavioral perspective can be summarized as follows: a stressor triggers the need for coping, a substance is obtained and used, its effects are experienced, the negative feelings from the stressor are blunted, and, consequently, the substance is used in greater quantities to mitigate personal or situational problems. This learned pattern then becomes an addiction from which the person is unwilling or unable to break.
Learning Theory Foundations
The behavioral therapies for addictions are based upon the early research conducted by Ivan Pavlov and B. F. Skinner. Pavlov studied the concept of classical conditioning, in which a neutral stimulus that previously did not evoke any positive or negative response could be conditioned to produce a positive or negative response. This classical conditioning paradigm involved the pairing of the neutral stimulus with a reward or punishment. When associated with a rewarding stimulus, a positive response to the neutral stimulus emerged. A negative or punishing stimulus when paired with the neutral stimulus would produce a negative or avoidance response.
Skinner is known for his work with operant conditioning
, which showed the power of positive reinforcement or reward in producing and maintaining responses. Skinner showed that a person will learn behavior that has been positively reinforced and will keep responding to earn the reward.
The foundations of classical and operant conditioning demonstrate that the pattern of addiction can be explained through the application of learning principles. Neutral settings may become classically conditioned to promote substance use and abuse through the power of rewards. Operant conditioning strengthens the behaviors associated with addictions, as the substance may initially manage stressors in a person’s life and then reward the person for engaging in the addictive actions. The behavioral therapies focus on reversing the previous patterns of classical and operant conditioning that produced the addiction patterns.
Treatment from the Behavioral Perspective
The behavioral therapies for addictions focus on the emotional or situational factors that promote episodes of substance use and on the underlying factors that maintain the behaviors. These therapies seek to break the learned pattern that promotes addiction and to replace the maladaptive pattern with new adaptive behaviors. The triggers for the learned pattern are identified as the antecedents for the maladaptive addiction. This helps a therapist determine the occasions or reasons for the substance use.
A number of antecedents to the pattern of maladaptive substance use exists, so therapists seek to identify what has produced the pattern of addiction. Some common triggers or antecedents are social pressures, interpersonal conflicts, depressive moods, anger or frustration in life, chronic pain, poor role models, or settings where substances are routinely abused. Once a pattern has been learned, a number of factors can contribute to its maintenance.
The addictive pattern can continue because of the physiological effects of a substance, because of a reduction in anxiety, or because of social reinforcement from others with similar addictions. For each person affected, treatment involves identifying the most common and powerful triggers or antecedents and developing behavioral strategies to learn effective ways to manage the triggering factors that had created the learned pattern of addiction.
Treatment can be difficult because each person may have significant behavioral deficits to overcome. Some persons may never have learned the coping skills or behaviors that would help them to handle personal or situational distress. Behavioral therapies not only try to break the pattern of addiction but also try to overcome skill deficits that keep a person from facing problems in an adaptive fashion.
Coping Skills
To overcome the detrimental long-term consequences of addictive behavior, treatment includes coping-skills training, a behavioral therapy designed to achieve abstinence and to learn adaptive behaviors. This training involves an initial functional analysis to determine the role of the addiction in the person’s life. Functional analysis shows what skills are lacking in the person’s behavioral repertoire, especially those skills needed to cope with situational or personal stressors, and shows how addictive behaviors have been used as ways to cope.
The clinical interview is used for the functional analysis in conjunction with a variety of assessment instruments. These instruments provide objective measures to identify the extent of the addiction behaviors. It has often been found in the functional analysis that a person’s emotional state is closely tied to the addiction. Feelings of depression, anxiety, loneliness, inadequacy, estrangement, and weakness are often inadequately managed because the person lacks effective coping skills. Substance use and abuse or some other behavioral addiction become conditioned responses to unpleasant emotional states.
With the completion of the functional analysis, behavioral therapy then enters a treatment planning phase that focuses on skills to overcome addictive behavior. Two major categories of skills make up the treatment planning phase: intrapersonal and interpersonal.
Intrapersonal skills involve the person’s decision-making patterns and problem-solving capabilities. Intrapersonal-skills training helps to improve a person’s ability to think through stressor situations (and anticipate problems) and then to select adaptive ways of coping with the situation or feeling. New ways of acting and thinking about problems or feeling states can be reinforced, resulting in a new pattern of behavior learned through the assistance of a behavioral therapist.
Interpersonal-skills training seeks to overcome problems with familial and social interactions. Behavioral therapies attempt to refresh or teach the skills needed for effective interpersonal relationships. The person with a substance abuse problem needs to learn how to refuse invitations from others to take substances and to avoid the social contexts that may reinforce addictive behaviors.
Having inadequate social skills also can contribute to feelings of loneliness and inadequacy. Interpersonal-skills training can bolster self-esteem and enhance a person’s resistance to addiction.
Training in Action
Coping-skills training begins with the establishment of specific behavioral goals that focus on the elimination and management of the triggers for substance abuse or behavioral addictions. Behavioral goals, which are regularly reviewed at the beginning of each therapy session, can be covered in an individual, group, or family format. Contingency management, the major technique used in behavioral therapy, attempts to modify a behavioral response by controlling the consequences of that response. Patients are rewarded when their adaptive behavior adheres with their behavioral goals. Failure to adhere to the behavioral goals in a treatment plan leads to a loss of reinforcement or reward. Contingency management is based upon the basic principles of operant conditioning, which predict that if a good or desirable behavior is rewarded, it is more likely to be repeated.
A component of contingency management is stimulus control. This is a procedure that is used to help a patient avoid or leave a situation that leads to substance abuse or behavioral addictions. Stimulus control is basically learning to pay attention to characteristics in the environment that can promote or trigger the pattern of addiction. Behavioral therapy is expanded for individual patients to whatever areas can promote adaptive function; it can include skill development in the areas of communication, parenting, time management, and occupational training.
Bibliography
Azrin, Donahue, et al. “Family Behavior Therapy for Substance Abuse and Other Associated Problems: A Review of Its Intervention Components and Applicability.” Behavior Modification 33 (2009): 495–519. Print.
Hougue, Aaron, et al. “Family Based Treatment for Adolescent Substance Abuse: Controlled Trials and New Horizons in Services Research.” Journal of Family Therapy 31 (2009): 126–54. Print.
Potenza, March, et al. “Neuroscience of Behavioral and Pharmacological Treatments for Addictions.” Neuron 69 (2011): 695–712. Print.
Witkiewitz, Katie, et al. “Behavioral Therapy across the Spectrum.” Alcohol Research 33 (2010): 313–19. Print.
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