Substance Abuse (aka Addictive Behaviors)
Definition: Excessive consumption of a chemical reinforcer that produces deleterious
consequences to health or social functioning
Prevalence: Drugs: 5%, Alcohol: 10%, Tobacco: 30%
Risks: CHD, liver disease, cancer, overdose, etc.
General Approaches to Treatment
Unspecified counseling
Abstinence programs (e.g., AA)
Moderation programs (controlled consumption)
What about other “addictions?”
What about addiction as “disease?”
Behavioral Interventions: Antecedent events
Modeling
Consumption rate by alcoholics (Caudill & Lipscomb, 1980)
Modification of response topography
Puff frequency and duration (Frederickson & Simon, 1978)
Stimulus fading
Scheduled access to locked cigarette case (Azrin & Powell, 1968)
Nicotine (cigarette brand) fading) (Foxx & Brown, 1979)
Behavioral Interventions: Consequences
Self-management programs (most common)
Multicomponent, controlled smoking program (Malott, Glasgow, O’Neill, & Klesges,
1984)
Reinforcement contingencies
Points ($) for cocaine and marijuana abstinence (Budney, Higgins, Delaney, Kent, &
Bickel, 1991)
Selection from Sr menu for benzodiazepine abstinence (Stitzer, Bigelow, Leibson, &
Hawthorne, 1982)
Aversive conditioning
Shock for cigarette smoking (DeRicco, Brigham, & Garlington, 1971)
Shock for alcohol consumption (Wilson, Leaf, & Nathan, 1975)
Anabuse studies also would go here
Prevention
Risk factor intervention: Chemical consumption itself is the only well-established risk factor
for addiction
Educational approaches: Emphasis on moderation (alcohol) or abstinence (drugs, smoking)
Contingency management approaches: Laws and other sanctions
Stitzer, Bigelow, Leibson, & Hawthorne (1982)
“Contingent reinforcement for benzodiadepine-free urines: Evaluation of a drug abuse
prevention program”
General focus: Supplemental drug use by methadone-maintenance patients
Purpose of study: To evaluate the effects of reinforcement for benzodiazepine abstinence
Procedures
Participants: 10 male methadone-maintenance patients w/ history of benzodiazepine
supplementation
DV:
Benzodiazepine-free urines
Monday & Friday urine tests
EMIT & TLC analysis
Conditions:
Baseline: Daily methadone at clinic, M & F urine tests
Treatment (choice of reinforcers for benzodiazine-free urine):
2 methadone take-home doses
$15 cash
2 methadone self-regulating doses (± 20 mg)
Experimental design: ABA reversal
Results
Individual patterns of results:
Benzo ∆- during treatment (BD, MJ, AS, MK, PT)
Benzo ∆- but loss of control (MC, NC, BH)
Cyclical responding (SD, but note NC also)
No apparent change (BB, but note NC and SD also)
Other drug supplementation (Table 3): About half of Ss used other drugs
Reinforcer choices:
63% money
37% take-home doses
Zero dosage self-regulation
Implications and Extensions
Major contributions:
Demonstrated effectiveness of DRO contingencies for abstinence from supplemental drug
use
Relatively accurate outcome measure
Use of practical reinforcers (take-home doses)
Limitations:
Half of Ss showed no effect, poor maintenance, other drug usage
Long-term effectiveness unknown
Extensions:
Smoking cessation programs (CO measurement)
What about extinction (e.g., Naltrexone)?