Substance Abuse (aka Addictive Behaviors)



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: Cardiovascular disease, 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)?

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