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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