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)?