<p> Substance Abuse (aka Addictive Behaviors)</p><p>Definition: Excessive consumption of a chemical reinforcer that produces deleterious consequences to health or social functioning</p><p>Prevalence: Drugs: 5%, Alcohol: 10%, Tobacco: 30%</p><p>Risks: Cardiovascular disease, liver disease, cancer, overdose, etc.</p><p>General Approaches to Treatment Unspecified counseling Abstinence programs (e.g., AA) Moderation programs (controlled consumption)</p><p>What about other “addictions?” What about addiction as “disease?”</p><p>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</p><p>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”</p><p>General focus: Supplemental drug use by methadone-maintenance patients</p><p>Purpose of study: To evaluate the effects of reinforcement for benzodiazepine abstinence</p><p>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</p><p>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)?</p>