Foundations of Addictions

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1 Foundations of Addictions Week 8 Glenn Maynard, LPC

2 Addiction as a maladaptive behavior This approach is grounded in psychology Model comes from classical conditioning, operative conditioning and social learning theory Addict is not responsible for the development of the addiction but is responsible for changing behavior

3 Classical (Pavlovian) Conditioning Prior to Pavlov, treatment for alcoholism included conditioning models Strycchine, tartar emetic and OD on alcohol were commonly used in the inebriate asylums If the alcoholic becomes sick enough will discontinue using alcohol

4 Pavlov s Dog Observed that a dog will salivate when presented with meat Salivation is the unconditioned response and the meat is the unconditioned stimulus When a bell was presented with the meat observed that after several trials, the bell elicits salivation The bell is the conditioned stimulus and salivation is the conditioned response

5 Operant (Skinnerian) Conditioning Behaviors are maintained by reinforcers that occur after the behavior Behavior appears voluntary Change in the rate of behavior is learning Reinforcers are changes in the environment that increase the frequency of behavior Positive reinforcers increase the frequency of behavior Negative reinforcers increase the frequency of behavior when they are removed

6 Examples of reinforcers Positive reinforcersfood money, social approval, sex Negative reinforcersfear, pain, social disapproval Primary reinforcerssatisfy basic human needs; food, water, escape from pain, sex Secondary reinforcersbecome associated with primary reinforcers; money is a secondary reinforcer

7 Generalization, Discrimination, and Extinction Generalization- responding in a new setting based on cues from an old setting Discrimination- learning different responses to similar stimuli Extinction-removal of reinforcer leads to cessation of behavior

8 Social Learning Emphasizes cognition and observation Modeling is an important reinforcer of behavior Person variables interact with situationsmost common person variables are encoding and expectancy (self-efficacy) Situations are reinforcing- contain cues that become learned

9 Learning and Maladaptive Behavior Addiction and abuse of drugs results from many reinforced episodes of drug use Drug has reinforcing properties as does the environment in which a drug(s) is used The reinforcement is a combination of classical, operant and social learning

10 Behavioral Definition of Addiction Operantly conditioned response which becomes stronger as a function of the quality, number, and size of reinforcers Categories of reinforcers: euphoria. Social variables, elimination of withdrawal sickness

11 Maladaptive Behavior Consistent with the history of behaviorism, the learning models are less interested in finding causes and are more interested in finding solutions Makes a direct connection between a person s expectations and environmental reinforcers

12 Contingency Management Functional Analysis What behavior is maladaptive? What behaviors should be increased or decreased What supports the behavior? Environmental contingencies, rewards? Punishers associated with avoiding use? What environmental changes can be manipulated to alter behavior?

13 Harm Reduction Proposed by Marlatt and based on learning principle of desensitization Recognizes that not everyone can start with abstinence Contracts for decreasing use of addictive drugs Highly controversial in AA and disease model communities but has empirical support

14 Assumptions of Behavioral Counseling Humans are neither good nor bad. They are experiencing organisms that have potential for all kinds of behavior Humans can conceptualize and control their behavior Humans are able to acquire new behavior Humans are able to influence and be influenced by others behavior

15 Controlled Drinking Studies of controlled drinking based on observation that some alcoholics may resume a normal pattern of drinking Longitudinal studies suggest that 10-30% of alcoholics become controlled drinkers Research suggests that severity of dependence and beliefs are major predictors of controlled drinking

16 Examples of Behavioral Approaches Controlled Drinking Contracting for Abstinence Community Reinforcement Training Behavioral Marital Therapy

17 Controlled Drinking and Abstinence Success Conditions associated with controlled drinking Lower severity of symptoms Younger age Employment Less contact with AA Conditions associated with abstinence Prior abstinence Contact with AA Self-label of alcoholic

18 COGNITIVE MODEL Elements of the Cognitive Model: Situation, Thoughts, Moods, Physical Reactions, Behavior. Situation > Thoughts > Moods >Physical Reactions > Behavior

19 COGNITIVE MODEL Core beliefs, intermediate beliefs, and automatic thoughts. Core Beliefs: basic belief about self, others and the world, which develops in childhood and remains very stable over time. Intermediate beliefs: attitudes, rules, and assumptions, which grow out of core beliefs. Automatic Thoughts: thoughts in response to a specific situation, which give meaning to the situation» Core Beliefs» Intermediate Beliefs Situation Automatic Thoughts > Moods

20 Principles of Cognitive Therapy 1.Cognitive therapy is based on an ever-evolving formulation of the client and his/her problems in cognitive terms. 2. Cognitive therapy requires a sound therapeutic alliance. 3. Cognitive therapy emphasizes collaboration and active participation. 4. Cognitive therapy is goal oriented and problem focused. 5. Cognitive therapy initially emphasizes the present. 6. Cognitive therapy is educative, aims to teach the client to be his/her own therapist, and emphasizes relapse prevention. Beck, Judith; Cognitive Therapy: Basics and Beyond; 1995

21 Principles of Cognitive Therapy 6. Cognitive therapy is educative, aims to teach the client to be his/her own therapist, and emphasizes relapse prevention. 7. Cognitive therapy aims to be time limited. 8. Cognitive therapy sessions are structured. 9. Cognitive therapy teaches clients to identify, evaluate, and respond to their own dysfunctional thoughts and beliefs 10. Cognitive therapy uses a variety of techniques to change thinking, mood, and behavior. Beck, Judith; Cognitive Therapy: Basics and Beyond; 1995

22 Goals of Cognitive Therapy 1. Monitor negative automatic thoughts 2.Recognize the connection between cognition, affect, and behavior 3. Examine the evidence for and against distorted automatic thoughts 4. Substitute more reality oriented interpretations for these biased cognitions 5. Learn to identify the beliefs that predispose the client to distort their experiences.

23 Relapse Prevention Behavioral and cognitive treatment approaches Goal is to identify high-risk situations for relapse Rehearsal of coping strategies Self-monitoring of craving and behavior Life style change

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