According to American Psychological Association 1994, as quoted by Taggart and colleagues, substance abuse can be defined as the harmful consumption of alcohol, illegal drugs and/or over-dose of prescribed medicines which are harmful to the persons physical, psychological, interpersonal and social health within a period of 12-months’ (TAGGART, L et al., 2006). This definition is broad enough to explain the meaning and upshots of substance misuse. It is clear, hence, that substance misuse includes any kind of harmful intake of illicit and prohibited drugs, alcohol or medicines. As a consequence, this harmful intake of substances harms the physical, psychological and social heath of the person.
Psychological Factors and Substance Misuse:
[How do the ideas of Classical Conditioning and Operant Conditioning explain why someone might misuse drugs? How can these theories be applied to the treatment of substance misuse?]
The notion of ‘Substance Misuse’ or ‘Substance Abuse’ has gained remarkable concentration of the researchers over the past (CANTWELL, R et al., 1999; WEISS, Friedbert et al., 2000; MITCHELL, D. P. et al., 2002; KAVANAGH, David J. et al., 2004; GALEA, Sandro et al., 2005; TAGGART, L et al., 2006; SKEER, Margie et al., 2009; TREFFURTH, Yvonne and Pal, Hem Raj, 2010; IRO, Chinedu J. et al., 2011). Some of the researchers have looked upon it from intellectual disabilities perspective (TAGGART, L et al., 2006), while some have seen it in familial conflicts’ perspective (SKEER, Margie et al., 2009), still some others focused on the psychological point of view (CANTWELL, R et al., 1999; SILVERMAN, Kenneth, 2004; SAUNDERS, Lee L. and Krause, James S., 2011). Here, we are interested in the association between psychological factors (mental health, depression, intellectual impairment, attitudes, perceptions, etc) and the intent to involve in substance misuse. For that matter, I will first introduce the psychological factors that possibly affect the likelihood of substance misuse, proceeding towards the understanding of the two conditioning approaches, and finally discussing the relationship between classical and operant conditioning and the substance misuse.
Research has shown that among all other factors, the psychological and environmental (or social) factors have the greatest impact on a person’s inclination towards substance use, than the physical and/or demographic factors (SAUNDERS, Lee L. and Krause, James S., 2011). Particularly, substance misuse is mostly found in people with some kind of psychological disorder, such as psychosis (CANTWELL, R et al., 1999). Even within the time-period of psychotic disorder, the potency of substance misuse is highest at the onset of the disorder rather than later stages (CANTWELL, R et al., 1999). Correspondingly, psychological stress has shown to have close linkages with the intent to use and misuse substances (GALEA, Sandro et al., 2005; SKEER, Margie et al., 2009). The psycho-social stress coupled with urbanized living and high income-difference creates inter-personal tension and violence, that ultimately increases the likelihood of substance abuse (GALEA, Sandro et al., 2005). Akin to it, previous research has found close association between adverse familial conditions and psychological stress; and strong association between psychological stress and substance misuse disorders; but in separate studies (SKEER, Margie et al., 2009). However, Skeer and teammates (2009) proposed and found that family-life conflicts have strong impact on inclination to substance misuse through the mediating roles of psychological stress (SKEER, Margie et al., 2009).
From gender perspective, males are more prone to substance abuse than females (CANTWELL, R et al., 1999; TAGGART, L et al., 2006; SAUNDERS, Lee L. and Krause, James S., 2011). Taggart and his team members established that young males having mild intellectual or mental disorder face a high risk of substance misuse (TAGGART, L et al., 2006). Moreover, drinking and other substances’ misuse is found to be present at younger age. The coexistence of mental health issues and substance misuse disqualifies a young person to get an appropriate job. This unemployment eventually leads to social isolation of the person and ultimately to suicide attempts (MITCHELL, D. P. et al., 2002).
Classical and Operant Conditioning:
The contemporary philosophy of conditioning regards the classical and operant conditioning as a way to bring change in behavior. As said by Kirsch and colleagues, Classical Conditioning is a “type of learning that involves the acquisition of elicited responses (i.e., responses, like the defensive eye blink, that are preceded by an identifiable stimulus and that are reflexive or automatic) (KIRSCH, Irving et al., 2004, p.370). Operant Conditioning, on the other hand, refers to “a type of learning that involves the acquisition of emitted responses (i.e., responses, like a wink of the eye that can occur in the absence of well-defined antecedent stimuli and are experienced as voluntary) (KIRSCH, Irving et al., 2004, p.370). Seeing these definitions, we can infer that classical conditioning is somewhat usual and involuntary learning, whereas operant conditioning is controlled or voluntary behavior. Moreover, classical conditioning establishes that ‘behavioral responses are conditioned or learned’; while operant conditioning holds that ‘reinforcement increases behavior’ (GAZZANIGA, Michael S et al., 2006).
In order to scrutinize the association between conditioning theories and substance abuse, it is necessary to look upon some pivotal terms, as explained by (GAZZANIGA, Michael S et al., 2006):
1. Unconditioned Stimulus- stimulus that produces a response automatically
2. Unconditioned Response- response that occurs automatically, without previous learning
3. Conditioned Stimulus- stimulus that is provided along with unconditioned stimulus, that intends to produce original response
4. Conditioned Response- response that occurs in reaction to the conditioned/learned stimulus
5- Reinforcement/Reinforcer- according to B.F. Skinner, as mentioned in (GAZZANIGA, Michael S et al., 2006), a reinforcer is the stimulus that appears after a response, and increases the likely repetition of the response.
Relationship between Conditioning Theories and Substance Misuse:
Behavioral theorists see substance abuse as a set of conditioned or learned behaviors (CURRAN, Val and Drummond, Colin., 2005). Therefore, we can surmise that learning new responses depends upon the contiguity of the stimuli (that is, stimuli that occur close/adjacent to each other) (GAZZANIGA, Michael S et al., 2006). It implies that behavior, which is followed by encouraging consequences, is most likely to be repeated (CARROLL, Kathleen M. and Onken, Lisa S., 2005).
The psychological intervention that focuses on conditioned responses is named as “cue exposure (CE)” (KAVANAGH, David J. et al., 2004). The terminology of cue exposure is derived from the psychological models of conditioning, and it refers to ‘consecutive exposure to the sight and smell of substance or drugs (“Alcohol” in Kavanagh’s study) with the directions to try to resist the craving for that substance’ (KAVANAGH, David J. et al., 2004). The hidden intent behind CE is to alleviate drugs and alcohol use by way of behavior change.
Besides CE, contingency management is also strongly linked to the substance/drug addiction issues (CARROLL, Kathleen M. and Onken, Lisa S., 2005; IRO, Chinedu J. et al., 2011). Contingency Management (CM) approach has its roots in operant conditioning (CARROLL, Kathleen M. and Onken, Lisa S., 2005; IRO, Chinedu J. et al., 2011) and behavioral pharmacology (CARROLL, Kathleen M. and Onken, Lisa S., 2005). In the CM approach, desirable behavior-change (elimination of drug addiction & substance abuse) is achieved by way of giving rewards to those patients who meet specified behavioral goals (CARROLL, Kathleen M. and Onken, Lisa S., 2005). Likewise, undesirable behavior is eliminated by removing such rewards and privileges, or by imposing time limits, or by inhibiting patient from clinic (IRO, Chinedu J. et al., 2011).
Cognitive Behavior Approach:
Another crucial approach in relapse prevention is the Cognitive Behavior (CB) approach, which is based on the concepts of operant conditioning and social learning theory (CARROLL, Kathleen M. and Onken, Lisa S., 2005). Firstly, emphasis is given on the understanding of drug use, its context (or reason) of use, its antecedents and the consequences. Next, skill training is provided to the prospective individuals, who learn to identify and avoid situations that may induce them to use drugs (CARROLL, Kathleen M. and Onken, Lisa S., 2005).
Silverman (2004) asserted that drug addiction can be seen as an operant behavior, and therefore, can be treated by applying the teachings of operant conditioning, that is, by reinforcement and rewards (SILVERMAN, Kenneth, 2004). Similarly, other researchers have focused and found significant role of conditioning theories in the detection and elimination of substance abuse, principally cocaine-related external stimuli that foster substance use and relapse (WEISS, Friedbert et al., 2000). In addition, the most widely used substance is found to be alcohol, besides illegal drugs and medicines (TAGGART, L et al., 2006). In case of needle fixation (drugs through injection), principles of classical and operant conditioning help to explain the addiction behavior. The difference between pre-injection anxiety and post-injection relaxation reinforces the repetition of injecting behavior (TREFFURTH, Yvonne and Pal,