Transcript Social Learning Models

MODELS OF ADDICTION:
A SUMMARY
Moral / Temperance Model
Addiction as Sin or Crime
Personal Irresponsibility
Disease Model
Genetic and Biological Factors **
12-Step Framework; Abstinence
Education as Treatment
Behavioral
Conditioning and Reinforcement
Cognitive-Behavioral and
Social Learning Models
Drug Expectancies; REBT
Cognitive Therapy; Modeling
Relapse Prevention
Behavioral Models
• Classical conditioning vs. Operant learning
• Initiation of substance use
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• Primary classes of reinforcers
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• Behavioral tolerance
Rats:
heroin
tolerant
Received
injection of
heroin 15 mg/kg
in familiar
environment
Overdose
rate: 32%
Rats:
heroin
tolerant
Received
injection of
heroin 15 mg/kg
in unfamiliar
environment
Overdose
rate: 64%
Control
rats: No
heroin
tolerance
Received
injection of
heroin 15 mg/kg
for first time
Overdose
rate: 96%
To some degree, drug tolerance is associated with
environmental factors. Tolerance may disappear or decrease
if a drug is used in an unfamiliar environment.
A diagram of Siegel’s rat experiment
Behavioral Models
• Contingency contracting (begins with A-B-C)
– CRA
– Outpt. TX for cocaine (Higgins)
– Token economies in residential settings
• Reciprocity contracting (e.g., Antabuse
contract)
Social-Cognitive Models
SLT’s Reciprocal Determinism: B-P-E
• Modeling
• Self-efficacy
(outcome & efficacy expectations)
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– Sources of self-efficacy
Relapse Prevention
a. Addressing ambivalence
b. Reduce drug availability
- physical vs. psychological availability
- identify triggers and high risk situations (e.g., conditioned cues)
- avoiding wrong people, places, situations
- lifestyle & relationship changes which support recovery
- money/cash
- drinking, other drugs
- need for mood monitoring; craving monitoring
Relapse Prevention (con’t)
c. Coping with High Risk Situations
- social skills, assertiveness training
- drink refusal skills
- urge surfing
d. Vigilance through knowledge about thinking -> feeling ->
behavior chain (REBT)
- apparently irrelevant decisions (AIDS)
- abstinence violation effect (AVE)
- lapse vs relapse - use as a learning opportunity, not
permission to use.
Goal not to catastrophize the lapse or induce shame,
but to prevent more use
Example:
Treatment for Cocaine Dependence
A. Drug TX
B. Psychological TX
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Community reinforcement
Payment for abstinence
Relapse prevention (triggers, cravings…)
Lifestyle modification
Self-help Groups (CA - cocaine anonymous)