Hello everyone and welcome back. In this section we begin to examine the second side of the nature/nurture controversy. That is, the nurture side of substance abuse. Now, there are many, many models that fall into this category. Some have more reliability and validity than others. However, we want to discuss them so we can get a good idea about the different models that are out there. So, let's look, first of all, at the psychological theories of substance abuse. As you have seen in the original form, there are two major groups when we talk about psychological theories.

The first major group is shown in slide two. They are the traditional learning models. These include classical and operant conditioning. The second major group is called social learning group models and cognitive models. We will talk about those in the next major section.

So let's begin by discussing the classical conditioning models related the substance abuse first. Basically as we know from our introductory psychology class, classical conditioning comes from the concepts of reflexology and physiology. The classical example of classical conditioning was developed by Pavlov.

What Pavlov developed as we can see in slide four is what we call the Classical Conditioning paradigm. Basically, what he found was that if you take an unconditioned stimulus such as food, it will cause some kind of unconditioned response such as salivation. This is genetically programmed in you and you can not stop it. If you then pair some kind of new substance (such as a bell) with the food and the animal salivates, over a period of time, the bell which Pavlov called the conditioned stimulus will elicit the salivation which Pavlov called the conditioned response. There are some examples of classical conditioning so let's use a couple of these in an addictions context.

The first of these is shown in slide five. Basically, what we do is have you take a drug called Emetine which causes nausea and projectile vomiting. That is, when you vomit, you vomit all over the walls. You then pair that with alcohol, so you give the person some alcohol and some Emetine they become nauseated and vomit. Over a period of time, the alcohol alone will elicit nausea and vomiting. This has been done in a variety of different treatment centers. The most famous is the Schick Shadel Hospital in Seattle.

The concept of classical conditioning (as we see in slide six) is very general across organisms. It occurs in dogs, cats, human fetuses, and even neurons. It also appears in many environments including classrooms, restaurants, the woods, etc.

There are a lot of related concepts that go along with classical conditioning. The first of these concepts is shown in slide eight and is called Extinction. Basically, with extinction, there is a decrease in the response due to repeated exposures of the CS. And again, the CS is occurring without the UCS (that is the food) being present. So, you give the alcohol but no emetine, and over a period of time, the nausea and vomiting will decrease and go to zero.

Now, there is another concept that goes along with Extinction is shown in slide nine. That is the concept of spontaneous recovery. After extinction has occurred, if you give a rest period, that is, you do not do anything and then you present the CS again, you will get the same conditioned response. But it is lower than the original conditioned response. You can do this several times.

As an example of all this and a graphic representation shown in slide ten. As you can see, there is an initial acquisition phase where the client responding goes up with the CS and UCS together. Then, when the CS is presented only, the CS continues to elicit response over period of time, and the response rate drops off to zero. Give a twenty-four hour rest period you present the CS again, you get spontaneous recovery, that is, you get a little bit of responding. You give another rest period, and then, again, you get a little responding until ultimately, there comes a time (as we see in slide eleven), when you present the CS but you get no conditioned response. That is extremely important when we talk about total extinction. That is, you get no response even when you present the CS.

Now, why is all this important? Because spontaneous recovery is an extremely important concept related to relapse. Let's say you have a client that is doing very well. They then see a cue or stimulus assisted with where they were using. It could be a bar, it could be a restaurant, or it could be a hotel. This causes all sorts of cravings. Why? Because you have the spontaneous recovery occurring.

There is another concept related to classical conditioning as well. This is the concept called generalization and shown in slide thirteen. When a response is acquired to some conditioned stimulus, other conditioned stimuli will also evoke the same response. In addition, the closer the new stimulus is to the original conditioned stimulus, the higher the probability that the response will occur.

So, what is an example of all this? As we can see in slide fourteen, if my original conditioned stimulus was a red light, I can use the red light and get a conditioned response. If I change the color to orange-red, I get the same response. Yellow-red; get less of a conditioned response. But, if I use a yellow light totally I get no conditioned response. If you use that out in the real world, think about a stop light and how you behave.

The key for the conditioned stimulus (as we can see in slide fifteen) is that the CS actually acts as a cue. Whatever the cue that is most reliable is the one that becomes most important. The CS must provide the most reliable information about the occurrence of the UCS over other stimulus cues. So, that is, the CS that predicts the UCS the best is the one that will become very powerful. But, other cues can also block or prevent the development of the CR.

So, how does all this work within substance abuse? As we can see in slide sixteen, there is a major aspect to substance abuse taking, and that is drug craving. Craving is the impulse to reintroduce drug- taking back into the system. Now, Robinson and Berridge have a major account of craving. What they basically contend is that drugs activate a particular part of the brain called the mesolimbic-dopamine system. Stimuli that occur with dopamine activation, that is, needles, mirrors, pipes, etc., acquire a salience that are linked to drug action and actually become exciting. When you have exposure or are thinking about these things, it begins to elicit a craving response for the drug. A classic example is a recent study that examined heroin users. Heroin users describe a phenomenon that they love their needles and that they love the injection of their needles. And, when they do that behavior, they can actually get high regardless of the substance they put in. So this is another aspect that goes along with classical conditioning.

Another major concept that goes along with classical conditioning and substance abuse is the saliency or nature of the CS. This is shown in slide seventeen. Basically, stimuli differ in their ability to become associated with the UCS, and some conditioned stimuli can't. Basically, saliency refers to the degree of associability of a particular CS to a UCS. Salient stimuli become associated, non salient do not. So, how does all this work in relation to substance abuse? Well, the stimuli that are in your environment differ in ability to become a trigger for a user. Some conditioned stimuli will never become associated. Salience is basically the degree of the associability. And, as we can see, salient material become associated and nonsalient material do not become associated. So, when you are looking at triggers and other things, you have to look at how salient are the stimuli and are they actually having an effect?

The next major concept we need to discuss in relation to classical conditioning is shown in slide eighteen. This is the opponent-process model developed by Soloman and Corbit. What Soloman and Corbit contend is very simple. All experiences produce an initial affective reaction they called the A state. The A state can be very pleasant, such as drinking alcohol or it can be unpleasant such as taking an exam. The strength of the A state also depends on the intensity of the particular experience. The stronger the event, the more intense the A state.

Now, as we can see in slide nineteen, the A state causes a second reaction they call the B state. The B state, is in essence, the opposite of the A state. So, if A is positive, B is negative and vice versa. For example, pain during an examination can create a pleasurable relief response when you are done with the exam. Solomon and Corbit contend that biological systems (or opposing responses) counter the initial effects of all events. When you think about it, it is very similar to the sympathetic and parasympathetic nervous system concepts you learned about in Introductory Psychology.

Now, as we can see in slide twenty, the B stage is initially less intense than the A state and it intensifies more slowly. Thus, it produces an adaptation effect or reduces the response while the event is occurring. B also diminishes more slowly than the A state. Basically what happens is after the A state is finished the B state is continuing on.

So let's give you an example of how this is going to work. The first of these is shown in slide twenty-one. Let's say that you are a smoker. You smoke a cigarette, you get pleasure, and you get an A state. But as you are getting the A state, you also get an arousal of state B which is a withdrawal due to the A state. The B state, and ultimately tolerance, causes the A state to diminish. So if you want to get more pleasure you have to smoke more cigarettes. Now what happens? When you stop smoking, the A state declines and you experience the B state, withdrawal. However, over time, the B state will deteriorate.

Let's look at a second example shown on slide twenty-two. The first part of the example is your classical conditioning paradigm. In this example we are going to talk about morphine or opiate users. We have a CS which is basically a hotel. The hotel is where we take our drugs and slow our system down. Consequently, the system begins to compensate to the UCS which is morphine. Over time as we continue to use we get tolerance. Further, when we use morphine over, and over, and over again at our hotel and shoot up, we have a reaction. Thus, over time, we will need more and more drug to get the same effect. And as we continue to shoot up, the system begins to compensate for the drug use.

So, we are slowing our system down from the drug, and our system is trying to compensate by speeding up. Thus, I need more drugs.

So, when I do that I have an alternative reaction. Now let's say that I change my cue. Instead of using my drug at the hotel, I do it at home. That is, I do not have A state. Consequently, I have no cue that says basically speed up because the drug is coming soon. I then give the same amount of drug that I normally use and I overdose.

So, changing the cues or the environment where I was using initially (even though I'm using the same amount of drug) will cause me then to have a different reaction; and in this case an overdose. That is why you see individuals who are using in one particular location in their own particular town go to a different city or different house and use the same amount of drug but die.

Another example is shown in slide twenty-three. This is the concept of conditioned withdrawal developed by Winkler and Prescor. What they did was place dogs in a distinctive cage they called the CS. They then gave the dogs morphine which is the UCS. The dogs feel good and get an unconditioned response. Over a period of time the dogs become addicted. So we have the CS being the cage. The UCS is the morphine. The unconditioned response is feeling good.

Later, we do is put the dog in the cage but do not give the morphine. So, basically we have the CS but no UCS. Ultimately, what this causes a withdrawal state. So the CS is the classic example of our detox center and then we go on to the extinction process. Now let's take the dogs after they have detoxed over a period of time and they are no longer addicted to the drugs, and stick them back into the distinctive cage. What happens? They all experience withdrawal symptoms, shaking, cravings, etc.

All this relates, again, to what we see in slide twenty-four, spontaneous recovery and opponent process.

So, what is the treatment alternative? Well, as we can see in slide twenty-five, Childress et al. exposed cocaine addicts to stimuli they were associating with drug taking. They showed videotapes of their cooking procedures, cocaine talk and paraphernalia, and basically measured their cravings and withdrawal responses. Guess what? Over time as the experimenters continued to expose them to using stimuli, they had decreased cravings and withdrawal responses due to repeated exposures. That is, they were going on extinction.

The key to this (as we see in slide twenty-six) is that you are presenting the stimuli under controlled settings. You are not doing these techniques out on the street. You are also using cognitive imagery or other techniques to use these kinds of procedures. These techniques are used as you get into more advanced counseling classes.

So, in conclusion, as we see in slide twenty-seven, classical conditioning is extremely important for addiction. It follows classic models. It has major implications in biological systems and the model has extremely high reliability and extremely high validity. The other major aspect of this model is that it uses experimental research techniques. That is, it is not using correlational designs. As a consequence, you are getting a valid finding versus a finding that may be a little more suspect.

Now, the next major model, as shown on slide twenty-eight, is called the Operant Conditioning models. These come out of the writings of BF Skinner and his colleagues. It has some similarity to classical conditioning except the focus in on the consequent stimulus rather than the conditioned stimulus or unconditioned stimulus.

Now within operant conditioning there are two major concepts we need to discuss. The first of these is shown on slide twenty-nine and relates to reinforcement. There are two types of reinforcement. The first of these is listed here and is, Positive Reinforcement. Positive reinforcement is defined as a procedure that occurs when you add something following a response that causes the behavior to increase. So, when you are hanging out, you take some cocaine and you feel good. Then the next time you are hanging out and you take cocaine again because it made you feel good.

The second type of reinforcement as we see in slide thirty is called negative reinforcement. Negative reinforcement is defined as a procedure that occurs when you remove something negative following a response which causes the behavior to go up. There are two major types that are especially important in addictions. This is escape conditioning and avoidance conditioning. Both of these are types of negative reinforcement.

So let's talk about escape conditioning on slide thirty-one first. In escape conditioning if you perform some kind of behavior to escape from something aversive, the next time that same situation occurs you will do the same behavior. So, in relation to substance abuse, if you begin craving for a drug and consequently take the drug, it stops the craving. So, when the next time you crave the drug you will take the drug again.

Related to this is Avoidance conditioning and shown in slide thirty-two. Here what you do is take something to prevent the craving from occurring in the first place. So, instead of waiting for the cravings, you take the drug to prevent the cravings from happening.

So what is so important about reinforcement? As we can see in slide thirty-three, reinforcement is extremely powerful. We have brain systems that are actually tied into reinforcement systems, including structures called the Medial Forebrain Bundle. These structures use Dopamine as its signaling agent. Reinforcement has lots and lots of different roles. It also is not an aspect of psychology that is obtuse and out in the hinterlands somewhere.

So what is the other major aspect of operant conditioning? As we see in slide thirty-four, this is the concept we call punishment; and there again are two types. In positive punishment, you add something following a response the behavior will decrease. So, you drink, you drive, you get arrested and thrown in jail, and you never drink and drive again. That is an example of positive punishment at work. Here is a second example: You take ecstasy, you have a bad experience and you never use ecstasy again. Both of these are classic examples of a positive punishment procedure.

Negative punishment on the other hand (like positive reinforcement) has two types.

The first type (as we see in slide thirty-six) is what is called response cost. Here you lose some kind of a goody after you make some kind of response. Let's say you are a high school drinker. You go out and you are drinking beer, you get an MIP and you are fined one hundred dollars. As a result of that you stop drinking beer. That is, the removal of a goody (money) makes you stop the behavior.

The other example is what is called time out. Time out is a classic technique used by a lot of parents (usually incorrectly) so we will describe it here. In time out (as we see in slide thirty-seven), it is time out from positive reinforcement. Here, what you do is remove the organism from the situation where it is receiving reinforcement. For example, a child is at a party where there is alcohol being given. The parent comes and takes the child away from the party. Child becomes embarrassed. Child no longer goes to parties where alcohol is available.

A second example, you have a person using a controlled drinking model. The person gulps drinks. Every time the person gulps drinks, they are removed from the bar setting. As a result of that you stop gulping drinks so you can stay with your friends.

So, what is the summary on punishment? As we can see in slide thirty-nine, it is very effective for controlling behavior. However, punishment is impacted by lots and lots of variables. For example, a punisher needs to be given very rapidly (within one hour of the behavior). If it is not given, then the punishment will not work. It also has to be severe. That is, to decrease the behavior. However, severity does also not equate to intensity. So, something could be very severe but of very low intensity.

Punishment also initially needs to be given every time. That is, when the response is given, the punisher needs to be given immediately following that response; and it needs to occur every time the behavior occurs. Later you do not need to do it as often. For parents with children, this means the parent needs to know what their children are doing, and, the parents need communicate with each about their children and what they are doing.

In conclusion, in relation to operant conditioning, both reinforcement and punishment (as we see in slide forty) are very effective in controlling or changing behavior. Both are tied in biological systems. Further, the models related to reinforcement and punishment have very high reliability and very high validity. In addition, the techniques work in all organisms, and when applied correctly can be by effective in controlling behavior. Operant Conditioning also has a huge literature under many conditions which it has been tested. This testing is not just correlational testing; the vast bulk of the testing is experimental testing.

Well, that concludes this section in relation to psychology and psychology models. In our next section we will continue talking about different psychological models but focus more on the cognitive aspects. So, until then, we hope you are enjoying this section and look forward to talking with you soon.

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