MSc in Addiction StudiesLearning Theories of Addiction

Operant conditioning, social learning theory and contingency management

Learning objectives

•After you have completed this lecture you will be able to;▫Describe the main concepts associated with

operant conditioning, social learning theory and contingency management

▫Describe the relevance of operant conditioning within addiction and relapse

▫Discuss the theoretical basis for contingency management and appraise its effectiveness

Operant conditioning•Skinner (1938)•Behaviours are learnt through the process of

reinforcement by punishment or reward▫Positive reinforcement – Increases the

probability of a behaviour by giving a reward▫Negative reinforcement – increases the

probability of a behaviour by taking away discomfort

▫Punishment – decreases the probability of a behaviour as the person will want to avoid it (terminate or avoid)

Skinner box

Reinforcement schedules

•What factors would effect strength of the reinforcer?

Reinforcement schedules continued…

•Occasional reinforcement•Contiguity – reinforcements/punishments

closely linked in time•Different schedules of reinforcement

▫Continuous reinforcement▫Partial reinforcement

Operant conditioning in drug addiction•Drugs of abuse are powerful positive

reinforcers •Animal self-administration studies -

▫e.g. Aigner and Balster (1978), rhesus monkeys given the choice between cocaine and food, choose cocaine.

Contingency management (CM)•Providing incentives to change behaviour

and/or engage with treatment

•How might contingency management be used in substance misuse services?

CM schedules

•Fixed monetary incentive▫Hep B vaccines, ConMan – one-off

monetary payment▫Adherence to TB treatment in injection

drug and cocaine users (Malotte et al.2001)

•Escalating monetary incentive▫Abstinence cannabis (Budney et al., 2000) ▫Naltrexone adherence in opiate

dependence (Preston et al. 1999)

CM schedules continued…• Prize based

▫Fish-bowl (Petry)▫Alcohol – abstinence and/or attendance▫Abstinence from methamphetamine (Roll et al., 2006),▫Adherence to antiretroviral medication for HIV (Rosen

et al., 2007)

• Other reinforcers▫Methadone take-homes, dosage decrease, progression

to next stage of the programme, discharge from treatment (see Prendergast 2006 for a review)

Effectiveness of CM

•What factors impact on the effectiveness of CM?

•What need to be considered when designing a CM protocol?

Summary so far

•Operant conditioning and Skinners experiments

•Contingency management ▫How it can be used in the treatment of

substance misuse▫Different schedules – what needs to be

considered when designing a schedule▫The long-term effectiveness of CM

Social learning theory (SLT)•Behaviour is learnt through observation

and experience within a social environment ▫Modelling – learn about the outcomes of a

behaviour by observing others.▫Bandura bobo doll experiments

Reciprocal determinism

Behaviour

EnvironmentPerson

SLT and relapse•Self-efficacy – the degree to which a person

feels competent or capable of performing an action▫Predict likelihood of attempting to abstain▫Abstinence violation effect – the effects and

consequences of not remaining abstinent•Marlatt and George (1984)

▫Contact with cues increases risk of relapse ▫Arouse positive outcome expectancies and

trigger motivation to use drugs 4▫Resources available to the person to be able to

abstain

Summary

•Operant conditioning and Skinner•CM – what is it how can it be used in the

treatment of substance abuse•Important factors when developing a CM

schedule•Social learning theory - Bandura•Social learning theory and relapse in

addiction

Learning objectives

•After you have completed this lecture you will be able to;▫Describe the main concepts associated with

operant conditioning, social learning theory and contingency management

▫Describe the relevance of operant conditioning within addiction and relapse

▫Discuss the theoretical basis for contingency management and appraise its effectiveness

Reading• Essential

▫Moss AC & Dyer KR. (2010) Psychlogy of Addictive Behaviour. Basingstoke UK: Palgrave MacMillan. Chapter 3

• Recommended▫West R. (2006). Theory of Addiction. London:

Blackwell Publishing• Additional

▫Prendergast M, Podus D, Finney J, Greenwell L, Roll J. (2006). Contingency management for treatment of substance use disorders: a meta-analysis. Addiction. 101, 1546-1560

References• Aigner TG & Balster RL. (1978). Choise behaviour in rhesus monkeys: cocaine vs food.

Science. 201, 534-535• Budney AJ, Higgins ST, Radonovich KJ, Novy PL. 2000). Adding voucher-based incentives

to coping skills and motivational enhancement improves outcomes during treatment for marijuana dependence. Journal of Consulting and Clinical Psychology. 68, 1051-1061

• Malotte CK, Hollingshead JR, Michelle L. (2001). Incentives vs. outreach workers for latent Tuberculosis treatment in drug users. American Journal of Preventative Medicine. 20, 103-107

• Marlatt GA, George WH. (1984). Relapse prevention: introduction and overview of the model. Addiction. 79, 261-273

• Prendergast M, Podus D, Finney J, Greenwell L, Roll J. (2006). Contingency management for treatment of substance use disorders: a meta-analysis. Addiction. 101, 1546-1560

• Preston KL, Silverman K, Umbricht A, DeJesus A, Montoya ID, Schuster CR. (1999). Improvement in naltrexone treatment compliance with contingency management. Drug and Alcohol Dependence. 54, 127-135

• Roll JM, Petry NM, Stitzer ML et al. (2006). Contingency management for the treatment of methamphetamine use disorders. American Journal of psychiatry. 163, 1993-1999

• Rosen MI, Dieckhaus K, McHahon TJ, Valdes B, Petry NM, Cramer J, Rounsaville B. (2007). Improved adherence with contingency management. AIDSPatient care and STDs. 21:1 DOI: 10.1089/apc.2006.0028

• Skinner B F. (1938). The Behavior of Organisms: An Experimental Analysis. New York: Appleton-Century