MSc in Addiction Studies Learning Theories of Addiction Operant conditioning, social learning theory and contingency management.
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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
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