Cognitive Approach

The cognitive approach explains addiction in terms of how it occurs through internal processing of information (thinking). It involves thoughts in terms of how they influence emotions and behaviors, and, in turn, how behavior and emotions influence thoughts. Addiction, then, would be the result of faulty thinking processes (CSAT, 1999). For example one might say, “I think I need cocaine to have fun, so therefore I use cocaine.” Research indicates that expectancies, for example, of positive effects of alcohol or another drug, contributes to use, relapse, and poorer substance use disorder outcomes (CSAT. 1999, p. 74).

You may hear people in addictions refer to “stinkin’ thinkin’,” which is an example of cognitive processes. I think negatively, therefore I feel or act negatively. Consequently, I need to change my “stinkin’ thinkin’” so that I have better behaviors.

Aaron Beck, who founded one of the schools of cognitive theory, examined how thoughts influence emotions and behavior. In order to change negative emotions and behaviors,a person would need to change my thinking (cognitions). Aaron Beck and later, David Burns, recognized “cognitive errors” or “distortions” which people make that impact their behaviors (see Table 3.1). Identifying these cognitive errors helps in changing them.

Learning Opportunity 3.6

Fill in these boxes with at least two negative thoughts you had had over the past two weeks. Then look at the cognitive distortion list and identify what types of cognitive distortions the negative thoughts are and, finally, give a rebuttal to the negative thought.

Extinction and Counterconditioning

As we stated at the beginning of the chapter, learning addiction means to “fix it,” then we need to unlearn it. The terminology used to refer to unlearning, with regard to classical conditioning, is “extinction and counterconditioning” (CSAT, 1999). Extinction occurs when a behavior either diminishes or disappears. For classical conditioning, extinction happens when the conditioned stimulus appears repeatedly without the unconditioned stimulus. In classical conditioning, for example, the person (or animal) is re-exposed to the conditioned cue in the absence of the unconditioned stimulus. As the person or animal learns that the cue no longer predicts the coming of the unconditioned stimulus, conditioned responding gradually decreases, or extinguishes. In the example of Pavlov’s dogs, who were classically conditioned to salivate to the sound of the bell, if the bell were to be rung over and over again but it is no longer being paired with the meat, then extinction would occur and the dog would eventually stop salivating. This process is also referred to as “cue extinction.”

In operant conditioning, behaviors can also be “extinguished.” Extinction occurs when positive reinforcement is withheld. Such would be the case when a rat is rewarded with a food pellet on an intermittent basis for bar-pressing. However, once the bar-pressing is no longer rewarded with a food pellet, eventually the rat stops bar-pressing. It’s important to remember that after a response has been extinguished, it can be quickly re-established through a process known as spontaneous recovery. Spontaneous recovery refers to the sudden reappearance of a previously extinct response. We see this among substance use disorder (SUD) clients who take a drink or use a drug after weeks, months or years of abstinence and relapse back to active use, often at the rate they left off at, at the height of their drinking or drug use.

Counterconditioning is used to change behavior by making those behaviors associated with positive outcomes less “attractive” by associating them with negative consequences (CSAT, 1999).

For operant conditioning, a counselor could use contingency management and coping skills training to help “extinguish” the learned behaviors from positive and negative reinforcement. We will discuss these treatment approaches in more depth.

Opponent Process Theory

Opponent process theory can best be conceptualized as a behavioral theory, in that, it focuses primarily on observable behavior and self-reported affective responses. However, when it was initially introduced in the 1970s by psychologist Richard Solomon, it was put forth as a theory that would describe “acquired motivations” (Solomon, 1980; Solomon & Corbit, 1974). Acquired motives include such things as love and social attachments, food and taste cravings, thrill-seeking behaviors (e.g. bungee jumping, parachute jumping), as well as the motivated behaviors such as achievement and power. What Solomon found was that many of these acquired motives operated according to the same empirical principles as addictions. What he discovered, however, was that there were two unique and opposite processes that describe how addictive behaviors come about. The “a-process” is aroused by a stimulus which can be either pleasurable or aversive. An opponent loop or “b-process” occurs, which is directly opposite to the “a-process,” therefore if the “a-process” after drinking alcohol is a pleasurable “buzz,” then the “b-process” might include the discomfort of experiencing a hangover. It’s important to take into account what happens with these two processes over time. Generally, the opponent process created by substance use becomes stronger over time and is only weakened by abstinence or disuse. Solomon (1980) claims “in every case of

Behavioral and Learning Theory Model 49 acquired motivation affective or hedonic processes are involved,” referring to either emotional (affective) or pleasurable (hedonic) experiences that are derived from the behavior or substance use. He then goes on to state, “in every case I have found, describe or measure [there are] three affective or hedonic phenomena ... a) affective or hedonic contrast (between a-process and b-process), b) affective or hedonic habituation (tolerance) and c) affective or hedonic withdrawal (abstinence) syndromes" (1980, p. 692).

Therefore, just as one experiences a high or euphoria upon first taking a substance, that is then contrasted with the after-effect or withdrawal, and these emotional responses change over time as a result of habituation. As we know with opiate use disorders, over time the b-process or withdrawal becomes stronger such that continued opiate use is primarily to alleviate withdrawal symptoms such as cramping, aches and pains, nausea, diarrhea, etc.

There appear to be neurological changes as well, which may help to explain how and why opponent processes occur. For example, when one ingests a substance that causes an activation of dopamine in the mesolimbic center of the brain, which then projects onto the nucleus accubens and amygdala, creating a feeling of positive reinforcement (a-process). The b-process then involves the down-regulation or shutting down of the mesolimbic dopamine system (Koob et al., 1997). The flood of dopamine in the mesolimbic system accounts for the subjective feeling of reward and hence is considered positively reinforcing. Keep in mind that this flood of dopamine can be activated by nearly all the drugs of abuse but also by particular foods, pleasurable sexual encounters, gambling and other process addictions.