A related behavioural theory is that of ‘operant conditioning’, where behaviour is understood in terms of the consequences of the behaviour. That is, a behaviour is maintained, or not, due to its reinforcing or punishing consequences. This theory would describe addictive behaviour as having formed due to the pleasant physical sensations, or reward, experienced through the use of the drug. These sensations are referred to as positive reinforcers, which encourage repetition of the behaviour that caused them. Where behaviour is seen to increase, then the consequences are said to be reinforcing, and where behaviour is seen to decrease, then the consequences are said to be punishing.
Silverman, Robles, Mudric, Bigelow & Stitzer (2004) experimented with a treatment program based upon the theory of operant conditioning. Cocaine addicts and methadone (a heroin replacement) patients were offered a positive reinforcement, of money, for abstinence. Increasing the importance of the reinforcement to the participant, and the amount, was found to increase the effectiveness of treatment and prevent relapse. This technique of abstinence reinforcement was found to significantly decrease the drug-taking behaviour. However, this intervention is not likely to be used, mainly because of cost factors. The key to such treatment is to identify practical ways of arranging and maintaining abstinence-reinforcement over extended periods of time. Also, the treatment was not found to be completely successful with every participant and, once the reinforcement was taken away, the substance use usually resumed.
Although the behaviourist theories can offer explanations of why individuals continue to use drugs and become dependent upon them, they do not explain why individuals begin to use drugs in the first place, despite many unpleasant side effects following initial use. Social learning theory uses aspects of classical and operant conditioning, but goes beyond these to give importance to the individual’s ability to think, reason, weigh up possible outcomes and make decisions about their behaviour. Learning from observation is a key aspect of social learning theory. While a person may learn directly from experience, as in classical and operant conditioning, they may also learn from other people’s experience. This process is known as modelling and is an efficient way of learning about social behaviour patterns and cultural norms. Addictive behaviours happen within a cultural and social context and so issues related to rules and values are important in explaining substance dependence.
With regards to substance use, social learning theory suggests that individuals are taught cultural rules, and copy the behaviour of parents and peers. Smythe, Barry and Keenan (2005) found that the socialised nature of heroin injecting in Dublin contributes to the Hepatitis C epidemic in the city. Users of the drug see their peers sharing needles and see no immediate negative effect. Therefore, they copy and conform to that behaviour to fit into their social group. Alcohol use in the Western world fulfils a social function in that people meet and relax in pubs and clubs. Similarly, heroin users meet and share the experience, often using their own language and social codes. Taking the drug ecstasy is the central activity at all-night ‘rave’ parties. It may be that within this subculture, the addict finds a socially validated role and that this is the motivation for continued substance use.
Social learning theory emphasises the importance of self-efficacy and self-regulation processes. Self-efficacy can be described as the system that enables the individual to exercise a measure of control over their thoughts, feelings, motivations and actions. This theory also sees personality and behaviour as changeable, and therefore if one can change the way the individual thinks, or change the environment they are responding to, their behaviour will change (McMurran, 1994). Applications derived from social learning theory include teaching individuals to recognise the risk factors that lead to substance use, improving alternative coping skills, and enhancing the individual’s self-efficacy beliefs so that these alternative skills may be used effectively.
Cognitive behavioural therapies are among the most popular treatments of substance dependence (Morgenstern, Blanchard, Morgan, Labouvie & Hayaki, 2001). These therapies are based upon social learning and behaviourist theories of substance abuse and focus on guiding substance users to cope with cravings, motivating them to change, managing thoughts about drugs, and developing problem solving skills. Litt, Kadden, Cooney and Kabela (2003) found that cognitive behavioural therapy significantly reduced drinking and increased abstinence rates in alcoholics.
The skills taught in cognitive behavioural therapy, for instance recognising, coping and avoiding high-risk situations, can be transferred to many problem areas of life. However, there are limitations with this treatment. An individual has to be an active participant in this form of therapy and, for it to have a great effect, hard work and practise is required on the part of the substance user. If motivation and self-efficacy are already lacking this can create difficulties, delays in recovery, and failure of the treatment process. In addition, substance dependence is often accompanied with some form of mental illness, which further impedes the effectiveness of cognitive behavioural therapies.
Wen-Hsin Chen and Davenport (2005) assert that such therapies have fundamental weaknesses when working with clients of non-Western culture. As the purpose of cognitive behavioural therapy is to change an individual’s thoughts and beliefs regarding their problem, cultural values and beliefs can obstruct the therapeutic process. Wen-Hsin Chen and Davenport (2005) suggest many modifications need to be made for effective therapeutic work with Chinese-American individuals, and it is thought that people of other cultures experience similar problems with the philosophies of this type of therapy.
The perspectives looked at so far do not account for the individual differences in drug use. For instance, they do not explain why one drug-user will go on to become dependent on a substance, whilst another, with a similar background and collection of experiences, will not. From the biological perspective, theorists would argue that neurobiological processes and physiological susceptibility play a role in offering better explanations of drug-use behaviour. Many studies have found a genetic factor related to substance dependence (Tsuang, Bar, Harley & Lyons, 2001; Hardie, 2002) and this perspective relies on the idea that addiction is a physical disease. The American Medical Association gave official approval of the disease model of substance dependency when they classified alcoholism as a medical disease in 1956. The disease model of substance dependency would suggest that addicts are different from the general population by way of some biological or genetic abnormality that was always there or that was triggered by the use of the drug.
According to Belcher & Shinitzky, (1998) (cited in Richter & Richter, 2001) adopted children with alcohol-dependent biological parents are at least twice more likely than other adopted children to become alcoholics. Although a majority of the research in this area has focused on a genetic predisposition to alcoholism, research on numerous drugs of dependence and abuse is growing. Kendler, Jacobson, Prescott and Neale (2003) found genetic links with substance abusers in male twin studies, although they were unable to find specific genetic links between different types of drugs. Soyka and Preuss (2003) found that certain mechanisms of neurons known as ‘glutamatergic’ may play an important role in addiction processes, including craving and addiction memory.
The disease model’s advantage is that it is uncomplicated and relatively simple to understand. The disease model removed the stigma traditionally associated with substance dependence and probably encouraged individuals to attend meetings or enter treatment programs who previously would have avoided treatment for fear of being labelled weak or depraved. Findings from the growing body of research into the biological and genetic basis of substance dependence can have positive applications within the field of treatment. Soyka and Preuss (2003) claim that their findings make the development of clinically effective anti-craving drugs a distinct possibility in the future.
However, it is difficult to separate biological and environmental contributions to substance dependence. Individuals who seem genetically predisposed to drug dependence may also live in social environments that are conducive to drug abuse, for example, they may have family members who use drugs. Researchers have not yet identified one gene or inherited quality that can be shown to be solely accountable for substance dependence. This perspective also discounts the role of personal responsibility in the development and treatment of substance-dependent behaviour. It is felt that these should not be overlooked.
The disease model of addiction sees addiction as a disease and the addictive behaviour as a symptom. However, these ‘symptoms’, for instance going to a pub and buying a drink, or sticking a needle in one’s arm, are voluntary actions and very unlike the involuntary symptoms of a disease such as a rash or high temperature. A further problem is that causation is difficult to prove with biological theories. For instance, if a certain gene is found in a substance abuser and not in the general population, it is unclear as to whether the genetic information caused the substance abuse or the substance abuse itself caused a change in genetic information.
There is a whole range of factors that influence behaviour and many factors must be taken into account when attempting to explain and understand substance dependence. Addictive behaviour varies between people and within a person across time. To complicate matters further, addiction can also be applied to non-substance related experiences such as gambling or exercise. No one can become dependent upon a substance without first using it, but not everyone who uses drugs becomes dependent on them. Additionally, not all substance-dependent individuals stay that way.
The different perspectives of psychological research offer varied explanations that can be applied to different aspects of the phenomenon of substance dependence. However, there is no one theory of addiction. In conclusion, it is clear that biological factors have a part to play by identifying predisposition to addiction and the varying ways the body reacts to and metabolises substances. However, addictive behaviour occurs within a cultural and social context and individuals are able to learn, make decisions and process information. Therefore, these factors interact with each other to determine the nature and degree of addictive behaviour within an individual. To fully understand substance dependence a more integrated approach is required, which considers the many different processes at work.
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