David Fawcett, PhD, LCSW, CSAT
Classical and operant conditioning provide two clear examples of addictive processes that affect the lives of every addict. Taking a few minutes to review these basic psychological concepts can help us better understand how various triggers and cues affect both the development of our addiction and our recovery.
You may remember hearing about classical conditioning in school (think Pavlov, metronomes, and salivating dogs). According to that principle of learning, a desire to use cocaine can be generated from either an unconditioned stimulus (one that was previously unassociated, such as the sound of a ring tone) or a conditioned stimulus (an association that already exists). For example, if I had used cocaine to fight my depression, I might have the urge to use it again next time I feel sad. With this type of classical conditioning, pairings are between the emotional, environmental, and subjective cues and the physiological and psychological mood-altering effects they produce.
Such associations have great power. For example, most drug users report being highly sensitive to visual images of either drugs or paraphernalia. Visual sensitivity is typically heightened in males and appears to be especially elevated for methamphetamine, pornography, sex, and chemsex addicts. Such images trigger both a psychological and a physiological reaction. I remember a client with six months sobriety from methamphetamine describing his body’s reaction to an unexpected text message from an old using buddy. As soon as he saw the name on his phone, he felt an involuntary wave sweep through his body that was similar to the moment he injected the drug. He even reported having the taste of the drug in his mouth. Fortunately, he took immediate recovery action steps and didn’t relapse. But the vividness and strength of this involuntary reaction shook him.
There are several methods to break or re-differentiate these involuntary learned responses. Managing them effectively is incredibly important because those cues are embedded on streets, in our neighborhoods, in songs on the radio, and even when we see a random sexy person. These responses can even arise within us from an upsetting thought or negative emotion. In early recovery, our ability to resist such cues is impaired, so the best strategy is to avoid them by not driving down that street or not going to those risky places. For the cues that we can’t avoid, we need skills to mitigate or neutralize them. These steps typically involve immediate action and establishing contact with a recovery support person.
The second type of learning is called operant conditioning. Here, the nature of the reward affects the frequency of the behavior. Every addiction creates, at least initially, a mood-altering experience or sensation that typically makes us want to repeat it. If the resulting sensations are rewarding or positive, there may be an increase in the frequency of the behavior, such as drug use or sexual acting out, that sparked it. The same is true if the result of the behavior helps us avoid or escape negative consequences (such as drinking to minimize social or sexual inhibition or using amphetamines to detach from negative moods or boredom).
Simply stated, classical conditioning teaches us that when we feel or experience certain things, we can soothe or numb ourselves by doing a specific activity, such as sexually acting out, using porn, or ingesting a substance (or both). The more successful those activities and/or substances are at making us feel better (including avoiding pain), the more likely it is that we will repeat them. This is operant conditioning, and it keeps the addiction rolling forward and escalating, especially as our bodies adapt and tolerance develops.
Fighting operant conditioning in addiction means that we need other ways to achieve feeling better, even if in the beginning they aren’t as effective as our addictive behaviors. If I’m feeling lonely and might have turned to drugs in the past, I now have tools such as a list of people I can call or meetings I can attend. Many people soon discover that the authenticity they experience at meetings, the shared experiences and a sense of belonging, go a long way in creating healthy ways to deal with loneliness.
For persons with a history of relapse, it has been found that the reinforcement magnitude (the strength of how good that new behavior makes them feel) must be strengthened and its duration may need to be increased. One method based on operant conditioning that has shown promising results is contingency management, whereby the “reward” that replaces the urge to act out addictively is in the form of a gift card. For example, having a clean urine drug screen for several weeks could result in a card with a certain dollar amount. More clean time might lead to a higher dollar amount (reward). When combined with psychotherapy and keeping the client engaged, contingency management has been shown to be a powerful component of treatment.
Recovery, especially in the early days, can seem overwhelming, but remembering these two key principles can keep us on track as we begin to move away from our addictive behaviors. The first is breaking the associations between various triggers and cues and our addictive behaviors. Over time these connections will begin to fade if they are not repeated and no reward is experienced.
The second and equally important principle is based on operant conditioning. With this principle, we need to actively find other sources of reward. As our addictive behavior becomes less pleasurable and more destructive, it becomes easier to give up. During the acute remorse and shame phase of the addiction cycle, for example, people are more willing to change their behavior. Best of all, as mentioned above, developing a sense of connection, purpose, and belonging becomes a new source of reward for many as they begin the journey of rebuilding their lives in recovery.