Learning Theory of Addiction and Recovery Implications:
A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D. , edited by C. E. Zupanick, Psy.D.
According to learning theory, addiction is simply a learned behavior. In other words, people learn to engage in addictive behavior according to well-established learning principles. There are two fundamental types of learning that apply to humans and animals alike: 1) learning by paired association, called classical conditioning and 2) learning from the consequences a behavioral choice, called operant conditioning. A third type of learning is called social learning. Social learning occurs when we learn something by observing others. Unlike classical conditioning and operant conditioning, only humans and certain animals (e.g., dogs, horses) have demonstrated the ability to learn by observation.
People may learn addictive behavior through classical conditioning by pairing the pleasure of addictive substances or activities, with environmental cues. For example, suppose someone always smokes marijuana in the car after work. The enjoyment of smoking marijuana forms a paired association with riding in the car. The timeframe "after work" also forms a paired association. By repeatedly pairing marijuana-with-car, and marijuana-after-work, both the car and after-work will become cues to smoke marijuana. Then these cues (getting into the car, getting off work) may create powerful cravings for marijuana.
Fortunately, what we learn can also be unlearned. For instance, if after-work has become a "cue" to smoke pot, then doing a different activity repeatedly after-work will form a new association. Someone could practice riding in the car without smoking. The power of a cue is diminished through a process called cue exposure. Cue exposure repeatedly presents a person with the cue, without pairing. This diminishes the cue's power to bring about cravings. Therefore, riding in the car and not smoking pot will reduce powerful cravings over time.
Counter-conditioning is a special type of classical conditioning. An addictions recovery application of counter-conditioning is called taste aversion (a strong dislike of a specific taste). Toxic foods make us sick. They lead to the development of an aversion to the taste of that food. Taste aversion is somewhat more complex than classical conditioning. Classical conditioning pairs the stimuli together within seconds of each other. The association between a toxic food and subsequent nausea will indeed develop. However, these two events may occur several hours apart. Schick Shadel Hospital has developed and advanced this approach. Patients taste and smell alcohol or other addictive substances. This is followed by induced nausea. Patients receive medication to bring about the nausea.
Operant conditioning is a second type of learning. A system of rewards and punishments forms the basis for this learning. If the first use of a substance is a rewarding experience, we are more likely to return to it. Likewise, without unpleasant consequences to addiction, there is little reason to stop. We know that people can enhance recovery efforts by allowing natural consequences to occur. For instance, loved ones can stop shielding someone from the negative consequences of their addiction; i.e., they stop "enabling." Without the heroic efforts of their loved ones, an addicted person may lose their job or may become homeless. Similarly, we can reward healthy choices so they become more appealing than addictive behavior. For example, a person may be permitted to return to their family and comfortable home; but only if they have demonstrated a period of sustained abstinence.
Questions for personal reflection from learning theory: Since I may have learned addictive behaviors, how can I unlearn them? How can I replace them with healthier, life-affirming activities? Wouldn't it be valuable to discover the cues that create powerful cravings and to find ways of overcoming them? Maybe I should get some professional help with these cues and cravings. What will happen if important people in my life learned to reinforce my positive behaviors? What will happen if they stop enabling me? Maybe I could find a professional who could help them.