The Meaning of Addiction - 3. Theories of Addiction - Exposure Theories: Conditioning Models

Written by Stanton Peele

Exposure Theories: Conditioning Models

Conditioning theories hold that addiction is the cumulative result of the reinforcement of drug administration. The central tenet of conditioning theories is that (Donegan et al. 1983: 112):

To say that a substance is used at a level considered to be excessive by the standards of the individual or society and that reducing the level of use is difficult is one way of saying that the substance has gained considerable control over the individual's behavior. In the language of behavior theory the substance acts as a powerful reinforcer: behaviors instrumental in obtaining the substance become more frequent, vigorous, or persistent.

Conditioning theories offer the potential for considering all excessive activities along with drug abuse within a single framework, that of highly rewarding behavior. Originally developed to explain narcotic addiction (cf. Woods and Schuster 1971), reinforcement models have been applied to most popular psychoactive drugs and to nondrug addictions like gambling and overeating (Donegan et al. 1983). Solomon (1980), in a broadly influential approach he calls the opponent-process model of motivation, has extended conditioning principles to every pleasurable and compulsive activity. The complex processes that characterize learning also allow increased flexibility in describing addictive behavior. In classical conditioning, previously neutral stimuli become associated with reactions brought on in their presence by a primary reinforcer. Thus an addict who relapses can be conceived to have had his craving for the addiction reinstated by exposure to the settings in which he previously used drugs (Wikler 1973; S. Siegel 1979, 1983).

The Myth of the Universal Reinforcer: The Inherent Pleasurableness of Narcotics

Conditioning theories leave open one critical question: What is a reinforcing activity? The assumption in narcotic addiction is usually that the drug provides an inherent, biologic reward and/or that it has strong reinforcement value due to its prevention of withdrawal pain (Wikler 1973). This assumption is part of a wide range of theories of addiction (cf. Bejerot 1980; Dole 1972; Goldstein 1976a; McAuliffe and Gordon 1974; Wikler 1973). Indeed, the belief that narcotics are irresistible to any organism that, once having tried them, has free access to drugs is the epitome of the exposure model of addiction. The body of work thought best to demonstrate the truth of this belief is the observation that laboratory animals can readily be induced to ingest narcotics and other drugs. Chapter 4 shows this view to be unfounded: drug use is no more self-perpetuating for animals than it is for humans. No less a biological determinist than Dole (1980) has now declared that "most animals cannot be made into addicts.... Although the pharmacological effects of addictive substances injected into animals are quite similar to those seen in human beings, animals generally avoid such drugs when they are given a choice" (p. 142).

If the behavior of laboratory animals is not locked in by drug action, how is it possible for human beings to become addicted and lose the possibility of choice? One proposal to account for the feverish pursuit of drugs and other human involvements has been that these experiences bring in ordinate pleasure, or euphoria. The idea that pleasure is the primary reinforcement in addiction is present in several theories (Bejerot 1980; Hatterer 1980; McAuliffe and Gordon 1974) and most especially has a central role in Solomon's (1980) opponent-process model. The ultimate source of this idea has been the supposedly intense euphoria that narcotics, particularly heroin, produce, a euphoria for which normal experience offers no near counterpart. In the popular image of heroin use and its effects, euphoria seems the only possible inducement for using a drug that is the ultimate symbol of self-destructiveness.

Some users describe euphoric experiences from taking heroin, and McAuliffe and Gordon's (1974) interviews with addicts revealed this to be a primary motivation for continuing to use the drug. Other research contests this notion vigorously. Zinberg and his colleagues have interviewed a large number of addicts and other heroin users over several decades and have found the McAuliffe and Gordon work to be extremely naive. "Our interviews have revealed that after prolonged heroin use the subjects experience a 'desirable' consciousness change induced by the drug. This change is characterized by increased emotional distance from external stimuli and internal response, but it is a long way from euphoria" (Zinberg et al. 1978: 19). In a survey of British Columbian addicts (cited in Brecher 1972: 12), seventy-one addicts asked to check their mood after taking heroin gave the following responses: Eight found the heroin experience to be "thrilling" and eleven found it "joyful" or "jolly," while sixty-five reported it "relaxed" them and fifty-three used it to "relieve worry."

Applying labels such as "pleasurable" or "euphoric" to addictive drugs like alcohol, barbiturates, and narcotics seems paradoxical, since as depressants they lessen intensity of sensation. For example, narcotics are antiaphrodisiacs whose use frequently leads to sexual dysfunction. When naive subjects are exposed to narcotics, usually in the hospital, they react with indifference or actually find the experience unpleasant (Beecher 1959; Jaffe and Martin 1980; Kolb 1962; Lasagna et al. 1955; Smith and Beecher 1962). Chein et al. (1964) noted the very special conditions under which addicts found narcotic effects to be pleasurable: "It is . . . not an enjoyment of anything positive at all, and that it should be thought of as a 'high' stands as mute testimony to the utter destitution of the life of the addict with respect to the achievement of positive pleasures and of its repletion with frustration and unresolvable tension" (in Shaffer and Burglass 1981: 99). Alcoholics' drinking does not conform any better to a pleasure model: "The traditional belief that alcoholism is maintained primarily as a function of its rewarding or euphorigenic consequences is not consistent with the clinical data" as "alcoholics become progressively more dysphoric, anxious, agitated and depressed during chronic intoxication" (Mendelson and Mello 1979b: 12-13).

The opposite picture—the rejection of positive drug rewards by those in a position to pursue more lasting satisfactions—is evident in a study of volunteer subjects' reactions to amphetamines (Johanson and Uhlenhuth 1981). The subjects originally reported the drug elevated their moods and preferred it to a placebo. After three successive administrations of the drug over several days, however, the subjects' preference for the amphetamine disappeared even though they noted the same mood changes from its use. "The positive mood effects, which are usually assumed to be the basis of the reinforcing effect of stimulants, . . . were not sufficient for the maintenance of drug taking, probably because during the period of drug action these subjects were continuing their normal, daily activities." The drug state interfered with the rewards they derived from these activities, and thus, "in their natural habitat these subjects showed by their preference changes that they were uninterested in continuing to savor the mood effects" (Falk 1983: 388).