The Meaning of Addiction - 3. Theories of Addiction - Former Addicts

Written by Stanton Peele

Conditioned responses are particularly unlikely to account for relapse, since most former addicts do not relapse to addiction after they use a drug again. Schachter (1982) found that former smokers would smoke at a party but not return to regular smoking. Vaillant (1983) noted that "relatively few men with long periods of abstinence had never taken another drink" (p. 184). Half of the addicted Vietnam soldiers used a narcotic at home, but only a minority became readdicted (Robins et al. 1975). Waldorf's (1983) investigation of heroin addicts who quit on their own found ex-addicts typically injected themselves with heroin after licking the habit to prove to themselves and others that they were no longer hooked. All these data point out that the unconditioned stimulus (actual drug use) is not sufficient provocation for a return to addiction. It is impossible that the weaker conditioned stimuli could provide sufficient motivation.

For Siegel and others who have analyzed the Vietnam remission data in conditioning terms, the crucial variable is simply situational change. All situational changes are equivalent in terms of this model as long as drugs have been taken in one environment and not the other, since then the new environment does not evoke conditioned withdrawal symptoms. This has prompted Siegel et al. to recommend a fresh setting as the best remedy for addiction. Yet it would certainly seem that other features of this new setting would be at least as important as familiarity for affecting addiction. Rats habituated to morphine in a diverse, social environment refused the drug in the same environment when offered a choice, while caged, isolated rats on the same presentation schedule continued to consume the morphine (Alexander et al. 1978). Zinberg and Robertson (1972) reported that addicts' withdrawal symptoms disappeared in a treatment environment where withdrawal was not accepted, while their withdrawal was exacerbated in other environments, such as prison, where it was expected and tolerated.

The Role of Cognition in Conditioning

Addicts and alcoholics—whether treated or untreated—who achieve remission often do experience important changes in their environments. These changes frequently result, however, from self-initiated attempts to escape the addiction and other life problems. There are also those who modify addictive habits without drastically rearranging their lives. This is especially true for those addicted to less socially disapproved substances like cigarettes but also holds for a distinct minority of former alcoholics and heroin addicts. Modification of the addict's environmental stimuli appears in these cases to be an entirely internal or psychological process. Siegel (1979) recognized this role for cognitive stimuli when he explained why some Vietnam veterans relapsed without returning to old drug haunts. He cited Teasdale (1973) and O'Brien (1975) to indicate men experienced withdrawal and craving when "talking about drugs in group therapy," "seeing pictures of drugs and 'works,"' or just "imagining themselves injecting drugs in their customary setting" (p.158).

The conditioned responses that occur with regard to subjective experience and as a result of environmental changes that addicts themselves bring about cast conditioning theories in a whole new light, where these responses seem an adjunct to individual self-control and motivation to change rather than the sources of such change. Moreover, conditioning theories in addiction are limited by their inability to convey the meaning the individual attaches to his or her behavior and environment. As a result, conditioning theories must be made so complex and ad hoc to explain the complexities of human drug taking that they lose the precision and predictive power that are their supposed scientific assets. They seem destined to suffer the same fate as did the U.S. intervention in Vietnam, the event that has prompted so much speculation about the role of conditioning in drug use. In both cases rationales become so cumbersome and counterproductive in the effort to respond to information from the field that they must collapse of their own weight.

Siegel's utilization of cognitive variables to account for conditioning anomalies observed in heroin use is part of a venerable tradition. The first explicitly cognitive conditioning model in addiction was Lindesmith's (1968, originally published in 1947), which contended that to be addicted the heroin user must be aware that the withdrawal pain he suffers is due to cessation of drug use and that readministering the drug will alleviate this pain. Thus so many nineteenth century narcotic users may have failed to become addicted because they simply didn't know that narcotics were addicting! Lindesmith elaborated how cognitions affect addiction in connection with hospital patients. Patients do realize they are taking a narcotic and understand the drug's effects, but they associate these effects with their illness. When they leave the hospital (or later when their prescription for painkillers runs out) they know any discomfort will be temporary and a necessary part of convalescence and thus they do not become addicted.

We may wonder why Lindesmith reserved the role of cognition in his model for this very limited number of ideas. For example, would not a hospital patient's belief that continued narcotic use was harmful or that other opportunities outweighed the option of giving in to the drug's effects be a part of the decision not to continue using narcotics? Such matters as self-conception, perceived alternatives, and values against drug intoxication and illicit activity would naturally seem to influence the individual's choices. It is not only the decision whether to continue using a drug that cognitions, values, and situational pressures and opportunities determine, however. They also determine how the drug's effects and withdrawal from these effects will be experienced. Contrary to Lindesmith's scheme, people who recover from illnesses almost never acknowledge craving narcotics outside the hospital (Zinberg 1974).