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

Written by Stanton Peele

Chein et al. (1964) noted that when ordinary subjects or patients find narcotics pleasurable they still do not become compulsive drug users and that a percentage of addicts find heroin to be extremely unpleasant at first but nonetheless persist in taking drugs until they became addicted. All these examples make clear that drugs are not inherently rewarding, that their effects depend on the individual's overall experience and setting, and that the choice of returning to a state—even one experienced as positive—depends on the individual's values and perceived alternatives. Reductionist models have no hope of accounting for these complexities in addiction, as illustrated by the most widely deployed of such models, Solomon's (1980) opponent-process view of conditioning.

Solomon's model draws an elaborate connection between the degree of pleasure a given state produces and its subsequent capacity to inspire withdrawal. The model proposes that any stimulus leading to a distinct mood state eventuates in an opposite reaction, or opponent process. This process is simply the homeostatic function of the nervous system, much the same way that presenting a visual stimulus leads to an after-image of a complementary color. The stronger and the greater the number of repetitions of the initial state, the more powerful the opponent reaction and the more rapid its onset after the first stimulus ceases. Eventually, the opponent reaction comes to dominate the process. With narcotics and other powerful mood-arousing involvements such as love, Solomon proposes, an initial positive mood is replaced as the individual's primary motivation for re-experiencing the stimulus by the desire to avoid the negative, or withdrawal state.

Solomon and Corbit (1973, 1974) constructed this model from experimental evidence with laboratory animals. As we have seen, neither the positive feelings it posits from narcotics use nor the traumatic withdrawal it imagines can account for human drug taking. Moreover, the model's mechanistic version of neurological sources of motivation creates a Platonic ideal of pleasure as existing independent of situation, personality, or cultural milieu. The model likewise holds that a person's response to this objective degree of pleasure (or else equally specifiable withdrawal pain) is a predetermined constant. People in fact display all sorts of differences in how ardently they pursue immediate pleasure or how willing they are to endure discomfort. For example, people vary in their willingness to delay gratification (Mischel 1974). Consider that most people find hot fudge sundaes and devil's food cake to be extremely enjoyable and yet only a very few people eat such foods without restraint. It simply isn't plausible that the main difference between compulsive and normal eaters is that the former enjoy the taste of food more or suffer greater withdrawal agony when not stuffing themselves.

Solomon uses the opponent-process model to explain why some lovers cannot tolerate the briefest of partings. Yet this separation anxiety seems less a measure of depth of feeling and length of attachment than of the desperation and insecurity of a relationship, which Peele and Brodsky (1975) called addictive love. For example, Shakespeare's Romeo and Juliet prefer to die rather than be parted. This state does not result from accumulated intimacies that were eventually replaced by negative sensations, as Solomon's model predicts. Shakespeare's lovers cannot bear to part from the start. At the time when they both commit suicide, they have met only a handful of times, with most of their meetings having been brief and without physical contact. The kinds of relationships that lead to the withdrawal extremes of murder and suicide when the relationship is threatened rarely coincide with notions of ideal love affairs. Such couplings usually involve lovers (or at least one lover) who have histories of excessive devotion and self-destructive affairs and whose feeling that life is otherwise bleak and unrewarding has preceded the addictive relationship (Peele and Brodsky 1975).

Associative Learning in Addiction

Classical conditioning principles suggest the possibilities that settings and stimuli associated with drug use either become reinforcing in themselves or can set off withdrawal and craving for the drug that lead to relapse. The first principle, secondary reinforcement, can explain the importance of ritual in addiction, since actions like self-injection acquire some of the reward value of the narcotics they have been used to administer. Conditioned craving leading to relapse would appear when the addict encountered settings or other stimuli that were previously connected with drug use or withdrawal (O'Brien 1975; S. Siegel 1979; Wikler 1973). For example, Siegel (1983) applied conditioning theory to explain why the Vietnam soldier addicts who most often relapsed after their return home were those who had abused drugs or narcotics before going to Asia (Robins et al. 1974). Only these men would be exposed to familiar drug-taking environments when they returned home that set off the withdrawal that in turn required them to self-administer a narcotic (cf. O'Brien et al. 1980; Wikler 1980).

These ingenious conditioning formulations of human drug use have been inspired by laboratory studies of animals and human addicts (O'Brien 1975; O'Brien et al. 1977; Siegel 1975; Wikler and Pescor 1967). For example, Teasdale (1973) demonstrated that addicts showed greater physical and emotional responses to opiate-related pictures than to neutral ones. However, the conditioned craving and withdrawal such studies uncover are by the evidence minor motivations in human relapse. In the laboratory, Solomon has been able to create negative opponent-process states that last for seconds, minutes, or at most days. O'Brien et al. (1977) and Siegel (1975) have found that responses associated with narcotic injections in humans and rats that can be conditioned to neutral stimuli are extinguished almost immediately when the stimuli are presented on unrewarded trials (that is, without a narcotic).

What is more important, these laboratory findings do not appear relevant to addicted street behavior. O'Brien (1975) reported a case of an addict just out of prison who became nauseated in a neighborhood where he frequently had experienced withdrawal symptoms—a reaction that led him to buy and inject some heroin. This case has been described so often that, in its repetition, it seems a typical occurrence (see Hodgson and Miller 1982: 15; Siegel 1983: 228). Yet it is actually a novelty. McAuliffe and Gordon (1974) reported that "We have interviewed 60 addicts concerning their many relapses, and we could find only one who had ever responded to conditioned withdrawal symptoms by relapsing" (p. 803). In their thorough study of the causes of relapse, Marlatt and Gordon (1980) found heroin addicts rarely reported postaddiction withdrawal to be the reason they relapsed. None of the cigarette smokers or alcoholics Marlatt and Gordon interviewed listed withdrawal symptoms as the cause of their relapse.