A Behavioristic Look at Addiction
Three components of successful treatment.
Posted August 14, 2018
Extinction is unpleasant. Extinction, in behavioral parlance, refers to a situation where a reinforcer is no longer available. The coke machine that won’t deliver, the Chinese restaurant that refused to give its cook a raise and now serves mediocre food, and a lost dog are all extinction situations. They all share the essential structure of a rat pressing a lever that has been disconnected from food pellets. There is a lot of responding at first, but eventually, the behavior goes extinct, whether the behavior is pressing the soda button, going to the restaurant, or looking for the dog.
The frustration and grief associated with extinction are different from the aversion of punishment. Punishment makes alternate behaviors more appealing because they avoid or escape the punishment (even though it doesn’t change the interest in the behavior that got punished, which re-emerges once the source of punishment is not present). The longing of extinction passes only with time, because hope keeps us engaged (to a behaviorist, hope is the feeling associated with intermittent reinforcement).
One of the biggest challenges in teaching any skill is to keep the frustration of extinction from dissuading the person from pursuing expertise, usually by potentiating steps toward expertise as reinforcement. A violinist who listens to Heifetz and doesn’t feel inspired is likely to feel disheartened: current efforts are not producing transcendent music, and those efforts extinguish if only transcendent music is rewarding. It is difficult to build steps toward skills when alternative reinforcements are easily accessed. Why would a child (or a graduate student) want to go through the process of learning something difficult when he can feel successful doing something easy? It probably helps to tell him he’s “correct” when he spells cat instead of telling him that he’s a genius; otherwise, hard words extinguish spelling efforts because “correct” isn’t good enough to serve as a reinforcement. Why would anyone want to go to all the trouble to learn to be a successful human when they can avoid fears of failure by immersing themselves in an addiction?
People always pursue alternatives to punishment, but some people also hate extinction so much that they won’t endure it. Rather than change themselves or improve their lives, they will turn to an activity that engrossingly rewards them. Most drugs provide positive rewards (they feel good) and negative rewards (they make unpleasant feelings go away). Gambling, sex, and social media also suffice. An addiction, then, loosely defined, is an activity whose avoidant functions are particularly prominent. That’s why for most people sleep, water, and nourishment are routinely engaged in but are not addictions—they’re not typically used to avoid something else (but consider sleep in depression and food in eating disorders).
An addiction, more tightly defined, would require withdrawal effects. Extinction of the high produced by the drug is accompanied by physical pain that continued usage avoids. (It’s fine to call any compulsive and avoidant behavior an addiction as long as we’re clear what we mean). We might also call this situation addiction-with-withdrawal-effects, since it may be too late to keep people from calling their excessive screen time an addiction.
Some behavior, then, is maintained not just by the pleasures associated with it, and not just by the intermittency of its reinforcement schedule, and not just by its avoidance of punishment and extinction, but also by aversive consequences associated with not engaging in the behavior itself (withdrawal effects). Gambling, sex, and social media are not addictions of this sort. They can be consuming and destructive, and a person can organize her life around them to the detriment of everything else, and giving them up can produce a combination of unpleasant extinction and having to face all the life-deficiencies that they were masking. But giving up sex or gambling or Facebook does not produce a hangover or physiological withdrawal effects (not to be confused with the unpleasantness of extinction).
Another effect of an addiction or a compulsive behavior is that it deadens the appeal of other reinforcers. The deadening can be primarily chemical, as with alcohol, or a function of intense responding, as with gambling. (Legend has it that the Earl of Sandwich did not want to leave the tables and took his meat cold and in a form that he could consume with one hand.) The question, “What else might you like to do?” is met with a blank look, as other reinforcers lose their appeal in the rush for chips (or food or porn or likes or whatever).
I’m not saying that withdrawal is worse than extinction. It often is, as with heroin or alcohol, but it doesn’t have to be. Someone can ruin her life with compulsive gambling behavior that is maintained by avoidance and by the monopoly of the thrill, and another person might have only the mildest withdrawal effects maintaining a caffeine addiction. But gambling is not an addiction in this tighter sense and caffeine usage can be—when one of the reasons for caffeine consumption is to avoid the headache associated with stopping.
The implication is that successful treatments for addiction must have, broadly speaking, three components, aimed at broadening reinforcement, alleviating withdrawal if present, and tolerating extinction.
The pleasures or reinforcers associated with the addictive behavior must either be supplemented or made contingent on non-addictive behavior. This can mean getting high in some other way or potentiating reinforcers that have extinguished or that have become aversive through association. The latter is easier said than done, since a long period of addiction (or compulsive behavior) can have the effect of ruining all other pleasures. This is partly because of disuse: Tasting food, even, may have lost its appeal after a period in which only the addictive behavior sounds good, and tasting food can come to signal an entry into a way of life (often called normal) at which the addict is failing. To enjoy a meal is to be someone who has failed at life, while not enjoying anything but heroin separates one from all that. It’s also partly because of loss: The friends with whom one might have enjoyed a convivial conversation may no longer be interested, and those who are interested may not have known the addict long enough to provide a conversation that is truly convivial. The lack of effectiveness of normal reinforcers is one of the main reasons that many addicts become sobers rather than normals, which is still a great achievement, but not the same as recovery. Of course, it’s much better to be sober than drunk, but both statuses suggest a dearth of reinforcements that have nothing to do with the addiction.
Extinction takes longer when the reinforcer has been available only intermittently. You keep playing a slot machine much longer than a coke machine because coke machines are reliable. Reliability leads to immediate frustration and fast extinction. (Think about the implications for romantic relationships, where more reliable partners are more enraging when they don’t come through, and unreliable partners are harder to get over.) One of the many benefits of a harm-reduction approach to addiction is that handing out needles and even providing the drug can make the drug more reliably available and reliably effective. This can lead to a higher tolerance, which is bad, but it can also lead to a shorter extinction curve (not to be confused with withdrawal pains).
Treatment must address withdrawal effects, if present. This might mean chemical intervention or at least framing the withdrawal as such so the addict knows what awaits. Take aspirin if you decide for some reason to stop drinking coffee. This is the only branch of the treatment that applies to addictions tightly defined rather than to addictions loosely defined.
Finally, treatment must offer an alternative way to deal with life’s disappointments and challenges, so that the utility of the addictive behavior will be diminished on that score. The only way to get good at anything, including life, is to be robust to setbacks and frustrations, and the treatment itself can serve as a window into the addict’s attitude toward frustration (since therapy is also frustrating when done well). The focus is often on how the person treats himself or herself in extinction situations, whether with encouragement or disdain or promises of glory in another sphere. This branch of the treatment can look like any other relational therapy.