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Social learning and cognitive theories put the person in a central
position
Strictly behavioral conditioning models, like those we looked at last week, assume that only observable responses and the environment are necessary for a scientific analysis of behavior.
In the 1950s Albert Bandura began to move beyond classical and operant conditioning
by studyingobservational learning (also called modeling).
Among his many discoveries was the fact that learning could take place simply by observing the actions of another, and that this learning occurred even if there was no observable response. He also noted that people could learn by observing the consequences that occurred to others – whether they were rewarded or punished for a certain response – a process often called "vicarious learning."
This was the beginning of what has come to be known asSocial Learning Theory (SLT),
which emphasizes the social nature of learning. And because it assumes that learning is talking place even when there is no observable response, it brought attention back to mental processes: to people’s thoughts, attitudes, beliefs, perceptions, expectations, mindsets, etc, which collectively involve what psychologists call cognitive processes, or simply cognition.
So the 1950s so not just the rise of SLT, but also more and more emphasis by many psychologists on trying to understand how people think and reason and make decisions and how these cognitive processes influence behavior:
George Kelly was developing hispsychology of personal constructs, which holds
that people are influenced by their internal constructions of themselves and the world
Albert Ellis was developing the techniques ofrational-emotive therapy (RET),
which holds that between Activating events in our environment and the Consequences that these events cause are Beliefs (Ellis referred to this as the ABC model of analysis). He developed a new approach in psychotherapy that
emphasizeddisputation – confronting clients about their irrational beliefs and
challenging them to change their thinking – this D created the acronym of ABCD.
In contrast to the unconscious determinism of psychoanalysis and the environmental determinism of behaviorism -- both of which reduce the conscious, thinking person to a purely passive reactive entity -- both SLT and cognitive psychology put the person back in the equation, based on what Bandura called reciprocal determinism :
People are influenced by their environments but they also influence their environments, and people both influence and are influenced by their behavior, and our behavior can alter our environment.
In SLT it is assumed that the influence of the environment on behavior is mediated by cognitive processes:
o Which environmental influences are attended to? Which are ignored? o How are these influences perceived and interpreted? (remember the cliché, "beauty is in the eye of the beholder"?) o Which influences will be remembered? Which forgotten? o Which influences are believed to be likely to occur in the future? What do people expect?
Humans are assumed to play an active role through the capacity forself-regulation --
drawing upon their history of observations and reinforcements, they develop internal standards by which they can reward and punish themselves.
Addiction can be thought of as related to self-efficacy and expectancies
Modeling
The work of Bandura and the emergence of SLT were the beginning of what some have
called thecognitive revolution in psychology. The first cognitive theory of addiction was
proposed in 1947 when Lindesmith argued that one can only become addicted if one
knows that the substance both causes and can relieve withdrawal. In other words, it is
not the pharmacology of the drug, it is what webelieve about the drug that matters.
Within this perspective, addiction is viewed not as thefailure of self-regulation (which is
what most disease as well as psychodynamic and psychiatric theories say) but as a purposeful expression of self-regulation, albeit with harmful consequences (which might not be attended to or interpreted accurately or remembered or seen as likely to recur). In this view, addiction is seen as a form of adaptation, with cognitive factors such as self-concept, perceived alternatives, and values against intoxication all playing a part in the person's intentional and constantly changing efforts to adapt to internal needs and external pressures.
Thus, to understand why a person drinks alcohol or uses drugs (the Behavior), we must look at the Person and the Environment, as well as at the substance itself and its actual and perceived properties.
SLT says that modeling (observational learning) can influence alcohol and drug use (or any other behavior) in three ways:
- acquisition (starting to use): if you see others using, you become more likely to begin to use
- inhibition and disinhibition (strengthening or weakening the restraints against use): if you see others giving in to temptation or resisting temptation, you become more likely to giver in or resist
- response facilitation (being more likely to use): you are more likely to engage in the behavior when others around you are engaging in the behavior
SLT provides us an obvious basis for understanding the widely-acknowledged importance of peer associations and peer influence. It is well known that in the life histories of alcoholics and addicts, first use most often occurred in early or mid-
Given alcohol? Yes No
Yes
Expect alcohol?
No
In these experiments, subjects are randomly assigned to one of the four conditions: participating in what they are told is a beverage tasting test, they are given a beverage to drink that they are told either does or does not contain alcohol (Expect Alcohol?), and the actual beverage they are given either does or does not contain alcohol (Given alcohol?). In examining the effects of drinking the beverage, the crucial comparison is between subjects in Condition 2 and 3 - can you figure out why this comparison is so
important? The very robust finding in many studies is that thebelief one has consumed
alcohol often hasmore effect than alcohol itself! In other words, research participants in
Condition 2 typically show a stronger alcohol-type reaction than those in Condition 3. Studies such as this have been conducted with both college students (presumably non- alcoholic) and with diagnosed alcoholics.
Survey research has also added support for the importance of expectancies.
The Alcohol Expectancies Questionnaire (AEQ) developed by Sandra Brown assesses six domains of alcohol's effects (global positive change, sexual enhancement, physical and social pleasure, increased social assertiveness, relaxation and tension reduction, and arousal with power).
Research with the AEQ shows that expectancies typically correlate with initial use, heavy use, and problem use in adolescents and in college students.
Brown and her colleagues have developed similar questionnaires for marijuana and cocaine and have found correlations with patterns of their use.
Of course, such correlations could be misleading, since expectancies might simply accompany use, but numerous prospective studies show clearly that expectancies have strong predictive value and are true antecedents (that is, people seem to have these
expectanciesbefore they start to use).
Expectancies are obviously linked to memory, and some studies suggest that heavy drinkers selectively remember positive outcomes while forgetting negative ones, and that this separation of memory can start at an early age.
Another method for studying expectancies can be examined by asking people to complete the phrase “drinking alcohol makes me…….”: social drinkers come up with words like "relaxed," "sleepy," "dizzy," "stupid," whereas heavy drinkers come up with words like "happy," "talkative," "funny," and "horny."
Automatic Cognitive Processing
Central to most models of addiction, and especially to the disease models, is the
emphasis on the addict'scraving – the uncontrollable desire for the pleasure produced
by the addiction and/or for the relief from the torments of withdrawal. But research by Tiffany suggests that a lot of the repetitive alcohol and drug use seen in addicts is not accompanied by much motivation at all; instead, the addict seems to be on "automatic pilot," mindlessly and effortlessly engaging in a familiar routine of obtaining and using the substance. (And remember, one DSM-IV criterion for dependence is that the person uses more than intended, and many alcoholics, when told how much they had to drink, often seem genuinely surprised—“I drank that much? I had no idea!”)
Think about driving your car along a very familiar route, say from home to work. Have you noticed that often you will arrive at work but without any specific recollection of having passed through a certain intersection or passed by a certain landmark? Yet you did arrive safely! Apparently, we can engage in very intentional behavior without much thought, and this may be true for addicts as well.
Relapse
Relapse is a central concept in addictions. To disease model proponents, the frequent occurrence of relapse is seen as "proof" that addiction is a chronic disease.
Relapse has also been a major focus of cognitive theories, along with emphasis on relapse prevention techniques, but within this perspective relapse is simply viewed as another pattern of acquired behavior that can be modified.
Some cognitive theorists have suggested that the disease model actually creates an
expectancy of relapse, which can turn minor slips into full-blown disasters.
In similar fashion, there is concern that an emphasis on "powerlessness" within the disease model sets up a self-fulfilling prophecy: if you are told that you are powerless over alcohol, then isn't it possible that the next time you drink you will drink to excess simply because you believe you have no control?
[As you probably know, Alcoholics Anonymous is known as a "12-step program," because it spells out 12 steps to recovery. Do you know what the first step is? Many
- It is also illogical to think that a newborn might be experiencing withdrawal given that several days or even weeks have probably passed since the mother used drugs
With respect to Fetal Alcohol Syndrome (FAS), Peele acknowledges that alcohol might have a damaging effect on the fetus, but o such damage, while tragic, does not constitute an alcohol addiction o no more than 2½% of babies born to mothers who consume alcohol during pregnancy are affected o many other factors might be involved
Situational Factors in Addiction
Regarding addiction in animals, there is the widely-told story that when rats are allowed to self-administer stimulants or opiates, they will do so with such frequency that they starve to death. Such "evidence" is cited as proving just how incredibly addictive such drugs are.
Stanton Peele argues that while it is clear that such drugs often operate as powerful reinforcers (in the sense that they lead to high rates of responding), there are several reasons to be cautious in drawing conclusions:
- no specific physiological mechanism has been identified
- other reinforcers can be just as powerful
- drugs operate most powerfully as reinforcers for animals that are caged, restrained in harnesses, deprived of social contact, etc.
- and most important, an animal actually starving itself to death is a rare event
In contrast to the typical studies conducted in highly abnormal settings, Peele describes at length the study of drug use among rats in "Rat Park," a laboratory environment 200 times larger than the usual cage and with many more varied contents.
Under these more natural conditions, rats still displayed a tendency to respond to a morphine solution, but much less so than reported in other studies, and they required a fair amount of encouragement to initiate use.
In addition, Peele points out that use was almost entirely under the control of external factors rather than factors related to the morphine itself: housing (confined to cage or not), social contact, roaming space, added inducements (e.g., sweeteners), deprivation, etc.
Peele concludes that addiction must be understood as a uniquely human condition, one that is neither limited to nor explained by chemical substances; addiction is, in other words, an indication of how people experience and react to their environment. In this way of thinking, situational and contextual factors become the most important determinants of whether or not someone will develop an addiction.
Is it possible that someone would choose to be an addict?
For many people, subscribing to the belief that addiction is a disease seems to be simply a matter of common sense. After all, as many people think, no one would ever choose to be an addict, right? Addictions are so self-destructive, so harmful to those that the addict cares about, so dangerous, that no one would ever choose to go down this path. So it must be some form of disease, beyond the addict’s control. Remember AA’s first step, the admission of powerlessness? Or Jellinek’s emphasis on loss-of-control as the key turning point from excessive use to disease?
One of the most controversial discussions of addiction in recent years is the work of Gene Heyman, who in 2009 published his seminal work, Addiction: A Disorder of Choice (Cambridge, MA: Harvard University Press). Though his arguments are not always easy to follow, at its simplest, his view is exactly what is stated in his title, that addicts have made a choice, that their addiction is voluntary.
And by exactly the same logic, he says that quitting an addiction is also simply a matter of choice, a choice that most addicts make, sooner or later, since most addicts become ex-addicts.
But wait a minute, you might say: alcoholism and other addictions are incurable, life- long—everyone knows that.
In response, Heyman cites study after study showing two well-documented—but among the general public and even among many healthcare professionals, largely unknown— facts:
- The lifetime “remission” rate for substance use disorders is somewhere between 60 and 80%, based on national surveys conducted over the past 20 years looking at the experiences of thousand of subjects
- These remission rates are among the highest for any psychological or behavioral disorder, which are often no higher than 40% (and other studies tell us that most of these remissions are “spontaneous,” that is, occurring without benefit of any formal treatment)
Heyman draws extensively on the psychological study of how people make choices, which he says are primarily determined by:
- Information and beliefs regarding costs and benefits
- Personal and cultural values
With regard to information and beliefs, there is an extensive research literature in psychology to show that rational, healthy, “normal” people have a strong tendency to overestimate benefits and underestimate costs, and that many of the choices and decisions we make are driven by emotion (desire greed, fear, envy). How many bad decisions and poor choices have you made?
In addition, even very intelligence people have a very hard time calculating odds accurately, so when figuring out the odds of whether some potential cost or benefit will occur, we make mistakes all the time. Why do you get so much more anxious when
Many cognitive techniques have now become commonplace in addictions/substance- abuse treatment: understanding high-risk situations, coping skills training, enhancing self–efficacy, and dealing with abstinence violations.
The social learning emphasis on modeling is viewed by many as a particularly powerful alternative to disease models and their emphasis on genetics. Given that addiction does seem to run in families, the idea that children learn by observing what they see growing up provides another way of understanding what this means. And dysfunctional families are often clustered in neighborhoods, with many dysfunctional peers who use alcohol and drugs, so the family’s influence is compounded by peer influence.
As we've seen, there is a great deal of empirical support for the role that expectancies play in the initiation and continuation of alcohol and drug use. Also, there have been some promising studies of the link between expectancies and treatment outcomes.
Despite the strong empirical base for many cognitive theories, however, evidence so far has not yet indicated that cognitive approaches to treatment are consistently superior to more purely behavioral or even traditional disease-education and 12-step approaches.
[However, it is also possible to reframe 12-step programs such as AA in social learning and cognitive terms and to discuss the potential value of such programs as stemming from the exposure to more positive models and to a shift in attitudes and expectancies due to the 12-step teachings.]
The Tension Reduction Hypothesis Controversy
Another confusing area involves whether or not the Tension Reduction Hypothesis (TRH) is supported by the empirical evidence (see Thombs, pages 176-180). The TRH has been a cornerstone of social learning models since Conger first proposed it 50 years ago, and its argument is very simple: alcoholics drink because they believe that drinking will reduce their tension and help them to deal with life's stresses.
Sure enough, many studies show that alcoholics do indeed believe this, much more so than social drinkers. However, research also shows that most alcoholics experience increased stress as a result of their problem drinking. So if they experience more stress, how can they continue to believe that drinking will relieve their stress?
One promising finding involves the relationship between alcohol and the appraisal of
stress: when alcohol is consumed before a stressor is appraised, there might be astress
dampening effect, and conversely, if alcohol is consumed after appraisal, the stress
response might be greater.
In summary, based on what you now know about social learning and cognitive models of addiction, how would you rate them in each of the following areas we identified a few weeks ago as the formal attributes of a good theory or model?
Clarity : are the social learning and cognitive models clear, well-articulated, easy to understand?
Comprehensiveness : do the social learning and cognitive models deal with all, or at least most, of the major issues? Explicitness : do the social learning and cognitive models use precise definitions in a way that allows for reliable measurement of key variables? Parsimony : do the social learning and cognitive models provide a simple way to understand addiction? Ability to generate useful research findings : are there good studies with strong scientific evidence to support these social learning and cognitive models?
