Path to Dependence

1. Path to Dependence How does dependence develop? Why does it happen to some people and not others?

2. Start with first experience • First drug experience Rewarded by Positive Reinforcement Unrewarded or Punished Stop use Continue use

3. Role of learning • From the very first encounter, see the effects of learning. • Learning plays a critical role in psychological dependence. • “craving for repeated or compulsive use of a drug because its effects are deemed pleasurable.”

4. Learning and behavior • Learning can be used to modify behavior. • Behaviorism was the first scientific paradigm for psychology. • JB Watson, BF Skinner • Principles widely applied at home, school and workplace. • And on the road: seatbelt use

5. Safer to wear seatbelts. • Well-known that seatbelts save lives. • Usage varies greatly. • 51% in Mass • 91% in Calif • 78% in CT • Required in CA but only suggested in MA

6. External to internal control • Forced or encouraged. • Not wearing seatbelt might lead to punishment. • Wearing reinforced by others and by vehicle. • Put them on as a matter of habit. • Internalized.

7. Punishment and reinforcement. • “Click it or ticket” • Threat of punishment. • Random checks. • Car comes with warning buzzers. • Stop if you buckle up. • Reinforces wearing.

8. Environment controls behavior • Extrinsic motivation. • External rewards and punishments. • Praise increase likelihood I’ll participate. • Criticism decrease the likelihood. • Principles of operant conditioning at work.

9. Reinforcement Leads to an increase in behavior. Punishment Leads to a decrease in behavior. Effects on behavior

10. Types of reinforcement • Positive reinforcement: behavior leads to reward. Negative reinforcement: behavior removes pain or anxiety • Ex: take pill for headache

11. Types of punishment • Goal of punishment is a decrease in unwanted behavior. Behavior leads to unpleasant outcome (Type I) or takes away something pleasant (Type II)

13. Rewards and punishments

14. Problems with punishment • Negative feelings towards person giving punishment. • Physical or psychological pain. • Escalate in severity. • Situational: substitute teacher syndrome. • Less likely to internalize.

15. Initial use punished • What might be present in the individual or the environment to make the initial use unpleasant? • Psychological characteristics. • Medical concerns. • Moral or religious beliefs. • Family background. • Other possibilities?

16. Reasons to remember • Guest turns down the offer of a drink. • Proper response from host? • Push even further. • Grill guest about reasons. • Remember some of reasons for individual choice. • 1/3 US adults don’t drink at all.

17. Reward leads to increase use. • Frequent use Body and brain adaptation Dependence Tolerance Increase use to maintain effect

18. Psychological and Physical Dependence Psychological Physical Abstinence causes craving Abstinence causes withdrawal and rebound and Sensitivity to triggers

19. Physical withdrawal Withdrawal and rebound Escape pain of withdrawal by taking drug (negative reinforcement Avoid withdrawal by continuous use (avoidance learning) Anti-social and/or criminal behavior to protect supply.

20. Understanding compulsion • Getting hooked. • Beginning single hook (positive reinforcement). • Escape withdrawal (negative reinforcement). • Avoid withdrawal (avoidance). • High-jacked brain thru learning.