6.4 Psychological theories

Using psychology also helps us understand substance use disorders.  There are a variety of psychological approaches that help us understand behaviours, treatment, and recovery.  Psychological theory can look at behaviour.  For example, helpers may look at how and why the behaviour is maintained; they may also engage in understanding the behaviours that are happening while a person is under the influence of a substance.^[1]  You may choose to review the work of Skinner, Pavlov  and Watson.

Learning theory is another example of a psychological theory.  Learning theory suggests that a substance use disorder results from the learning we receive from the social environment, our experiences.  For example, observing a peer or parent smoke or vape may influence whether a young person also begins smoking or vaping.  Is the child or youth seeing a positive or a negative experience in the substance use?  These observations “can instill positive expediencies for the effects of these substances and provide models that show how to obtain and use them”.^[2]

Classical conditioning and operant conditioning are two types of learning models.  When we use classical conditioning in the field of substance use disorders, we examine the relationship between the substance use and its connection with the environment.  For example, let us examine smoking tobacco.

Classical conditioning helps individuals understand their relationship with a substance and how they may crave a particular substance based on their environment.  For example, someone who smokes tobacco may feel a pleasant feeling every time they visit a particular store, as that is the store where they buy cigarettes from, and often smoke as soon as they leave the store.  There are numerous resources to help a person quit smoking based on classical conditioning.  These resources help individuals identify “triggers” or activators, they look at factors that can make someone feel like they need to use a substance, because of their relationship to the environment.  “Common triggers that bring-on cravings include drinking coffee or alcohol, relaxing after work or after a meal, talking on the phone, driving, feeling stressed or angry”.^[3]  Using classical conditioning, you can examine activators and help an individual identify strategies to reduce the emotions associated with the activators.  These activators or cravings will reduce over time, the more a person is able to engage with the environment without using the substance.

Operant conditioning uses the concept of rewards and punishments.  If a person uses a substance, there are biological changes that happen (refer to Chapter 3 and 4).  For some it is a pleasant feeling, for others, it is unpleasant.  Not every person who uses a substance will develop a disorder; for some the pleasant feeling is just that, a pleasant feeling. For others the pleasant feeling takes over, and the reward becomes the focus.  This focus can then develop into a substance use disorder.  The Community Reinforcement Approach builds on operant conditioning; “the goal of CRA is to help people discover and adopt a pleasurable and healthy lifestyle that is more rewarding than a lifestyle filled with using alcohol or drugs”.^[4]  Please read this primer on the Community Reinforcement Approach by the Canadian Centre on Substance Use and Addiction.^[5]

This type of conditioning has also been seen in television programs like Intervention Canada, where family members stage an intervention with the person using substances and give the individual an “ultimatum.” Operant conditioning can be highly effective; however, interventions which focus on punishment rarely lead to a life without substances.  Confrontation is highly ineffective in decreasing the use of alcohol and other substance.^[6]

Psychological theories of substance use are varied and may help you explore how to best serve the individuals you will be working with.