Addiction: Cognitive & Social Learning Perspectives on Environment, Person & Substance, Exercises of Cognitive Sociology

Download Addiction: Cognitive & Social Learning Perspectives on Environment, Person & Substance and more Exercises Cognitive Sociology in PDF only on Docsity! 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 studying observational 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 as Social 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 his psychology of personal constructs, which holds that people are influenced by their internal constructions of themselves and the world  Albert Ellis was developing the techniques of rational-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 emphasized disputation – 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 for self-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 the cognitive 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 we believe about the drug that matters. Within this perspective, addiction is viewed not as the failure 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: 1. acquisition (starting to use): if you see others using, you become more likely to begin to use 2. 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 3. 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- 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's craving – 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 think that it is admitting to being an alcoholic, which is sort of right. But to be more precise, the first step requires that one admits to being "powerless" over alcohol.] Stress is known to be a significant factor in relapse, and cognitive theories emphasize the appraisal of stress and the role of coping self-efficacy. Another major focus is the thinking patterns and beliefs of addicts. If you perceive the stress in your life to be excessive or intolerable ("I can't stand it"), or if you see yourself as unable to cope with it ("I don't know what to do"), then the stress – even if minor by any objective standard – could "drive you to drink." And simply saying to yourself, “I need a drink” over and over can create a belief that you really really really have to have a drink to function. Ellis has identified numerous dysfunctional and irrational beliefs that constitute what he calls the Low Frustration Tolerance pattern. Various cognitive theorists have constructed chains of processes that culminate in problematic use: Ellis's beliefs, Marlatt's "apparently irrelevant decisions," and what Marlatt calls the "abstinence violation effect" represent significant links in the chain and are the focus of cognitive interventions. There is widespread misinformation about how addiction occurs in infants and animals A particular challenge to more psychological (behavioral, social learning, and cognitive) views of addiction comes from the widely-reported “evidence” of drug addiction in human infants and caged animals. It has been widely reported in the popular media that children born to drug-using mothers are often born addicted, and it has also been widely reported that lab animals offered cocaine or heroin become almost instantly addicted. If taken at face value, such evidence would suggest that addiction can be explained almost entirely in pharmacological terms. The fetus or the lab animal is exposed to the drug and presto!, addiction occurs. However, Stanton Peele argues that the actual evidence, if closely examined, does not justify the conclusions that most so-called experts have reached. Drug-addicted Newborns Regarding heroin and cocaine addicted babies, Peele points out that • When observer bias is controlled, the number of confirmed cases of acutely distressed newborns is small • Confirming that such distress actually represents withdrawal is impossible; the distress might be due to any number of factors (and it is common sense that drug-using mothers might very well present a wide range of unhealthy influences on their new-born: malnutrition, cigarette use, injury resulting from domestic violence, life stress, etc. • 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? 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 a stress 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?