What causes addiction, and what is the best approach to counteract it?

One contemporary view on the main causes of addiction is positive reinforcement. While there are many factors that contribute to both chemical and physical addiction, including psychosis, a disruptive childhood, or cognitive impairment, positive reinforcement is the major underlying characteristic that envelops an individual’s substance addiction (Osher, 1989). Though the reasons for compulsive drug self-administration varies widely, most, if not all users of drugs do so to avoid negative feelings including anxiety, depression, angst and fear (Goldsmith, Holzer & Manderscheid, 1998).

Positive reinforcement is a concept first described by psychologist B. F. Skinner in his theory of operant conditioning. Skinner introduced reinforcement to the law of effect (Thorndike, 1905) in psychology, stating that behaviour that is reinforced is likely to be repeated and strengthened, while behaviour that is not reinforced will likely be extinguished (McLeod, 2007). Positive reinforcement refers to the rewarding and confident emotions that drug users experience when self-administering drugs or other substances. This theory highlights that the common denominator of a wide range of addictive substances is their ability to cause psychomotor activation (Wise & Bozarth, 1987). This view is related to the belief that all positive reinforcers activate a common biological mechanism, with one of the most common components being dopamine fibres that project up the medial forebrain bundle from the midbrain to limbic and cortical regions (Wise & Bozarth, 1987), altering the user’s approach behaviour.

In 1938, Skinner defined operant conditioning as the change in behaviour by the use of reinforcement, which is given after the desired response. Skinner (1948) illustrated positive reinforcement by placing a hungry rat into a “Skinner’s Box” (refer to diagram 1). Every time the rat pulls the lever to the left, a pellet of food is dispensed. This rewarding consequence of the pellets of food encourages the rat to repeat this action. This same concept of positive reinforcement can be used to describe the causes of addiction- an individual is more likely to repeat an action if they receive an effect that they find rewarding. Skinner then repeated this experiment with the same rat, but instead of having the lever dispense food every time it was pulled, it released an electric
Diagram 1. “Skinner’s Box”
Diagram 1. “Skinner’s Box” shock. This negative result of pulling the lever discouraged the rat from doing so, and eventually averted the rat from touching the lever at all. This negative reinforcement can therefore be contrasted to positive reinforcement in the context of drug addiction, where the rewarding effects of substance use motivates further drug consumption for users (Skinner, 1938).

Skinner’s experiments were performed in carefully controlled laboratory conditions, where the rats’ behaviours were intently observed by scientists. In Skinner’s studies, the rats pulled the lever on their own accord; they were not taught to pull the lever because they wanted food. This behavioural study meant that it was primarily concerned with observable behaviour, unlike internal events such as thinking or emotions (Skinner, 1938). This can be related to human behaviour since our learning is majorly influenced by our environment; a lot of the things we do is not because of the situation itself, but rather the rewarding results that we achieve from it (Skinner, 1953). Based on this, Skinner’s experiment is highly reliable since humans’ way of learning is very similar to that of other animals, i.e. humans way of learning is comparable to the way the rats learnt to pull the lever in the Skinner’s Box.

The best approach for substance and physical addiction is behaviour therapy, specifically cognitive behaviour therapy (CBT). CBT is a type of psychotherapy that helps individuals change their unhealthy or unhelpful attitudes, habits and behaviours. Unlike medication approached treatments that divert drug users’ dependence from substances to medication, cognitive behaviour therapy aims to control an individual’s dependency on substances through identifying and correcting their behaviour problems by modifying their learning processes and enhancing their self control (Carroll & Onken, 2005). CBT seeks to help patients recognise, avoid and cope with the situations in which they would typically use drugs (McHugh, Hearon & Otto, 2010). This is achieved through the treatment process by modifying users’ attitudes towards substances to promote a healthy lifestyle. CBT treats drug addiction through heterogeneous treatment elements, including cognitive and motivational elements, operant learning strategies and skills building interventions (McHugh, et al. 2010). This is successful because substance use disorders are heterogeneous conditions characterised by recurrent maladaptive use of psychoactive substances (Magill, 2009). This highlights CBT’s success in treating drug addiction because of CBT’s direct treatment of the elements that cause drug addiction.

CBT is essentially a combination of two elements of psychotherapy: cognitive therapy and behaviour therapy (Tiffany, 1990), which work together to improve a drug user’s behaviour and thoughts. Cognitive therapy aims to change an individual’s thoughts about the issue causing their drug addiction, while behaviour therapy is the techniques or skills that an individual uses to alter their negative bahaviour (National Institute on Drug Abuse, 2005). CBT is structured, goal-oriented, and focuses on the immediate problems faced by drug users. It is an effective and individualised approach that concentrates on relapse prevention, and is typically achieved after 12 to 16 sessions with a therapist (Marlatt & Donovan, 2005).

While there are many causes for both physical and substance addiction, ranging from cognitive impairment to an abusive childhood, the underlying characteristic in addiction is the theory of positive reinforcement. Many drug users self-administer substances to escape their negative emotions, including anxiety and fear, which further encourages drug use through the rewarding effects and emotions they attain while under the influence of a substance (Goldsmith, et al., 1998)). An individual’s addiction can be treated through cognitive-behaviour therapy, which can be used in monotherapy, or in conjunction with other treatments such as medical approaches or rehabilitation. CBT’s success is underlined by altering an individual’s negative attitudes and behaviours by recognising and correcting an individual’s behaviour problems by modifying their learning processes and promoting self control (Niaura, 2000), which ultimately stimulates a healthy lifestyle.

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