Although there are recognized physiological factors involved in hardcore addiction, the sine qua non for drug abuse/addiction is to be found in learning theory.

A variety of components, such as cultural environment, availability, exposure to drug use patterns, and self-perceived needs, contribute to the acquisition of a drug habit.

The fact that physical relief occurs in the addictive cycle cannot be separated from the psychological aspects which accompany it. The impact of profound relief adds appreciably to the learning process. What was so satisfying during the initial period of tension reduction will be likely to repeat itself under similar circumstances on the next occasion.

A learning framework can explain not only drug abuse/addiction but other related behaviors as well. This has been noted previously by the author (1972, 1973), by Frederick and Resnik (1971), and by Frederick et al. (1973).

The learning theory paradigm tends to follow a particular sequence. When an intense stimulus situation remains relatively unchanged, it will inevitably be followed by anxiety, a state which requires diminution.

In terms of traditional reinforcement theory, anxiety is a secondary reinforcer, since the attainment of the goal object (drug) possesses its own reinforcing properties.

This occurs because, through past experience, drug ingestion has become associated with a primary drive state, such as a physiological need or imbalance. For our purposes here, any stimulus condition which contributes to this drive state is sufficient to support the notion of drug abuse as learned behavior.

The response that follows is likely to become progressively more prominent as a specific act which brings results, since it evokes dramatic attention along with a need for drug ingestion.

The ensuing tension reduction from the drug brings relief and reinforcement of the act which induced the administration of the drug in the first place. As this process is repeated, the sequence of events is shortened in time because the decrease in tension reduction becomes so powerfully reinforced, and every point in the sequence becomes an associative cue for the ultimate relief.

With each reinforcement, the act of substance abuse becomes strengthened, and the likelihood of its recurrence under similar conditions is increased. In cases when the tension is particularly acute, such an act may be learned very quickly. The paradigm looks like 191 this: stimulus situation (stress, shame, guilt) tension (anxiety) addictive acts (drug seeking/receiving/ingesting) tension reduction stimulus situation--and the cycle repeats itself.

Other authors (Wikler 1965, 1973b; Jaffe 1970a; Crowley 1972), have also commented upon the learning components inherent in drug abuse. A description of the theoretical contribution of each of the major elements in this treatise can not only illustrate the theory but can make each of the five elements of drug abuse--initiation of use, continuation, shift or transition from use to abuse, cessation, and relapse-- more understandable, especially to the therapist.

Drug abuse is expressed as a ratio of destructive factors to constructive factors operating in the personality. These factors are multiplicative functions of each other as they contribute to drug behavior.

This may be illustrated as follows:

Ba = Pd x Md x Hd x Rd / PC x MC x Hc x Rc

or Ba = destructive factors / constructive factors

where
Ba = Drug addiction or abuse
Pd = Personality components that are weak and destructive
Md = Motivation or strength of drive state toward destructive, undesirable behavior
Hd = Habits as a function of the number of reinforcements associated with drug-taking behavior
Rd = Risk-taking stimuli associated with drug ingestion
Pc = Personality components that are strong and constructive
MC = Motivation or strength of drive state toward constructive, desirable behavior
Hc = Habits as a function of the number of reinforcements associated with favorable responses to stress
Rc = Risk-taking stimuli associated with constructive responses

Let the value of 1.0 be considered the point where drug addiction or abuse will definitely occur; zero represents the value where no likelihood of such behavior obtains. As the proportion moves upward from the equally weighted value of 50 percent (0.50). the probability of drug abuse, thereby, increases as the value of 1.0 is approached.

Conversely, the likelihood of drug abuse occurring decreases proportionately as the numerical value approaches zero. Each of the variables listed in the formula will possess its own weights, according to past experience and those influences currently operating in the life of the individual.

Since destructive and constructive factors in drug addiction or abuse may be expressed illustratively as a ratio, strong personality and motivational variables predominate as constructive forces in the denominator, while habits and motivation are equal in both the numerator and denominator.

In order to show the learning principles involved, let us assume that there is an equal chance for the growth of destructive and constructive factors which contribute to the development of drug-related behavior.

A 50-percent probability represents this situation numerically. This may be shown by substituting arbitrary values for each of the variables in the formula, as follows: When the risk-taking aspects of the destructive factors increase even slightly, there is a growth in the likelihood that drug abuse will develop.

This will obtain even when other factors remain the same as those in the situation noted above, with a 50-percent probability in the level of occurrence. This change may be demonstrated by increasing the risk factor (Rd) by one point in the formula, since the ratio value now becomes 0.60, which is closer to 1.0 than is 0.50.

Conversely, when the constructive aspects of risk are strengthened by one point in the formula, the likelihood of drug abuse developing decreases, inasmuch as the resulting proportion of 0.42 is closer to zero than is 0.50. Obviously, when the other factors in the equation change through reinforcement or nonreinforcement, the ratio changes accordingly.

If one or more of the variables is weakened through nonreinforcement, the scales are tipped in either a destructive or constructive direction, depending upon the total value of the proportion.

For purposes of simplification, only the risk factor has been varied here to illustrate the importance of a single value in the ratio. Moreover, factors other than those noted may be involved, although these seem to be the most prominent, especially if environmental influences are subsumed under those listed.

Risk-taking behavior, in particular, is likely to be responsive to environmental stimuli, for example. The abuser/addict should be aware of the increase in risk-taking behavior as a destructive force since mere geographic placement into an old, familiar environment can often stimulate the recurrence of a previous drug problem.

This is due to the strength of past associations as they contribute to old habits of drug use. Substitute medications, such as methadone, may alter the balance of destructive factors in the behavioral equation by reducing anxiety and a tendency toward depression on a tentative basis.

Frederick et al. (1973) report that clinical depression recurs during methadone abstinence, and, hence, the abuser/addict and the therapist should be cognizant of this fact as well as of the temporary palliative effects of drug substitutes like methadone.

This must be taken into account in the readjustment process of a therapy program. Substitutes in effective living can be supplied, rather than replacing one drug with another, particularly at a point in treatment when the habit has begun to lose strength. The relearning process affects every facet of the treatment program through the same principles by which abuse/addiction develops and continues. 193 The strengthening of the addictive act is not merely a direct function of the number of reinforcements.

Reinforcement of drug responses on an intermittent basis can lead to greater conditioning and more resistance to extinction than can reinforcement of every response. Anticipation of the receipt of a drug can stimulate further drug-seeking/receiving behavior. In extinguishing the drug response, the intermittent reinforcement principle holds for punishment as well as for reward.

Once drug abuse/addiction has begun, it constitutes a punishing state of affairs when the person goes without the drug. Not receiving this strong reinforcer on each anticipated occasion contributes both to the drive to use it and to its suppression and extinction.

Going “cold turkey” exemplifies this. The heightened drive state increases the likelihood of the addictive response when the strength of the habit remains constant or is even slightly reduced, depending upon the value of the drive state. Nonreinforcement of the habit, which is tantamount to punishment, causes it to weaken.

After the drive reaches its peak, a decrement occurs in the strength of the habit, resulting in a diminution of the addictive response.

General reinforcement principles are employed to account for the various facets of the development of drug usage for purposes of clarification, although it is evident that intermittent reward and punishment also operate in concert with the theory as outlined.

The entire treatment spectrum, including administration of substituted medications, milieu therapy, and psychotherapy, is governed by these principles, as well. 

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From N.I.D.A. Monograph 30 - Theories on Drug Abuse: Selected Contemporary Perspectives.  [Page for pdf download, which includes diagrams and reference list.]