Abnormal Psychology

Substance Use Disorders 401

substance can eliminate withdrawal symptoms. That is, once a substance develops

dependence, he or she probably will experience withdrawal as the substance wears

off—with symptoms that can range from mildly unpleasant to extremely unpleasant

and potentially lethal. Substance use eliminates the unpleasant withdrawal state,

which increases the likelihood of subsequent use. (Note that this type of desire to

use a substance differs from relief craving, in which an individual has an urge to use

a substance to reduce an uncomfortable state brought on by factors not related to

withdrawal.)

Fourth, people who go on to abuse substances may respond more than others to

a particular pattern of operant conditioning. Research has revealed that compared

to people who don’t abuse substances, people who do abuse substances are more

likely to prefer smaller amounts of reinforcement that occur immediately after a

behavior to larger amounts of delayed reinforcement (Bickel & Marsch, 2001).

They also prefer larger but delayed losses (punishment) over smaller but more im-

mediate losses (Higgins, Heil, & Lussier, 2004). Thus, when a substance abuser can

choose between taking a drug (with immediate reinforcement, along with possible

delayed losses or punishment) and not taking it (with a loss of immediate reinforce-

ment), he or she may choose the immediate reward of drug use.

Classical Conditioning

Stimuli associated with drug use (such as drug paraphernalia) are referred to as

drug cues, and they come to elicit conditioned responses through their repeated

pairings with drug use. The drug cues are then associated with the reinforcing

(positive or negative) effects of the drug and, in fact, drug cues can themselves

elicit the activation of the dopamine reward system (Tomkins & Sellers, 2001).

Being exposed to such cues—or even thinking about them—can lead to drug crav-

ings (Hyman, 2005; Stewart, de Wit, & Eikelbloom, 1984). For example, people

often handle money when buying cocaine and then use the cocaine shortly after-

ward; handling money can then become a conditioned stimulus. Thus, a person

addicted to cocaine can come to crave it after handling money (Hamilton et al.,

1998). Similarly, for cigarette smokers, certain conditioned stimuli—such as a full

sensation in the belly after dinner—can lead to a craving for a cigarette among af-

ter-dinner smokers (Lazev, Herzog, & Brandon, 1999). Even after successful treat-

ment for substance abuse, being exposed to drug cues can lead a former abuser to

experience powerful cravings and can increase the risk of relapse (Hyman, 2005;

Torrens & Martín-Santos, 2000).

Cravings do not last indefi nitely, however. When a person craves a substance but

does not use it, the craving normally disappears within an hour (Wertz & Sayette,

2001). Researchers have found that a person is more likely to feel the craving when

he or she expects to be able to take the drug. Because expectations moderate cravings

and cravings can lead to relapse, expectations play a role in causing relapses.

Table 9.7 summarizes the psychological factors that contribute to abuse of and

dependence on stimulants.

P S

N

A stimulus associated with substance use can

lead a person to crave the substance. For some,

simply handling money can cause a strong

craving for cocaine.

Jonathan Torgovnik/Getty Images

• Observational learning: People observe models using substances as a coping strategy and
  develop expectations about drug use.*


• Operant conditioning:
  
  
  • Positive reinforcement leads to subsequent expectations of reward, which in turn lead to
    reward craving.*
  
  
  • Substance use alleviates a negative state, which provides negative reinforcement and
    leads to relief craving; substance use can become a chronic coping strategy.*
  
  
  
  


• Classical conditioning: Drug cues elicit a craving
  This factor is not unique to stimulant abuse and dependence.

Table 9.7 • Psychological Factors That Contribute to

Abuse of and Dependence on Stimulants

Drug cues

The stimuli associated with drug use that

come to elicit conditioned responses through

their repeated pairings with use of the drug.