Negative reinforcement and substance abuse: Using a behavioral conceptualization to enhance treatment.

Reinforcement history is a particularly potent predictor of future addictive behaviors. For the most part, researchers have studied the operant in order to understand and control positive reinforcement that maintains substance use behavior. However, negative reinforcement can be just as powerful in increasing the likelihood of substance use in the future, and some data suggest that negative (and not positive) reinforcement predicts increased difficulties associated with substance abuse over a person's lifetime. Negative reinforcement may be occurring if clients are avoiding withdrawal symptoms, escaping reality, self-medicating, or avoiding loss of using friends. In such cases, therapists may wish to use strategies such as response prevention, generating alternative activities, environmental interventions within the family and community, and emotion regulation and distress tolerance skills. ********** Examining the function of substance use behavior is the foundation of credible psychosocial research and clinical practice concerning the prevention and treatment of addictive behaviors. Reinforcement history is a particularly potent predictor of future addictive behaviors. For the most part, researchers have studied the operant in order to understand and control positive reinforcement that maintains substance use behavior. The most obvious example of positive reinforcement concerns physical euphoria associated with drug use. The rewarding effects can be immediate and quite powerful, making it likely that the behavior will be repeated in the future. Furthermore, if the euphoria is not always predictable and occurs intermittently, then reduction or cessation of the substance use becomes even more difficult since intermittent positive reinforcement schedules tend to maintain persistent behavior in the absence of consistent access. However, negative reinforcement also can powerfully increase the likelihood of substance use in the future. Some research findings suggest that negative (and not positive) reinforcement may predict increased difficulties associated with substance abuse over a person's lifetime (e.g., Carey & Correia, 1997). People who abuse substances often make statements such as "using makes me feel normal," which provide clues to the function of the behavior. The language implies that without the substance use the person feels abnormal, and that substance use takes away the aversive abnormality (hence, negative reinforcement). NEGATIVE REINFORCEMENT OF SUBSTANCE USE Negative reinforcement is understood to increase the likelihood that a behavior will be repeated in the future. A negative reinforcer "strengthens" behavior that reduces an aversive outcome (e.g., Skinner, 1974). Negative reinforcement of substance use means that an aversive outcome is reduced by the use of the substance, making it more likely that substance use behavior will occur again in the future. Substance use is often negatively reinforced on an intermittent schedule, making extinction of the behavior more difficult. Indeed, extinction of substance use does appear to be a difficult proposition, perhaps owing to the power of the intermittent reinforcement schedule. One function of problematic drug use may be to reduce aversive withdrawal symptoms. A coffee-drinking reader who has experienced the pain of a caffeine headache after a prolonged period without coffee may understand the function of drinking coffee to reduce the headache. For other more life threatening forms of addictive behaviors, one common question asked of people to determine the extent of a substance use problem is something like, "do you use substances to reduce a hangover or stop the shakes?" A positive response to such a question often suggests a greater constellation of consequences associated with problematic substance use (Buchsbaum, Buchanan, Centor, Schnoll, & Lawton, 1991; Dyson, et al., 1998). In the case of reduction of aversive withdrawal symptoms, negative reinforcement via substance use can be extraordinarily powerful. …