In the last article, we explained how one outpatient rehab, Alternatives, uses exposure therapy to teach alcohol-addicted clients to moderate their alcohol use. The executive and clinical directors of Alternatives, Drs. Jaffe and Kern, pointed out in this article that there are other components to the program, like mindfulness, but we’re focusing in this article on extinction.
Exposure Therapy is repeated exposure to a stimulus without the associated reward
Extinction is an ongoing, intensified exposure to a stimulus without the good stuff normally associated with that stimulus. It’s accomplished through something called exposure therapy. But, as we said above, extinction “isn’t the only way that Alternatives readies its clients to resume moderate drinking.” The treatment center also has other components such as affect regulation, which means “learning how to change your feelings in a healthy way,” neurofeedback sessions, and life skills enhancements such as exercise, nutrition, and self-care. Of course, mindfulness is a major component of the regimen. (Alternatives even employs someone whose official title is Director of Mindfulness.”)
Exposure Work Helps Manage Cravings
Exposure work originally comes from psychotherapy, where it is used to treat phobias, PTSD, and anxiety disorders. Addiction therapists find that it is an effective Cognitive Behavioral Therapy (CBT) for managing cravings. As stated in the previous article, “in exposure therapy, the client experiences, directly or indirectly, the very thing that’s feared in an effort to learn to gain control of the distress that it causes.”
When we’re speaking about drug addiction, the there aren’t any fears, per se, to gain control over. Exposure therapy breaks the bond between a stimulus and its reward. A stimulus is whatever causes a reward to be expected. A physiologist named Pavlov trained dogs to perceive the sound of a bell as a stimulus. The dogs would salivate when they heard the bell because they had been conditioned to expect food (the reward) after the sound (the stimulus). For people with substance abuse issues, triggers create a strong expectation of getting high. Once a substance abuser either accidentally comes across or intentionally “sets off” one of these triggers, it becomes extremely difficult not to continue through to the reward. That is why triggers are dangerous for people who are trying to get sober.
Tips for quitting weed: Know what triggers your weed use.
You have to know what your triggers are. Identifying and then treating your triggers with exposure therapy is gaining in popularity, but it is still considered somewhat unconventional as a treatment. The most popular type of behavioral therapy is stimulus avoidance. Most substance abuse programs, AA for example, teach people to avoid their triggers.
Face or Run Away from Triggers?
Unlike AA, moderation-based training operates on the theory that if triggers can be created, they can also be uncreated. The association between trigger and getting high can be broken. This is done by exposing the patient to the stimulus over and over again without its normal reward. When the reward is no longer expected, extinction has been achieved.
There’s a new theory about exposure therapy, discovered through animal research, that points less towards ideas about unlearning a stimulus and more towards developing new associations to it. Todd Becker highlights how important this distinction is in his article, “Overcoming Addiction.” Becker states that “the original addictive response to stimulating cues will never die…merely by not reinforcing those stimuli. Rather, it is important to learn new behavioral responses to those old cues…to ‘mask’ or dominate the old responses. Cue extinction is an active process, not a passive one!” Becker points to current research that shows extinction works for both moderation-based training and abstinence:
“In cases where the goal is moderation and not abstinence, it is
important the cue exposure involve actually take small doses
(e.g. one drink), while preventing any follow up drinks, to re-train
the response. This is based on observations that addicts or
alcoholics respond to a small dose as a cue that ‘more is coming’.
Without this type of conditioning, there may be increased risk of
Do Try This At Home
Do you need to go to rehab facility or therapy in order to give exposure therapy a whirl? Of course not. You can create your own exposure therapy routines. Statistics show that most people quit drugs—even hard drugs—on their own. Reading about the techniques the pros use, as you’re doing here, is a good start. Next: a sample DIY exposure therapy routine for moderating marijuana use.