ABA in the Treatment of Behavioral Addictions

Applied Behavioral Analysis can be used to help mitigate behavioral addictions, reducing harmful impacts from addictive and learned behaviors. Upon hearing the word “addiction,” many people think immediately of substance misuse, including prescription drugs such as opioids, or alcohol and tobacco, addictions are not limited to these behaviors. People may be addicted to a variety of behaviors which are self-reinforcing, including sex, gambling, mobile/online gaming, and social media. Applied Behavioral Analysis (ABA) has been found to be effective in reducing addictive behavior in many different areas, incorporating cognitive-behavioral therapy techniques and strategies.

Addictive Behaviors Have Behavioral Solutions

Although addictive behaviors may be influenced by genetic, environmental, and behavioral factors, addictive behaviors are learned and are reinforced by the effects of behavioral choices. According to the National Institute on Drug Abuse for Teens, children of parents with addiction problems are at increased risk of addictive behaviors themselves. At the same time, environmental factors and the addictive behaviors themselves result in reinforcement of biochemical rewards found in natural human brain chemistry. Applied Behavioral Analysts (ABAs) can select from evidence-based techniques to change behaviors in the addiction cycle or process.

Learned Behavior Modification through Applied Behavioral Analysis

The learned aspects of addictive behavior can be modified in several ways that are all based on recognized principles of learning theory and conditioning. Classical conditioning takes place through paired association. For example, a person with a gambling addiction pairs the reward of winning even a small amount of money with gambling. They may further pair pay dates with trips to the card club or casino, which acts as a “cue”. Applied behavioral analysis techniques can assist the gambling addict to make new paired associations by modifying one, or both, of the cues. For example, substituting a pleasurable, healthy reward on pay dates instead of a trip to the casino may help the addict to form new paired associations that don’t reinforce gambling behaviors.

Using Screening Tools for Functional Behavioral Assessments

In order to develop treatment plans and interventions for individuals with gambling, sex, food, or other behavioral addictions, ABAs need to conduct functional behavioral assessments (FBAs). There are a number of assessment tools for gambling addictions, including screening tools that can aid in the functional behavioral assessment: the South Oaks Gambling Screen (SOGS), Brief Biosocial Gambling Screen (BBGS), and the Lie-Bet Questionnaire. The BBGS and Lie-Bet Questionnaire are brief surveys that patients can take on their own. The Sexual Addiction Screening Test (SAST) and PATHOS Screening Tool are two of the primary tools used to indicate a potential sex addiction. The Yale Food Addiction Scale (YFAS) and Food Addiction Inventory are tools that ABAs may find useful in helping to identify food-related addictions.

Implementing Functional Behavioral Techniques for Behavioral Addictions

In prior decades, negative reinforcement was used to deter undesirable addictive behaviors. Clinicians may have used shock therapy or aversion therapy to associate negative cues with addictive behaviors. The benefits of positive associations with positive behavior have since been recognized. ABAs now seek to aid behavioral addicts to develop positive cues, eliminate negative cues, and provide exposure therapy which will help addicts to desensitize themselves to the neurological stimulation they receive as a result of engaging in addictive behavior. Because gambling, sex, and food addicts are adept at hiding their addictive behaviors, in some cases, even from themselves, many of the direct observational techniques ABAs may use that can benefit other types of behavioral modification are not effective. Gambling, sex, or food addicts may also have a number of co-occurring disorders, such as substance misuse or depression, which can make the development of behavioral intervention plans (BIPs) challenging and complex. Assisting people with these addictions to form new, positive associations with healthy, non-addictive behavior is one of the most-effective techniques ABAs can use.

Using Cognitive-Behavioral Therapy to Benefit Behavioral Addictions

Cognitive-Behavioral Therapy enables ABAs to provide both operant conditioning through recognized ABA techniques, and social learning through therapeutic talk about the addictive behavior and reasoning regarding behavioral choices. The majority of sex, gambling, food, and related addicts are adults with developed systems of learning and functioning. ABAs have achieved success in assisting addicts to modify and reduce addictive behaviors through a combination of behavioral techniques, and therapeutic talk to strengthen cognition and self-actualization through learning and growth. Cognitive-Behavioral therapy enables addicts to understand the addiction process and how their physiology affects their behavior and choices.

Preparing for a Career Working in Behavioral Addictions as an Applied Behavioral Analyst

Applied Behavioral Analysts may work directly for a community-based or specialized clinic serving patients with behavioral addictions, including gambling, sex, and food addiction. First, ABAs will need to complete a master’s degree in psychology, applied behavioral analysis, or a closely-related degree. Then, they will need to obtain their certification from the Behavioral Analysis Certification Board (BACB). Further specialization and certification may be provided through professional organizations, including the National Board for Certified Counselors and the National Association for Addiction Professionals. Addiction-specific organizations offer certificate programs at both the national and state levels. Professionals seeking to treat gambling addiction may be certified by the National Council on Problem Gambling through the International Certified Gambling Counselor Program (ICGC). Certified Sex Addiction Therapists may be certified through the International Institute for Trauma and Addiction Professionals. The Food Addiction Institute offers training and certification in specific food-related addictions and recovery.

Further Reading on Applied Behavioral Analysis in Behavioral Addictions

Association for Behavioral Analysis International (ABAI) Gambling Special Interest Group offers resources, software, and a newsletter for ABAs interested in working with individuals with gambling addictions.

The Sexual Behavior Research and Practice SIG of the ABAI disseminates research in the field, maintains a database of reports and e-mail list, and provides meetings and symposia for practitioners.

Scientific American’s report on “How the Brain Gets Addicted to Gambling,” covering the history of psychological and neurological understanding of gambling addiction, case studies, and research.

International Institute for Trauma & Addiction Professionals (IITAP) Resources, including the organization’s blog covering industry news, frequently-asked questions, and knowledge base with articles and videos about sexual addiction and sexual health.

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