ABA in the Treatment of Substance Abuse
Substance abuse is a problem that costs society billions of dollars annually in medical treatments, law enforcement, and legal costs and in supporting families affected by drug addiction. Addiction, if left untreated, is almost always fatal. People who abuse drugs generally have co-existing mental health issues, physical disabilities and behaviors that lead to risk-taking. Substance abuse also creates a cycle in which children of abusers get caught and repeat their parents’ behavior. There are several ways to treat substance abuse.
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Treatments for Drug and Other Substance Abuse
Medications are used to suppress cravings and to lessen the effects of withdrawal from drugs. The first step in treatment is detox or ridding the body of the substance. Afterward, patients can receive medications that have been developed to reestablish normal functioning in the brain and to help the body overcome the physical compulsion to use the substance. There are specific medications for use with opioids like heroin and morphine. The medications target the same centers of the brain as the drugs and reduce drug-seeking tendencies. There are also devices that can electronically stimulate nerves in the brain to suppress the symptoms of withdrawal. The problem with medications is that, because they differ according to the substance being abused, patients with multiple addictions must be given several medications. Another treatment for substance abuse is psychological therapy such as Behavioral Analysis (Applied Behavioral Analysis, or ABA).
Treating Addicts Like Overeaters
According to an article in Psychology Today Magazine, drug addictions are much like behavioral addictions and can be addressed with some of the same tools. One of these tools is Behavioral Analysis. This is a treatment process that “focuses on improving specific behaviors such as social skills, communication, reading and academics as well as adaptive learning skills such as fine motor dexterity, hygiene, grooming, domestic capabilities, punctuality and job competence.” It is used with adults and children, in many conditions including autism and problems associated with aging.
Steps of Behavioral Analysis
The first step in the process is helping the client decide which behaviors need to be addressed. In the case of addiction, it may seem like a simple issue, but addictions are complex and involve triggers such as stress and depression. Helping clients avoid these triggers is not as easy as telling an obese patient to stay away from fast food restaurants. Stress can come from many places, and depression can seemingly materialize out of nowhere. The second step in Behavior Analysis is setting goals for treatment. The third is learning new skills to address the problems in positive ways. The fourth is deciding how to measure success (such as four clean urine samples in a month).
There are different kinds of ABA. Some of these are Discrete Trial Training, Incidental Training and Pivotal Response Training. The type that has been the most successful with addictions, however, is Contingency Management. This approach treats addiction breaking like a trainable behavior. The National Institute of Health Drug, Alcohol and Tobacco Use web page says that addiction is the result of a combination of genetic and environmental factors. It is a chronic condition and requires long-term intervention. ABA therapy helps patients change their attitudes about drug use, build healthy life skills and become motivated to continue with other forms of treatment. Contingency Management, as a form of ABA, uses conditioning techniques to treat addictions. Patients, aided by the therapist, look at the prompts that preceded the behavior. This could be depression, anxiety or another stressor. It might be something as vague as the desire to escape reality. Then client and therapist look at the behavior itself. Finally, they examine the consequences of the behavior. In most cases that is the stimulation of the pleasure centers of the brain. They discover positive behaviors that could be used to replace the negative responses to the prompts or triggers. Contingency Management then uses a reward system such as vouchers or actual prizes to reinforce the positive behaviors. If a client has a clean urine sample one week, he might be given a voucher for a small prize like a movie pass that would be something he could enjoy in a drug-free lifestyle. After three weeks of clean UAs, the prize would be greater. Contingency Management has been found to be effective in motivating clients to abstain from drug use. It can be used in conjunction with other ABA interventions.
Other Behavioral Analysis Treatments
These other interventions include cognitive-behavioral therapy, in which patients are taught to anticipate and deal with trigger situations, and multidimensional family therapy used primarily with youth and their families to improve the functioning of the family unit. Additionally, motivational interviewing is used, which takes advantage of positive reinforcement to encourage clients in their struggle to overcome addiction. In the beginning, these therapies may occur as inpatient interventions on an intensive daily basis, employed along with medicines or devices to combat the addiction.
Later, the patient may receive therapy on an out-patient basis and some of the more aggressive treatments may be modified or abandoned. The behavioral analysis therapies are intended to be long-term. As the client experiences new stressors in his life, he learns to apply the principles of BA to address the problems with positive behaviors like exercise and meditation. Addictions can fuel criminal behaviors. If the client is an offender, his Behavioral Analysis treatment will be tailored to reflect adjusted ideas of entitlement and empathy for the victims of criminal behaviors that result from addictions or the attempt to get addictive substances. They will also include mandatory after-release therapy and be coordinated with his or her probation.
Becoming a Behavioral Analysis Therapist
Although certification is possible with an undergraduate degree, most therapists choose to get a bachelor’s degree in a related field such as psychology, sociology or criminal justice, then earn a master’s degree in behavioral analysis. Afterward, it is advisable to obtain certification from the Behavior Analyst Certification Board.
The rate of addiction relapse is high. Merely removing the client from the drug does nothing to stop the cravings or to teach the addict how to deal with life situations apart from drugs. Like teaching a starving man to fish solves hunger, teaching him to examine the behaviors that lead to his addiction produces sobriety.
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