Cue exposure therapy for substance use: A complement to functional analysis

Abstract

This chapter addresses the theoretical and empirical bases as well as the possible clinical implications of a model that highlights the importance of respondent conditioning and its interaction with operant conditioning in substance use and dependence. Aversive physiological states experienced by the individual are compensatory conditioned responses that "protect the organism" from harmful substance effects. Such compensatory action is responsible for tolerance, withdrawal-like symptoms, craving, and overdose. According to this theory, relapse and active drug-seeking, following abstinence periods, are an effect of reexposure to a drug-conditioned stimulus that elicits and evokes responses that increase motivation to active drug-seeking. There can be failure to extinguish proprieties of the conditioned cues such as its motivating effect that evokes operant responses, reinforced by the substance's positive effects and the removal of withdrawal-like aversive effects. A possible relapse after treatment has been addressed with the combination of cue exposure therapy (CET) and urge-specific coping skills training, which allows substance users to experience the reduction of drug-conditioned responses while practicing coping skills, along with aiming to generalize these skills beyond clinical settings.