Addiction induction--will it be tested?

Abstract

BRIEF PROPOSAL ADDICTION INDUCTION—WILL IT BE TESTED? PERITZ LEVINSON* The power ofaddictive drugs to modifyhuman behavior is wellknown. Thestrength, endurance, and ingenuity demonstrated by the narcotic addict in the pursuit ofhis drug is remarkable when one considers the relatively passive premorbid personalities often found in these individuals [i]. The idea ofharnessing this power, traditionally destructive , and turning it to useful purposes is an alluring one. This report proposes the use of the aversive aspect of the addictive state in the treatment of chronic schizophrenic patients . Drug addiction would be induced to replace disorganized behavior by sustained opiate-directed activity. Long-term maintenance would be accomplished by methadone. During the past thirty years, the experimental techniques generated by operant-conditioning theory have been valuable in the analysis ofthe behavioral aspects ofopioid dependence [2]. The general thesis of operant conditioning is that behavior is controlled by its consequences. Consequences which strengthen behavior are called reinforcers. Important reinforcing features ofmorphine include reduction ofaversiveproperties ofwithdrawal , long-lasting euphoria, and reduction of pathogenic drive tension [3, 4]. Behavior theory holds that the compulsive user ofnarcotics has a complex set ofconditional responses that perpetuates the use of drugs and predisposes to relapse after detoxification [4, 5]. Within this framework, drug use is an emitted response that grows as each reductionin tensionreinforcesthedrug-seeking behavior. With regular use, physicaldependence develops and gives rise to still another tension when the drug is not used— withdrawal distress [6]. Theoretically, this drug-dependent condition can organize the behavior ofschizophrenics by preempting random and chaotic responses to the various stimuli (internal and external) that usually determine their reactions. Behavior may be further controlled by limited withdrawal following asocial acts through withholding the drug or giving nalorphine. A new set of behavior patterns may be induced by the patient 's concentration on avoiding withdrawal symptoms and by the conditioning aimed at the extinction ofpsychotic behavior. Operant-conditioning techniques have been successful in a variety of psychiatric settings [7]. Conditioning turned out to be a powerful and useful technique when used on "hard core" chronic state-hospital patients in Minnesota, the results far outstripping the * Creedmoor State Hospital, Queens Village, New York 11427. 67I national average [8]. Two important types of conditioning techniques under investigation [9] are reward and punishment. A whole series ofstudies, mainly with chronic schizophrenics , has shown these patients to acquire new response patterns when positive reinforcement or reward depends upon the emission ofa novel response [10, irl- Verbal reward has been found to be least effective [12], while materialreward has yielded betterresults [13]. Aversive stimulation or punishment is particularly effective [14, 15]. This is especially so when information about the correct and incorrect responses is also provided [16]. Schizophrenics appear to be differentially responsive to specific classes of reinforcers [17]. Material incentives and, to an even greater extent, physically noxious stimuli tend to be more facilitating than are socially derived reinforcements. In summary, many experiments have been done on psychotic patients in an effort to influence ward behavior [18]. It has been demonstrated that complex behavior can be manipulated by reinforcement contingencies. The problem oftransition from ward to life outside the hospital remains. Development ofa pharmacological behavior reinforcer would be invaluable since it could be discharged with the patient. Unlike the aversive chemical disulfram (antabuse), which can be discontinued without pain, an addictive drug cannot be readily shed by its host and must remain with him like a cardiac pacemaker . Important Relevant Research Wikler [19] induced drug dependence on morphine in three chronic schizophrenic men. He reported that regular, repeated doses ofmorphine in increasing quantities have only equivocal effects in the direction of reducing the bizarre, stereotyped activities. Wikler's results would contradict the possibility ofinducing drug-seeking, "purposive" behavior ifnot for one crucial theoretical development from later research. Nichols [4] argued that, in order for drug-seeking behavior to develop, the drug administration must be contingent upon an operant response. That is, the condition under which the patient is introduced to morphine is crucial in determining the subsequent behavior toward the drug. This may account for the very low incidence of individuals, including doctors, who develop dependence upon opiates after medical treatment with these drugs. In contrast , physicians...