Behavioral therapy is based on learning theory which deals with the role of externally applied positive or negative contingencies on the learning of behaviors, including complex behaviors such as using drugs. Substance abuse is seen as behavior that is reinforced by consequences such as how it makes the user feel (better, stronger, etc.). Additionally, internal and external cues, which are reminders or associations with substance use, are thought to trigger craving and desires to use again. All behavioral therapies have the same goal: to stop substance abuse by changing contingencies. This can be accomplished by (1) rewarding behaviors that are inconsistent with substance abuse, (2) removing or deactivating the cues that initiate substance abuse, and/or (3) pairing unpleasant experiences with substance abuse. Specific types of behavioral therapies are described below.
Contingency management (CM) interventions are reported to be among the most successful behavioral therapies for the treatment of substance abuse.[2,3] The conceptual basis for CM approaches came from the view that drug use is a form of operant behavior, and therefore making available non-drug reinforcers should decrease drug use. In general, CM is a behavioral therapy that provides immediate reinforcement in the form of cash or voucher incentives as long as the patient can provide biological evidence of drug abstinence.
Community Reinforcement Approach
The community reinforcement approach (CRA) is based on the theory that environmental reinforcers for substance use perpetuate substance use disorders and that, at the same time, patients with substance use disorders lack positive environmental reinforcers for sober activities and pleasures.[5,6]
CRA provides the means of changing various lifestyle choices in order to have a successful recovery. This includes:
Overall, CRA aims to improve the social environment of a substance abuser so that a sober lifestyle is seen as more preferable than a substance-dependent lifestyle.
Cue Exposure and Relaxation Training
Cue exposure therapy refers to treatment in which an abstinent drug user is exposed to cues that induce craving for a drug while preventing the user’s habitual response; that is, actual use of the drug. Cue exposure therapy can be paired with relaxation techniques and drug-refusal training to facilitate the extinction of classically conditioned craving.
This treatment prevents substance use behaviors by combining them with punishment. It couples substance use with an unpleasant experience such as a mild electric shock or medically induced vomiting.