Modification of excessive drinking by cue exposure

Abstract The value of an individual case study depends to a large extent on the nature of the predictions which are tested. If, for example, behaviour is modified by a method which flies in the face of current theory and practice, then it is worth reporting, and if detailed predictions about day-to-day changes are confirmed, so much the better. This individual case study was designed to test the possibility that excessive drinking behaviour can be modified by prolonged exposure to drinking cues. Our approach is based on the hypothesis that addictive behaviour is analogous to discriminated operants. We are also making the assumption that drinking, in the alcoholic, is frequently reinforced through the avoidance of unpleasant consequences (e.g. an escalation in anxiety, frustration or withdrawal symptoms) and that these avoidance responses are discriminated since they are triggered only by certain cues. Avoidance learning has been investigated in humans and animals for at least 50 years but in recent years strong evidence has accumulated which suggests a particular modification procedure. First, it has now been demonstrated that, in animals, a very effective extinction procedure involves exposure to the discriminative stimulus (i.e. cue) whilst blocking the avoidance response (Baum, 1969). Second, psychologists have considered obsessive-compulsive rituals to be analogous to avoidance responses (Hodgson and Rachman, 1972). Compulsive gas-tap checking, for example, avoids both catastrophic events and also unpleasant emotional states. During the last ten years an effective method of modifying obsessive-compulsive rituals has been developed which involves exposure to significant cues followed by response prevention which is either supervised (Meyer, 1966) or self-imposed (Rachman et al. , 1971; Hodgson et al. , 1972). The same method has also been successful in the modification of compulsive masturbation (Hodgson and Rachman, 1975).