Sue had gone thirteen years without using cocaine and she was darn proud of her accomplishment! During those thirteen years she had snared a master’s degree in counseling and a number of addiction certification credentials, which led to a job at a well-known treatment center. With her advanced educational arsenal she had literally helped hundreds, if not thousands of folks, who were in the same boat she was in during her days of using cocaine. The urge to use cocaine had become a vague, distant memory, but an office party threatened to change all of that.

The chemical dependency treatment center where Sue worked had staged a huge gala Christmas party that year with wall-to-wall people, elaborate decorations and a seemingly endless supply of food. Everybody seemed to be having a good time. Everybody, that is except for Sue.

Sue broke into a sweat and began thinking (no make that obsessing) about using cocaine. It seemed like she had been magically transported back in time to an era where this reaction would have been the norm.

She literally grabbed Bill and Norm, two other counselors at the center, and she whispered, “Get me out of here, I feel like using coke again.”

“Why?” they asked.

“I don’t know”, she replied, her voice now anxious and cracking, “Just get me out of here now.”

Sue’s feelings did not rapidly subside. As the party was winding down she was still baffled by her own strange reaction. Why here? Why now?

Bill and Norm were intent on answering those two perplexing questions. As the party animals began leaving, Bill and Norm attacked the enigma with a fervor that could have sparked a new CSI Addictions television series.

Nevertheless, after nearly thirty minutes of investigation and probing Bill and Norm were no closer to solving the mystery.

“Well,” commented Bill, “if there’s a smoking gun, I sure can’t find it.”

“Yeah,” replied Norm, “but that sure is a nice Christmas display you are leaning on.”

The two looked at each other with that aha insight reaction that one wishes for, but rarely sees in clients. “Do you see what I see Bill?”

“You bet I do,” said Norm.

Bill was leaning on a large table with a beautiful Christmas display replete with a model house on it. The ground — actually the tabletop itself — was a shiny mirror. On the mirror was perfect line of fake white fake snow that went from the street, to the front door of the model home.

Could it be anymore obvious? Sue was a victim of stimulus generalization — a principle of Pavlovian classical respondent conditioning.

Classical conditioning can enslave your clients, as witnessed in aforementioned saga about Sue, yet it can also be a potent source of healing.

Another look at the dog, the bell, and the meat stuff you dreaded in
psychology class

Although most sources attribute the discovery of classical conditioning to the Russian physiologist, Ivan Petrovich Pavlov (1849-1936), a good case could be made that the true pioneer was a University of Pennsylvania graduate student, Edwin. B. Twitmeyer (1873-1943).

In 1902 Twitmeyer, drafted a doctoral dissertation in which he examined a phenomenon related to the patellar reflex (a good old fashioned knee jerk). Twitmeyer used a bell to warn subjects that a hammer was going to impact their knee. He knew that when a hammer was used to strike the knee an individual’s knee his or her foot would shoot straight ahead.

Quite by accident the bell prior rang without the hammer blow and presto — the patellar reflex occurred nonetheless. In 1904 Twitmeyer would present his monumental serendipitous finding at an American Psychological Association conference only to have his ideas fall on deaf ears.

Seventy years later (1974, Twitmeyer) the “Journal of Experimental Psychology” would finally publish his conclusions!

The death of Twitmeyerian conditioning and the life of Pavlov’s dogs

One of Pavlov’s overwhelming interests in life was investigating the digestive systems of dogs and in 1904 Pavlov snared a Nobel Prize in physiology and medicine for his work in this area.

Nevertheless, Pavlov’s ongoing fame would result from his popularity in psychology fueled by his now famous drooling dog experiments. He discovered that if a hungry dog was provided with a piece of meat immediately after a bell was rung for a number of trials, eventually the bell alone would enhance the saliva flow in the dog.

In plain everyday English, the bell, also known as a conditioned stimulus (CS) or neutral stimulus (NS), was acting as if it were the meat.

Pavlov — who purportedly was not overly fond of psychologists — termed this a “conditioned reflex,” but most experts agree that had he been a behavioral scientist rather than a physiologist, he would have chosen the term “associative reflex.” The bell in Pavlov’s experiment has no power of its own. It gets its power from the association it has with the meat.

Cocaine capers: When the dog part of the personality gets out of whack

A stimulus, such as a very loud noise or the meat, is known as a UCS or unconditioned stimulus. An unconditioned stimulus produces an automatic or reflexive reaction known as a UR or unconditioned response. Unconditioned in this case merely means unlearned. A dog, for example, need not attend an ivy league school in order to salivate when shown a piece of meat; which prompted Andrew Salter, the father of conditioned reflex therapy to comment that “the dog salivates even if it doesn’t know the principles of classical conditioning.” In human terms, the cocaine user will not need a course in physiology with a B- or better to get high on cocaine since cocaine will automatically stimulate the pleasure center of the brain.

Pavlov noticed another interesting phenomenon. If the dog heard a noise that was similar to the bell, the same salivation response would take place. This has been termed stimulus generalization. Thus, when Sue saw a line of fake snow on a mirror that looked similar (though not identical) to real cocaine, then she reacted as if she was viewing an actual line of cocaine.

To review:
Snorting, injecting or tooting real cocaine — An unconditioned stimulus (UCS) that produces an automatic cocaine high (UR).

Viewing a line of real cocaine — A conditioned stimulus (CS) that is associated with the cocaine use that generally follows.

Sue perceiving fake snow that is visually similar to an actual line of cocaine constitutes stimulus generalization that produces nearly the same reaction as looking at an actual line of cocaine.

As a counselor in this field you’ve heard old cliché that clients must find new playmates and new playpens. Why? Simply put, playmates (people who use drugs with clients and playpens (i.e., places where clients engage in drug usage)) are very powerful CS’s or conditioned stimuli. Thus, a person who comes in contact with his or her dealer will seemingly magically begin thinking about using since the dealer is associated with drug usage. The user who passes a corner where he or she bought drugs is urged to take a different route because the corner acts as a powerful CS.

Toy story: Using classical conditioning in treatment

The idea of using classical conditioning in the treatment of addiction maladies is not new. Rubenstein (1931) describes a case in which he massaged a client’s arm after injecting him with a hypodermic needle. He began gradually decreasing the morphine dosage, but continued to provide the massage (a CS). He discovered that the treatment proved efficacious and was void of the typical withdrawal patterns noted in such cases.

I have often used olfactory stimuli when working with addicted clients. For example, I might hypnotize a client or put her through a guided imagery session that is paired with a certain smell in my office, say cherry. I will then instruct the client to carry a cherry scented lip-gloss stick and to take a very brief whiff of it when the urge to smoke, gamble or whatever seems overpowering. The cherry fragrance is now associated with feelings of confidence and non-addictive thoughts.

Using classical conditioning in the real world is often difficult and requires a smidgen of psychotherapeutic creativity. I once had a client who abused prescription and nonprescription drugs to deal with the intense pain of his migraine headaches. Some biofeedback research has demonstrated that migraine sufferers sometimes (but not always) experience relief from increased hand temperature. I thus purchased a miniature metal toy frog that made a clicking noise when a tab underneath the body was pushed.

Clicking the frog was a conditioned or neutral stimulus since the clicking frog itself has no magical therapeutic powers. Nevertheless, I instructed the client to go home and click the frog and then dunk his hand into a basin of very warm water several hundred times a day.

Within a few days, he could click the toy frog, which was now associated with his hand becoming warm, and the migraine would be thwarted, therefore, he had no reason to abuse drugs. Wouldn’t it be wonderful all clients responded this well to treatment?
The old drooling dog treatment, well, I guess you could say it works for me.

References

Pavlov, I.P. (1927). Conditioned Reflexes. Routledge and Kegan Paul.

Rubenstein, C. (1931) "The treatment of Morphine Addiction In Tuberculosis by Pavlov's Conditioning Method." American Review Tuberculosis. 24, 682-685.

Twitmeyer, E.B. (1902). A study of the knee-jerk. Unpublished doctoral dissertation, University of Pennsylvania.

Twitmeyer, E.B. (1974). A study of the knee jerk. Journal of Experimental Psychology, 103, 104, 7-1066

Howard Rosenthal, EdD, MAC is professor and Program Coordinator of Human Services at St. Louis Community College at Florissant Valley. He is a frequent contributor and the author of the Encyclopedia of Counseling, which helps counselors secure licensing and certification and the Human Services Dictionary. His forthcoming book Gems of Wisdom: Insightful Interviews With 20 Accomplished Counselors and Therapists should be released in the near future. His website is www.howardrosenthal.com.

This article is published in Counselor,The Magazine for Addiction Professionals, April 2005, v.6, n.2, pp.55-57

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