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Free-operant avoidance of alcohol: An analogue study of alcohol aversion
1. Lkhav.
Thcr. d Erp. Pxychler.
Vol. 8. pp. 371.376.
Pcrgmon
Press. 1977. Prmred in Great Bntam.
FREE-OPERANT AVOIDANCE OF ALCOHOL: AN ANALOGUE STUDY OF ALCOHOL AVERSION ANTHONY R. CIMINERO University
of Georgia and
ROBERT S. DAVIDSON V.A.
Hosptial.
Miami,
Florida
Summary-An experimental analysis of the effects of peripheral electric shock on free-operant avoidance of alcohol was performed on five hospitalized alcoholics. A single-case design in which the aversive stimulus was systematically presented and withdrawn was used with each subject. There was little or no avoidance responding by any of the subjects in the initial baseline (no shock) condition. During conditioning, four of the subjects required relatively high shock intensities before making any avoidance responses. Removing and reinstating the shock contingency demonstrated that the shock exerted precise control over two subjects’ avoidance behavior, some control over one subject and little or no control over the other two. After 100% avoidance was established, each subject continued to avoid alcohol even when the shock contingency was removed. Although there appeared to be some generalization of the avoidance to the subjects’ natural environment, there are serious questions about the treatment potential of the procedure because of the high shock intensities that were necessary to condition the avoidance.
Various aversive conditioning procedures including chemical aversion (Lemere and Voegtlin, 1950), verbal aversion via covert sensitization (Anant, 1967). and electrical aversion (Davidson, 1974) have been used to modify alcoholic drinking behavior. In spite of the amount of research, assessment of alcohol aversion still poses some problems. Simply demonstrating that an individual has a conditioned nauseous reaction to alcohol does not guarantee that the alcohol will function as an aversive stimulus (see Franks and Wilson, 1975, p. 585). Recently, studies have employed freeoperant methods to assess alcoholic behavior (Miller, 1977). However, showing that an individual will not work to obtain alcohol simply demonstrates that the alcohol is not functioning as a positive reinforcer. Within the operant paradigm, one would have to demonstrate that an individual will work to escape or avoid the alcohol before alcohol could technically be considered an aversive stimulus (i.e. a negative Requests for reprints should be addressed to Anthony
reinforcer). Although escape/avoidance contingencies using electric shock have been used with alcoholics (e.g. Blake, 1965; Hsu, 1965; MacCulloch, Feldman, Orford and MacCulloch. 1966; Miller, Hersen, Eisler and Hemphill, 1973; Morosko and Baer, 1970; Vogler, Lunde, Johnson and Martin, 1970; Wilson, Leaf and Nathan, 1975) none of these studies have systematically examined the effects of the unconditioned aversive stimulus (i.e. electric shock) on the escape/avoidance of alcohol. One case study by Ciminero, Doleys and Davidson (1975) demonstrated within an analogue setting that strong peripheral electric shock was necessary to develop an active avoidance of alcohol. Although shock exerted control over free-operant avoidance responding shortly after this behavior was initiated, shock was not necessary to maintain the alcohol avoidance after the behavior was firmly established. The present study replicated the
R. Ciminero.
Athens, Georgia 30602. 371
Department
of Psychology,
University
of Georgia,
372
ANTHONY
R. CIMINERO
and ROBERTS.
previous procedure to examine further the development and maintenance of free-operant avoidance of alcohol.
METHOD Subjects Five male veterans, hospitalized for their drinking problems.volunteered to participate in the alcohol research project at the Miami VA Hospital. Subjects ranged in age from 46-52 and had an average of an eleventh grade education. Four of the subjects were divorced. Each individual had a history of excessive drinking for several years (X = 10.4 yr), had previous hospitalizations for treatment, and had a primary or secondary diagnosis of chronic alcoholism. Three patients reported a daily consumption of a fifth or more of hard liquor while the other two reported consuming less than a fifth of liquor per day during the previous month.
Apparatus The experimental rooms contained sound proofed industrial acoustic chambers (IAC 402A and IAC 403A) in which subjects could be observed via closed circuit television. Within each chamber was a wooden console that contained two Lindsley plunger manipulanda (Gerbands), a small white light above each manipulandum, two recessed magazines each housing a removable one-ounce shot glass, and a small projection screen (see Ciminero et al.. 1975. or Davidson, 1974, for a more complete description). Solenoid liquid valves (Lehigh Valley Electronics, 1527) were used to dispense automatically 2cm’ of liquid into one of the glasses. Beer was dispensed undiluted but hard liquid was diluted 50% with water. The shock source (Grason-Stadler. 60708) delivered constant current shock of various intensities from 0 to 40mA through electrodes that could be mounted on the subject’s forearm or on the fingertips.
Procedure In the first session, each subject was told that his favorite beverage would occasionally be poured into the glass and that pulling the right plunger would delay the alcohol delivery. After demonstrating the procedure, the subjects were informed that they could respond in any way they wanted, but they should drink any liquor that was dispensed. The electrodes were then attached and the patient’s questions were answered before the experimenter left the room. With few exceptions, subjects were seen for two halfhour sessions each weekday. A single case design in which a shock contingency was systematically presented and withdrawn was used with each subject. This A-B-A-B-C design is briefly described below (for a more complete description, see Ciminero et al., 1975). Baseline phase (alcohol avoidance). Each response postponed alcohol delivery for 20 set (the response-alcohol interval). If a response did not occur within 20 set after the onset of the response-alcohol interval, 2cm’ of liquor was dispensed. Whenever alcohol was delivered, the next 20 set
DAVIDSON
interval did not begin until the shot glass was removed and then replaced in the magazine. Although the electrodes were mounted on the subject’s forearm, no shock was delivered during the baseline sessions. However, prior to the first three sessions estimates of detection thresholds and tolerance levels were obtained for each subject. A series of 0.5 set shocks of increasing intensities was administered to the subject who was to indicate when he first felt the shock and when the shock was as high as he could tolerate. Conditioning phase I (shock-alcohol avoidance). A 0.5 set shock was presented simultaneously with each alcohol delivery. The shock intensity during the first conditioning session was equal to the subject’s detection threshold and was increased in the following sessions until the subject avoided 50% of the available alcohol. If 40mA shocks to the arm were not sufficient, the shock site was changed to the fingertips and the intensity was decreased to 10 mA. After the subject had a minimum of 50% avoidance for four consecutive sessions, the reversal phase began. Reversal phase (alcohol avoidance). Although the electrodes were still mounted on the subject, no shock was administered during this return to baseline. Conditioning phase II (shock-alcohol avoidance). Shock was again paired with each alcohol delivery. Shock intensity began at the level that was used at the end of the first conditioning phase and increased until 100% avoidance was established. After two consecutive sessions of 100% avoidance, all threat of shock was eliminated for the maintenance phase. Maintenance phase (alcohol avoidcnce). The electrodes were not mounted to see if the subject would maintain his avoidance behavior without any threat of shock. If the subject avoided alcohol 100% for two consecutive sessions, the basic experimental analysis for the subject was terminated. Additional follow-up visits were scheduled over a two year period. Whenever scheduling permitted, subjects were given a l5-min session in the experimental space without the electrodes attached.
RESULTS A summary of the data from the five subjects is presented in Table 1. Although there were individual differences in how each subject responded, there were many consistencies in their performance. First, little or no avoidance responding occurred during the baseline phase where each subject received 50 to 70 alcohol deliveries per session. All but one subject (Subject No. 4) required high shock intensities before initiating any avoidance responding. The shock intensity necessary to establish the avoidance was quite high and averaged 32.8 mA for the five subjects at the end of the first conditioning phase. Differences in responding by the subjects were most apparent during the
FREE-OPERANT AVOIDANCE OF ALCOHOL: AN ANALOGtJE STUDY OF ALCOHOL AVERSION
373
Table 1. Summary data on the five subjects Mean number of alcohol deliveries per session *
Baseline
Shock parameters (in mA)
Conditioning I Reversal Last 5 First 5 sessions sessions
Cond. II Maintenance (Last 2 sessions)
Detection threshold
Tolerance level
Subject No. 1
62.4
69.0
25.0
34.5
1.2
0.0
0.4
9.0
Subject No. 2
63.2
13.2
43.6
57.6
16.9
0.0
0.6
9.0
Subject No. 3
61.0
67.0
17.8
13.8
1.9
1.0
0.5
4.0
Subject No. 4 Subject No. 5
52.0 52.0
42.2 56.6
24.4 20.2
4.8 0.8
4.2 0.0
0.0 0.0
0.5 0.6
4.0 13.0
reversal phase. The shock exerted considerable control over the avoidance responding by Subjects No. 1 and No. 2, some control with Subject No. 3, and little or no control over Subjects No. 4 and No. 5. In the second conditioning phase, each subject eventually avoided all of the available alcohol. Four of the subjects achieved the avoidance by simply pulling the plunger at least once every 20 seconds to prevent the alcohol deliveries. Subject No. 3 developed a pattern of permitting one alcohol delivery which he would not drink. Again, it should be noted that rather high shock intensities were necessary to develop this 100% avoidance (Table 1). The avoidance behavior Is
omllft /
F
'0
‘-
40.0 30.0 40.0 20.0 40.0 40.0 30.0 40.0
(Arm) (Fingers) (Arm) (Fingers) (Arm) (Fingers) (Arm) (Arm)
was continued by each subject during the maintenance phase when the electrodes were removed to eliminate the threat of shock. Figures 1 and 2 present the data for two subjects who best represent two general avoidance patterns that were observed. Subject No. 1 (Fig. 1) had a long period of non-avoidance followed by a relatively rapid development of avoidance responding. Removing and ’ reinstating the shock contingency demonstrated the control of the aversive stimulus over avoidance responding. However, the control gradually weakened until the subject would avoid alcohol without any threat of shock. In contrast, Subject No. 4 (Fig. 2) gradually developed avoidance respon-
coIDl1lonl16 0.4_40.0 mA- irm
f.
Maximum shock in conditioning
\
-ALCOHOL -RESPONSES
Fig. I. The mean number of avoidance responses per minute and the total number of alcohol deliveries per session for Subject No. 1.
374
ANTHONY
R. CIMINERO
and ROBERTS.
EUl#t CONO11lONlN6REVERSAL CON!lIlI0NING MAIN 6or 0.4-40mA I JO-PlUmA 1 &I
Fig. 2. The mean number of avoidance minute and the total number of alcohol session for Subject No. 4.
responses deliveries
DAVIDSON
months to two years. The avoidance behavior was durable in that each subject maintained an identical pattern of avoidance that was in effect at the end of the experimental program. .
per per
ding with relatively low levels of shock. Removing the shock did not indicate control over the alcohol avoidance which was eventually maintained without any threat of shock. A two-year follow-up was available on four of the subjects and a one-year follow-up was obtained for the fifth subject. The follow-up data were categorized according to whether the subject remained abstinent (no alcohol consumed), controlled his drinking on a daily basis (less than 6 oz of liquor per day) or in binges (more than 6 oz per day on an average of no more than one day per week), or had no control over his drinking (more than 6 oz per day more than once a week). Most of these data were based on self-reports which were corroborated by significant others whenever possible. At the six-month and one-year follow-up, two subjects were abstinent and three were drinking in a controlled fashion. At the two-year follow-up, three subjects were drinking in a controlled fashion and one in an uncontrolled manner. Interestingly, subjects who were least controlled by the shock in the experimental setting maintained longer initial periods of abstinence; those subjects whose avoidance behavior was most controlled by the shock developed a controlled pattern of drinking within six months of their discharge. The longest follow-up observation of subjects in the experimental chamber ranged from six
DISCUSSION The results of the present study are consistent with the previous report (Ciminero et al., 1975) that very high intensities of peripheral electric shock were necessary to condition free-operant avoidance of alcohol. Although shock detection thresholds appeared normal, the shock intensities reported as painful by three of the subjects (1, 2 and 5) prior to aversive conditioning appeared to be higher than most other subjects seen in our laboratory. Thus, there may have been some peripheral neuropathy that would account for the high levels of shock these subjects tolerated in order to continue receiving alcohol. However, the fact that all subjects exhibited strong flexion responses to the higher intensity shocks suggests that subjects were responsive to the shocks. There are other possible factors that may account for the need for high shock intensities to establish alcohol avoidance. At a very practical level, it appears that when a very powerful reinforcer (i.e. alcohol) is available for non-avoidance behavior, it will require relatively stronger aversive events (i.e. shock) to condition an avoidance response that postpones both a positive and a negative reinforcer. In other words, the shock must be sufficiently aversive to counteract the reinforcing effects of the alcohol. Second, the shock intensity during conditioning phases was increased gradually between sessions until avoidance responding was initiated. This may have allowed subjects to adapt to higher shock intensities. Introducing relatively strong shocks earlier in conditioning may have had a more immediate effect (Azrin and Holz, 1966; Wilson et al., 1975). Finally it is possible that pairing the shock with a very powerful reinforcer (alcohol) may have resulted in the shock actually having some conditioned positive reinforcing properties (e.g. Ayllon and Azrin,
FREE-OPERANT
AVOIDANCE
OF ALCOHOL:
AN
1966). This may have been particularly true during the early stages of conditioning where four of the five subjects showed slight increases in alcohol consumption with low intensity shocks delivered. Although the therapeutic effectiveness of free-operant avoidance could not be directly evaluated because of the absence of a control group in the present study, there was some avoidance alcohol that the suggestion generalized to naturalistic settings. However, it must be cautioned that these data were based on corroborated self-reports which are of questionable validity (Summer, 1970); the only direct evidence of the effectiveness of the aversive conditioning was the maintenance of avoidance responding in the laboratory setting for up to two years. These results are in contrast to several other studies that have not found electrical aversion to be very successful (cf. Hallam, Richard and Falkowski, 1972; MacCulloch et al., 1966; Miller ef al., 1973; Vogler et al., 1970). Since the present study employed very strong shock, the ineffectiveness of electrical aversion in previous studies could have been due to the relatively low shock intensities used. There is an ethical question about using any technique that requires high shock intensities if other less aversive treatments are available. Although four of the subjects appeared to benefit from the avoidance conditioning procedure, the technique would have to be comparatively more effective than non-aversive procedures to warrant the use of such intense aversive stimulation in therapy. Since there were only two subjects (40%) abstinent at the six-month and one-year follow-up, and none totally abstinent at two years, the avoidance in not be as effective procedure may establishing complete abstinence as other less aversive treatments (e.g. Hedberg and Campbell, 1975). Even though avoidance conditioning procedures can be more effective than originally suggested by MacCulloch et al. (1966), for ethical reasons it does not appear that the procedures will be used very extensively
ANALOGUE
STUDY
OF ALCOHOL
AVERSION
375
unless they can be shown empirically to be considerably more effective than other treatment methods. Although the treatment implications of the present study are somewhat limited, the freeoperant avoidance procedure does seem to provide the most direct measure of alcohol aversion. Thus, free-operant avoidance may turn out to be more useful as a behavioral assessment method than as a treatment strategy. Research comparing avoidance measures and other behavioral assessment strategies seems warranted. REFERENCES Anant S. S. (1967) A note on
the treatment of alcoholics by a verbal aversion technique. Gun. Psycho/. 1. 19-22. Ayllon T. and Azrin N. H. (1966) Punishement as a discriminative stimulus and conditioned reinforcer with humans, J. exp. Analvsis Behav. 9,41 J-419. Azrin N. H. and Holz W. C. (1966) Punishment, Operunf Behavior: Areas of Research and Applicariorr (Ed. by Honig W. K.), Appleton-Century-Crofts. New York. Blake B. C. (1965) The application of behavior therapy to the treatment of alcoholism, Behav. Res. & Therupy 3,
75-85. Ciminero A. R.. Doleys D. M. and Davidson R. S. (1975) Free-operant avoidance of alcohol, J. Behav. Ther. &
Exp. Psychiar. 6,242-245. Davidson R. S. (1974) Alcoholism: Experimental analyses of etiology and modification. Innovarive Merhods in Ps,vchopiiholo,e_v (Ed. by Calhoun K. S.. Adams H. E. and Mitchell I<. M.). Wiley-Interscience. New York. Franks C. M. and Wilson G: T. (Eds.) (1975) Annuul Review of Behavior Therapy Theory & Pracrice (Vol. 3). Brunner-Mazel. New York. Hallam R.. Rachman S. and Falkowski W. (1972) Subjective attitudinal and physiological effects of electrical aversion therapy, Behav. Res. & Therup_v 10. l-13. Hedberg A. G. and Campbell L. (1974) A comparison of four behavioral treatments of alcoholism. J. Behav.
Ther. & Exp. Psychior. 5.251-256. Hsu J. J. (1965) Electroconditioning therapy of alcoholics: A preliminary report. Q. JI Srud. Alcohol 26.
449459.
Lemere T. E. and Voegtlin W. F. (1950) An evaluation of the aversion treatment of alcoholism, Q. II Slud. Alcohol 11, 199-204. MacCulloch Xl. J.. Feldman M. P., Orford J. F. and MacCulloch Xl. L. (1966) Anticipatory avoidance learning in the treatment of alcoholism: A record of therapeutic failure. Behov. Res. & Therap.v 4. 187-196. Miller P. M. (1977) Assessment of addictive behaviors, Handbook of Behavioral Assessment (Ed. by Ciminero A. R., Calhoun K. S. and Adams H. E.). WileyInterscience. New York.
376
ANTHONY
R. CIMINERO
and ROBERT
Miller P. M., Hersen M., Eisler R. M. and Hemphill D. P. (1973) Electrical aversion therapy with alcoholics: An analogue study, Behov. Res. & Therupy 11, 491497. Morosko T. E. and Baer P. E. (1970) Avoidance conditioning of alcoholics. Confrol of Humutt Behavior, Vol. II. F&n Cure to Prevention, -(Ed. by Ulrich R., Stachnik T. and Mabry J.). Scott, Foresman. Glenview, Ill.
S. DAVIDSON
Summers T. (1970) Validity of alcoholics’ self-reported drinking history. Q. JI Stud. Alcohol 13, 972-974. Vogler R. E., Lunde S. E. and Johnson G. R. (1970) Electrical aversion conditioning with chronic alcoholics;
1. Consult. Clin. Psvchol. 34.302-307. Wilson G. T., Leaf R. C. and Nathan P. E. (1975) The aversive control of excessive alcohol consumption by chronic alcoholics in the laboratory setting, J. uppl.
Behav. Anal. 8, 13-26.
Thcr. d Erp. Pxychler.
Vol. 8. pp. 371.376.
Pcrgmon
Press. 1977. Prmred in Great Bntam.
FREE-OPERANT AVOIDANCE OF ALCOHOL: AN ANALOGUE STUDY OF ALCOHOL AVERSION ANTHONY R. CIMINERO University
of Georgia and
ROBERT S. DAVIDSON V.A.
Hosptial.
Miami,
Florida
Summary-An experimental analysis of the effects of peripheral electric shock on free-operant avoidance of alcohol was performed on five hospitalized alcoholics. A single-case design in which the aversive stimulus was systematically presented and withdrawn was used with each subject. There was little or no avoidance responding by any of the subjects in the initial baseline (no shock) condition. During conditioning, four of the subjects required relatively high shock intensities before making any avoidance responses. Removing and reinstating the shock contingency demonstrated that the shock exerted precise control over two subjects’ avoidance behavior, some control over one subject and little or no control over the other two. After 100% avoidance was established, each subject continued to avoid alcohol even when the shock contingency was removed. Although there appeared to be some generalization of the avoidance to the subjects’ natural environment, there are serious questions about the treatment potential of the procedure because of the high shock intensities that were necessary to condition the avoidance.
Various aversive conditioning procedures including chemical aversion (Lemere and Voegtlin, 1950), verbal aversion via covert sensitization (Anant, 1967). and electrical aversion (Davidson, 1974) have been used to modify alcoholic drinking behavior. In spite of the amount of research, assessment of alcohol aversion still poses some problems. Simply demonstrating that an individual has a conditioned nauseous reaction to alcohol does not guarantee that the alcohol will function as an aversive stimulus (see Franks and Wilson, 1975, p. 585). Recently, studies have employed freeoperant methods to assess alcoholic behavior (Miller, 1977). However, showing that an individual will not work to obtain alcohol simply demonstrates that the alcohol is not functioning as a positive reinforcer. Within the operant paradigm, one would have to demonstrate that an individual will work to escape or avoid the alcohol before alcohol could technically be considered an aversive stimulus (i.e. a negative Requests for reprints should be addressed to Anthony
reinforcer). Although escape/avoidance contingencies using electric shock have been used with alcoholics (e.g. Blake, 1965; Hsu, 1965; MacCulloch, Feldman, Orford and MacCulloch. 1966; Miller, Hersen, Eisler and Hemphill, 1973; Morosko and Baer, 1970; Vogler, Lunde, Johnson and Martin, 1970; Wilson, Leaf and Nathan, 1975) none of these studies have systematically examined the effects of the unconditioned aversive stimulus (i.e. electric shock) on the escape/avoidance of alcohol. One case study by Ciminero, Doleys and Davidson (1975) demonstrated within an analogue setting that strong peripheral electric shock was necessary to develop an active avoidance of alcohol. Although shock exerted control over free-operant avoidance responding shortly after this behavior was initiated, shock was not necessary to maintain the alcohol avoidance after the behavior was firmly established. The present study replicated the
R. Ciminero.
Athens, Georgia 30602. 371
Department
of Psychology,
University
of Georgia,
372
ANTHONY
R. CIMINERO
and ROBERTS.
previous procedure to examine further the development and maintenance of free-operant avoidance of alcohol.
METHOD Subjects Five male veterans, hospitalized for their drinking problems.volunteered to participate in the alcohol research project at the Miami VA Hospital. Subjects ranged in age from 46-52 and had an average of an eleventh grade education. Four of the subjects were divorced. Each individual had a history of excessive drinking for several years (X = 10.4 yr), had previous hospitalizations for treatment, and had a primary or secondary diagnosis of chronic alcoholism. Three patients reported a daily consumption of a fifth or more of hard liquor while the other two reported consuming less than a fifth of liquor per day during the previous month.
Apparatus The experimental rooms contained sound proofed industrial acoustic chambers (IAC 402A and IAC 403A) in which subjects could be observed via closed circuit television. Within each chamber was a wooden console that contained two Lindsley plunger manipulanda (Gerbands), a small white light above each manipulandum, two recessed magazines each housing a removable one-ounce shot glass, and a small projection screen (see Ciminero et al.. 1975. or Davidson, 1974, for a more complete description). Solenoid liquid valves (Lehigh Valley Electronics, 1527) were used to dispense automatically 2cm’ of liquid into one of the glasses. Beer was dispensed undiluted but hard liquid was diluted 50% with water. The shock source (Grason-Stadler. 60708) delivered constant current shock of various intensities from 0 to 40mA through electrodes that could be mounted on the subject’s forearm or on the fingertips.
Procedure In the first session, each subject was told that his favorite beverage would occasionally be poured into the glass and that pulling the right plunger would delay the alcohol delivery. After demonstrating the procedure, the subjects were informed that they could respond in any way they wanted, but they should drink any liquor that was dispensed. The electrodes were then attached and the patient’s questions were answered before the experimenter left the room. With few exceptions, subjects were seen for two halfhour sessions each weekday. A single case design in which a shock contingency was systematically presented and withdrawn was used with each subject. This A-B-A-B-C design is briefly described below (for a more complete description, see Ciminero et al., 1975). Baseline phase (alcohol avoidance). Each response postponed alcohol delivery for 20 set (the response-alcohol interval). If a response did not occur within 20 set after the onset of the response-alcohol interval, 2cm’ of liquor was dispensed. Whenever alcohol was delivered, the next 20 set
DAVIDSON
interval did not begin until the shot glass was removed and then replaced in the magazine. Although the electrodes were mounted on the subject’s forearm, no shock was delivered during the baseline sessions. However, prior to the first three sessions estimates of detection thresholds and tolerance levels were obtained for each subject. A series of 0.5 set shocks of increasing intensities was administered to the subject who was to indicate when he first felt the shock and when the shock was as high as he could tolerate. Conditioning phase I (shock-alcohol avoidance). A 0.5 set shock was presented simultaneously with each alcohol delivery. The shock intensity during the first conditioning session was equal to the subject’s detection threshold and was increased in the following sessions until the subject avoided 50% of the available alcohol. If 40mA shocks to the arm were not sufficient, the shock site was changed to the fingertips and the intensity was decreased to 10 mA. After the subject had a minimum of 50% avoidance for four consecutive sessions, the reversal phase began. Reversal phase (alcohol avoidance). Although the electrodes were still mounted on the subject, no shock was administered during this return to baseline. Conditioning phase II (shock-alcohol avoidance). Shock was again paired with each alcohol delivery. Shock intensity began at the level that was used at the end of the first conditioning phase and increased until 100% avoidance was established. After two consecutive sessions of 100% avoidance, all threat of shock was eliminated for the maintenance phase. Maintenance phase (alcohol avoidcnce). The electrodes were not mounted to see if the subject would maintain his avoidance behavior without any threat of shock. If the subject avoided alcohol 100% for two consecutive sessions, the basic experimental analysis for the subject was terminated. Additional follow-up visits were scheduled over a two year period. Whenever scheduling permitted, subjects were given a l5-min session in the experimental space without the electrodes attached.
RESULTS A summary of the data from the five subjects is presented in Table 1. Although there were individual differences in how each subject responded, there were many consistencies in their performance. First, little or no avoidance responding occurred during the baseline phase where each subject received 50 to 70 alcohol deliveries per session. All but one subject (Subject No. 4) required high shock intensities before initiating any avoidance responding. The shock intensity necessary to establish the avoidance was quite high and averaged 32.8 mA for the five subjects at the end of the first conditioning phase. Differences in responding by the subjects were most apparent during the
FREE-OPERANT AVOIDANCE OF ALCOHOL: AN ANALOGtJE STUDY OF ALCOHOL AVERSION
373
Table 1. Summary data on the five subjects Mean number of alcohol deliveries per session *
Baseline
Shock parameters (in mA)
Conditioning I Reversal Last 5 First 5 sessions sessions
Cond. II Maintenance (Last 2 sessions)
Detection threshold
Tolerance level
Subject No. 1
62.4
69.0
25.0
34.5
1.2
0.0
0.4
9.0
Subject No. 2
63.2
13.2
43.6
57.6
16.9
0.0
0.6
9.0
Subject No. 3
61.0
67.0
17.8
13.8
1.9
1.0
0.5
4.0
Subject No. 4 Subject No. 5
52.0 52.0
42.2 56.6
24.4 20.2
4.8 0.8
4.2 0.0
0.0 0.0
0.5 0.6
4.0 13.0
reversal phase. The shock exerted considerable control over the avoidance responding by Subjects No. 1 and No. 2, some control with Subject No. 3, and little or no control over Subjects No. 4 and No. 5. In the second conditioning phase, each subject eventually avoided all of the available alcohol. Four of the subjects achieved the avoidance by simply pulling the plunger at least once every 20 seconds to prevent the alcohol deliveries. Subject No. 3 developed a pattern of permitting one alcohol delivery which he would not drink. Again, it should be noted that rather high shock intensities were necessary to develop this 100% avoidance (Table 1). The avoidance behavior Is
omllft /
F
'0
‘-
40.0 30.0 40.0 20.0 40.0 40.0 30.0 40.0
(Arm) (Fingers) (Arm) (Fingers) (Arm) (Fingers) (Arm) (Arm)
was continued by each subject during the maintenance phase when the electrodes were removed to eliminate the threat of shock. Figures 1 and 2 present the data for two subjects who best represent two general avoidance patterns that were observed. Subject No. 1 (Fig. 1) had a long period of non-avoidance followed by a relatively rapid development of avoidance responding. Removing and ’ reinstating the shock contingency demonstrated the control of the aversive stimulus over avoidance responding. However, the control gradually weakened until the subject would avoid alcohol without any threat of shock. In contrast, Subject No. 4 (Fig. 2) gradually developed avoidance respon-
coIDl1lonl16 0.4_40.0 mA- irm
f.
Maximum shock in conditioning
\
-ALCOHOL -RESPONSES
Fig. I. The mean number of avoidance responses per minute and the total number of alcohol deliveries per session for Subject No. 1.
374
ANTHONY
R. CIMINERO
and ROBERTS.
EUl#t CONO11lONlN6REVERSAL CON!lIlI0NING MAIN 6or 0.4-40mA I JO-PlUmA 1 &I
Fig. 2. The mean number of avoidance minute and the total number of alcohol session for Subject No. 4.
responses deliveries
DAVIDSON
months to two years. The avoidance behavior was durable in that each subject maintained an identical pattern of avoidance that was in effect at the end of the experimental program. .
per per
ding with relatively low levels of shock. Removing the shock did not indicate control over the alcohol avoidance which was eventually maintained without any threat of shock. A two-year follow-up was available on four of the subjects and a one-year follow-up was obtained for the fifth subject. The follow-up data were categorized according to whether the subject remained abstinent (no alcohol consumed), controlled his drinking on a daily basis (less than 6 oz of liquor per day) or in binges (more than 6 oz per day on an average of no more than one day per week), or had no control over his drinking (more than 6 oz per day more than once a week). Most of these data were based on self-reports which were corroborated by significant others whenever possible. At the six-month and one-year follow-up, two subjects were abstinent and three were drinking in a controlled fashion. At the two-year follow-up, three subjects were drinking in a controlled fashion and one in an uncontrolled manner. Interestingly, subjects who were least controlled by the shock in the experimental setting maintained longer initial periods of abstinence; those subjects whose avoidance behavior was most controlled by the shock developed a controlled pattern of drinking within six months of their discharge. The longest follow-up observation of subjects in the experimental chamber ranged from six
DISCUSSION The results of the present study are consistent with the previous report (Ciminero et al., 1975) that very high intensities of peripheral electric shock were necessary to condition free-operant avoidance of alcohol. Although shock detection thresholds appeared normal, the shock intensities reported as painful by three of the subjects (1, 2 and 5) prior to aversive conditioning appeared to be higher than most other subjects seen in our laboratory. Thus, there may have been some peripheral neuropathy that would account for the high levels of shock these subjects tolerated in order to continue receiving alcohol. However, the fact that all subjects exhibited strong flexion responses to the higher intensity shocks suggests that subjects were responsive to the shocks. There are other possible factors that may account for the need for high shock intensities to establish alcohol avoidance. At a very practical level, it appears that when a very powerful reinforcer (i.e. alcohol) is available for non-avoidance behavior, it will require relatively stronger aversive events (i.e. shock) to condition an avoidance response that postpones both a positive and a negative reinforcer. In other words, the shock must be sufficiently aversive to counteract the reinforcing effects of the alcohol. Second, the shock intensity during conditioning phases was increased gradually between sessions until avoidance responding was initiated. This may have allowed subjects to adapt to higher shock intensities. Introducing relatively strong shocks earlier in conditioning may have had a more immediate effect (Azrin and Holz, 1966; Wilson et al., 1975). Finally it is possible that pairing the shock with a very powerful reinforcer (alcohol) may have resulted in the shock actually having some conditioned positive reinforcing properties (e.g. Ayllon and Azrin,
FREE-OPERANT
AVOIDANCE
OF ALCOHOL:
AN
1966). This may have been particularly true during the early stages of conditioning where four of the five subjects showed slight increases in alcohol consumption with low intensity shocks delivered. Although the therapeutic effectiveness of free-operant avoidance could not be directly evaluated because of the absence of a control group in the present study, there was some avoidance alcohol that the suggestion generalized to naturalistic settings. However, it must be cautioned that these data were based on corroborated self-reports which are of questionable validity (Summer, 1970); the only direct evidence of the effectiveness of the aversive conditioning was the maintenance of avoidance responding in the laboratory setting for up to two years. These results are in contrast to several other studies that have not found electrical aversion to be very successful (cf. Hallam, Richard and Falkowski, 1972; MacCulloch et al., 1966; Miller ef al., 1973; Vogler et al., 1970). Since the present study employed very strong shock, the ineffectiveness of electrical aversion in previous studies could have been due to the relatively low shock intensities used. There is an ethical question about using any technique that requires high shock intensities if other less aversive treatments are available. Although four of the subjects appeared to benefit from the avoidance conditioning procedure, the technique would have to be comparatively more effective than non-aversive procedures to warrant the use of such intense aversive stimulation in therapy. Since there were only two subjects (40%) abstinent at the six-month and one-year follow-up, and none totally abstinent at two years, the avoidance in not be as effective procedure may establishing complete abstinence as other less aversive treatments (e.g. Hedberg and Campbell, 1975). Even though avoidance conditioning procedures can be more effective than originally suggested by MacCulloch et al. (1966), for ethical reasons it does not appear that the procedures will be used very extensively
ANALOGUE
STUDY
OF ALCOHOL
AVERSION
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unless they can be shown empirically to be considerably more effective than other treatment methods. Although the treatment implications of the present study are somewhat limited, the freeoperant avoidance procedure does seem to provide the most direct measure of alcohol aversion. Thus, free-operant avoidance may turn out to be more useful as a behavioral assessment method than as a treatment strategy. Research comparing avoidance measures and other behavioral assessment strategies seems warranted. REFERENCES Anant S. S. (1967) A note on
the treatment of alcoholics by a verbal aversion technique. Gun. Psycho/. 1. 19-22. Ayllon T. and Azrin N. H. (1966) Punishement as a discriminative stimulus and conditioned reinforcer with humans, J. exp. Analvsis Behav. 9,41 J-419. Azrin N. H. and Holz W. C. (1966) Punishment, Operunf Behavior: Areas of Research and Applicariorr (Ed. by Honig W. K.), Appleton-Century-Crofts. New York. Blake B. C. (1965) The application of behavior therapy to the treatment of alcoholism, Behav. Res. & Therupy 3,
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