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Positive and negative reinforcements are not as simple as they seem, and are often misunderstood. Usually mistaken for a system of reward or punishment, these terms refer to psychological processes that cause certain behaviors to be repeated. In the field of substance abuse, positive and negative reinforcements can be helpful at encouraging desirable behaviors or substituting new behaviors for unhealthy habits.
When considering treatments, therapists should carefully understand how positive and negative reinforcements function – especially since research suggests people who abuse drugs or alcohol to avoid negative feelings are more likely to have lifelong problems with substance abuse than people who use drugs for the pleasurable feelings they provide.
Reinforcement is any action that causes a behavior to be repeated more frequently. For example, a mouse will travel a maze over and over if he smells cheese at the end of the tunnel. Also called positive reinforcement, the subject receives a reward for good behavior and is likely to repeat it.
Negative reinforcement also causes a behavior to be repeated, but in this case, the action causes a bad feeling or situation to go away. For example, some people repeatedly self-medicate with prescription drugs, alcohol or other substances because it removes unpleasant feelings of stress or anxiety.
For people with substance abuse problems, the perceived rewards of drug abuse were probably learned long ago: taking a drug or consuming alcohol brings a feeling of pleasure or euphoria, however brief.
Experts warn that when the good feelings wear off, the user is likely to keep abusing the drug because it brings relief from bad feelings – such as stress, anxiety or withdrawal. Unfortunately, this can create a difficult pattern of negative reinforcement and cause a patient to abuse substances for longer periods of time.
Sometimes negative reinforcements cause a person to remain stuck even when the consequences aren’t likely to take place, which can open the door to compulsive behaviors. One example is if a person avoids social situations even as an adult because he received repeated embarrassment or ridicule as a child. The mind feels compelled to rely on old mechanisms or behavior patterns, even though they aren’t necessary anymore.
Some patients with behavior disorders say they self-medicate with illegal substances because they provide quicker relief or escape from depression or pain than prescribed drugs. Referred to as “bait and switch,” the good feelings associated with drugs are the initial bait, but then the patient continues the substance abuse because it becomes the way bad feelings or bad situations are removed.
There are treatment options for applying negative and positive reinforcements in substance abuse cases. Therapists can try eliminating the stressful situation that causes the patient to need to escape. This may mean counseling family members on how to be a positive influence on their loved ones, instead of berating them and causing more stress.
Another strategy is to allow the patient to encounter the stressor, or literally face their fears, and then not permit them to resort to their escape strategy – but instead find new ways to cope.
Teaching tolerance skills for dealing with a range of emotions may also be helpful, especially when people self-medicate. Positive and negative reinforcements can both bring success in substance abuse cases, especially when the substance problem is accompanied by anxiety or depression.