A behavioral approach to the treatment of substance use disorders

This chapter describes a behavioral approach to the treatment of substance use disorders (SUDs) based on the principles of behavior analysis, behavioral pharmacology, and behavioral economics. For many decades, the principles of behavior analysis and behavioral pharmacology have supported a conceptual framework in which substance use is considered a form of operant responding that is maintained by the primary reinforcing effects of the pharmacological actions of drugs. More recently, behavioral economics has extended this work beyond basic operant learning approaches. This relatively new conceptualization of SUDs considers the combined effects of (1) high valuation for immediate drug reinforcers and (2) an excessive preference for immediate acquisition of a reinforcer in spite of negative long-term consequences. The combination of these two factors are hypothesized to be important contributors to the addictive process and therefore are potential targets of interventions. In this chapter we illustrate how these approaches have informed the development of an effective outpatient treatment for cocaine dependence called the Community Reinforcement plus Vouchers Approach (CRA + vouchers). We provide an outline of the functional assessment and analysis of SUD-related behavior, description of the CRA + vouchers treatment, a brief review of the evidence supporting its efficacy, and an illustration of its application in the form of a case study.