Counterconditioning In The Treatment Of Addictions

Counterconditioning in addiction treatment is one of the fundamental techniques for achieving the difficult – but not impossible – goal of quitting a destructive habit.

They say we should nip evil in the bud and this is, even though it may seem simple, basically the aim of the counter-conditioning technique. It is designed to eliminate stimuli that can trigger addictive behavior. In today’s article, we’ll focus more on the issue of addictions, but counterconditioning can be done in the context of any destructive habit.

As we said above, the technique itself is quite simple: we only have to make changes to the stimuli prior to the response to avoid emitting the behavior.

However, the fact that it looks simple does not imply that it is really that easy to achieve the end result. For this, both the therapist and the patient must be able to apply the technique properly, with empathy on the one hand and commitment on the other. In this way, the results will be practically guaranteed.

On the one hand , the therapist must be empathetic with the person in front of him, but this without losing touch with reality. Not all stimuli that we want to suppress or modify can actually go through this process, and in those cases we will have to find alternatives.

On the other hand, the patient must be very motivated and very convinced that he wants to change. If the person is, according to the Model of Prochaska and Di Clemente, in a pre-contemplative or contemplative state, it will be difficult for him to perform the counter-conditioning. The patient must have made a decision and commit to carrying out the tasks proposed by his therapist.

How to put the technique into practice

There are many ways to put counterconditioning into practice, from directly eliminating the stimulus that precedes the response to making physiological changes within our bodies. In any case, the therapist will have to ensure that the patient is capable of performing it and that the act is practically feasible.

This last point depends a lot on each case, on the resources the person has, social support, self-control, motivation, etc.

In this sense, we know that it is much better to work on the earliest or primary gears in the chain of behavior. In other words, if I suffer from emotional dependence on a person and whenever I drink alcohol I look for them, it is better to work on the drinking behavior first than on the avoidance behavior of the person.

Some ways in which we can put counterconditioning into practice are:

• Eliminate antecedent stimuli. This option is made especially when the addictive behavior is very severe and the person lacks self-control skills. An example could be a situation in which the patient is trying to quit smoking and, whenever he drinks coffee, he needs to accompany him with a cigarette. In this case, we should advise eliminating coffee altogether, as this would make it easier for the patient’s self-control to work, avoiding smoking associated with that moment.
• Decrease antecedent stimuli. This is a form of counter-conditioning indicated when the patient has a certain amount of self-control and, furthermore, antecedent stimuli cannot be radically eliminated. An example would be a case in which the patient feels that every time he goes out on the street, there is a very strong impulse to buy or acquire objects. In this case, it is more realistic to ask the patient to leave credit cards at home and leave with little cash. It would be unrealistic to ask you to cancel your credit card or leave home with no money.

• Delaying the behavior. Another very effective way to tackle addictive behavior is to commit to delaying it. We often feel a strong urge to go to the market and buy that chocolate that seems to be calling us. In that case, we must make the decision not to go, but only for the next 20 minutes. During this period, and this is important, we must engage in some other behavior to distract ourselves. If this commitment is kept, there is a good chance that, after 20 minutes, the momentum has already lost strength and we can control it more easily.
• Make changes at the physiological level. Finally, a good option for not falling into the addictive behavior web is to make changes in the body itself. There is a counter-conditioning option for severe cases of alcoholism. It is a remedy, Disulfiram or Antabuse. The alcoholic patient takes the drug and the action it has on the body is to suppress the enzyme that is in charge of metabolizing alcohol.

Therefore, what will happen is that the patient will have a really unpleasant reaction to the substance, with vomiting, tachycardia, sweating, etc.

In addition to this extreme case of counterconditioning, another example of using changes that happen at the physiological level could be going to the market right after lunch, without hunger, to avoid buying high-calorie products.

Conclusions on the role of counterconditioning in the treatment of addictions

Counterconditioning is a very effective technique for treating addictions when applied properly. However, it is difficult for the total abandonment of the substance to be achieved with it alone. Therefore, counterconditioning must be combined with other techniques to maximize the final effect.

Some of the techniques with which it can be made compatible are generally part of the cognitive therapies group. These are designed to change erroneous beliefs that the patient may have about their problem, or other techniques such as relaxation, techniques for dealing with the withdrawal syndrome and even mindfulness.