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Addiction is a complicated process, what motivates individuals to use illegal substances in self-destructive ways? What keeps them hooked despite the negative consequences occurring from their substance abuse? There are several underlying factors that encourage substance misuse and must be addressed through the top de-addiction treatments in India. One factor could be the “high” or euphoric feeling people experience when they use a drug. The pursuit of pleasure motivates alcoholics, for example, to go for another drink. But what happens when all that once seemed pleasurable isn't any longer achievable? What keeps them going? Two phenomena at play help explain this phenomenon: positive and negative reinforcement.

The repetition of a habit-based on-off relationship with a stimulus is known as reinforcement. We can classify it as positive and negative reinforcement, but this in itself doesn’t equal “good or bad”. Both result in the drug user increasing their consumption which requires intervention in the form of the best rehabilitation centers in the world. In any case of reinforcement, we add to the desired effect through an external stimulus or some sort of trigger, and/or we remove an aversive stimulus. The key result of any “reinforcement” is that it maintains the given behavior in this context. This means that users continue to increase their drug use regardless of whether it was positive or negative reinforcement altering the environment to the state that drives them toward needing to take more drugs.

Positive and negative reinforcement, either measured as drinking motives or alcohol expectancies have been associated with alcohol use and misuse [1] [2] [3]. Positive reinforcement generally refers to the pleasant feelings and social enhancement effects that alcohol provides, while negative reinforcement encompasses relief from negative affective states like stress or anxiety. Some studies suggest differential effects of positive and negative reinforcement across different alcohol use outcomes. Positive reinforcement of alcohol intake is generally associated with greater frequency and quantity of alcohol consumption, whereas negative reinforcement is more predictive of subsequent drinking-related problems and alcohol use disorders [4][5]. Understanding how positive and negative reinforcement of alcohol intake may differentially influence alcohol use behaviors as individuals develop alcohol use disorder is important.

For example, someone who needs to achieve higher grades in school, and uses a drug that helps them study better, may continue using the drug because of the positive outcome i.e., increased grades, and therefore reinforce further drug usage. Alternatively, someone battling depression may discover that drugs provide enough relief so that they can temporarily feel better and depending on the substance, continues using it. In both examples, the removal of a negative situation essentially reinforces further substance use.

Positive Reinforcements

Positive reinforcements in relation to substance abuse include getting drunk to be a sociable person, being creatively inspired after taking LSD, feeling courageous while intoxicated, being happy when taking prescription medications, feeling calm and relaxed while taking sedatives, and the feeling of being uninhibited after drinking alcohol.

Let’s examine the role of positive reinforcement for example in overcoming pain. The individual comes to their family doctor and asks for advice on how to deal with physical discomfort. They are directed towards a treatment that medicates/releases them from pain, perhaps as a result of an automobile accident or any other severe injury they may sustain. This medication works effectively at reducing the level of stress and makes it possible to enjoy mobility with reduced pain thus providing relief to those who need it. Furthermore, the drug gives rise to the feeling that relieves pain in the body which again acts as a mood enhancer that gently supports (or reinforces) the action of taking it.

Expanding on the above storyline of someone prescribed an opioid to assist in reducing pain, they later discover that they have a better mood overall and continue to use opioids even after the pain subsides. In this case, the use of pain medication has a positive effect on one’s state of mind, that they are “happier”- the reinforcing nature of having their mood improve due to actual physical changes (better endorphin). Obviously, this is dangerous. The pharmacodynamics and mechanisms of action with opioids are readily observable as once someone becomes physically dependent in a very short time—this means it will take less time for you not to feel well if you suddenly stop using these drugs.

Opioids stimulate the release of neurotransmitters like dopamine (responsible for feelings of pleasure) and endorphins (regulates pain levels), making them highly addictive. After the brain has gotten used to a certain amount of opioids, abruptly stopping their intake can cause various psychological and physical stress symptoms. Additionally, chronic intake can lead to tolerance development as neurons adapt to the constant presence of specific substances, reducing the drug's potency. This results in a person seeking not only more of the same substance or a similar one with better potency but also causing noticeable side effects such as nausea or constipation, which might have been previously unnoticed either due to lack of experience with recreational drugs or because they were so small that they didn't impact the user very much at all since they weren't "coming from" anything significant beforehand.

That second part of understanding the study of drug abuse and addiction leads us to explore a new psychological concept known as negative reinforcement. Depending on how many drugs an individual takes and how much they take at once, a level of tolerance towards these substances might be established over time. For many people who suffer from drug abuse or alcoholism, it's not uncommon to grasp onto any excuse possible in order to continue consuming their chosen vice. This leads us to now ask ourselves whether we're dealing with negative reinforcement here.

In the case of substance abuse, negative reinforcement can include an individual using alcohol to remove anxiety in social situations. The same goes for someone who may have a bad trip while taking LSD and may then add benzodiazepines (a.k.a benzos) to calm their mind. An example of negative reinforcement gone awry is when someone is depressed following the lack of drug use, causing them to get high again just to boost their mood. When it comes to becoming increasingly impulsive or distracted lessens or even disappears altogether with repeated dosing of cocaine.

Negative reinforcement is an often-misunderstood concept. We see the word negative and feel that it's because something notable happened, like a bad result. But it's a bit more complicated than that -- when using drugs or alcohol in an addictive fashion, the process fits under this feature of addiction; however, in this context, we speak of the removal of aversive stimuli or situations that further reinforces not seeing the substance in question.

One such instance of negative reinforcement is when an individual first starts utilizing prescription medication, such as opioids to treat a legitimate pain condition. The drug at first provided relief — securing this positive outcome reinforced its use. Over time, however, the positive outcomes ceased to occur — the drug no longer had a positive effect (i.e., produced pleasure). Despite having treated the original issue which led one to use the drug in the first place, one continued to use the opiate because using the drug served as a coping strategy for reducing or negating withdrawal symptoms. This is when treatment is required at the top rehabilitation centers in India.

The irony of addiction is sometimes subtle but it’s there. It usually starts out as experimentation or just wanting to have fun. But for people who are prone to addiction, a lot of times it gets them into trouble when they mix drugs with alcohol. Psychiatrists and Doctors say physiological urges combined with vulnerability to drug abuse lead some people to cross the line between a recreational user and an addict. There can still be great hope for many addicts if caught early enough, in time, before the condition progresses past recovery or “maintenance” levels. However once someone has crossed the threshold beyond the point of no return, the individual is then forced to align their life around trumps essential requirements and activities while they deal with their withdrawal symptoms and numbing effects during any given day after overcoming their latest bout of chemical dependency.

When analyzing a substance use disorder, there are a multitude of variables that compound upon one another. Some other issues may arise such as reinforcement models without even taking into account reinforcing stimuli along with the environmental entry factors into the equation that could promote addiction. So whether you’re using for pleasure and it grows into tolerance and physical dependence from using repeatedly or if you were using substances due to medical complications or distressing psychological conditions, it doesn't matter in these circumstances because no matter what, once one persists in continuing this vicious cycle they will be choosing negative reinforcement to escape the pain they are experiencing and relieve themselves of the aversive stimuli being presented.

Happily, substance use disorder treatment at the top 10 rehabilitation centers in India can get people on their way to recovery. Pursuing treatment offers the tools one needs in order to address both physical and psychological issues that exist with addiction and start the journey of living a drug-free life.

Fortunately, it is possible to get the help needed at the best de-addiction centers in India. This vicious cycle can be broken. Going through rehabilitation at the best rehab centers in India is a positive step that provides people with the resilience and skills they need to develop rewarding lives in recovery. There are ways to pursue rewards and deal with issues - without drug use.

For more information on addiction and treatment options, contact a treatment provider today such as the best rehabilitation centre in India.

REFERENCES-
  • 1. Brown SA, Goldman MS, Inn A, & Anderson LR (1980). Expectations of reinforcement from alcohol: Their domain and relation to drinking patterns. Journal of Consulting and Clinical Psychology, 48, 419–426.
  • 2. Cooper ML, Frone MR, Russell M, & Mudar P (1995). Drinking to regulate positive and negative emotions: A motivational model of alcohol use. Journal of Personality and Social Psychology, 69, 990–1005.
  • 3. Kuntsche E, Knibbe R, Gmel G, & Engels R (2005). Why do young people drink? A review of drinking motives. Clinical Psychology Review, 25, 841–861.
  • 4. Grotmol KS, Vaglum P, Ekeberg O, Gude T, Aasland OG, & Tyssen R (2010). Alcohol expectancy and hazardous drinking: A 6-year longitudinal and nationwide study of medical doctors. European Addiction Research, 16, 17–22.
  • 5. Jester JM, Steinberg DB, Heitzeg MM, & Zucker RA (2015). Coping expectancies, not enhancement expectancies, mediate trauma experience effects on problem alcohol use: A prospective study from early childhood to adolescence. Journal of Studies on Alcohol and Drugs, 76, 781–789.


AUTHOR- Dr. Niharika Singh (MBBS, MD Psychiatry, MIPS)

Dr. Niharika Singh received her MBBS degree from Kurukshetra University, following which she went on to complete MD Psychiatry from Rajiv Gandhi University of Health Sciences, Bangalore. During her residency program, she pursued her thesis on psychosocial factors and personality profiles of early and late-onset Alcohol dependence syndrome. With a view to stay up-to-date with the latest developments in the field of mental health, she then continued to train regularly with premier institutes such as Harvard Medical School - McLean Hospital (USA) in Mind-Body Medicine, Beck Institute (USA) in Cognitive Behavior Therapy, NIMHANS (Bangalore) in Addiction Psychiatry, Behaviour Medicine, Clinical Neurophysiology and Non-Invasive Brain Stimulation and has completed Fellowship in Transcranial Magnetic Stimulation from Duke University (USA). After post-graduation, her goal has been to inform the public about addiction issues. Her mission is to help those in need of treatment find the best option for them. And with this being her consistent vision, she believes in de-stigmatizing the field of addiction psychiatry and rehabilitation center treatment in India and has been working at a licensed dual-diagnosis facility in New Delhi. Through her contributions to rehabsindia.in she aims at providing licensed, professional rehabilitative care choices to patients and their families.

REVIEWED BY- Gauri Kapoor (Addiction Recovery Counselor)

Gauri Kapoor embarked on her journey into sobriety 7 years ago, which led her to her current career path as a Certified Professional Addiction Recovery Coach in Delhi, India. She works closely with facilities that provide residential addiction treatment such as 12-Step programs and other nonprofits to help individuals deal with their addiction.

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