The ABC model of behaviour
Models are useful tools rather than theoretical truths. The ABC model is a shorthand for a mix of psychological theories and it helps us to understand the interactions between psychology and substance use including pharmacotherapies.
'A' is for activating event or trigger - Events, situations, or conditions that immediately precede a behaviour. These can be internal (thoughts, feelings) or external (people, places).
'B' is for behaviour - The specific, observable, and recordable responses, which may be beliefs or actual behaviours such as drinking or drug use.
'C' is for consequences - What happens immediately after the behaviour. Consequences dictate the likelihood of the behaviour being repeated (reinforcement) or stopped (punishment).
The ABC model underpins an approach to relapse prevention as described in this YouTube video…
Key concept…
reinforcement
In psychology reinforcement is about how the consequences of drinking or drug taking make it more likely that the behaviour will be repeated.
Positive reinforcement is where drink or drugs have a nice effect. Negative reinforcement is where something unpleasant, eg withdrawal symptoms, low mood or stress is avoided. Both make repeating the behaviour more likely.
A bad or neutral drink or drugs experience makes repeating the behaviour less likely.
How the ABC model works
Each drinking or drug taking episode is a learning experience which strengthens or weakens the desire to repeat drinking or drug taking. Good experiences feedback to strengthen the expectation that a repeat of the drinking or drug taking will again be a nice thing to do. This is how dependence is created…
Using the ABC model - methadone substitution
Note that any drug that is taken for a long time, as in substitution therapy, reinforces further use because it is taken repeatedly and often at a fixed time. A single dose of methadone is not a powerful reinforcer.
In this example we see what happens psychologically when someone takes a substitute drug, such as methadone. First, what if they stick to the treatment plan…
In the real world people often supplement their substitute prescription. It may be they were never committed to the treatment goals or maybe they felt life was not getting better as hoped by taking methadone. Supplementing changes expectations...
Using the ABC model - detoxification
In this example we see what happens psychologically when someone starts on a detoxification drug such as chlordiazepoxide and sticks to the treatment plan...
While many detoxification programmes are successfully completed this is not always the case. Often a failed detoxification is because the person was not well prepared. This can create negative expectations that may then persist and disrupt future plans...
Using the ABC model - disulfiram
In this example we see what happens psychologically when someone takes the alcohol relapse prevention medication disulfiram and remains abstinent from alcohol...
In the real world not everybody is committed to abstinence, even though they seem to have agreed that is what they want. Maintaining abstinence just because you are taking disulfiram is an act of belief (expectation) and there is always the chance that somebody has a go to see if disulfiram really works...
Using the ABC model - naltrexone
In this example we see what happens psychologically when someone takes the opiate relapse prevention medication naltrexone and and remains abstinent from opiates...
In the real world, as with drinking, not everybody is committed to abstinence, even though they seem to have agreed that is what they want. Maintaining abstinence just because you are taking naltrexone is an act of belief (expectation) and there is always the chance that somebody has a go to see if naltrexone really works...
Practitioner guides to iSBNT…
