The ABC model of behaviour
Models are useful tools to help guide our thinking. The ABC model is a shorthand for those psychological concepts that help us to understand the interactions between psychology and substance use, and hence has helped to plan treatments and relapse prevention strategies.
'A' is for antecedent cue or trigger - Events, situations, or conditions that immediately precede a behaviour. These can be internal (thoughts, feelings) or external (people, places, times of day). They carry certain expectations for different courses of action.
'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).
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 in the short term. This is referred to as ‘punishment’.
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 feed back 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. Bad experiences do not reinforce the behaviour and so change expectations regarding future trigger events.
Before constructing a comprehensive relapse prevention plan, we will apply the ABC model to a number of pharmacological interventions…
Using the ABC model - detoxification
In this example we see what happens psychologically when someone starts a detoxification with a 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 - methadone substitution
Note that when a drug is taken for a long time, as in substitution therapy, the initial reinforcement can be strengthened by the addition of positive consequences such as creating a new routine and establishing a stable life style around it. A single dose of methadone is a less powerful reinforcer.
In this example we see what happens psychologically when someone takes a substitute drug, such as methadone.
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 - naltrexone
In this example we see what happens psychologically when someone takes the opiate relapse prevention medication naltrexone 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...
Using the ABC model to design a psycho-social relapse prevention plan
Above we have looked at how pharmacological interventions work at the psychological level to inform behaviour change plans. The art in a comprehensive relapse prevention plan is to incorporate components which will strengthen the chances that the first example in each case, the positive outcome, will occur.
Antecedent Cue or Trigger
The principle is to change the response to the antecedent cue by changing its occurrence or the circumstances in which it occurs. Some cues can be avoided, eg going to the pub, and some cannot be avoided, eg time of day or family events. For time of day: change where you are, have someone with you, do something absorbing.
Thoughts and Expectations
The principle is to expect it to be difficult at first and to discuss strategy with a supportive other. Focus on short term benefits. Check whether the plan changes your belief in your ability to cope with the situation. If YES then try it out. If NO then work up a different plan that you do believe will work.
Behaviour
The principle is to establish a different routine; remember that for new behaviours to be learned, they need to be practised repeatedly. Try it out, record what happened, if it didn’t work, change the plan; if it worked, repeat - again and again.
Consequences
The principle is to ensure the consequences of not drinking are rewarding in a positive way, by doing an alternative enjoyable thing and remembering reasons for doing this. The subject of drinking is avoided
Use the principles of the ABC model to inform making treatment plans in the guides below…
effective practitioners…
