Applied Behavior Analysis in the Treatment of Behavioral Addictions

Applied behavior analysis, and in particular the hybrid approach of cognitive behavioral therapy (CBT), are both used extensively in the treatment of various behavioral addictions including internet, sex, and gambling addiction. By applying techniques of operant conditioning, applied behavior analysts can reduce or remove the reinforcing influences of addictive behaviors and replace them with less destructive and more socially acceptable behaviors.

When addiction treatments are discussed, people usually tend to think of alcohol and drug addiction. Although those represent major societal problems, they sometimes tend to eclipse another class of addictions that do not involve external chemical dependency, but which are equally devastating personally and socially to those suffering from them: behavioral addictions.

There is no official diagnostic classification for many behavioral addictions, which can include internet gaming, compulsive and out-of-control sexual behavior, and gambling. But there is a growing body of science that is beginning to uncover the common roots of these addictions. They tend to revolve around the body’s own neurochemical reinforcement and learning process, sharing the same neurological signatures with substance abuse addictions and tracing back to some of the same genetic vulnerabilities.

Because these addictions are all learned behaviors, they can also be unlearned. Applied behavior analysis offers the right set of tools and techniques to address behavioral addictions.

Addictive Behaviors Are Learned Behaviors

Behavioral addictions stem from exactly the same sort of reward and reinforcement model that all applied behavior analysis works with. Gambling, gaming, and sex all have the potential to offer intermittent, but potent, natural rewards within the brain’s mesolimbic pathway, commonly known as the reward center of the brain. The biochemical reactions, spurred by a control protein called Delta FBJ murine osteosarcoma viral oncogene homolog B (Delta FOSB for short), are engendered by sex and gambling addictions are indistinguishable from those created by chemically addictive substances.

Because most of these disorders are not officially recognized or tracked, it’s difficult to say how prevalent they are but both sex addiction and gambling addiction are thought to afflict around three percent of the population. The American Psychiatric Association has recognized pathological gambling as an addictive disorder since 2013.

Few ABAs specialize in treating behavioral addictions specifically, but most private addiction treatment counselors do not distinguish between accepting patients for substance abuse versus those with behavioral addiction issues.

Only licensed psychologists are allowed to diagnose addictive disorders but an ABA may conduct a functional behavior assessment, or FBA, on potential clients to spot problematic behaviors, even in the absence of an official diagnosis. If a behavior is causing an issue for the patient or their loved ones, an ABA can address it.

FBAs for addictions are more difficult than for many other issues, since patients commonly attempt to hide or disguise their behaviors. Direct observation may be of limited value. Interviews with the patient and with friends and family are the most important component. With gambling addictions, the ABA may use formal tests, such as:

  • South Oaks Gambling Screen
  • Canadian Problem Gambling Inventory
  • Victorian Gambling Screen

With information from the FBA in hand, the ABA next formulates a behavior intervention plan for the patient.

Originally, aversion therapies were common in treating behavioral addictions. Electroshock and less dramatic techniques were used to provoke a negative response when patients were exposed to behavior triggers.

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Today, more promising applied behavioral techniques have largely replaced aversion therapies. These include:

  • Activity scheduling – Recognizing that free time for addicts is often spent fulfilling addictive compulsions, ABAs teach addicts to tightly schedule their time to avoid opportunities for relapses.
  • Desensitization – By overexposing addicts to the positive stimuli they receive from the addictive behavior, the pleasure that reinforces that behavior can be muted—forced play of Internet games past the point of enjoyment may blunt addictive rewards.

Behavioral addictions often accompany or are accompanied by other conditions, such as:

  • Substance abuse issues
  • Depression
  • Anxiety
  • Borderline Personality Disorder

In some cases, the addictive behaviors may simply be a symptom of a deeper psychological issue. Behavioral intervention plans (BIPs) designed for patients with such combinations of problems have to be specially designed in order to work effectively.

Cognitive Behavioral Therapy Combines Aspects of Behavioral and Psychological Therapies

The most promising approach combines behavioral with traditional psychotherapies in a technique called cognitive behavioral therapy, or CBT.

CBT deploys many of the same operant conditioning techniques as pure applied behavior analysis, but also introduces a talk-based component where the therapist leads the patient through the logic and mechanisms driving the addiction. By both showing the patient how the addiction is shaping their brain (the cognitive component) and offering them tools to disrupt the addiction mechanism (the behavioral element), a viable form of self-therapy is introduced.

This has the valuable quality of functioning full-time, not just when the patient happens to be in a session with the therapist.

CBT can train the patient to understand the triggers that lead to addictive behaviors, to recognize the consequences of those behaviors, and to displace them with alternative behaviors that are less risky. A gambler feeling an urge to drive to a casino, for instance, might instead be encouraged to drive to a gym or movie… a cognitive recognition with a behavioral response.

The combination works, eventually, to rewire how the brain reacts to environmental stimuli, and to eliminate the addictive behaviors.

Preparing for a Career in Applied Behavior Analysis Treating Behavioral Addictions

ABAs working in addiction counseling will usually need to obtain an official certification from the Behavior Analyst Certification Board (BACB). This certificate, the Board Certified Behavior Analyst (BCBA®), requires a master’s degree or better in either psychology, education, or applied behavior analysis.

Because most behavioral addiction patients will be older individuals, the educational route makes little sense for ABAs interested in becoming counselors in this field. Unlike substance addictions, most treatment options for behavioral addictions are privately funded. A position with a private clinic or counseling firm is the most likely avenue to treating behavioral addicts.

There are a number of specialty certifications available for addiction counselors, including those offered by the National Association for Addiction Professionals and the National Board for Certified Counselors. Most certificates are offered at the state level, however, and you should consult professional associations for counselors in the state where you intend to practice to find more information.

There are also some addiction-specific certification courses available to behavioral addiction therapists. The International Institute for Trauma and Addiction Professionals offers a Certified Sex Addiction Therapist program that ABAs working with sex addicts might find useful. The National Council on Problem Gaming offers an International Certified Gambling Counselor certification.

Many of these certifications require degrees in psychology or counseling. The course sequences necessary to qualify for a BCBA® are often available as part of psychology programs but may be difficult to find in counseling or addiction treatment degree programs.

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Further Reading on Treating Behavioral Addictions with Applied Behavior Analysis

Association for Behavior Analysis International Special Interest Groups – The ABAI has two special interest groups of particular interest to addiction counselors, the Gambling SIG and a SIG on Sexual Behavior: Research and Practice issues.

The Association for Addiction Professionals Certificate Programs – The NAADAC is a national non-profit offering three different levels of addiction treatment certification.

National Board for Certified Counselors – The NBCC offers a national counseling certification with a specialty option available for addiction counseling.

National Association for Addiction Treatment Professionals – A national non-profit association to provide leadership, advocacy, and training for addiction treatment providers.