Page 47 - PhD GT

environment and triggered in the absence of recent alcohol or drug use (Siegel 1999), suggesting that such conditioning may account for the ubiquity of relapse. Ludwig and Wikler (1974) described the commonly seen phenomenon of hospitalised alcoholics who experience no craving or desire for alcohol in the hospital setting and express confidence in the ability to remain abstinent, only to lose that confidence upon discharge when faced with previously conditioned drinking cues.
2.3 Decline in dependence
Although it has been argued (Glautier and Remington 1995) that conditioning processes are not able to account for all observed drug using responses and that the complexity of such processes makes prediction in the individual case difficult, some general principles can nonetheless be agreed. In a Pavlovian conditioning paradigm, the strength of the conditioned response will diminish when the conditioned stimulus is continually presented in the absence of the unconditioned stimulus. Simply put, drug or alcohol seeking behaviour (or the perceived need for the drug) will eventually diminish when drug taking or drinking itself ceases to occur in that environment, but this will be a function of the strength of the original conditioning process: the more powerful the reinforcement which occurs as a result of the drug use (whether this is positive or negative reinforcement) the longer the environment will continue to elicit drug seeking and drug taking behaviour (Siegel 1999). The process of extinction is an active one: if the environment which previously conditioned craving and the desire for use has not been experienced without the reinforcement of such use, then no extinction of the craving response will have occurred. It is the presence of what has been described as a memory of reinforcement, more commonly described as craving which has supported the view that dependence is not something which is exclusively attached to current drinking or drug taking behaviour, but endures through a period of abstinence only to be reinstated in its former strength with subsequent reinforcement.
In the previous section, a number of factors that contribute to a decline in dependence
were suggested. With reference to smoking, Russell (1971) implied that such decline rarely occurred; rather that the nature of the reward changed from the pharmacological to the physiological - from smoking for the positive pharmacological reinforcement of nicotine to smoking for the negative reinforcement of avoiding withdrawal effects and that this system of reward remained all powerful until the balance was changed by the introduction of smoking related illness. Russell’s figures were based upon prevalence in the earlier part of the 20th century, before
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