Pharmacological Extinction and the Sinclair Method
In terms of the sinclair method and operant conditioning, extinction doesn’t refer to the immediate end of a negative behavior. Instead, it refers to the process of ending a behavior that has repeatedly been rewarded.
A common example is a child who throws tantrums until they receive a treat. The solution is to withhold the treat – even in the face of ongoing tantrums – until the child learns that this behavior will not bring them the reward they want and extinction occurs.
In the context of Alcohol Use Disorders, the problematic behavior is drinking alcohol and the reward is the release of endorphins.
This behavior has been rewarded each and every time you’ve had a drink your entire life. The solution is to withhold the treat–the pleasurable buzz–until your brain learns that it will no obtain the expected reward it’s seeking.
When your brain learns that drinking no longer results in a pleasurable reward, extinction has occurred. But extinction with the Sinclair Method does not happen overnight.
Factors That Influence the Rate of Extinction
Extinction can be more complex, though, especially in adults who have developed ingrained behaviors that produce harmful consequences (e.g. alcoholism).
This is why it’s important to understand how to influence the rate of extinction.
A behavior does not have to be rewarded every single time it occurs, in order for it to continue. Rewards that are given at regular or irregular intervals are highly reinforcing as well.
If extinction of a behavior is the goal, the behavior must never be rewarded. This is why you must take Naltrexone at least one hour prior to drinking 100% of the time. If the use of Naltrexone is less than 100%, then a Partial Reinforcement schedule will be created.
To understand why this is a problem, consider these common examples of partial reinforcement schedules that keep people seeking rewards:
Fixed-Interval: The behavior is reward only after a specific amount of time has passed. An example would be getting a paycheck every two weeks.
Fixed-Ratio: The behavior is reward only after a specific number of repetitions. An example is receiving a payment for every 50 envelopes that you stuffed.
Variable-Interval: The behavior is rewarded after random amounts of time. An example is pressing the button for the elevator. No matter how many times you press the button, the elevator (the reward) will only arrive after an interval of time.
Variable-Ratio: The behavior is rewarded after a random number of acts. An example would be gambling–you are rewarded with a payoff after a random number of pulls on the slot machine.
The first two schedule types are considered continuous because of their consistent, predictable reward schedules. These tend to work best for teaching new behaviors.
The last two are intermittent schedules, because reinforcement isn’t delivered in a predictable way. These generally work best for maintaining previously learned behaviors.
Watch the video below for more details.
If an individual is repeatedly exposed to the conditioned stimulus that triggers their negative behavior, habituation may eventually set in. As a result, the stimulus would be less likely to produce the conditioned response and the individual may even begin ignoring it altogether.
3. Pharmacological Assistance
Medicine can play a vital role in extinction. For example, the prescription medication Naltrexone has proven effective at helping alcoholics. When taken before drinking, the drug literally denies the alcoholic of the endorphins they’d normally enjoy. They receive no reward from drinking.
It is equally important to understand the factors that may impede the process of extinction.
One very common challenge is an extinction burst. This usually occurs shortly after extinction procedures begin. After the negative behavior begins to decrease in frequency, the individual will suddenly display a sharp increase, despite the efforts to erase it. This is why extinction efforts must maintain consistency. An extinction burst may be interpreted as proof they are not working. In reality, it’s a predictable symptom of the initial stages of extinction.
Spontaneous recovery is a similar phenomenon. This is when a behavior that seemed to be extinct reappears after a prolonged period of time.
Again, the answer is consistency and not the assumption that the extinction procedures didn’t work. Spontaneous recovery can occur numerous times during the extinction process. However, unless further conditioning is available to reinforce it, the responses will progressively weaken in nature as extinction continues.
Applying Extinction to Addiction
If we view addiction as a form of operant conditioning, then extinction becomes the solution.
In the case of alcoholism, the release of endorphins reinforced the behavior of drinking on a fixed ratio schedule. Every time the alcohol was consumed, it resulted in an immediate reward of endorphins. This will not simply go away over time, which is why the abstinence approach doesn’t work. In fact, the abstinence-only approach increases the brain’s preoccupation with alcohol, escalating an alcoholics cravings.
The brain’s association with alcohol as a source of pleasure will remain for the alcoholic’s life unless extinction of this operant conditioning occurs. This happens when the reward (endorphins) is denied the alcoholic.