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Advances in Social Sciences Research Journal – Vol. 11, No. 8

Publication Date: August 25, 2024

DOI:10.14738/assrj.118.17361.

Silva, A. M. A., Borloti, E., & Ferrari, J. V. (2024). Relapses in Alcohol and Cocaine Dependence in Spousal Relationships: A Behavioral

Assessment with Couple. Advances in Social Sciences Research Journal, 11(8). 44-65.

Services for Science and Education – United Kingdom

Relapses in Alcohol and Cocaine Dependence in Spousal

Relationships: A Behavioral Assessment with Couple

Adriana Madeira Alvares da Silva

ORCID: 0000-0002-8078-0304

Federal University of Espírito Santo, Vitória, Brazil

Elizeu Borloti

ORCID: 0000-0002-6217-6541

Federal University of Espírito Santo, Vitória, Brazil

Jaqueline Vago Ferrari

Federal University of Espírito Santo, Vitória, Brazil

ABSTRACT

Contingency analysis is a central concept and method in behavior analysis for

understanding how the environment influences human behavior. In the treatment

of chemical dependency, this analysis makes it possible to examine the functional

relationships between antecedent stimuli, behaviors, and consequences

(antecedent-behavior-consequence model) in order to understand and modify

behavior. Through contingency analysis, professionals can personalize and adapt

interventions according to the individual needs of substance-dependence patients,

making it a fundamental tool in the multidisciplinary approach to relapse

prevention. The purpose of this article is to conduct analyses of contingencies

described in reports of relapse episodes of psychoactive substance use by

individuals diagnosed with alcohol dependence and cocaine dependence, formally

married, throughout their spousal behavioral histories. Based on detailed and

systematic information about more than one case in comparison, contingency

analyses of relapse episodes were conducted. The study sample consisted of four

heterosexual couples (total N = 8), with one individual in the couple diagnosed with

alcohol or cocaine dependence. The selection was made through the Rehabilitation

Program of a Military Police Hospital located in Vitória/ES, Brazil. The analyses

revealed common contingencies, including social pressure (from the friends' group

with their invitations), negative emotional states (elicited by plans gone wrong,

adverse conditions), and physiological dependence (craving, withdrawal

syndrome, tolerance, and salience of use). The specificity of the spousal

relationship provided the nuance for these contingencies, emphasizing the

importance of therapeutic interventions with couples to assist in preventing

relapses, including stress management skills, craving coping, conflict resolution,

frustration tolerance, and communication.

Keywords: Alcohol dependence, Cocaine dependence, Relapse, contingency analysis,

Spousal Relationship.

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Silva, A. M. A., Borloti, E., & Ferrari, J. V. (2024). Relapses in Alcohol and Cocaine Dependence in Spousal Relationships: A Behavioral Assessment

with Couple. Advances in Social Sciences Research Journal, 11(8). 44-65.

URL: http://dx.doi.org/10.14738/assrj.118.17361

INTRODUCTION

The recurrences of psychoactive substance use (PSU) in substance-dependence are events

which are typically observed during various stages of the process of changing such use, even

when they are motivated to change [1]. Thus, these recurrences are relevant for observation

and analysis in their antecedent and consequent events. The analysis of antecedent and

consequent events to a behavior is the analysis of contingencies. Contingencies are functional

relations between events, and the term has been used to depict how the probability of an

event's occurrence can be influenced by other events [2].

Skinner [3] defines contingency as any relationship of regularity between environmental and

behavioral events. This definition applies to the relationship between, at minimum, three of its

terms: discriminative stimulus (SD), response (R), and consequence (C); and its relationship is

described as a triple contingency, a conceptual instrument for analyzing relations between

organism and environment [4].

In the scheme of triple contingency, the following stand out: (a) the antecedent context that has

a relational function with an operant behavior due to differences in responding because of this

event being present (SD); or it has motivational functions, increasing the reinforcing value or

decreasing the punishing value of the consequence of this operant, and thus altering the

probability of its occurrence or that of another operant related to it (establishing operations,

EOs); and/or it has an eliciting function (Eliciting Stimuli, ES) of a respondent accompanying

this operant (US or CS, unconditional or conditional stimulus); (b) the response in occurrence

(R), evoked (operant) or elicited (respondent) by the presence of this antecedent context; and

(c) the consequent or reinforcing events of the response, the reinforcing stimulus, product or

alteration in the environment produced by the occurrence, whether positive (when added to

the context, it increases the frequency of the behavior that added it) or negative (when removed

from the context, it increases the frequency of the behavior that removed it).

The alteration in the environment would not occur if the occurrence of R were in the absence

of the antecedent context; or if there were no such occurrence [5]. Thus, the antecedent context

to the occurrence is organized in such a way that it signals that the consequent events will be

products of the occurrence, in a probability given by a relational condition. In the example of a

couple, a change in the environment of the two members forming it (consequent event) will be

signaled by a specific antecedent context, to the fact of one member behaving in a certain way

(occurrence).

This probabilistic statement presents itself as a rule specifying the relationships between

events occurring together, in the framework "when..., if..., then...". Returning to Skinner [6], this

framework is read as follows: “only in the presence of an antecedent context (the "when") the

occurrence (the "if") will be followed by a consequent context (the "then")”. These relations

generally occur in events that occur in sequence or with temporal proximity [7]. Because such

contingencies emphasize relationships between events, it is possible to predict behaviors from

them, as they are functional relationships. When described, such antecedent-behavior- consequent relationships can be verbal mediators of behavior control, such as rules or self- rules. Rules are accurate or inaccurate relationships described and presented by other people

for individual behavior control. Self-rules, both accurate and inaccurate, are self-produced and

self-presented [8]. Rules and self-rules can have discriminative (SD), motivational (EO), or

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Advances in Social Sciences Research Journal (ASSRJ) Vol. 11, Issue 8, August-2024

Services for Science and Education – United Kingdom

function-altering functions, producing changes in the functions: discriminative of SDs,

motivational of EOs; reinforcing (Rf+ or Rf-) of consequent stimuli and eliciting of antecedent

stimuli [9].

EOs are conditions occurring within a time frame that alter the reinforcing effectiveness of a

stimulus, as well as evoke behaviors that have been followed by such stimulus in the past [10,

11]. They involve physiological conditions of the organism, such as deprivation, and/or

environmental conditions, such as adversities or contrariness. The deprivation of a specific

PSU, for example, establishes an increase in the effectiveness of the consequence of its use while

evoking its use.

Among all possible objectives in the treatment of PSU [12], such as reducing the frequency of

use, reducing the amount used, or reducing the harm caused by using, maintaining the period

during which drug use (R) is not emitted, i.e., the state of abstinence, has been the most

challenging. This maintenance is challenging because the individual in treatment constantly

faces an antecedent context for occurrence ("lapse") and/or for the recurrence of R ("relapse"),

which produces the reinforcing stimulus that maintains it [13].

The emission of self-control behaviors, compatible or competing with the abstinence state of

PSU, such as denying invitations from friends who use it, is a difficult task for the substance- dependent person, making the occurrence or recurrence of R during treatment a rule rather

than an exception. The violation (interruption of the period) of abstinence, even in a single

episode of PSU during treatment (lapse), is often described by the substance-dependent

individual as an assessment of their treatment failure, generally accompanied by frustration

and guilt, which can function as EOs for the recurrence of use. This fact reinforces the

importance of replacing the terms "lapse" and "relapse" with, respectively, "occurrence of PSU

behavior" ("lapse") during treatment and "recurrence of this use in the same pattern as before

treatment" ("relapse") [14]. The substitute terms occurrence and recurrence can be functional

for the control of private events by: (a) bypassing moral and religious rules and self-rules

embedded in the substituted terms; (b) minimizing the guilt and embarrassment that

accompany the occurrence or recurrence of use during treatment; (c) increasing adherence and

motivation in treatment due to the modification of the pessimistic perception of one's own

progress [15].

Marlatt and Donovan's theoretical model [16] emphasizes private events as potential

reinforcers of PSU recurrence. According to the authors, use in dependency is a function of

consequent events, generally feelings of pleasure (positive reinforcers, produced or

maximized) and sensations and feelings of displeasure (aversive events, which become

negative reinforcers when ceased or minimized). PSU is also maintained by vicarious learning,

involving another person [17] who assumes the function of an event in the substance- dependent person's public-social environment. In this social environment, recurrence may

have one or more of the antecedent and/or consequent functions: "social pressure for

occurrence/recurrence of PSU"; "interpersonal conflict", "intensification of pleasant emotional

states"; "test of personal control"; "good times with others"; "urges and temptations", and

"physical discomfort". Thus, if the occurrence of use has previously been reinforced in a specific

antecedent context, there will be a greater probability of its recurrence in similar contexts.