Kyle is a 42-year-old, single, Caucasian male, with 16 years of education. He works as a software programmer. Kyle reports that he is seeking assistance in helping to "kick his drinking problem." Kyle explains that his use of alcohol has gotten progressively worse over the last five years. He explains that he began drinking as a teenager in high school, but then only occasionally. He never felt that his drinking was problematic until he returned from the service and in the last five years it has gotten worse. He began drinking more regularly following his deployment in the Gulf War. As a reservist in the U.S. Marines Kyle served in Iraq and while on a weekend leave just before he was sent back to the United States Kyle was exploring a rural marketplace with several military colleagues. A bomb detonated at the market killing several dozen local civilians and one of Kyle's colleagues. Kyle, who was not hurt in the blast, heroically assisted both his colleagues and many of the civilians who were critically wounded. Kyle does not experience any significant PTSD symptoms associated with this event such as flashbacks, dreams, etc., but noted that he began regularly drinking "socially" regularly as an effort to deal first with the anxiety associated with his military experiences and later to relieve the minor stress from his work.
Kyle now goes to a local tavern every evening following work, has dinner, and then stays at the tavern until 8:00 or 9:00 PM every weekday evening drinking beer and socializing. He returns on Saturdays in the afternoon drinking until closing time. He reported that his drinking initially helped him deal with the stress and anxiety of his job, but that he recently was arrested twice for impaired driving and has been having issues at work related to his being "sluggish" following the prior evening's drinking. He denies experiencing blackouts or other physical withdrawal symptoms.
From a classical conditioning perspective (CC) one could view Kyle's experience of anxiety as an unconditioned stimulus that was originally perceived as threatening...
His response to this physical discomfort was to use a central nervous system depressant, alcohol, to relieve his anxiety and stress. Whenever Kyle experienced this anxiety or stress he repeated this behavior. Later, when experiencing stress and anxiety in the work environment Kyle took to visiting the local tavern and found a relief for this physical discomfort. He initially went to the local tavern occasionally; however, the environment of the tavern and all of the cues there may have also served as a conditioned stimulus that may have resulted in his experiencing less discomfort from the stress and anxiety at work, thus he now goes to the tavern daily whether he is stressed or not. Kyle could benefit from any of the several types of therapies are based on CC principles. Two are cue exposure therapy and aversion therapy.
Cue exposure therapy (Drummond, Cooper, & Glautier, 1990) interprets cues associated with substance abuse (in this case the stress at work and the sights, people, and all environmental stimuli in the tavern) as conditioned stimuli. By having Kyle experience repeated exposure to the cues without engaging in the substance abuse the effect of the cues could be extinguished. This would probably be best using imagery-based exposure therapy with relaxation to learn to handle the stress and then having him attend the tavern with someone else who would make sure that he didn't drink while he was there. Over time he would not associate the conditioned stimulus with the conditioned response. Of course another way would be just have him stop going to the tavern altogether (but we still need to address his stress). However, it is never possible to identify all the cues associated with a conditioned behavior and over time the behavior could spontaneously remit is Kyle continues to experience stress at work and/or go to the tavern.
Aversion therapy (O'Farrell et al., 1992) intentionally cares an association between an unwanted or dysfunctional behavior and an unpleasant experience. In this case…
