Pouring a drink-in order to stop drinking. Rolling a joint-to kick a pot habit. Laying out a few lines of cocaine-to overcome the desire to snort it. These aren't oxymorons or acts of a fool. They are examples of a unique form of therapy for chemical addiction called ERP.
ERP, or exposure response prevention, is a proven behavioral technology applied in the 1980's to successfully treat obsessive-compulsive disorders and phobias. Our team of behavioral health care professionals applied ERP technology to the problem of chemical addiction and craving (Santoro, DeLetis and Bergman, 2001). Since 1990, we have successfully treated chemically addicted people with ERP.
ERP is based on principles of operant and respondent learning. Respondent learning takes place when we associate a new stimulus with one that already has an effect on us. For example, we experience respondent learning when we associate the name of a new restaurant with the already familiar experience of having a delicious meal.
Operant learning takes place when we associate rewards, punishments, success, and failure with individual patterns of behavior. Everyday we experience operant learning. It is the primary way in which we learn new behaviors and strengthen or weaken existing behaviors. When we meet a new person we use conversation that was operantly rewarded in the past. When we learn to serve a tennis ball we undergo an intense operant learning experience that will eventually (we hope) lead to a more effective serve.
Conventional wisdom advises people recovering from chemical addiction to avoid the people, places, and things they previously associated with their drug and alcohol abuse. This advice is based on the fact that the addict associates, through respondent learning, people places, and things with the preparation and use of their addicted substances. Respondent learning gives these stimuli the power to trigger strong desires to use drugs or alcohol.
For example, if a recovering addict meets a friend with whom they snorted cocaine in the past the addict will get the urge or impulse to use cocaine because of the respondent connection between their friend and cocaine use. Because of this connection conventional treatment advises that the recovering person avoid these stimuli completely.
Unfortunately, it is virtually impossible to avoid all former stimuli connected with drug and alcohol abuse (Chiauzzi & Liljegren, 1993). This fact partially explains why the relapse rate for recovering addicts is about 75% within one year. As Dr. Joe Santoro explains, "We realized that the conventional advice just didn't work for most addicted people. We needed to find a way to teach them how to cope with stimuli connected to their former addictions to give them a better chance of staying clean." Dr. Santoro went on to say, "So we applied exposure response prevention techniques to the problem. If we could simulate exposure to the most powerful forms of stimuli associated with chemical use, we could show the patient that after repeated therapeutic exposure to these stimuli their impulse to use would completely extinguish."
Studies completed by Dawe et al. (1993) and Powell et al. (1993) provide research data that supports the effectiveness of ERP for the treatment of opiate addiction. Blakely & Baker (1980) and Hodgson & Rankin (1982) documented the effectiveness of exposure therapy for alcohol use stimuli.
ERP kits are made up of simulated drugs, drug use paraphernalia, and photographs that the user associates with their chemical abuse. The cocaine ERP kit includes a white powder, razor blade, straw, mirror, small spoon etc. Each of these objects has the power to trigger a strong level of craving in an addicted individual. They have little to no effect on a non-addicted person. We also developed a photocards depicting a hierarchical sequence of drug preparation and use scenes by substance. There are card sets available for crack, cocaine, alcohol, heroin and marijuana.
Robert DeLetis, Director of ERP Therapy, developed the format for an ERP therapy session. Patients need to learn that they can ride their craving wave (see illustration) without giving into a desire to use. Through repeated ERP therapy sessions the impulse to use triggered by the ERP stimuli becomes weaker and weaker. Eventually, the patient feels virtually no desire to use at all. It is at that point that the patient feels they have really accomplished something special.
The impulse to use rises upon exposure to a triggering stimulus (point B). If the person does not use, their craving will peak (point C) and then decline to zero (point D).
ERP therapy should never be used as the sole treatment for substance abuse problems. Substance abuse is a complex disorder that requires a comprehensive treatment approach. This approach should include: