Summary: Harm Reduction Journal
Gerevich, Bacskai, Farkas, and Danics’ case report studied if Pavlovian conditioning can directly relate to death from overdose. The case followed a young that had been treated multiple times for an addiction to heroin. As a result for the multiple treatments studies have shown that drug overdose occurs most frequently when the patient accustomed to the drug gives up its use then after a while attempts to continue addictive behavior with the same dose before withdrawal. His daily dose had not differed even the fatal overdose, thus proving the conditioned tolerance failed to operate. This indicates that morphine concentrations measured in cases of drug related death do not differ substantially form those measured in cases where the outcome is not fatal. Conditioning can contribute to prevention of fatal cases however, also contribute to cases of tolerance becoming fatal.
Summary: Pavlovian conditioning and Drug Overdose: When Tolerance Fails Siegel’s performed a study of that which Pavlovian conditioning and drug overdose play an important and integral relationship with one another. Siegel researched and studied cases of overdose and examined rats injected with an opiate. He observed that Pavlovian conditioning contributes to tolerance when the user begins to make observations of the effects of the drug in the presence of cues that were previously paired with the drug. Two stimuli are present and one will presumably predict the other, this includes the drug. When the tolerance the chance for overdose increases as well. The unconditioned stimulus in Pavlov’s conditioning is the effect of the drug. This conditioning makes relapsing common because of the craving for unconditioned stimulus. It is necessary to allow extinction the cues that are presented with the drug in order for recovery. Overdose doesn’t necessarily have to come from the conditioning process but many experiments verify a higher risk if conditions are present.
In 1927 Ivan Pavlov studied a direct relationship between a conditioned stimulus and an unconditioned stimulus. As the result of as series of conditionings, Pavlov discovered that the conditioned stimulus is able to create the same response as the unconditioned stimulus over a period of time. The relationship of the two is evident and a major factor in fatal overdoses, whether in drug overdose or binge drinking. The correlation between classic conditioning and overdose can be observed where tolerance fails. If one were to treat an addiction, one must acknowledge the conditioning process and eliminate conditioned cues related with the drug (Bacskai, Danics, Farkas & Gerevich, 2005). Cases where tolerance failed can be directly found in classical conditioning involved with drug or drinking paired cues and environmental cues as well as associated with the addiction, therefore the cue must be eliminated in order for proper recovery.
Tolerance plays a crucial role in overdose as well as addiction. Overdose becomes fatal when tolerance does not occur. According to Siegel, “Evidence that drug tolerance depends not only upon experience with the drug but also experience with the drug-paired cues” (p. 505, 2001). Addicts suffer from overdose primarily because they do not show the level of tolerance that they expect in drug-experienced individuals (Siegel, 2001). Those suffering with addiction have become conditioned not only physically, but also emotionally in need of the high that is released with a substance. The addiction is the conditioned stimulus, which leaves room for the effects of the drug or drink to be the unconditioned stimulus. Siegel found that events that occur during the drug administration directly correspond to a Pavlovian conditioning trial (2001). Over time the effects become a conditioned response in which they will relate the experience of the high as a cue. Cues are dangerous when dealing with conditioning and treatment.
Cues accompanying the drug effect function as CSs, and the direct drug effect constitutes the UCS. Prior to any learning, this UCS elicits responses- UCRs- that compensate for drug-induced disturbances. After some pairings of the pre-drugs CS and pharmacological UCS, the drug compensatory response are elicited by drug-paired stimuli as CRs (Siegel, 2001, p. 505). Thus, in approach to treatment prior to an overdose, the cues must be eliminated. In the study by Siegel, it is studied that drugs and alcohol in particular will have a greater impact if they are administered in the presence of unique cues rather than in the presence of predictable cues that it is associated with (2011). In Bacskai, Danics, Farkas and Gerevich study, they followed the life of an addict which overdosed and claimed that the user could not recover properly due to learned conditioning regarding his heroin addiction. In the autopsy report they were able to clarify that his over dosage was the exact same as his normal dosage of .05mg/L. “The fatal consequences of the heroin injection may have been caused by the failure in the action of conditioned tolerance” (Bacskai, Danics, Farkas & Gerevich, 2005).
Environmental cues are also factors of conditioning that are paired with cases of overdose. The term tolerance situational-specificity, according to Siegel, results because we prepare ourselves in advance for the psychological changes produced by the drug when we are provided with certain cues that a drug or drink can imminent (2011). An example can be taken from Shapiro and Nathan in1986 when they studied the relationship between environmental cues and substance ingested. They had two groups, one that drank at home and one that drank in the lab environment. After 10 days they reversed the environment for the remaining participants. Upon the discovery they realized that those who had consumed alcohol in the lab environment were less affected in their performance tasks than those who consumed alcohol in the home environment. This demonstrating that tolerance was situationally precise to the environment in which the alcohol was once consumed. Environmental cues can be anywhere from a party to a room in a house. They can also be an atmosphere or specific type of people. It is important to identify these cues apart from the actual addiction. Now that cues can be identified separate from the drug of drink, the conditioned response must be eliminated in order to treat recovery. Pavlov discovered that in order to eliminate a behavior, it is necessary to remove or substitute the conditioned stimulus.
In order to eliminate any such cue, one must identify the cues present. In severe cases one might create a lesion in the hippocampal area located in the brain but it is not completely necessary. The most likely case in elimination is when a conditioned response becomes extinct. In order for extinction to occur the conditioned stimulus must be presented without the unconditioned stimulus. An example of a drug or drinking paired cue could be a positive or negative factor, like vomiting or, a party like environment. The cue can be created with induced vomiting when the drug or alcohol is present. This creates a fear tactic, which becomes associated with the addiction and thus making one afraid of the substance. Environmental cues can be both simple and difficult to eliminate. One must be taken out of his or hers setting of addiction. This could mean a living room, bathroom, party scene, work scene, or anywhere that the drug or drinking is associated with. These environments can cause pressure in the subconscious toward the substance. Remember the Shapiro and Nathan experiment in1986; environment does affect one’s attitude toward the addiction. In Siegel’s 2001 study he discovered that when heroin was injected in an unfamiliar place the user is not as dangerous or place to overdose. The dangers of not eliminating cues can allow tolerance to take its role until overdose occurs. “Users familiar with the concept of conditioned place preference could have greater chances of survival than those who are not aware of it” (Bacskai, Danics, Farkas & Gerevich, 2005). Demonstrating that it is necessary for the cues to be eliminated to reduce the risk of overdose.
Therefore, Pavlov’s conditioning has a direct and present relationship involved in overdose cases. Conditioning turns unconditioned stimulus into conditioned responses. The responses can act as cues, which can trigger the addiction. Cues can be both drug, or drinking paired and environmentally stimulated. Tolerance has been proven to fail in fatal cases of overdose due to classical conditioning. In order to recover properly these cues must be eliminated. Treatments can include anything from fear tactics, to removing the entire substance. Severe cases of addiction, which relate to overdose can be treated with lesions in the brain.
Gerevich, J., Bacskai, E., Farkas, L., & Danics, Z. (2005). A case report: Pavlovian conditioning as a risk factor of heroin “overdose” death. Harm Reduction Journal, 2. Siegel, S. (2011). The Four-Loko Effect. Perspective on Psychological Science, 6, 357-361. Siegel, S. (2001). Pavlovian conditioning and drug overdose: When tolerance fails. Addiction Research and Theory, 9, 503-513. Shapiro, A. P., Nathan, P. E. (1986). Human tolerance to alcohol” The role of Pavlovian conditioning processes. Psychopharmacology, 88, 90, 95.