Reinforcer pathology, probabilistic choice, and medication adherence in patients with multiple sclerosis

Abstract

The reinforcer pathology model posits that core behavioral economic mechanisms, including delay discounting and behavioral economic demand, underlie adverse health decisions and related clinical disorders. Extensions beyond substance use disorder and obesity, however, are limited. Using a reinforcer pathology framework, this study evaluates medical adherence decisions in patients with multiple sclerosis. Participants completed behavioral economic measures, including delay discounting, probability discounting, and a medication purchase task. A medical decision-making task was also used to evaluate how sensitivity to mild side effect risk and efficacy contributed to the likelihood of taking a hypothetical diseasemodifying therapy. Less steep delay discounting and more intense (greater) medication demand were independently associated with greater adherence to the medication decision-making procedure. More generally, the pattern of interrelations between the medication-specific and general behavioral economic metrics was consistent with and contributes to the reinforcer pathology model. Additional research is warranted to expand these models to different populations and health behaviors, including those of a positive health orientation (i.e., medication adherence).

Delay Discounting for HIV/STI Testing

“…On the other hand, people may perceive relatively mild STIs like chlamydia and gonorrhea as non-serious, unurgent, or unimportant, and consequently be more susceptible to the inconvenience and unpleasantness of waiting. Further, because the rates of discounting can be affected by the amount or size of the outcomes (Green & Myerson, 2004 ; Jarmolowicz et al, 2023 ), the perceived values of testing for chlamydia and gonorrhea might be low in the first place, resulting in higher degrees of discounting. However, even nonlethal STIs can cause serious and permanent health damage if left untreated (e.g., infertility) (Hull et al, 2017 ).…”

“…The delay discounting approach has also been used to examine medical decision making. For example, steeper delay discounting for monetary rewards was associated with lower adherence to medication procedures in patients with multiple sclerosis (Jarmolowicz et al, 2023 ). Regarding testing decisions, one study found that testing intentions for COVID-19 decreased as the delay to receiving the test or its results increased (Strickland et al, 2022 ).…”