The Behavioral Economics and Neuroeconomics of Alcohol Use Disorders

Abstract

Background Behavioral economics and neuroeconomics bring together perspectives and methods from psychology, economics, and cognitive neuroscience to understand decision making and choice behavior. Extending an operant behavioral theoretical framework, these perspectives have increasingly been applied to understanding alcohol use disorders (AUDs) and this review surveys the theory, methods, and findings from this approach. The focus is on three key behavioral economic concepts: delay discounting (i.e., preferences for smaller immediate rewards relative to larger delayed rewards), alcohol demand (i.e., alcohol reinforcing value), and proportionate alcohol-related reinforcement (i.e., relative amount of psychosocial reinforcement associated with alcohol use). Findings Delay discounting has been linked to AUDs in both cross-sectional and longitudinal studies, and has been investigated cross-sectionally using neuroimaging. Alcohol demand and proportionate alcohol-related reinforcement have both been robustly associated with drinking and alcohol misuse cross-sectionally, but not over time. Both have also been found to predict treatment response to brief interventions. Alcohol demand has also been used to enhance the measurement of acute motivation for alcohol in laboratory studies. Interventions that focus on reducing the value of alcohol by increasing alternative reinforcement and response cost have been found to be efficacious, albeit in relatively small numbers of randomized controlled trials (RCTs). Mediators and moderators of response to these interventions have not been extensively investigated. Future Directions The application of behavioral economics and neuroeconomics to AUDs has given rise to an extensive body of empirical work, although significant gaps in knowledge remain. In particular, there is a need for more longitudinal investigations to clarify the etiological roles of these behavioral economic processes, especially alcohol demand and proportionate alcohol reinforcement. Additional RCTs are needed to extend and generalize the findings from reinforcement-based interventions and to investigate mediators and moderators of treatment success for optimization. Applying neuroeconomics to AUDs remains at an early stage and has been primarily descriptive to date, but has high potential for important translational insights in the future. The same is true for using these behavioral economic indicators to understand genetic influences on AUDs.

Unique prediction of cannabis use severity and behaviors by delay discounting and behavioral economic demand

“…The marriage of behavioral economics with substance use research over the last three decades has advanced an understanding of the etiology and treatment of drug-taking behavior (Bickel et al, 2000; Chivers and Higgins, 2012; Hursh, 1984; MacKillop, 2016). Two of the most common applications of behavioral economics to drug use are delay discounting and behavioral economic demand.…”

Cross-Commodity Delay Discounting of Alcohol and Money in Alcohol Users

“…The Centers for Disease Control and Prevention (CDC) estimate the economic cost of alcohol use in the United States to be $249 billion (Sacks, Gonzales, Bouchery, Tomedi, & Brewer, 2015). The study of intertemporal choice has provided valuable insights into the characterization of addictive disorders including alcohol use disorder (MacKillop, 2016). Studies of intertemporal choice, or delay discounting, show excessive valuation of more proximal rewards and steeper discounting of more distal rewards compared to healthy controls (Kirby, Petry, & Bickel, 1999; Petry, 2001).…”

Using crowdsourcing to examine behavioral economic measures of alcohol value and proportionate alcohol reinforcement.

“…Application of behavioral economics to the study of addictive behavior has undergone a substantial expansion over the last two decades, particularly in the case of alcohol use disorder (Bickel, Johnson, Koffarnus, MacKillop, & Murphy, 2014; MacKillop, 2016). Two relevant behavioral economic constructs include alcohol demand (i.e., the quantitative relationship between alcohol consumption and its cost, reflecting the relative value of alcohol to the individual; Murphy & MacKillop, 2006) and proportionate alcohol-related reinforcement (i.e., the relative reinforcement derived from alcohol-related activities as relative to non-alcohol-related activities; Murphy, Correia, Colby, & Vuchinich, 2005).…”