Toward Narrative Theory: Interventions for Reinforcer Pathology in Health Behavior

Bickel, Warren K.; Stein, Jeffrey S.; Moody, Lara; Snider, Sarah E.; Mellis, Alexandra M.; Quisenberry, Amanda J.

doi:10.1007/978-3-319-51721-6_8

Cited by 51 publications

(48 citation statements)

References 164 publications

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“…The Reinforcer Pathology theory proposes conditions that result in an excessive valuation of addictive substances as observed in drug addiction and obesity (Bickel, Jarmolowicz, Mueller, & Gatchalian, 2011;Carr, Daniel, Lin, & Epstein, 2011). The first iteration of this theory (Reinforcer Pathology 1.0) proposed that such conditions may result from the co-occurrence of two independent forces; that is, strong value for a reinforcer and excessive preference for immediate rewards, as measured by delay discounting (i.e., the reduction in the value of a reinforcer as a function of its delay; Bickel et al 2017). Although these interactions are continuous, for the purpose of explicating the ideas they were proposed as a two by two matrix (Fig.…”

Section: The Reinforcer Pathology Theorymentioning

confidence: 99%

A Reinforcer Pathology perspective on relapse

Bickel

2019

J Exper Analysis Behavior

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The Reinforcer Pathology theory proposes conditions under which drugs emerge as excessively preferred reinforcers compared to other available reinforcers among drug users. The theory highlights 2 key variables as important determinants of drug preference: (a) excessive preference for immediate rewards (high discounting of future rewards); and (b) excessive valuation for addictive reinforcers (e.g., drugs). Two iterations of the Reinforcer Pathology theory exist with the latest iteration (i.e., Reinforcer Pathology 2.0) specifying that the temporal window of reinforcer integration (measured by delay discounting) is a determinant of reinforcer value. The 2 iterations of the Reinforcer Pathology theory are described. A novel insight and understanding of abstinence and relapse from a Reinforcer Pathology perspective, limitations, and future directions are discussed. The Reinforcer Pathology theory continues the long-standing efforts to scientifically understand and better define novel concepts and methods to further translational research and improve treatment outcomes. Exploring the complementary relation between the Reinforcer Pathology perspective and other current approaches could have a valuable effect.

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Section: The Reinforcer Pathology Theorymentioning

confidence: 99%

A Reinforcer Pathology perspective on relapse

Bickel

2019

J Exper Analysis Behavior

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“…For example, research on delay discounting has informed the etiology of substance use disorders and intervention efforts (Bickel et al, 2012, 2017; Washio et al, 2011). Exploration of other behavioral economic principles not traditionally studied in substance use may provide insight into the origins and persistence of maladaptive patterns of drug taking.…”

Section: Introductionmentioning

confidence: 99%

A pilot study of loss aversion for drug and non-drug commodities in cocaine users

Strickland

Beckmann

Rush

et al. 2017

Drug and Alcohol Dependence

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Background Numerous studies in behavioral economics have demonstrated that individuals are more sensitive to the prospect of a loss than a gain (i.e., loss aversion). Although loss aversion has been well described in “healthy” populations, little research exists in individuals with substance use disorders. This gap is notable considering the prominent role that choice and decision-making play in drug use. The purpose of this pilot study was to evaluate loss aversion in active cocaine users. Methods Current cocaine users (N = 38; 42% female) participated in this within-subjects laboratory pilot study. Subjects completed a battery of tasks designed to assess loss aversion for drug and non-drug commodities under varying risk conditions. Standardized loss aversion coefficients (λ) were compared to theoretically and empirically relevant normative values (i.e., λ = 2). Results Compared to normative loss aversion coefficient values, a precise and consistent decrease in loss aversion was observed in cocaine users (sample λ ≈ 1). These values were observed across drug and non-drug commodities as well as under certain and risky conditions. Conclusions These data represent the first systematic study of loss aversion in cocaine-using populations and provide evidence for equal sensitivity to losses and gains or loss equivalence. Futures studies should evaluate the specificity of these effects to a history of cocaine use as well as the impact of manipulations of loss aversion on drug use to determine how this phenomenon may contribute to intervention development efforts.

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“…Compulsion theories go further and claim that S-R associations become maladaptive (fixed) such that they can no longer be modified by direct experience of punishment or harmful consequences (unlike habitual S-R/reinforcement learning which can be modified by experience of changed outcome value) [17]. Finally, neurocognitive accounts argue that chronic drug use produces structural and functional brain changes [18] and thus cognitive deficits [19], including impaired inhibitory control [20] and impaired foresight of future rewards and costs [21], rendering drug-seeking less susceptible to change by decision making.…”

Section: Reconciling Relative Value and Dual-process Theories Of Addimentioning

confidence: 99%

Relative expected value of drugs versus competing rewards underpins vulnerability to and recovery from addiction

Field¹,

Hogarth²

2020

Preprint

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Behavioural economic theories of addiction contend that greater expected value of drug relative to alternative non-drug rewards is the core mechanism underpinning vulnerability to and recovery from addiction. To evaluate this claim, we exhaustively review studies with human drug users that have measured concurrent choice between drugs vs. alternative rewards, and explored individual differences. These studies show that drug choice can be modulated by drug cues, drug devaluation, imposition of costs/punishment and negative mood induction. Regarding individual differences, dependence severity was reliably associated with overall drug preference, and self-reported drug use to cope with negative affect was reliably associated with greater sensitivity to mood induced increases in drug choice. By contrast, there were no reliable individual differences in sensitivity to the effect of drug cues, drug devaluation or punishment on drug choice. These findings provide insight into the mechanisms that underpin vulnerability to dependence: vulnerability is conferred by greater relative value ascribed to drugs, and relative drug value is further augmented by negative affective states in those who report drug use coping motives. However, dependence does not appear to be characterised by abnormal cue-reactivity, habit learning or compulsion. We then briefly review emerging literature which demonstrates that therapeutic interventions and recovery from addiction might be attributed to changes in the expected relative value of drug versus alternative rewards. Finally, we outline a speculative computational account of the distortions in decision-making that precede action selection in addiction, and we explain how this account provides a blueprint for future research on the determinants of drug choice, and mechanisms of treatment and recovery from addiction. We conclude that a unified economic decision-making account of addiction has great promise in reconciling diverse addiction theories, and neuropsychological evaluation of the underlying decision mechanisms is a fruitful area for future research and treatment.

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Toward Narrative Theory: Interventions for Reinforcer Pathology in Health Behavior

Cited by 51 publications

References 164 publications

A Reinforcer Pathology perspective on relapse

A Reinforcer Pathology perspective on relapse

A pilot study of loss aversion for drug and non-drug commodities in cocaine users

Relative expected value of drugs versus competing rewards underpins vulnerability to and recovery from addiction

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