Using behavioral economics to predict opioid use during prescription opioid dependence treatment

Abstract

Background Research grounded in behavioral economics has previously linked addictive behavior to disrupted decision-making and reward-processing, but these principles have not been examined in prescription opioid addiction, which is currently a major public health problem. This study examined whether pre-treatment drug reinforcement value predicted opioid use during outpatient treatment of prescription opioid addiction. Methods Secondary analyses examined participants with prescription opioid dependence who received 12 weeks of buprenorphine-naloxone and counseling in a multi-site clinical trial (N = 353). Baseline measures assessed opioid source and indices of drug reinforcement value, including the total amount and proportion of income spent on drugs. Weekly urine drug screens measured opioid use. Results Obtaining opioids from doctors was associated with lower pre-treatment drug spending, while obtaining opioids from dealers/patients was associated with greater spending. Controlling for demographics, opioid use history, and opioid source frequency, patients who spent a greater total amount (OR = 1.30, p < .001) and a greater proportion of their income on drugs (OR = 1.31, p < .001) were more likely to use opioids during treatment. Conclusions Individual differences in drug reinforcement value, as indicated by pre-treatment allocation of economic resources to drugs, reflects propensity for continued opioid use during treatment among individuals with prescription opioid addiction. Future studies should examine disrupted decision-making and reward-processing in prescription opioid users more directly and test whether reinforcer pathology can be remediated in this population.

Prospective Analysis of Behavioral Economic Predictors of Stable Moderation Drinking Among Problem Drinkers Attempting Natural Recovery

“…In summary, the ASDE index contributed unique information in an account of resolution outcomes that was useful for identifying problem drinkers with a higher probability of achieving stable moderation. The multiple replications of the utility of the ASDE index to predict stable moderation (Tucker et al., , , , , ), coupled with similar money‐based findings from other research groups (Murphy et al., ; Worley et al., ), support adding assessment of spending on substances to established substance‐related assessment procedures. However, the discordance observed here among the BE measures adds to evidence that the reinforcement value of substances is a multidimensional construct in need of further explication.…”

“…The money‐based ASDE index thus may aid identification of problem drinkers who are relatively better candidates for a moderation drinking goal. Other recent intervention studies (Murphy et al., ; Worley et al., ) have similarly found that spending on substances contributed to the prediction of substance‐related outcomes; for example, Murphy and colleagues () found that lower discretionary spending on alcohol predicted reduced drinking and alcohol problems 6 months after a brief motivational intervention among college drinkers. Together with the present study, these findings support the utility of adding assessment of real spending on substances to established assessment procedures to predict outcomes of natural and treatment‐assisted resolution attempts.…”

Preresolution Drinking Problem Severity Profiles Associated with Stable Moderation Outcomes of Natural Recovery Attempts

“…Fifth, the expanded TLFB assessment of drinking practices and monetary expenditures likely has limited utility in clinical settings in its present form. Brief measures of monetary allocation to alcohol or drugs have been developed and found to predict treatment outcomes (Murphy et al, ; Worley et al, ). Collectively, these findings support adding assessment of real spending on substances to established assessment procedures to predict outcomes of recovery attempts.…”

Sources of Prescription Medication Misuse Among Young Adults in the United States

“…Consistent with prior studies, there were other sources of PDM associated with lower (e.g., free from friends/relatives) or greater (e.g., purchased) risk for SUD and substance dependence. 31–34 PDM source can predict treatment outcome among those with prescription opioid dependence. 31 Taken together, these findings indicate the importance of screening for PDM, and if positive, ascertain if multiple PDM sources are involved and conduct a more comprehensive SUD assessment to identify young adults who are at the greatest risk for developing substance-related consequences.…”