Behavioral economics of drug self-administration. IV. The effects of response requirement on the consumption of and interaction between concurrently available coffee and cigarettes

Assessment of ethanol and nicotine interactions using a reinforcer demand modeling with grouped and individual levels of analyses in a long-access self-administration model using male rats

Previous reports have indicated the reciprocal effects of nicotine and ethanol on their rewarding and reinforcing properties, but studies using methodological approaches resembling substance use in vulnerable populations are lacking. In our study, rats first self-administered ethanol, and their sensitivity to ethanol's reinforcing effects was assessed using a reinforcer demand modeling approach. Subsequently, rats were equipped with intravenous catheters to self-administer nicotine, and their sensitivity to nicotine's reinforcing effects was evaluated using the same approach. In the final phase, rats were allowed to self-administer ethanol and nicotine concurrently, investigating the influence of one substance on the rate of responding for the other substance. Group analyses revealed notable differences in demand among sucrose, sweetened ethanol, and ethanol-alone, with sucrose demonstrating the highest demand and ethanol-alone exhibiting greater sensitivity to changes in cost. At the individual level, our study finds significant correlations between rats' demand for sucrose and sweetened ethanol, suggesting parallel efforts for both substances. Our individual data also suggest interconnections in the elasticity of demand for sweetened ethanol and ethanol-alone, as well as a potential relationship in price response patterns between ethanol and nicotine. Furthermore, concurrent self-administration of ethanol and nicotine at the group level displayed reciprocal effects, with reduced responding for nicotine in the presence of ethanol and increased responding for ethanol in the presence of nicotine. This study provides valuable insights into modeling the co-use of ethanol and nicotine and assessing their interaction effects using reinforcer demand modeling and concurrent self-administration or noncontingent administration tests. These findings contribute to our understanding of the complex interplay between ethanol and nicotine and have implications for elucidating the underlying mechanisms involved in polydrug use.

What Is Addiction? How Can Animal and Human Research Be Used to Advance Research, Diagnosis, and Treatment of Alcohol and Other Substance Use Disorders?

The current article highlights key issues in defining, studying, and treating addiction, a concept related to but distinct from substance use disorders. The discussion is based upon a roundtable discussion at the 2017 annual meeting of the Research Society on Alcoholism where Warren K. Bickel and John C. Crabbe were charged with answering a range of questions posed by Kenneth J. Sher. All the presenters highlighted a number of central concerns for those interested in assessing and treating addiction as well as those seeking to conduct basic preclinical research that is amenable to meaningful translation to the human condition. In addition, the discussion illustrated both the power and limitations of using any single theory to explain multiple phenomena subsumed under the rubric of addiction. Among the major issues examined were the important differences between traditional diagnostic approaches and current concepts of addiction, the difficulty of modeling key aspects of human addiction in nonhuman animals, key aspects of addiction that have, to date, received little empirical attention, and the importance of thinking of recovery as a phenomenon that possibly involves processes distinct from those undergirding the development and maintenance of addiction.

Toward quantifying the abuse liability of ultraviolet tanning: A behavioral economic approach to tanning addiction

Many adults engage in ultraviolet indoor tanning despite evidence of its association with skin cancer. The constellation of behaviors associated with ultraviolet indoor tanning is analogous to that in other behavioral addictions. Despite a growing literature on ultraviolet indoor tanning as an addiction, there remains no consensus on how to identify ultraviolet indoor tanning addictive tendencies. The purpose of the present study was to translate a behavioral economic task more commonly used in substance abuse to quantify the "abuse liability" of ultraviolet indoor tanning, establish construct validity, and determine convergent validity with the most commonly used diagnostic tools for ultraviolet indoor tanning addiction (i.e., mCAGE and mDSM-IV-TR). We conducted a between-groups study using a novel hypothetical Tanning Purchase Task to quantify intensity and elasticity of ultraviolet indoor tanning demand and permit statistical comparisons with the mCAGE and mDSM-IV-TR. Results suggest that behavioral economic demand is related to ultraviolet indoor tanning addiction status and adequately discriminates between potential addicted individuals from nonaddicted individuals. Moreover, we provide evidence that the Tanning Purchase Task renders behavioral economic indicators that are relevant to public health research. The present findings are limited to two ultraviolet indoor tanning addiction tools and a relatively small sample of high-risk ultraviolet indoor tanning users; however, these pilot data demonstrate the potential for behavioral economic assessment tools as diagnostic and research aids in ultraviolet indoor tanning addiction studies.

The Experimental Tobacco Marketplace I: Substitutability as a Function of the Price of Conventional Cigarettes

INTRODUCTION

Behavioral economic studies of nicotine product consumption have traditionally examined substitution between two products and rarely examined substitution with more products. Increasing numbers of tobacco products available for commercial sale leads to more possible cross-product interactions, indicating a need to examine substitution in more complex arrangements that closely mirror the tobacco marketplace.

METHODS

The experimental tobacco marketplace (ETM) is an experimental online store that displays pictures, information, and prices for several tobacco products. Smokers were endowed with an account balance based on their weekly tobacco purchases. Participants then made potentially real purchases for seven (Experiment 1) or six (Experiment 2) tobacco/nicotine products under four price conditions for conventional cigarettes while prices for other products remained constant. Smokers returned 1 week later to report tobacco/nicotine use and return unused products for a refund.

RESULTS

In Experiment 1 (n = 22), cigarette purchasing decreased as a function of price. Substitution was greatest for electronic cigarettes and cigarillos and significant for electronic cigarettes. Experiment 2 (n = 34) was a replication of Experiment 1, but with cigarillos unavailable in the ETM. In Experiment 2, cigarette purchases decreased as a function of price. Substitution was robust and significant for electronic cigarettes and Camel Snus.

CONCLUSIONS

The ETM is a novel, practical assay that mimics the real-world marketplace, and functions as a simple research tool for both researchers and participants. Across the two experiments the product mix in the ETM altered which products functioned as substitutes suggesting complex interactions between purchasing and product availability.

IMPLICATIONS

This article adds a novel method of collecting purchasing data that mimics real world purchasing to the existing literature. The ETM is a practical avenue by which to study both hypothetical and potentially real purchasing.

Nicotine reduction as an increase in the unit price of cigarettes: a behavioral economics approach

Urgent action is needed to reduce the harm caused by smoking. Product standards that reduce the addictiveness of cigarettes are now possible both in the U.S. and in countries party to the Framework Convention on Tobacco Control. Specifically, standards that required substantially reduced nicotine content in cigarettes could enable cessation in smokers and prevent future smoking among current non-smokers. Behavioral economics uses principles from the field of microeconomics to characterize how consumption of a reinforcer changes as a function of the unit price of that reinforcer (unit price=cost/reinforcer magnitude). A nicotine reduction policy might be considered an increase in the unit price of nicotine because smokers are paying more per unit of nicotine. This perspective allows principles from behavioral economics to be applied to nicotine reduction research questions, including how nicotine consumption, smoking behavior, use of other tobacco products, and use of other drugs of abuse are likely to be affected. This paper reviews the utility of this approach and evaluates the notion that a reduction in nicotine content is equivalent to a reduction in the reinforcement value of smoking-an assumption made by the unit price approach.

The association between changes in alternative reinforcers and short-term smoking cessation

BACKGROUND

While more than 50% of smokers make a serious quit attempt each year, less than 10% quit permanently. Evidence from studies of adolescent smoking and other substances of abuse suggest that alternative reinforcers, a construct of Behavioral Economic Theory, may contribute to the likelihood of smoking cessation in adults. This study examined the behavioral economics of smoking cessation within a smoking cessation clinical trial and evaluated how depressive symptoms and behavioral economic variables are associated with smoking cessation.

METHODS

A sample of 469 smokers, enrolled in an effectiveness trial that provided counseling and 8 weeks of 21 mg nicotine patches, was analyzed. Alternative reinforcers (substitute and complementary reinforcers) and depressive symptoms were examined in relation to 7-day point prevalence abstinence, verified with breath carbon monoxide, 8 weeks after the quit date.

RESULTS

Controlling for covariates associated with cessation (nicotine dependence, age of smoking initiation, patch adherence), participants who were abstinent at week 8 showed significantly higher substitute reinforcers at all time-points, compared to those who were smoking (p's<.05). Participants who were abstinent at week 8 showed lower complementary reinforcers and depressive symptoms at all time-points, compared to those who were smoking, but significant differences were confined to week 8 (p's<.01). There was no significant interaction between alternative reinforcers and depressive symptoms across the 8 weeks on week 8 abstinence.

CONCLUSIONS

These results support continued examination of Behavioral Economic Theory in understanding adult smoking cessation in order to inform future treatments and guidelines.

Effects of caffeine on persistence and reinstatement of nicotine-seeking behavior in rats: interaction with nicotine-associated cues

RATIONALE

Caffeine and nicotine are the most commonly co-used psychostimulants. However, it is still unclear whether caffeine exposure enhances nicotine-seeking behavior.

OBJECTIVE

The present study examined the effects of caffeine on nicotine-seeking in rats trained to self-administer nicotine with and without presession administration of caffeine.

METHODS

Male Sprague-Dawley rats were trained to intravenously self-administer nicotine (0.03 mg/kg/infusion, freebase) on a fixed ratio 5 schedule of reinforcement and associate a stimulus cue with each nicotine administration. Five minutes before the sessions, the rats received an intraperitoneal administration of caffeine (5 mg/kg). Extinction tests were conducted under four conditions: presession caffeine administration, response-contingent presentation of nicotine cues, neither condition, or both conditions. Reinstatement tests were conducted after responding was extinguished by withholding presession caffeine, nicotine, and its cues. A separate group of rats trained without presession caffeine exposure was also subjected to the reinstatement tests.

RESULTS

In the rats trained with presession caffeine exposure, continued caffeine administration sustained nicotine-seeking responses and interacted with nicotine cues to significantly delay the extinction of nicotine-seeking behavior. Readministration of caffeine after extinction effectively reinstated nicotine-seeking behavior. In caffeine-naive rats, caffeine administration did not reinstate extinguished nicotine-seeking behavior but significantly potentiated the cue-induced reinstatement of nicotine-seeking.

CONCLUSION

These data demonstrate that caffeine administration sustained and reinstated nicotine-seeking behavior, possibly via its acquired discriminative-stimulus properties predictive of nicotine availability. These findings suggest that smokers who attempt to quit may benefit from stopping caffeine consumption.

Sleep deprivation alters valuation signals in the ventromedial prefrontal cortex

Even a single night of total sleep deprivation (SD) can have dramatic effects on economic decision making. Here we tested the novel hypothesis that SD influences economic decisions by altering the valuation process. Using functional magnetic resonance imaging we identified value signals related to the anticipation and the experience of monetary and social rewards (attractive female faces). We then derived decision value signals that were predictive of each participant’s willingness to exchange money for brief views of attractive faces in an independent market task. Strikingly, SD altered decision value signals in ventromedial prefrontal cortex (VMPFC) in proportion to the corresponding change in economic preferences. These changes in preference were independent of the effects of SD on attention and vigilance. Our results provide novel evidence that signals in VMPFC track the current state of the individual, and thus reflect not static but constructed preferences.

The behavioral economics of drug dependence: towards the consilience of economics and behavioral neuroscience

In this chapter, we review the research in this growing field by first discussing the concepts related to price and consumption (demand), its applications to the study of drug consumption and drug seeking, and the impact of other commodities on drug consumption. We then review the discounting of future commodities and events among the addicted, review the most recent research examining the neural correlates of discounting, and describe and review the new theory of addiction that results from that research. We conclude by addressing the next research steps that these advances engender.

Don't wanna go through that madness no more: quality of life satisfaction as predictor of sustained remission from illicit drug misuse

Individuals who have developed a clinical dependence on drugs and/or alcohol often report that they sought help because they were "sick and tired of being sick and tired." Quality of life (QOL) remains the missing measurement in the addictions arena. The few studies conducted to date show that QOL is typically poor during active addiction and improves as a function of remission. An intriguing question bears on the role of QOL in subsequent remission status. Reasoning that higher life satisfaction may "increase the price" of future use and thus enhance the likelihood of sustained remission, this exploratory study tests the hypotheses that QOL satisfaction prospectively predicts sustained remission, and that motivational constructs mediate the association. Inner city residents (N = 289, 53.6% male, mean age 43) remitting from chronic and severe histories of dependence to crack and/or heroin were interviewed three times at yearly interval beginning in April 2003. Logistic regression findings generally support our hypotheses: Controlling for other relevant variables, baseline life satisfaction predicted remission status 1 and 2 years later and the association was partially mediated by motivation (commitment to abstinence) although the indirect effect did not reach statistical significance. Findings underline the importance of examining the role of QOL satisfaction in remission processes. Limitations of this exploratory study are discussed, including the use of a single-item global life satisfaction rating; suggestions for future studies are discussed including the need to embrace QOL as a bona fide clinical outcome and to use comprehensive standardized QOL measures that speak to individual dimensions of functioning. Implications are noted, especially the need for the addiction field to continue moving away from the pathology-focused model of care toward a broader model that embraces multiple dimensions of positive health as a key outcome.

Economic principles motivating social attention in humans

We know little about the processes by which we evaluate the opportunity to look at another person. We propose that behavioural economics provides a powerful approach to understanding this basic aspect of social attention. We hypothesized that the decision process culminating in attention to another person follows the same economic principles that govern choices about rewards such as food, drinks and money. Specifically, such rewards are discounted as a function of time, are tradable for other rewards, and reinforce work. Behavioural and neurobiological evidence suggests that looking at other people can also be described as rewarding, but to what extent these economic principles apply to social orienting remains unknown. Here, we show that the opportunity to view pictures of the opposite sex is discounted by delay to viewing, substitutes for money and reinforces work. The reward value of photos of the opposite sex varied with physical attractiveness and was greater in men, suggesting differential utility of acquiring visual information about the opposite sex in men and women. Together, these results demonstrate that choosing whom to look at follows a general set of economic principles, implicating shared neural mechanisms in both social and non-social decision making.

A behavioral economic analysis of cocaine and remifentanil self-administration in rhesus monkeys

RATIONALE

Behavioral economics can be used to evaluate the relative reinforcing effectiveness of drugs and the economic interaction between drugs, information which may help to explain patterns of polydrug abuse in humans.

OBJECTIVES

In phase 1, the reinforcing effectiveness of the opiate remifentanil and the stimulant cocaine was compared using a demand-curve analysis. In phase 2, the economic relation between these drugs was determined.

MATERIALS AND METHODS

Rhesus monkeys pressed levers according to fixed-ratio schedules for intravenous drug infusions. A demand-curve analysis was conducted (phase 1) in which drug consumption was measured as the response requirement, or price, was increased, and the rate at which consumption decreased with increases in price (demand elasticity) provided an index of the reinforcing effectiveness of each drug. Cocaine and remifentanil were then available concurrently (phase 2), and the price of one drug was increased (the manipulated-price alternative) while the price of the other drug was held constant (the fixed-price alternative). Consumption of the fixed-price alternative was measured as a function of increases in the price of the manipulated-price alternative, and demand for the manipulated-price alternative was assessed.

RESULTS

The reinforcing effectiveness of cocaine and remifentanil did not significantly differ, and these drugs functioned as economic substitutes. As the price of the manipulated-price alternative increased, consumption of the fixed-price alternative increased. In addition, demand for the manipulated-price alternative became more elastic with the concurrent availability of the fixed-price alternative.

CONCLUSION

Polydrug use involving stimulants and opiates may occur because these drugs are highly substitutable.

Human nicotine conditioning requires explicit contingency knowledge: is addictive behaviour cognitively mediated?

RATIONALE

Two seemingly contrary theories describe the learning mechanisms that mediate human addictive behaviour. According to the classical incentive theories of addiction, addictive behaviour is motivated by a Pavlovian conditioned appetitive emotional response elicited by drug-paired stimuli. Expectancy theory, on the other hand, argues that addictive behaviour is mediated by an expectancy of the drug imparted by cognitive knowledge of the Pavlovian (predictive) contingency between stimuli (S+) and the drug and of the instrumental (causal) contingency between instrumental behaviour and the drug.

AIMS AND METHOD

The present paper reviewed human-nicotine-conditioning studies to assess the role of appetitive emotional conditioning and explicit contingency knowledge in mediating addictive behaviour.

RESULTS

The studies reviewed here provided evidence for both the emotional conditioning and the expectancy accounts. The first source of evidence is that nicotine-paired S+ elicit an appetitive emotional conditioned response (CR), albeit only in participants who expect nicotine. Furthermore, the magnitude of this emotional state is modulated by nicotine deprivation/satiation. However, the causal status of the emotional response in driving other forms of conditioned behaviour remains undemonstrated. The second source of evidence is that other nicotine CRs, including physiological responses, self-administration, attentional bias and subjective craving, are also dependent on participants possessing explicit knowledge of the Pavlovian contingencies arranged in the experiment. In addition, several of the nicotine CRs can be brought about or modified by instructed contingency knowledge, demonstrating the causal status of this knowledge.

CONCLUSIONS

Collectively, these data suggest that human nicotine conditioned effects are mediated by an explicit expectancy of the drug coupled with an appetitive emotional response that reflects the positive biological value of the drug. The implication of this conclusion is that treatments designed to modify the expected value of the drug may prove effective.

Physical activity as a substitute for sedentary behavior in youth

BACKGROUND

Youth may choose to be sedentary rather than physically active.

PURPOSE

The purpose of this study was to use behavioral economics methods to investigate how experimental changes in the amount of sedentary behaviors influenced physical activity.

METHODS

Fifty-eight 8- to 16-year-old youth were studied in a within-subject crossover design with three 3-week phases: baseline, increasing, and decreasing targeted sedentary behaviors by 25% to 50%.

RESULTS

At baseline, boys were more active than girls (518.9 vs. 401.2 accelerometer counts/min, p = .02), and obese youth more sedentary than nonobese youth (240.5 vs. 174.4 min/day, p = .003). During the increase sedentary behavior phase, targeted sedentary behaviors increased by 52.1%, with girls increasing sedentary behaviors more than boys (114.7 vs. 79.8 min/day, p = .04). Physical activity decreased (-48.3 counts/min, p < .01) when sedentary behaviors increased, with obese youth decreasing total and moderate to vigorous physical activity (MVPA) more than nonobese youth (-110.4 vs. 8.9 counts/min, p < .001; -3.3 vs. -.03 % MVPA, p = .013). During the decrease sedentary behavior phase, targeted sedentary behaviors decreased by 55.6% from baseline as nonobese youth increased physical activity, whereas obese youth decreased physical activity (55.8 vs. -48.0 counts/min, p = .042; 1.1 vs. -2.1% MVPA, p = .021). Youth who substituted physical activity when sedentary behaviors were increased had greater standardized body mass index (z-body mass index = 1.4 vs. 0.4, p = .018), whereas youth who substituted physical activity when sedentary behaviors were decreased were less active at baseline (396.1 vs. 513.7 counts/min, p = .035).

CONCLUSIONS

Behavioral economics provides a methodology to understand changes in physical activity when sedentary behaviors are modified and to identify factors associated with substitution of physically active for sedentary behaviors.

On the learning curve: the emerging evidence supporting cognitive-behavioral therapies for adolescent substance abuse

AIMS

Cognitive-behavioral therapy (CBT) approaches to intervention for adolescent substance use disorders has been limited and formal controlled clinical efficacy trials have been rare. Moreover, the early literature on the efficacy of CBT for adolescent substance abuse has been characterized by significant methodological limitations. Recent innovations in the treatment of adolescent substance abuse and the recent completion of several randomized clinical trials has brightened the picture with respect to establishing the empirical support for CBT. The aim of this review is to integrate the findings from controlled trials of CBT for adolescent substance abuse.

METHOD

Studies representing randomized clinical trials were reviewed using criteria provided by Lonigan et al. and Nathan & Gorman as a guide.

FINDINGS AND CONCLUSIONS

Despite some prominent differences in design and methodology, the studies reviewed provide consistent empirical evidence that group and individual CBT are associated with significant and clinically meaningful reductions in adolescent substance use. The evidence for the efficacy of group therapy is particularly important, countering the assertion that aggregating problem youths into group treatment settings is associated with iatrogenic effects. The findings from the randomized trials reviewed represent significant developments in treatment outcome research and lay the foundation for validating CBT for adolescent substance use disorders. Future research directions include improving short- and long-term outcomes, enhancing treatment motivation and engagement, and identifying mechanisms and processes associated with positive change, especially for youths with comorbid conditions.

The effect of reinforcement or stimulus control to reduce sedentary behavior in the treatment of pediatric obesity

Obese children were randomly assigned to a family-based behavioral treatment that included either stimulus control or reinforcement to reduce sedentary behaviors. Significant and equivalent decreases in sedentary behavior and high energy density foods, increases in physical activity and fruits and vegetables, and decreases in standardized body mass index (z-BMI) were observed. Children who substituted active for sedentary behaviors had significantly greater z-BMI changes at 6 (-1.21 vs. -0.76) and 12 (-1.05 vs. -0.51) months, respectively. Substitution of physically active for sedentary behaviors and changes in activity level predicted 6- and 12-month z-BMI changes. Results suggest stimulus control and reinforcing reduced sedentary behaviors are equivalent ways to decrease sedentary behaviors, and behavioral economic relationships in eating and activity may mediate the effects of treatment.

Substitutes for tobacco smoking: a behavioral economic analysis of nicotine gum, denicotinized cigarettes, and nicotine-containing cigarettes

Both pharmacological and nonpharmacological stimuli may be responsible for the reinforcement and maintenance of tobacco smoking. The present study examined the self-administration of nicotine gum, denicotinized cigarettes, and nicotine-containing cigarettes utilizing a behavioral economic design in order to investigate the pharmacological and nonpharmacological aspects of cigarette smoking. Cigarette-deprived, dependent smokers worked for cigarette puffs and nicotine gum in daily operant sessions. In one phase, nicotine-containing cigarettes were available at increasing unit prices across sessions. Three phases replicated these sessions with nicotine gum, denicotinized cigarettes, or both, concurrently available at a constant unit price. As nicotine-containing cigarette unit price increased, consumption decreased. However, as nicotine-containing cigarette unit price increased, nicotine gum and denicotinized cigarette consumption increased. Consumption of nicotine gum, but not denicotinized cigarettes, diminished when all three reinforcers were concurrently available. Concurrently available denicotinized cigarettes, but not nicotine gum, caused a statistically significant reduction in nicotine-containing cigarette consumption. In another phase, denicotinized cigarettes were available at increasing unit prices across sessions while nicotine gum was concurrently available at a constant unit price. This phase demonstrated that nicotine content had no reliable effect on cigarette or nicotine gum consumption. These results suggest that denicotinized cigarettes are a more effective alternative reinforcer than nicotine gum, indicating that nonpharmacological stimuli of smoking merit attention in smoking cessation treatment. Furthermore, these findings indicate that alternative reinforcement would be most effective in smoking cessation treatment when combined with high prices for cigarettes.

Measures and models of nicotine dependence: positive reinforcement

This paper addresses the problem of assessing nicotine dependence. The main objective is to develop theory-led suggestions for measures that will be relevant in the early phases of tobacco use, as well as in established smokers. Theoretical models of addiction falling into the general class of 'positive reinforcement theories' were identified and reviewed. From this review a number of drug effects and patterns of behaviour were distilled and categorized as either vulnerability or dependence indicators. A comparison of those features with the International Classification of Diseases (ICD-10) and Diagnostic and Statistical Manual (DSM-IV) diagnostic systems shows that neither system includes detailed assessment of vulnerability indicators. It is argued that measurement of vulnerability indicators, in addition to dependence indicators, may add to the predictive validity of assessments carried out in early career tobacco users, especially where there is limited evidence of established dependence. In addition, it is suggested that examination of measures that differentiate a subgroup of early career smokers termed 'rapid accelerators' may prove profitable and enable identification of the key parameters of nicotine reinforcement.

Applying a behavioral economic framework to understanding adolescent smoking

Adolescents' choice to smoke may depend on substitute reinforcers for smoking, complementary activities to smoking, and individual differences in reinforcer value. The influence of these variables on smoking was determined among 983 adolescents. Substitutes were school involvement, academic performance, physical activity, and sports team participation: complements were peer smoking and substance use; delay discounting assessed individual differences in reinforcer value. Latent growth modeling indicated that substitute reinforcers reduced the odds of smoking progression almost two-fold, complementary reinforcers increased the odds by 1.14. and delay discounting indirectly influenced the odds of smoking progression through complementary reinforcers. Adolescents who smoke may have fewer reinforcers that protect against smoking and more reinforcers that promote smoking. Discounting of future rewards affects smoking through reinforcer type.

Sensitivity of nicotine-containing and de-nicotinized cigarette consumption to alternative non-drug reinforcement: a behavioral economic analysis

A previous report from our laboratory showed similar measures of reinforcing efficacy for nicotine-containing and de-nicotinized cigarettes when each cigarette type was presented alone. The present experiment further compared the reinforcing efficacy of nicotine-containing and de-nicotinized cigarettes by assessing the effects of alternative non-drug reinforcement on self-administration of both cigarette types. Eight human subjects responded on a progressive-ratio schedule in which the number of plunger pulls required for standardized cigarette puffs increased across sessions. Responding for the two types of cigarette was examined when each was available alone and when the concurrent opportunity to earn money was available. Consumption of nicotine-containing and de-nicotinized cigarettes was decreased by both increases in price and by the concurrent availability of money. The two cigarettes types did not differ in their sensitivity to price or alternative non-drug reinforcement. These results replicate our previous report of similar measures of reinforcing efficacy for the two cigarette types when each was presented alone, and extend our previous findings to a choice situation involving an alternative non-drug reinforcer. These data suggest the importance of further examination of non-pharmacological variables in the maintenance of drug taking and the sensitivity of drug taking to alternative non-drug sources of reinforcement. Factors potentially contributing to the maintenance of smoking the de-nicotinized cigarettes (i.e. conditioned reinforcement, primary reinforcement by respiratory stimulation, instructional control, demand characteristics) are also discussed.

Community reinforcement and family training (CRAFT): engaging unmotivated drug users in treatment

Although motivation for drug abuse treatment is a substantial problem, unilateral intervention through concerned significant others (CSOs) represents a promising method for engaging unmotivated individuals. The Community Reinforcement and Family Training (CRAFT) program, based on principles of reinforcement was developed for this specific purpose. In Phase I, CSOs received the CRAFT intervention, whereby they were taught skills for modifying a loved one's drug-using behavior and for enhancing treatment engagement. CSOs were evaluated at 3 and 6 months. In Phase II, engaged drug users received treatment using the Community Reinforcement Approach (CRA). A total of 62 CSOs participated in this evaluation of the effectiveness of CRAFT. CSOs completed, on average, 87% of offered treatment sessions. During the 6-month study period, 74% succeeded in engaging their resistant loved one in treatment. Reported abstinence both from illicit drugs and alcohol increased significantly for drug users engaged in treatment, but not for unengaged cases. All CSOs showed significant reduction in depression, anxiety, anger, and physical symptoms, with average scores dropping into the normal range on all measures. CRAFT provides a promising alternative to confrontational and detachment approaches in counseling CSOs to help their loved ones.

Nicotine gum as a substitute for cigarettes: a behavioral economic analysis

The present experiment attempted to identify a substitute for cigarette smoking in a laboratory analog of the behavioral economics of drug dependence. The interaction between cigarette consumption and nicotine gum consumption was examined with eight human smokers by increasing the price of cigarettes (i.e. the number of responses required to obtain puffs) across sessions, while the price of concurrently available nicotine gum remained constant. In another phase, the price of nicotine gum was increased while the price of concurrently available cigarettes remained constant. To determine whether the presence of concurrently available nicotine gum influenced cigarette consumption, we also examined the effect of increasing the price of cigarettes on cigarette consumption without available nicotine gum. When cigarettes and nicotine gum were concurrently available, increases in the price of cigarettes increased consumption of nicotine gum. When the price of nicotine gum increased while the price of cigarettes remained constant, smokers nearly exclusively consumed cigarettes. The presence or absence of nicotine gum did not affect the relation between cigarette consumption and cigarette price. The results suggest that nicotine gum can maintain operant behavior of smokers in the laboratory and can function, in a behavioral economic sense, as a weak substitute for cigarette puffs. As a result, nicotine gum may be useful in human laboratory studies of the behavioral economics of reinforcer interactions and their role in drug dependence.

Three predictions of the economic concept of unit price in a choice context

Economic theory makes three predictions about consumption and response output in a choice situation: (a) When plotted on logarithmic coordinates, total consumption (i.e., summed across concurrent sources of reinforcement) should be a positively decelerating function, and total response output should be a bitonic function of unit price increases; (b) total consumption and response output should be determined by the value of the unit price ratio, independent of its cost and benefit components; and (c) when a reinforcer is available at the same unit price across all sources of reinforcement, consumption should be equal between these sources. These predictions were assessed in human cigarette smokers who earned cigarette puffs in a two-choice situation at a range of unit prices. In some sessions, smokers chose between different amounts of puffs, both available at identical unit prices. Individual subjects' data supported the first two predictions but failed to support the third. Instead, at low unit prices, the relatively larger reinforcer (and larger response requirement) was preferred, whereas at high unit prices, the smaller reinforcer (and smaller response requirement) was preferred. An expansion of unit price is proposed in which handling costs and the discounted value of reinforcers available according to ratio schedules are incorporated.

Similar consumption and responding across single and multiple sources of drug

Two experiments were conducted to assess whether total response output and total consumption would be similar when drugs are available from single and multiple sources of reinforcement, as predicted by behavioral economics. In Experiment 1, cigarette-deprived smokers were exposed to a concurrent-chains schedule in which equal fixed-ratio schedules served as the initial links, and different reinforcer magnitudes (i.e., number of cigarette puffs) were arranged across alternatives. After the session, obtained unit price was calculated and imposed in the next session when a different number of puffs was available according to a single fixed-ratio schedule. Thus, the unit price at which cigarette puffs could be earned was yoked within subjects across the single and concurrent-chains schedules. When plotted as a function of unit price, similar consumption and response rates were usually obtained across these schedules. Experiment 2 addressed a weakness of Experiment 1, namely, that responding was allocated exclusively to the larger reinforcer magnitude in concurrent-chains conditions, and therefore this schedule may have functioned as a single schedule. In Experiment 2, subjects were instructed to alternate responding between the two alternative schedules. Instructions produced approximately equal response allocation between the two alternatives. Again, similar consumption and response rates were observed across the single and instructed concurrent-chains schedules. These findings are discussed in the context of direct effects and behavioral economics perspectives of drug self-administration.

Reducing the addictiveness of cigarettes. Council on Scientific Affairs, American Medical Association

OBJECTIVE

To assess the feasibility of reducing tobacco-caused disease by gradually removing nicotine from cigarettes until they would not be effective causes of nicotine addiction.

DATA SOURCES

Issues posed by such an approach, and potential solutions, were identified from analysis of literature published by the US Food and Drug Administration (FDA) in its 1996 Tobacco Rule, comments of the tobacco industry and other institutions and individuals on the rule, review of the reference lists of relevant journal articles, other government publications, and presentations made at scientific conferences.

DATA SYNTHESIS

The role of nicotine in causing and sustaining tobacco use was evaluated to project the impact of a nicotine reduction strategy on initiation and maintenance of, and relapse to, tobacco use. A range of potential concerns and barriers was addressed, including the technical feasibility of reducing cigarette nicotine content to non-addictive levels, the possibility that compensatory smoking would reduce potential health benefits, and whether such an approach would foster illicit ("black market") tobacco sales. Education, treatment, and research needs to enable a nicotine reduction strategy were also addressed. The Council on Scientific Affairs came to the following conclusions: (a) gradually eliminating nicotine from cigarettes is technically feasible; (b) a nicotine reduction strategy holds great promise in preventing adolescent tobacco addiction and assisting the millions of current cigarette smokers in their efforts to quit using tobacco products; (c) potential problems such as compensatory over-smoking of denicotinised cigarettes and black market sales could be minimised by providing alternate forms of nicotine delivery with less or little risk to health, as part of expanded access to treatment; and (d) such a strategy would need to be accompanied by relevant research and increased efforts to educate consumers and health professionals about tobacco and health.

CONCLUSIONS

The council recommends the following: (a) that cessation of tobacco use should be the goal for all tobacco users; (b) that the American Medical Association continue to support FDA authority over tobacco products, and FDA classification of nicotine as a drug and tobacco products as drug-delivery devices; (c) that research be encouraged on cigarette modifications that may result in less addicting cigarettes; (d) that the FDA require that the addictiveness of cigarettes be reduced within 5-10 years; (e) expanded surveillance to monitor trends in the use of tobacco products and other nicotine-containing products; (f) expanded access to smoking cessation treatment, and strengthening of the treatment infrastructure; and (g) more accurate labelling of tobacco products, including a more meaningful and understandable indication of nicotine content.

Further analysis of choice between cocaine and food using the unit price model of behavioral economics

Behavioral economics defines unit price (UP) as the ratio of the response requirement to magnitude of reinforcer. When applied to drug self-administration, the UP model defines UP as the ratio of the response requirement to the unit dose of drug. This model makes two predictions about drug self-administration: increasing UP decreases consumption and consumption at a given UP will be constant regardless of the response requirement and dose that make up the UP. In previous experiments conducted in rhesus monkeys allowed to choose between an i.v. injection of cocaine and food, the UP model has failed to adequately predict drug consumption in that consumption varied (increased with dose) at a given UP. However, previous experiments have allowed a fixed number of choice trials/day, thereby imposing a procedural ceiling on consumption that may have influenced conformity to the UP model. In the present experiment, the number of choice trials available was varied in such a way that constant drug consumption was possible over the range of UPs tested. The response requirement for cocaine was varied between 15 and 1200 lever presses/injection and the dose of cocaine was varied between 0.05 and 0.2 mg/kg/inj, yielding UPs from 300 to 5600 responses/mg/kg. The response requirement for food was always 30. As predicted by the UP model, cocaine consumption decreased as UP increased. Moreover, in contrast to previous experiments, consumption did not vary significantly across the response requirement/dose combinations that made up a UP. A detailed analysis suggested that a decrease in magnitude of the alternative reinforcer (one rather than three food pellets), rather than the increase in trials, was responsible for the improved conformity to the UP model in the present experiment relative to previous experiments. Taken together with previous experiments, the present experiment suggests that conformity to the UP model of drug consumption in a choice situation is dependent upon the magnitude of alternative reinforcers that are available. Consumption was best predicted by the UP model when the magnitude of the alternative reinforcer was small.

The effect of chewing gum on tobacco withdrawal

When smokers are in situations where smoking is prohibited, chewing gum is believed to reduce cravings to smoke. However, there is little scientific evidence to support this widely held assumption. The present study assessed craving for a cigarette and nicotine withdrawal in 20 dependent cigarette smokers under one of two conditions. All subjects smoked an initial cigarette upon arrival to the experimental session and were informed that they would not be allowed to smoke for the remainder of the session. The session consisted of each subject watching a movie, then waiting an additional 30 minutes. Half of the subjects were assigned to a Gum Condition where they were given free access to chewing gum throughout the experimental session; half were assigned to a No-Gum Control. Nicotine withdrawal was assessed immediately following the movie (Time 1) and again 30 minutes later (Time 2). Results from this study indicate that chewing gum reduces craving and helps with withdrawal when a nicotine-dependent person cannot smoke.

The effects of a cold-water immersion stressor on the reinforcing and subjective effects of fentanyl in healthy volunteers

The reinforcing and subjective effects of fentanyl, an opioid analgesic, were tested in ten healthy volunteers without histories of drug abuse, as a function of the temperature of a water bath in which the volunteers' forearms were immersed. The temperatures were body-temperature (37 degrees C), moderately cold (10 degrees C), and very cold (2 degrees C). A discrete-trial choice procedure was used in which, in each session, volunteers sampled 50 micrograms of fentanyl (delivered as a bolus via an infusion pump) and saline, and then on three successive trials, chose between the two. Volunteers then had to immerse their non-dominant forearm in the water bath 5 min after a drug delivery. Fentanyl was chosen on 77% of choice occasions in the 10 degrees C and 2 degrees C water conditions, which was significantly different from chance levels, and on 60% of choice occasions in the 37 degrees C water condition, which did not differ from chance levels. Several subjective effects of fentanyl were also modulated by the temperature of the water bath. We conclude that in the context of a painful stimulus, 50 micrograms of fentanyl functions as a reinforcer in non-drug abusers.

Unit-price analysis of opioid consumption by monkeys responding under a progressive-ratio schedule of drug injection

Several reports have indicated that drug consumption in self-administration procedures is a function of the ratio of the instrumental requirement to the dose of drug, a quantity termed unit price. We evaluated three predictions from this unit-price model in a reanalysis of data on opioid self-administration in rhesus monkeys responding under a progressive-ratio schedule (Hoffmeister, 1979). We evaluated whether consumption was inversely related to unit price, and compared the goodness of fit of an equation devised by Hursh, Raslear, Shurtleff, Bauman, and Simmons (1988) to that of a linear model predicting consumption as a function of dose. We also tested whether consumption was constant when the same unit price was comprised of different combinations of dose and instrumental requirement. Consumption declined overall as unit price increased. The equation devised by Hursh et al. and the linear model based on dose fit the data equally well. Drug consumption was not uniform at a given unit price. The analyses suggest limits on the unit-price model as a characterization of drug consumption.

The behavioral economics of concurrent drug reinforcers: a review and reanalysis of drug self-administration research

In economics, goods can function as substitutes, complements, or be independent of one another. These concepts refer to increases, decreases, or no change in the consumption of one item as the price of a second item increases. This review examined whether these economic terms can be used to describe relationships between concurrently available reinforcers in drug self-administration research. Sixteen drug self-administration studies that examined the effects of concurrent reinforcers were identified through a MEDLINE search. Across these studies, the following substances were employed: caffeinated coffee, cocaine, etonitazene, ethanol, heroin, food, methadone, morphine, nicotine cigarettes, pentobarbital, phencyclidine, sucrose and water. These studies were reanalyzed and the results were shown to be consistent with these economic notions. These analyses also showed that relationships among the concurrently available reinforcers were reliable within and across studies, that concurrently available reinforcers can affect each other asymmetrically, and that the relative price may determine the magnitude of effect for substitutes. These findings suggest that these economic concepts may be useful in characterizing the type and magnitude of interactions between concurrently available reinforcers and may suggest potential mechanisms that determine these relationships.

Subjective and behavioural evaluation of cigarette cravings

Cigarette cravings were evaluated in a sample of moderately heavy smokers, using the Questionnaire on Smoking Urges (QSU: Tiffany and Drobes 1991), which produces scores on two factors, related to the positive (factor I) and negative (factor II)-reinforcing properties of smoking, respectively. Smoking motivation was also assessed behaviourally using a progressive-ratio operant procedure, in which responding on a computer keyboard was reinforced by puffs on a cigarette, under a progressively increasing work requirement. Abstinence (4-14 h) increased scores on both subjective and behavioural measures. In non-deprived subjects, behavioural measures and cigarette liking correlated more strongly with factor I of the QSU than with factor II, while in abstinent subjects, correlations with factor II were stronger than with factor I. The significant relationships between the QSU and cigarette-reinforced progressive-ratio operant performance support the validity of both of these procedures as measures of cigarette craving.

A behavioral economic analysis of concurrently available money and cigarettes

In economic terms, consumption of a reinforcer is determined by its price and the availability and price of other reinforcers. This study examined the effects of response-requirement (i.e., price) manipulations on the self-administration of two concurrently available reinforcers. Six cigarette smokers participated in 4-hr sessions in which money and puffs on a cigarette were concurrently available according to fixed-ratio schedules of reinforcement. Once stable responding was obtained with both reinforcers available at Fixed Ratio 100, the response requirement for one reinforcer was systematically varied (Fixed Ratio 1,000 and 2,500), while the other reinforcer remained scheduled at Fixed Ratio 100. Increasing the fixed-ratio size for a reinforcer decreased its consumption, with a greater decrease occurring for monetary reinforcement. This finding was quantified in economic terms as own-price elasticity, with elasticity coefficients greater for money than cigarettes. The effects of fixed-ratio size on response output also differed across the two reinforcers. Although greater responding occurred for money at Fixed Ratio 100, increases in fixed-ratio size (for money) decreased responding for money, whereas the same increase in fixed-ratio size (for puffs) increased responding for puffs. Finally, increasing the fixed-ratio size for one reinforcer had little effect on consumption of the other concurrently available reinforcer. This finding was quantified as cross-price elasticity, with elasticity coefficients near 0.0 for most subjects, indicating little or no reinforcer interaction. The results indicate that the reinforcing effects of cigarettes and money in the setting studied here differed, and that the effects produced by changing the price of one reinforcer did not interact with the consumption of the other concurrently available reinforcer.

Tobacco abstinence, smoking cues, and the reinforcing value of smoking

One definition of the reinforcing value of a drug is the degree to which an organism will work to obtain it. Male and female smokers (n = 8 each) engaged in a task involving concurrent schedules of reinforcement for responding to receive cigarette puffs versus money on four occasions, following overnight abstinence versus no abstinence and in the presence of a lit cigarette (smoking "cue") or with no cigarette (2 x 2 design). Reinforcement schedule for puffs ranged from variable ratio 4 (VR4) to VR32, with schedule order during the first five trials (VR4 first, VR32 first) counterbalanced and repeated in reverse sequence during the second five trials. Schedule for money remained at VR4 during all trials. Results indicated significantly greater responding for puffs after overnight abstinence and in the presence of the smoking cue, although effect of the cue was specific to the "leaner" VR schedules (VR16, VR32). Unexpectedly, not only was reinforcement schedule for puffs a significant determinant of responding, but the order of these schedules (i.e., VR4 first vs. VR32 first) produced a significant overall difference in responding for puffs, especially in the presence of the cue. There was no difference in responding between males and females. These findings indicate that the reinforcing value of smoking is increased by overnight abstinence, the presence of a lit cigarette under lean reinforcement conditions, and the order in which reinforcement schedules are presented.

Behavioral economics: a novel experimental approach to the study of drug dependence

Drug abuse and dependence are among the most important problems facing society today. Understanding the determinants of drug abuse has been advanced by a considerable quantity of research on environmental and pharmacological factors that control drug taking in a variety of settings and species. Behavioral economics, which is the application of economic principles to the behavior of the individual, may have the potential to integrate a number of these empirical observations in a novel quantitative framework. In this paper the utility of behavioral economics for the study of drug dependence is reviewed. Specifically, we reviewed (i) the parsimony behavioral economics affords via the integration of variables, (ii) a ubiquitous behavioral process it has identified, (iii) the precise quantification of that behavioral process and its predictive utility, (iv) a novel independent variable suggested by behavioral economics, and (v) the utility of behavioral economic notions for the process of medication development. We conclude that behavioral economics provides a novel conceptual framework that has utility for the study of drug dependence.

Behavioral economics of drug self-administration. III. A reanalysis of the nicotine regulation hypothesis

The maintenance of a characteristic level of nicotine in a smoker's body is referred to as nicotine regulation. Considerable research has examined this question of whether smokers regulate nicotine intake. This is because nicotine regulation raises the question of whether smokers who, to decrease their intake of tar, switch to low tar/low nicotine cigarettes will increase the number and/or intensity of cigarettes smoked. Although the results of studies examining nicotine regulation are reported as generally consistent, considerable variability exists across these analyses such that the health hazards of smoking low tar/nicotine cigarettes remains uncertain. In the present analysis, these studies were analyzed to ascertain whether a behavioral-economic interpretation could better quantify the effects of changing nicotine yield on individuals' nicotine and smoke consumption. Specifically, 17 nicotine-regulation studies were reanalyzed using a unit-price analysis (i.e., cost-benefit analysis). The reanalysis showed less variability across regulation studies than previously reported; a positively-decelerating demand curve was found across most studies, consistent with previous unit-price analyses of food- and drug-maintained behavior. The benefits of this reanalysis versus the traditional regulation interpretation are that the behavioral economics approach: 1) brings unity to a variable set of data, 2) shows a nonlinear relationship, previously considered to be linear, between nicotine consumption and nicotine yield, 3) shows that nicotine yields higher, and not lower, than the smoker's usual brand decrease smoke consumption and thus decreases consumption of the harmful agents in tobacco, 4) better quantifies the data and provides a more parsimonious interpretation that generalizes to other drugs and food-maintained behavior in humans and nonhumans and, 5) integrates behavioral and pharmacological factors that control the consumption of reinforcers. These results suggest the value of behavioral economics in the study of consumptive behaviors and clinically suggest, in agreement with the studies contained herein, that decreasing the smoker's usual nicotine yield can have potential health risks for smokers who are unable to stop smoking.