Stimulus Control And Drug Dependence

Identifying Substitute Activities for Alcohol Consumption: A Preliminary Analysis

Individuals with alcohol use disorder may excessively value alcohol reinforcement over other types of rewards and may seek out environments supportive of alcohol consumption despite negative consequences. Therefore, examining ways to increase engagement in substance-free activities may be useful in treating alcohol use disorder. Past research has focused on preference and frequency of engagement in alcohol-related versus alcohol-free activities. However, no study to-date has examine the incompatibility of such activities with alcohol consumption, an important step in preventing possible adverse consequences during treatment for alcohol use disorder and for ensuring that activities do not function in a complementary fashion with alcohol consumption. The present study was a preliminary analysis comparing a modified activity reinforcement survey with the inclusion of a suitability question to determine the incompatibility of common survey activities with alcohol consumption. Participants recruited from Amazon's Mechanical Turk (N=146) were administered an established activity reinforcement survey, questions regarding the incompatibility of the activities with alcohol consumption, and measures of alcohol-related problems. We found that activity surveys may identify activities that are enjoyable without alcohol, but that some of these activities were still compatible with alcohol. For many of the activities examined, participants who rated those activities as suitable with alcohol also reported higher alcohol severity, with the largest effect size differences for physical activity, school or work, and religious activities. The results of this study are an important preliminary analysis for determining how activities may function as substitutes, and may hold implications for harm reduction interventions and public policy.

Why it is crucial to understand thinking and feeling: An analysis and application to drug abuse

Behavior analysis has long accepted the legitimacy of the analysis of private events in a natural science of behavior. However, the topic has languished as a focus of empirical research in either applied or basic arenas. We argue that recent empirical work examining the bidirectional nature of verbal relations may shed light on the role of private events in complex human behavior. Skinner argued that although it would be possible to analyze private events, we need not, because thoughts and feelings were viewed as co-occuring products of the same contingencies that are responsible for changes in overt responses. However, the bidirectional transformation of stimulus function inherent in verbal behavior changes the way that private events participate in complex behavioral episodes for verbal organisms. We examine why we have reached such a conclusion, with special emphasis on the role of self-awareness. Finally, we conclude with an application of our analysis to the problem of substance abuse.

The pursuit of value: sensitization or tolerance?

Two issues are raised. (1) What is the nature of the drug effect Heyman thinks confers value to drugs? (2) What is the evidence that drug use decreases the value of drugs and of conventional incentives over the long-term? There is considerable evidence for the opposite; a persistent increase in the sensitivity of neural systems that mediate drug value.

Future directions for the melioration model of addiction

For use in applied settings, the melioration model will need to incorporate changes in the shapes of local value functions over time, treat current value as a continuous function of time since previous choices, and take into account discounting of the effects of current behavior on future value. The policy implications of the model for regulating drugs are limited.

Behavioral choice theory can enhance our understanding of drug dependence and other behavioral disorders

I support the major theme of Heyman's target article that behavioral choice theory can enhance our understanding of drug dependence, but I raise concerns about the critique of the operant model of drug dependence, the underscoring of melioration to the exclusion of other theories of choice, and assertions about the unique effects of drug reinforcement.

Stimulus factors in addiction

Heyman's analysis of addiction in terms of matching to local relative value can be supplemented by stimulus-control processes. Stimulus equivalence can broaden the set of situations that occasion addictive behavior, and the situation-reinforcer correlation can enhance its persistence. The joint effects of stimulus-control and reinforcement processes may complicate treatment.

Understanding addiction: Conventional rewards and lack of control

The conflict between drug and conventional rewards leads to a paradox: Sanctions against drug use decrease access to conventional rewards and push drug users toward drug abuse, whereas increased access to the rewards of family, friends, and work may help reduce drug abuse. Lack of control is not specific to drug addiction and is unlikely to yield to a shift in bookkeeping.

Who determines the value of drug-taking behavior? Cultural considerations for a theory of behavioral choice

Heyman's analysis of addiction suggests that drug taking is irrational. The irrationality of drug taking, however, may depend on the acceptance of mainstream society's view of what is valuable. Consideration of the addict's viewpoint and cultural aspects of drug taking may be useful in trying to fathom the “rationality” of drug taking.

An economic perspective on addiction and matching

Economic models of addiction are choice-based. These models push the choice paradigm too far by modeling addiction as rational, normative behavior. Heyman's target article provides a sensible alternative to this economic approach by emphasizing that addiction is characterized by ambivalence and a perceived loss of self control. However, matching may not be a satisfactory platform on which to build this alternative model. Matching experiments do not provide evidence of ambivalence or perceived loss of self control.

Resolving the contradictions of addiction

Research findings on addiction are contradictory. According to biographical records and widely used diagnostic manuals, addicts use drugs compulsively, meaning that drug use is out of control and independent of its aversive consequences. This account is supported by studies that show significant heritabilities for alcoholism and other addictions and by laboratory experiments in which repeated administration of addictive drugs caused changes in neural substrates associated with reward. Epidemiological and experimental data, however, show that the consequences of drug consumption can significantly modify drug intake in addicts. The disease model can account for the compulsive features of addiction, but not occasions in which price and punishment reduced drug consumption in addicts. Conversely, learning models of addiction can account for the influence of price and punishment, but not compulsive drug taking. The occasion for this target article is that recent developments in behavioral choice theory resolve the apparent contradictions in the addiction literature. The basic argument includes the following four statements: First, repeated consumption of an addictive drug decreases its future value and the future value of competing activities. Second, the frequency of an activity is a function of its relative (not absolute) value. This implies that an activity that reduces the values of competing behaviors can increase in frequency even if its own value also declines. Third, a recent experiment (Heyman & Tanz 1995) shows that the effective reinforcement contingencies are relative to a frame of reference, and this frame of reference can change so as to favor optimal or suboptimal choice. Fourth, if the frame of reference is local, reinforcement contingencies will favor excessive drug use, but if the frame of reference is global, the reinforcement contingencies will favor controlled drug use. The transition from a global to a local frame of reference explains relapse and other compulsive features of addiction.

In search of the relevant behavioral variables

Heyman s analysis of the relevant complex behavioral variables associated with addiction is evaluated in relation to identifying the appropriate variables in behavior analysis. The model of behavioral allocation and choice known as melioration, discussed by Heyman as a way to understand the complexities of addiction, is examined and contrasted with another model of matching called ratio invariance, which is offered in this commentary as another behavioral account with a significant potential for resolving the contradictions of addiction.

Positive reinforcement, the matching law and morality

Addictive behavior has never seemed rational because it persists in spite of drastic aversive consequences. This is a particular problem for models of addiction such as operant psychology which hold that behavior is controlled by its consequences. Inspite of claims to the contrary, Heymans target article illustrates how operant psychology resolves this contradiction. By using the matching law, Heyman suggests a mechanism that explains why delayed aversive events may not control behavior, and a conceptual framework in which we can understand successful therapies.

Melioration and addiction

I discuss various theoretical issues concerning maximizing, matching, and melioration. The model of addiction based on melioration has the key feature that a reduction in drag use increases both the value of drag-taking and the value of conventional activities. I found Heyman's target article stimulating. I don't feel competent to comment on drags but I do have some thoughts, both general and specific, on the theoretical issues.

Is melioration the addiction theory of choice?

Heyman makes a convincing case that a melioration choice strategy is sufficient to produce addictive behavior. But given a plethora of addiction theories, the question is whether melioration theory is superior to rivals more sophisticated than a simple disease model or operant conditioning account. Heyman offers little direct evidence that melioration actually causes the addictions we observe.

A scientific fix for the classical account of addiction

Heyman's two crucial theses are that people over-value immediate rewards, and that addictive substances “subvert the value of competing commodities.” These perennial ideas were discussed by Plato. Whereas Heyman provides scientific clarification and support for the first, the second remains problematic. I outline how this deficiency might be remedied via evolutionary considerations.

Control versus causation of addiction

Heyman explains useful ways to bring addictive drug use under environmental control. We doubt that relapse is explained by drug features such as immediate reinforcement, clouding of judgment, and so forth. Relapse may require explanation in terms of enduring sensitization of incentive neural substrates, but even if its causal assumptions are wrong, Heyman's model makes useful predictions for behavioral control.

Self-control and impulsiveness: Resolution of apparent contradictions in choice behavior

Choosing the smaller, less delayed reinforcers of drug abuse (including cessation of withdrawal) over the larger, more delayed reinforcers of a healthy life can be described as impulsiveness (the opposite of self-control). Examination of drug abuse using a self-control/impulsiveness framework can help explain many of the puzzles about this behavior, while tying drug abuse into a large research database.

Who is at risk for addiction?

Numerous individual differences determine the effectiveness of the multiple external reinforcement contingencies that control drug seeking behavior. Differences in the capacity to frame reinforcement and also the toxic effects of drugs modulate susceptibility to addiction. As a result, not all individuals are at the same degree of risk for addiction.

Haloperidol does not attenuate conditioned place preferences or locomotor activation produced by food- or heroin-predictive discriminative cues

The present study examined whether a discriminative cue previously predictive of food or heroin reinforcement could activate and direct behavior in an environment that had never been paired with primary reinforcement. Olfactory cues, predicting the availability (S+) or unavailability (S-) of either heroin (0.1 mg/kg i.v.) or food (45 mg Noyes food pellets) reinforcement in the goal box of a straight-arm runway, were later tested in a separate environment for their ability to elicit locomotion (activate behavior) or induce a conditioned place preference (direct behavior). Presentation of the S+, but not the S-, resulted in a reliable increase in spontaneous locomotor activity that was not blocked by pretreatment with the dopamine receptor antagonist, haloperidol. Similarly, subjects displayed a preference for a novel location in which the S+, but not the S-, was placed. This preference was also unaltered by pretreatment with haloperidol. These data suggest that discriminative cues can profoundly affect behavior, even in environments that have themselves never been associated with primary reinforcement. Additionally, the conditioned motivational quality of these cues is unaltered by treatment with the same dopamine receptor antagonist shown in previous work to attenuate the primary reinforcing properties of heroin and food.

Addiction as choice? Yes. As melioration? Maybe, maybe not

Melioration is not superior and may be inferior to other extensions of behavioral choice theory to addiction studies. Progress in the addiction field will be accelerated by the demise of the disease model rather than by attempting to resolve the contradictions it has created.

Maximization should sometimes lead to abstinence

Heyman's model, paradoxically, predicts that whereas a maximizing approach to drug choice will prevent escalation of drug use it will never yield complete abstinence. We suggest an alternative model that overcomes this difficulty by focusing on changes in drug tolerance. A small modification allows maximization to predict either abstinence or moderation (e.g., social drinking).

Which behavioral consequences matter? The importance of frame of reference in explaining addiction

The target article emphasizes the relationship between a matching law-based theory of addiction and the disease model of addiction. In contrast, this response emphasizes the relationship between the matching law theory and other behavioral approaches to addiction. The basic difference, I argue, is that the matching law specifies that choice is governed by local reinforcement rates. In contrast, economics says that overall reinforcement rate controls choice, and for other approaches there are other measures or no clear prediction at all. The response also differs from the target article in that there is more emphasis on the finding that stimulus conditions determine whether choice is under local or overall reinforcement rate control.

The contradiction unresolved

Extreme sensations – thirst, pain – can focus attention on local consequences at the expense of the overall, perhaps for good evolutionary reasons. Maybe the same phenomenon evolves from prolonged use of addictive substances. The matching law explains mistaken choice, not how a person who has confronted personal catastrophe manages to ignore it in making a locally induced choice.

Addiction is not as puzzling as it seems

Heyman's target article seeks to resolve the apparent paradox surrounding the issue of control in relation to addictive behaviour. The present commentary argues that addiction is in fact less paradoxical and more easily understandable than Heyman supposes. A fully satisfactory model of addiction, however, requires a more multifaceted approach than that provided by the type of behavioural choice theory favoured by Heyman.

The Janus faces of addiction

Heyman proposes that external stimuli can promote a switch from a local to a global frame of reference for evaluating the consequences of behavior and that such a change might be critical to breaking the grip of drag addiction. Could incentive stimuli promote a switch in the opposite direction and thus contribute to relapse in the recovered addict?

Relationship between melioration and the controlling variables

Knowledge of specific instances of melioration does not imply knowledge of the variables controlling behavior. Drug self-administration has been successfully analyzed in terms of standard variables such as the immediacy and magnitude of the drug reinforcer. An appeal to melioration may not be necessary.

The behavioral economics of addiction: A comprehensive alternative

Heyman's target article makes a strong case for a behavioral approach to addiction, yet some important assumptions require justification, and promising behavioral alternatives to the author's melioration approach should be considered. In particular, the behavioral economic approach to addiction appears well developed and comprehensive. How does the melioration approach complement or improve on a behavioral economic account?

The ameliorating addict: An illusion reviewed

It is difficult to accommodate compulsive drug use that destroys regulation by consequences in a unitary framework of melioration or maximization, especially as both are strategies of behavioral regulation. The “contradiction” of addictive behavior despite aversive consequences is an illusory issue because consequences that do not decrease addictive behavior cannot be considered punishing.

Addiction requires philosophical explanation, not mere redescription

Heyman's model explains the irrationality of addictive behavior, but it does not satisfactorily answer the question of whether this behavior is voluntary because it does not address the issue of the choice of preference functions. Furthermore, although Heyman disconfirms the disease model of addiction, this does not resolve the issue of whether addiction should be classified as a mental illness.

Matching and melioration as accounts of reinforcement and drug addiction

Heyman's view that addiction can be viewed as a natural outcome predictable by melioration and the matching law is provocative. Remaining to be explained more fully, however, are exactly how his view is an improvement on other reinforcement-based accounts. Included in these elaborations should be an account of how different “bookkeeping schemes” are developed and controlled and what new approaches to treatment and prevention of drug addiction are indicated.

How do people choose between local and global bookkeeping?

The matching law accounts for both addictive behavior and the usefulness of a person's evaluating choices in overall categories. To explain why overall bookkeeping, once learned, does not easily win out over local bookkeeping, another implication of matching is needed: intertemporal bargaining. The role of melioration, though probably important for new addiction is separate.

Addiction: Taking the brain seriously

Heyman's target article is an analytical tour de force, but it makes too hard a distinction between voluntary and driven behavior. It is more fruitful to think about brain and behavior as shifting, interacting “agents,” represented by multiple neural circuits. This has the virtue of better connecting behavioral analysis with wet neuroscience.

Heyman's steady-state theory of addiction

Heyman's target article contributes to our understanding of addictions by offering solutions to several paradoxes and by recognizing the stable nature of addictive behavior. Previous classical and operant conditioning models have emphasized molecular processes, such as acquisition and extinction, and have failed to address the aggregate effects of long-term exposure to the contingencies of drug and alcohol use.

Matching observation to addiction theory

Over the years, many theories have been proposed to account for the aberrant behavior of drug dependent individuals. Heyman posits that the existing theories of drug dependence are inadequate to explain the complex processes inherent in human drug-taking. He proposes that incongruous behaviors that comprise addiction, such as continued drug use in spite of adverse consequences, can be explained by application of the matching law approach. While the matching law theory of addiction explains certain aspects of human behavior, its application to the area of addiction must be subjected to experimental verification.

Resurgence of derived stimulus relations

Resurgence has been shown in human and nonhuman operant behavior, but not in derived relational responses. The present study examined this issue. Twenty-three undergraduates were trained to make conditional discriminations in a three-choice matching-to-sample paradigm. The training resulted in three equivalence classes, each consisting of four arbitrarily configured visual stimuli. The same 12 stimuli were then reorganized, and the conditional discrimination training was repeated such that three new classes were possible. In a subsequent test of derived relations, most subjects showed response patterns that were consistent with the altered conditional discriminations. Subjects were then exposed to conditional discrimination trials under extinction. Most subjects continued to respond consistently with the most recently reinforced conditional discrimination trials. During the next phase, subjects were exposed to symmetry and equivalence trials. Responses consistent with the most recent training produced feedback saying that the responses were incorrect, whereas other responses produced no feedback. Most subjects showed a resurgence of responding that was consistent with their earlier training. Finally, subjects were exposed to conditional discrimination trials carried out in extinction. Most subjects continued to show a resurgence of responding that was consistent with their early training.

Verbal self-reports of emergent relations in a stimulus equivalence procedure

During a preliminary training phase, college students were taught to categorize each of their responses accurately in a conditional discrimination task as either correct or incorrect. Next, in the absence of self-reports, subjects acquired conditional discriminations (involving novel stimuli) prerequisite to the formation of two four-member equivalence classes. The self-report procedure was reinstated during probe sessions that tested for untrained relations indicative of equivalence class formation. Interspersed trials involving trained relations provided a positive control, and trials with no class-consistent comparison provided a negative control. Eight of 10 subjects demonstrated equivalence class formation; all accurately reported their performance on trained relations and on trials with no class-consistent comparison. Subjects also reported their performance on most untrained (emergent) relations accurately, but in several instances self-reports indicated failure or uncertainty despite nearly perfect emergent-relations performance. These inconsistencies add to a growing body of literature that suggests there are differences between individual types of emergent relations. We suggest that the present procedure may be helpful in understanding these differences and other equivalence-related effects.