The Behavioral Economics and Neuroeconomics of Alcohol Use Disorders

Value-based decision-making in regular alcohol consumers following experimental manipulation of alcohol value

BACKGROUND

Devaluation of alcohol leads to reductions in alcohol choice and consumption; however, the cognitive mechanisms that underpin this relationship are not well-understood. In this study we applied a computational model of value-based decision-making (VBDM) to decisions made about alcohol and alcohol-unrelated cues following experimental manipulation of alcohol value.

METHOD

Using a pre-registered within-subject design, thirty-six regular alcohol consumers (≥14 UK units per week) completed a two-alternative forced choice task where they chose between two alcohol images (in one block) or two soft drink images (in a different block) after watching videos that emphasised the positive (alcohol value), and separately, the negative (alcohol devalue) consequences of alcohol. On each block, participants pressed a key to select the image depicting the drink they would rather consume. A drift-diffusion model (DDM) was fitted to reaction time and choice data to estimate evidence accumulation (EA) processes and response thresholds during the different blocks in each experimental condition.

FINDINGS

In the alcohol devalue condition, soft drink EA rates were significantly higher compared to alcohol EA rates (p = 0.04, d = 0.31), and compared to soft drink EA rates in the alcohol value condition (p = 0.01, d = 0.38). However, EA rates for alcoholic drinks and response thresholds (for either drink type) were unaffected by the experimental manipulation.

CONCLUSIONS

In line with behavioural economic models of addiction that emphasise the important role of alternative reinforcement, experimentally manipulating alcohol value is associated with changes in the internal cognitive processes that precede soft drink choice.

Human laboratory models of reward in substance use disorder

Human laboratory models in substance use disorder provide a key intermediary step between highly controlled and mechanistically informative non-human preclinical methods and clinical trials conducted in human populations. Much like preclinical models, the variety of human laboratory methods provide insights into specific features of substance use disorder rather than modelling the diverse causes and consequences simultaneously in a single model. This narrative review provides a discussion of popular models of reward used in human laboratory research on substance use disorder with a focus on the specific contributions that each model has towards informing clinical outcomes (forward translation) and analogs within preclinical models (backward translation). Four core areas of human laboratory research are discussed: drug self-administration, subjective effects, behavioral economics, and cognitive and executive function. Discussion of common measures and models used, the features of substance use disorder that these methods are purported to evaluate, unique issues for measure validity and application, and translational links to preclinical models and special considerations for studies wishing to evaluate homology across species is provided.

Role of relative-reinforcement value of alcohol-free activities during recovery from alcohol use disorder in an adult clinical sample

Behavioral economic theory has been extensively applied to understand alcohol use disorder (AUD). Applications of behavioral economic theory conceptualize AUD as a pattern of harmful alcohol use over extended periods of time in which choices between drinking or engaging in alcohol-free activities favor drinking. Recovery, in contrast, entails a sustained shift toward a pattern of selecting rewarding alcohol-free activities. The present study examined whether alcohol-free activity engagement and the relative-reinforcement value (RRV) of engaging in those activities predicted AUD treatment outcomes via secondary analysis of data from Project MATCH, a multisite randomized clinical trial examining behavioral treatments for AUD (N = 1,279, 75.8% male, 81.0% non-Hispanic White, 9.5% Black, 7.7% Hispanic/Latino, 1.5% American Indian/Alaska Native, < 1% Asian American, and other race/ethnicity). Regression analyses indicated that every additional alcohol-free activity reported at 6 months posttreatment was associated with 7% fewer drinking days, 5% fewer heavy drinking days, and approximately one less drink per drinking day, as well as with significant improvements in depression, purpose in life, and psychosocial functioning at 12 months following treatment. Consistent with behavioral economic theory, higher RRV of alcohol-free activities also predicted significant reductions in drinking and improvements in functioning, and these associations were stronger compared to results for alcohol-free activity frequency only. The findings highlight the importance of understanding environmental contexts conducive to recovery and support the value of increasing alcohol-free activity engagement and the RRV of engaging in such activities to facilitate reductions in drinking and improved functioning among individuals with AUD. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Longitudinal examination of alcohol demand and alcohol-related reinforcement as predictors of heavy drinking and adverse alcohol consequences in emerging adults

BACKGROUND AND AIMS

Behavioral economic theory predicts that high alcohol demand and high proportionate alcohol-related reinforcement are important determinants of risky alcohol use in emerging adults, but the majority of research to date has been cross-sectional in nature. The present study investigated prospective and dynamic relationships between alcohol demand and proportionate alcohol-related reinforcement in relation to heavy drinking days and alcohol problems.

DESIGN

Longitudinal cohort with assessments every 4 months for 20 months.

SETTING

Ontario, Canada.

PARTICIPANTS

Emerging adults reporting regular heavy episodic drinking (n = 636, Mage = 21.44; 55.8% female).

MEASUREMENTS

Heavy drinking days (HDD; Daily Drinking Questionnaire), alcohol problems (Brief Young Adult Alcohol Consequences Questionnaire), alcohol demand (Alcohol Purchase Task) and proportionate alcohol-related reinforcement (Activity Level Questionnaire).

FINDINGS

Linear mixed effects models revealed that behavioral economic indicators and alcohol-related outcomes significantly decreased over the study, consistent with 'aging out' of risky alcohol use. Random intercept cross-lagged panel models revealed significant between-person relationships, such that higher alcohol demand and alcohol-related reinforcement were positively associated with HDD and alcohol problems (random intercepts = 0.187-0.534, Ps < 0.01). Moreover, alcohol demand indicators (particularly the rate of change in elasticity of the demand curve, as measured by α, and the maximum expenditure, Omax) and proportionate alcohol-related reinforcement significantly forecasted changes in HDD at all time points (|βs| = 0.063-0.103, Ps < 0.05) in cross-lagged relationships, with bidirectional associations noted for the rate of change in elasticity (βs = -0.085 to -0.104, Ps < 0.01). Proportionate alcohol-related reinforcement also significantly forecasted changes in alcohol problems at all time points (βs = 0.072-0.112, Ps < 0.01).

CONCLUSIONS

Multiple behavioral economic indicators (demand elasticity, maximum expenditure and reinforcement ratio) forecast changes in heavy episodic drinking and alcohol problems over the course of emerging adulthood. These results further implicate alcohol demand and proportionate alcohol-related reinforcement as etiologically and developmentally important mechanisms in alcohol use trajectories.

Opioid Risk Tool, in-hospital opioid exposure, and opioid demand predict pain outcomes following traumatic injury

Prescribed opioids are a mainstay pain treatment after traumatic injury, but a subgroup of patients may be at risk for continued opioid use. We evaluated the predictive utility of a traditional screening tool, the Opioid Risk Tool (ORT), and two other measures: average in-hospital milligram morphine equivalents (MME) per day and an assessment of opioid demand in predicting pain outcomes. Assessments of pain-related outcomes (pain intensity, interference, injury-related stress, and need for additional pain treatment) were administered at 2 weeks and 12 months post-discharge in a sample of 34 patients hospitalized for traumatic injury. Bayesian linear models were used to evaluate changes in responses over time as a function of predictors. High-risk ORT, higher MME per day, and greater opioid demand predicted less change in outcomes over time. This report provides first evidence that malleable factors of opioid and opioid demand have utility in predicting pain outcomes following traumatic injury.

A Rapid Procedure to Assess Shifts in Discriminative Control Over Drinking During Recovery-Like Behavior

BACKGROUND

Previously, we reported that recovery-like behavior decreases stimulus control over drinking, and this likely plays a role in the clinical observation that longer recovery increases relapse resistance. Those studies were conducted using a procedure that required repeated assessment, preventing a longitudinal analysis of the changes in stimulus control over time in each individual. Here we recapitulate those results and extend them to female rats using a more efficient procedure that allows repeated assessment of changes in stimulus control over drinking during recovery.

METHODS

Under a multiple concurrent schedule, rats were trained to reliably respond predominately for ethanol (concurrent Ethanol FR5, Food FR150) in the presence of one stimulus and for food (concurrent Ethanol FR5, Food FR5) in the presence of another stimulus. Stimuli were either lights or tones, depending on the group. After that, a drinking phase in which only the stimulus occasioning ethanol responding was presented (10 or 20 sessions) followed by recovery-like sessions in which only the stimulus occasioning food responding was presented. During these sessions, rats were exposed to the ethanol stimulus under extinction during the first component on sessions 0, 1, 2, 4,8, and 16. The number of food responses during these stimulus exposures prior to the first 5 ethanol responses was the primary measure.

RESULTS

Consistent with the earlier procedure, the number of food responses during ethanol tests increased as a function of the number of recovery sessions completed, regardless of whether the stimuli were visual or auditory. However, there were no significant effects of extended alcohol exposure or sex.

CONCLUSIONS

A rapid procedure consistent with the earlier procedure and clinical evidence was developed in which stimulus control over drinking decreased following longer periods of recovery. Under conditions tested, stimulus type, length of drinking history and sex did not affect this relationship.

Alcohol cues increase behavioral economic demand and craving for alcohol in nontreatment-seeking and treatment-seeking heavy drinkers

BACKGROUND

Behavioral economic research has revealed significant increases in alcohol demand following exposure to alcohol-related cues. Prior research has focused exclusively on nontreatment-seeking heavy drinkers, included only male participants, or used heterogeneous methods. The current studies sought to replicate and extend existing findings in treatment-seeking and nontreatment-seeking heavy drinkers while also examining sex effects and moderation by alcohol use disorder (AUD) severity.

METHODS

Study 1 included 117 nontreatment-seeking heavy drinkers (51.5% women; M age 34.69; 56.4% AUD+), and Study 2 included 89 treatment-seeking heavy drinkers with AUD (40.4% women; M age = 41.35). In both studies, alcohol demand was measured using a hypothetical alcohol purchase task (APT), and subjective alcohol craving was measured using visual analog scales. Measures were collected following exposure to neutral (water) cues in a standard room and alcohol cues in a bar lab.

RESULTS

Alcohol demand (intensity, Omax , breakpoint, and elasticity) and craving were significantly increased following alcohol cues compared to neutral cues (ps < 0.005) with effect sizes ranging from small to large (ηp 2  = 0.074-0.480). Participants with AUD (Study 1) or with higher AUD severity (Study 2) reported higher craving and higher demand for most indices (i.e., main effects; ps < 0.032, ηp 2  = 0.043-0.239). A larger alcohol cue increase in Omax was found for AUD+ participants in Study 1 compared to non-AUD participants (p = 0.028, ηp 2  = 0.041) but not for any other indices in Study 1 or Study 2. There were no significant sex effects.

CONCLUSIONS

These findings replicate and extend prior research by offering additional insight into alcohol cue effects on the reinforcing value of alcohol and subjective motivation to drink. The results also suggest that sex and AUD severity do not meaningfully impact cue effects across most indices of demand.

Resting state functional connectivity as a predictor of brief intervention response in adults with alcohol use disorder: A preliminary study

BACKGROUND

Brief interventions for alcohol use disorder (AUD) are generally efficacious, albeit with variability in response. Resting state functional connectivity (rsFC) may characterize neurobiological indicators that predict the response to brief interventions and is the focus of the current investigation.

MATERIALS AND METHODS

Forty-six individuals with AUD (65.2% female) completed a resting state functional magnetic resonance imaging (fMRI) scan immediately followed by a brief intervention aimed at reducing alcohol consumption. Positive clinical response was defined as a reduction in alcohol consumption by at least one World Health Organization (WHO) risk drinking level at 3-month follow-up. rsFC was analyzed using seed-to-voxel analysis with seed regions from four networks: salience network, reward network, frontoparietal network, and default mode network.

RESULTS

At baseline, responders had greater rsFC between the following seed regions in relation to voxel-based clusters than non-responders: (i) anterior cingulate cortex (ACC) in relation to left postcentral gyrus and right supramarginal gyrus (salience network); (ii) right posterior parietal cortex in relation to right ventral ACC (salience network); (iii) right interior frontal gyrus (IFG) pars opercularis in relation to right cerebellum and right occipital fusiform gyrus (frontoparietal); and (iv) right primary motor cortex in relation to left thalamus (default mode). Lower rsFC in responders vs. nonresponders was seen between the (i) right rostral prefrontal cortex in relation to left IFG pars triangularis (frontoparietal); (ii) right IFG pars triangularis in relation to right cerebellum (frontoparietal); (iii) right IFG pars triangularis in relation to right frontal eye fields and right angular gyrus (frontoparietal); and (iv) right nucleus accumbens in relation to right orbital frontal cortex and right insula (reward).

CONCLUSIONS

Resting state functional connectivity in the frontoparietal, salience, and reward networks predicts the response to a brief intervention in individuals with AUD and could reflect greater receptivity or motivation for behavior change.

Use of drug purchase tasks in medications development research: orexin system regulation of cocaine and drug demand

Commodity purchase tasks provide a useful method for evaluating behavioral economic demand in the human laboratory. Recent research has shown how responding to purchase tasks for blinded drug administration can be used to study abuse liability. This analysis uses data from a human laboratory study to highlight how similar procedures may be particularly useful for understanding momentary changes in drug valuation when screening novel interventions. Eight nontreatment-seeking participants with cocaine use disorder (one with partial data) were enrolled in a cross-over, double-blind, randomized inpatient study. Participants were maintained on the Food and Drug Administration-approved insomnia medication suvorexant (oral; 0, 5, 10, 20 mg/day) in randomized order with experimental sessions completed after at least 3 days of maintenance on each suvorexant dose. Experimental sessions included administration of a sample dose of 0, 10 and 30 mg/70 kg intravenous cocaine. Analyses focused on purchase tasks for the blinded sample dose as well as alcohol, cigarettes and chocolate completed 15 min after the sample dose. As expected based on abuse liability, near zero demand was observed for placebo with dose-related increases in cocaine demand. Suvorexant maintenance increased cocaine demand in a dose-related manner with the greatest increase observed for the 10 mg/kg cocaine dose. Increased demand under suvorexant maintenance was also observed for alcohol. No effect of cocaine administration was observed for alcohol, cigarette, or chocolate demand. These data support the validity of demand procedures for measuring blinded drug demand. Findings also parallel self-administration data from this study by showing increases in cocaine use motivation under suvorexant maintenance.

Associations between alcohol demand, delayed reward discounting, and high-intensity drinking in a diverse emerging adult sample

The high-intensity drinking threshold (HID; 8+/10+ drinks for women/men) is more strongly associated with significant alcohol-related health consequences than the more common heavy episodic drinking threshold (HED; 4+/5+ drinks for women/men). Behavioral economic measures of alcohol reward value (demand) and delayed reward discounting (DRD) have shown associations with other alcohol-related risk behaviors and may contribute to efforts to identify individuals who are at risk for HID from the larger subgroup of at-risk drinkers who engage in HED. Logistic regression analyses tested if alcohol demand and DRD were associated with HID in a sample of 477 emerging adults who reported recent heavy drinking. Receiver operating curve (ROC) analyses were conducted to test these variables' ability to classify HID group membership and to select an optimal cutoff score. In logistic regression analyses controlling for typical weekly drinking, demographics, and other variables associated with HID, participants reporting higher demand intensity (amount of alcohol purchased when price is zero; Adjusted Odds Ratio (AOR) = 20.27, 95% CI [5.71, 71.91]) and lower demand elasticity (sensitivity of alcohol consumption to increases in cost; AOR = .29, 95% CI [.11, 72]) were more likely to report HID relative to HED. Omax (maximum alcohol expenditure) and DRD were associated with HID in bivariate, but not in multivariate models. The ROC analysis provided support for an intensity cutoff of 7.5 or higher. These findings suggest that brief alcohol demand curve measures, in particular demand intensity and elasticity, may have utility in identifying individuals who are at risk for HID. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

How is Patient Adherence Possible? A Novel Mechanistic Model of Adherence Based on Humanities

Patient non-adherence is a major contemporary medical issue because of its consequences in terms of frequency, morbidity and mortality, and health care costs. This article aims to propose a mechanistic model of adherence based on the tenet that non-adherence is the default option, as long-term adherence in chronic diseases requires sustained effort. The real question becomes, how is patient adherence possible? By focusing on adherent patients, the paper explains the mental mechanisms of adherence using concepts largely drawn from humanities, philosophy of mind, and behavioral economics and presents the findings of empirical studies supporting these hypotheses. The analysis first demonstrates the relationship between patient adherence and temporality and the influence of character traits. Further, it points out the importance of habit, which allows adherence to become non-intentional, thereby sparing patients' cognitive efforts. Finally, it points out the importance of the quality of the interaction between the person with a chronic disease and the health professional. These features explain why adherence is a syndrome (the healthy adherer phenotype), separating people into those who are safe and those who are at risk of non-adherence, non-control of diabetes, and complications. The concepts presented in this article summarize 20 years of personal clinical and philosophical reflection on patient adherence. They are mainly illustrated by examples from diabetes care but can be applied to all chronic diseases. This novel model of adherence has major practical and ethical implications, explaining the importance of patient education and shared medical decision-making in chronic disease management.

A qualitative examination of positive and negative consequences young adults experience from simultaneous alcohol and cannabis use

OBJECTIVE

Alcohol and cannabis are two of the most commonly used substances among young adults, and most individuals who use both substances use them simultaneously, that is, on the same occasion such that their effects overlap. Given the high prevalence of simultaneous alcohol and cannabis use, it is important to understand the relationship between simultaneous use and consequences. This study presents a qualitative examination of positive and negative consequences of simultaneous use.

METHOD

We conducted individual interviews among 36 young adults who engage in simultaneous use (23 women, 12 men, 1 trans man). Interviews included open-ended questions examining negative and positive consequences of simultaneous use and how simultaneous use differed from single substance use (alcohol only use, cannabis only use). Interviews were analyzed using applied thematic analysis.

RESULTS

Young adults reported numerous negative and positive consequences of simultaneous use, many overlapping with single substance use. Yet, they also reported unique combinations of positive consequences not experienced by single substance use. Young adults discussed patterns of use that were sometimes approached intentionally (e.g., quantity of substances used, order) that influenced consequences.

CONCLUSIONS

Together these findings provide further insight into young adults' simultaneous use experiences. Next steps should include quantitative exploratory research to identify and determine the frequency of specific consequences experienced during simultaneous use and examine the relationship between simultaneous use consequences and particular patterns of use. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Blinded-Dose Purchase Task: assessing hypothetical demand based on cocaine, methamphetamine, and alcohol administration

RATIONALE

Behavioral economic drug purchase tasks quantify the reinforcing value of a drug (i.e., demand). Although widely used to assess demand, drug expectancies are rarely accounted for and may introduce variability across participants given diverse drug experiences.

OBJECTIVES

Three experiments validated and extended previous hypothetical purchase tasks by using blinded drug dose as a reinforcing stimulus, and determined hypothetical demand for experienced effects while controlling for drug expectancies.

METHODS

Across three double-blind, placebo-controlled, within-subject experiments, cocaine (0, 125, 250 mg/70 kg; n=12), methamphetamine (0, 20, 40 mg; n=19), and alcohol (0, 1 g/kg alcohol; n=25) were administered and demand was assessed using the Blinded-Dose Purchase Task. Participants answered questions regarding simulated purchasing of the blinded drug dose across increasing prices. Demand metrics, subjective effects, and self-reported real-world monetary spending on drugs were evaluated.

RESULTS

Data were well modeled by the demand curve function, with significantly higher intensity (purchasing at low prices) for active drug doses compared to placebo for all experiments. Unit-price analyses revealed more persistent consumption across prices (lower α) in the higher compared to lower active dose condition for methamphetamine (a similar non-significant finding emerged for cocaine). Significant associations between demand metrics, peak subjective effects, and real-world spending on drugs also emerged across all experiments.

CONCLUSIONS

Orderly demand curve data revealed differences across drug and placebo conditions, and relations to real-world measures of drug spending, and subjective effects. Unit-price analyses enabled parsimonious comparisons across doses. Results lend credence to the validity of the Blinded-Dose Purchase Task, which allows for control of drug expectancies.

Initial development and validation of a brief assessment of marijuana demand among young adult college students

Hypothetical purchase tasks assess substance demand, but the length of purchase tasks makes repeated assessment of state-dependent changes in demand difficult, often limiting clinical utility. Although brief assessments of alcohol and cigarette demand exist, brief measures of cannabis demand do not. College students (N = 209, Mage = 19.92, SD = 1.45; 63% female; 56.9% non-Hispanic Caucasian) who reported using cannabis at least 3 days in the past month, completed an online survey including the full-length marijuana purchase task (MPT), a three-item brief assessment of marijuana demand (BAMD) assessing intensity, Omax and breakpoint, and cannabis use outcomes. Convergent and divergent validity were examined. Independent samples t tests compared demand on the BAMD and MPT based on presence or absence of cannabis use disorder (CUD) symptoms, and one-way between-subject analyses of variance compared effects of CUD severity (mild/moderate/severe) on BAMD indices. All indices were significantly correlated across both assessment measures (ps < .01). Similarly, all indices on both demand measures were significantly correlated with craving, CUD severity, and cannabis-related consequences (ps < .01); whereas only intensity and Omax were significantly correlated with cannabis use frequency (ps < .01). Individuals with (vs. without) CUD symptoms reported significantly greater intensity and Omax (ps < .01) and significant differences in CUD severity on BAMD indices were found as well (ps < .05). The BAMD demonstrated convergent and divergent validity with the MPT. Findings suggest that brief cannabis demand can be easily assessed as an indicator for high-risk cannabis use. Thus, the BAMD may be a useful and clinically relevant tool to assess cannabis demand in real-world settings. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A contextualized reinforcer pathology approach to addiction

Behavioural economic accounts of addiction conceptualize harmful drug use as an operant reinforcer pathology, emphasizing that a drug is consumed because of overvaluation of smaller immediate rewards relative to larger delayed rewards (delay discounting) and high drug reinforcing value (drug demand). These motivational processes are within-individual determinants of behaviour. A third element of learning theory posits that harmful drug use depends on the relative constraints on access to other available activities and commodities in the choice context (alternative reinforcers), reflecting the substantial influence of environmental factors. In this Perspective, we integrate alternative reinforcers into the contemporary behavioural economic account of harmful drug use - the contextualized reinforcer pathology model - and review empirical literature across the translational spectrum in support of this model. Furthermore, we consider how increases in drug-related mortality and health disparities in addiction can be understood and potentially ameliorated via a contextualized reinforcer pathology model in which lack of alternative reinforcement is a major risk factor for addiction.

Association of therapeutic and recreational reasons for alcohol use with alcohol demand

Motives for alcohol use and behavioral economic measures of demand are associated with alcohol consumption and alcohol-related problems. However, it is unclear how differences in reasons for alcohol use may affect alcohol demand. Additionally, although alcohol is commonly used to self-manage conditions such as pain and sleep problems, the impact of these reasons for alcohol use on alcohol demand is not well characterized. The present study addressed this gap. Participants were adults recruited via Amazon Mechanical Turk as part of a larger study investigating health behaviors. Analyses included participants who reported alcohol use in the past year (N = 637). Participants were categorized as having recreational, therapeutic, or both recreational and therapeutic reasons for using alcohol. A brief, three-item measure of alcohol demand was administered. Multivariate analysis of variance (MANOVA) analyses revealed that alcohol drinkers endorsing both recreational and therapeutic reasons for use had significantly higher average intensity, Omax, and breakpoint indices compared to those who only reported recreational or therapeutic drinking motives (ps < .05; Cohen's d = .09-.17). Secondary analyses revealed differences in demand according to therapeutic reason for alcohol use endorsed. Significant main effects were found for use to relieve pain and anxiety/depression/stress, while interactive effects were detected for use to relieve pain and improve sleep and use to relieve pain and anxiety/depression/stress. Overall, results suggest that alcohol demand is highest in drinkers who consume alcohol for both therapeutic and recreational reasons. This group may be at elevated risk for alcohol use disorder and alcohol-related consequences. Continued research is necessary to examine this possibility. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Translational models of addiction phenotypes to advance addiction pharmacotherapy

Alcohol and substance use disorders are heterogeneous conditions with limited effective treatment options. While there have been prior attempts to classify addiction subtypes, they have not been translated into clinical practice. In an effort to better understand heterogeneity in psychiatric disorders, the National Institute for Mental Health Research Domain Criteria (RDoC) has challenged scientists to think beyond diagnostic symptoms and to consider the underlying features of psychopathology from a neuroscience-based framework. The field of addiction has grappled with this approach by considering several key constructs with the potential to capture RDoC domains. This critical review will focus on the efforts to apply translational models of addiction phenomenology in human clinical samples, including their relative strengths and weaknesses. Opportunities for forward and reverse translation are also discussed. Deep behavioral phenotyping using neuroscience-informed batteries shows promise for a better understanding of the clinical neuroscience of addiction and advancing precision medicine for alcohol and substance use disorders.

Hazardous drinking and alcohol use disorders

Alcohol is one of the most widely consumed psychoactive drugs globally. Hazardous drinking, defined by quantity and frequency of consumption, is associated with acute and chronic morbidity. Alcohol use disorders (AUDs) are psychiatric syndromes characterized by impaired control over drinking and other symptoms. Contemporary aetiological perspectives on AUDs apply a biopsychosocial framework that emphasizes the interplay of genetics, neurobiology, psychology, and an individual's social and societal context. There is strong evidence that AUDs are genetically influenced, but with a complex polygenic architecture. Likewise, there is robust evidence for environmental influences, such as adverse childhood exposures and maladaptive developmental trajectories. Well-established biological and psychological determinants of AUDs include neuroadaptive changes following persistent use, differences in brain structure and function, and motivational determinants including overvaluation of alcohol reinforcement, acute effects of environmental triggers and stress, elevations in multiple facets of impulsivity, and lack of alternative reinforcers. Social factors include bidirectional roles of social networks and sociocultural influences, such as public health control strategies and social determinants of health. An array of evidence-based approaches for reducing alcohol harms are available, including screening, pharmacotherapies, psychological interventions and policy strategies, but are substantially underused. Priorities for the field include translating advances in basic biobehavioural research into novel clinical applications and, in turn, promoting widespread implementation of evidence-based clinical approaches in practice and health-care systems.

The Effects of Citalopram and Thalamic Dopamine D2/3 Receptor Availability on Decision-Making and Loss Aversion in Alcohol Dependence

Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for patients who misuse alcohol, especially in the context of comorbid depressive symptoms. Deficits in impulse control and decision-making are linked to routine alcohol consumption and alcohol dependence. The goal of this study was to determine the effects of a single dose of citalopram on measures of impulsivity, decision-making, and/or brain dopamine receptor availability in alcohol-dependent individuals. A double-blind, placebo-controlled, within-subject, outpatient study was conducted with active alcohol-dependent (DSM-IV-TR criteria) participants (n = 12) and matched healthy controls (n = 13). Serial doses of both citalopram (40 mg) and saline were administered intravenously before laboratory tests of decision-making (Balloon Analogue Risk Task, delay discounting task, and Loss Aversion Gambling Task) and positron emission tomography with [¹⁸F]-fallypride to measure dopamine D_2/3 receptor availability, separated by at least one week. Alcohol-dependent participants demonstrated greater loss aversion than healthy controls, but there were no group differences in risk taking on the Balloon Analogue Risk Task. Citalopram increased delay discounting across groups, with no group difference in the effect. There were no effects of citalopram on risk taking on the Balloon Analogue Risk Task. PET showed a negative correlation between thalamic dopamine D_2/3 receptor availability and loss aversion across groups. The effect of citalopram to decrease the valuation of monetary reward as a function of delay raises the possibility that SSRIs can influence risky decision-making in clinical populations. In addition, these results suggest that altered thalamic dopamine signaling may play an important role in disproportionately valuing losses in patients with Alcohol Use Disorder. This trial is registered under ClinicalTrials.gov registration NCT01657760.

Alcohol demand as a predictor of drinking behavior in the natural environment

BACKGROUND AND AIMS

Alcohol demand, a measure of alcohol's reinforcing value, is associated with greater alcohol consumption and alcohol-related problems. Although alcohol demand has primarily been evaluated as a 'trait-like', individual difference measure, recent evidence indicates that demand exhibits meaningful short-term fluctuations. We aimed to determine whether moment-to-moment fluctuations in alcohol demand in individuals' natural drinking environments predicted drinking occurrence, drinking continuation, and drinking quantity.

DESIGN

Observational study.

SETTING

Individuals' natural drinking environments in Columbia, Missouri, USA.

PARTICIPANTS

Eighty-nine young adults (56% female; mean age = 24.8) participated from November 2018 to October 2020. Participants reported 14.5 drinking days [standard deviation (SD = 8.1)] and 4.1 drinks per occasion (SD = 2.5) during ecological momentary assessment (EMA).

MEASUREMENTS

Participants completed the alcohol purchase task at baseline. Following this, participants reported on their alcohol demand (breakpoint, O_max , intensity) and drinking behavior during EMA at daily, timed prompts from 6 p.m. to 2 a.m. They provided breathalyzer samples using a BACtrack Mobile® Pro. Models tested concurrent and prospective (lagged) associations between alcohol demand and drinking occurrence and drinking continuation after drinking initiation. Additional models tested concurrent associations between demand and breath alcohol concentrations (BrACs).

FINDINGS

Higher alcohol demand was associated with higher odds of drinking and continued drinking for all demand indices at the momentary [odds ratio (OR) = 1.27-1.56, ps ≤ 0.03] and day-level (OR = 2.14-3.39, ps < 0.001). Additionally, lagged demand predicted higher odds of drinking occurrence and continuation at the following prompt (OR = 1.32-1.53, ps ≤ 0.004). Higher alcohol demand was associated with higher BrACs at the momentary (bs = 0.0011-0.0026, ps ≤ 0.03) and day-level (bs = 0.0053-0.0062, ps < 0.001). At the person-level, findings varied depending on the demand measure.

CONCLUSIONS

Alcohol demand appears to be associated with both when and how much individuals drink in their natural drinking environments. Elevations in alcohol demand appear to be associated with increased likelihood of drinking and continuing to drink, and greater total alcohol consumption, both within and across drinking days.

A neuroeconomic signature of opioid craving: How fluctuations in craving bias drug-related and nondrug-related value

How does craving bias decisions to pursue drugs over other valuable, and healthier, alternatives in addiction? To address this question, we measured the in-the-moment economic decisions of people with opioid use disorder as they experienced craving, shortly after receiving their scheduled opioid maintenance medication and ~24 h later. We found that higher cravers had higher drug-related valuation, and that moments of higher craving within-person also led to higher drug-related valuation. When experiencing increased opioid craving, participants were willing to pay more for personalized consumer items and foods more closely related to their drug use, but not for alternative "nondrug-related" but equally desirable options. This selective increase in value with craving was greater when the drug-related options were offered in higher quantities and was separable from the effects of other fluctuating psychological states like negative mood. These findings suggest that craving narrows and focuses economic motivation toward the object of craving by selectively and multiplicatively amplifying perceived value along a "drug relatedness" dimension.

(Non-) impact of task experience on behavioral economic decision-making

Behavioral economic research has been widely conducted via crowdsourcing resources to evaluate novel task designs or pilot interventions. One under recognized and yet-to-be tested concern is the impact of non-naïvety (i.e., prior task exposure) on behavioral economic task performance. We evaluated the influence of non-naïvety on task performance in two popular areas of behavioral economic research: behavioral economic demand and delay discounting. Participants (N = 485) recruited using Amazon Mechanical Turk (mTurk) completed alcohol and soda purchase tasks and delay discounting tasks for monetary and alcohol outcomes. Equivalence of responding and effect sizes with clinical variables were compared based on prior task experience. Over one quarter of participants reported demand task experience (26.9%) and nearly half endorsed delay discounting task experience (48.6%). Statistically equivalent responding was observed for alcohol purchase task data with less-than-small effect size differences based on task experience (d = 0.01-0.13). Similar results were observed for a soda purchase task thereby supporting generalization to a non-alcohol commodity. Measures of convergent and discriminant validity for behavioral economic demand indicated medium-to-large and stimulus-specific effect sizes with little variation based on prior task exposure. Delay discounting for money and alcohol showed some sensitivity to prior task experience (i.e., less steep discounting for non-naïve participants), however these effects were attenuated after accounting for group differences in alcohol use. These findings support the fidelity of behavioral economic task outcomes and emphasize that participant non-naïvety in crowdsourcing settings may minimally impact performance on behavioral economic assays commonly used in behavioral and addiction science. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Beyond Systematic and Unsystematic Responding: Latent Class Mixture Models to Characterize Response Patterns in Discounting Research

Operant behavioral economic methods are increasingly used in basic research on the efficacy of reinforcers as well as in large-scale applied research (e.g., evaluation of empirical public policy). Various methods and strategies have been put forward to assist discounting researchers in conducting large-scale research and detecting irregular response patterns. Although rule-based approaches are based on well-established behavioral patterns, these methods for screening discounting data make assumptions about decision-making patterns that may not hold in all cases and across different types of choices. Without methods well-suited to the observed data, valid data could be omitted or invalid data could be included in study analyses, which subsequently affects study power, the precision of estimates, and the generality of effects. This review and demonstration explore existing approaches for characterizing discounting and presents a novel, data-driven approach based on Latent Class Analysis. This approach (Latent Class Mixed Modeling) characterizes longitudinal patterns of choice into classes, the goal of which is to classify groups of responders that differ characteristically from the overall sample of discounters. In the absence of responders whose behavior is characteristically distinct from the greater sample, modern approaches such as mixed-effects models are robust to less-systematic data series. This approach is discussed, demonstrated with a publicly available dataset, and reviewed as a potential supplement to existing methods for inspecting and screening discounting data.

Alcohol demand and supersized alcopop consumption among undergraduate college students

Supersized alcopops are sugar-sweetened beverages with extraordinarily high alcohol content; consumption is highly prevalent among college students and is associated with a variety of negative alcohol-related consequences. However, few studies have examined risk factors for consumption of these products. The objective of this study was to examine, among a college student sample, whether the behavioral economic principle of alcohol demand was associated with self-reported lifetime consumption of Four Loko-the most popular brand of supersized alcopop among underage drinkers. Participants were 170 undergraduate students who were at least 18 years of age and reported at least 1 day of alcohol consumption within the past month. Study participants completed a self-administered questionnaire assessing demographics, Four Loko consumption and associated problems, and alcohol demand (using the Brief Assessment of Alcohol Demand). Hierarchical logistic regression analyses revealed that intensity (drinks they would consume if free) significantly predicted Four Loko consumption but not breakpoint (maximum expenditure per drink) or Omax (maximum expenditure for all drinks). Findings support that students who prefer consuming large quantities of alcohol when it is free are more likely to have consumed Four Loko. Interventions increasing price or reducing the availability of Four Loko may be especially protective for this at-risk population. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Behavioral economic analysis of topiramate pharmacotherapy for alcohol: a placebo-controlled investigation of effects on alcohol reinforcing value and delayed reward discounting

RATIONALE

Pharmacotherapies are an important clinical strategy for treating alcohol use disorder and an understanding of their functional mechanisms can inform optimal use. Behavioral economics provides a translational platform that may advance our understanding of the motivational impacts of pharmacotherapies.

OBJECTIVES

This secondary analysis study examined the effect of topiramate, a promising pharmacotherapy for treating alcohol use disorder, on two behavioral economic domains, the reinforcing value of alcohol (alcohol demand and alcohol-specific monetary expenditures) and delayed reward discounting (preference for smaller immediate rewards over larger delayed rewards).

METHODS

A double-blind randomized placebo-controlled study (n = 99) was conducted with non-treatment seeking heavy drinkers, comparing topiramate (target dose of 200 mg/day titrated for 3 weeks and remained at the target dose for 2 weeks) to matched placebo.

RESULTS

We found that compared to placebo, topiramate reduced the reinforcing value of alcohol, as shown by a reduction in two alcohol demand indices (intensity and Omax), money spent per week on alcohol and an almost a 50% increase in days without expenditures on alcohol from baseline. Directionally consistent patterns were also present for breakpoint and elasticity (ps = .08). No significant effects were found for delayed reward discounting.

CONCLUSIONS

This study provides evidence that topiramate reduces alcohol's reinforcing value as measured by alcohol demand and alcohol expenditure. More broadly, these findings support the utility of behavioral economics for understanding how medications reduce alcohol use.

A systematic review and meta-analysis of delay discounting and cannabis use

Delay discounting reflects the systematic reduction in the value of a consequence by delay to delivery. Theoretical and empirical work suggests that delay discounting is a key behavioral mechanism underlying substance use disorder. Existing work on cannabis use, however, is mixed with many studies reporting null results. The purpose of this review was to provide an in-depth assessment of the association between delay discounting and cannabis use. We conducted metaregression analyses to determine the omnibus correlation between delay discounting and cannabis use, and to evaluate task-based and sample-based moderators. Studies included evaluated an association between delay discounting and cannabis quantity-frequency or severity measures in human participants (27 studies, 61 effect sizes, 24,782 participants). A robust variance estimation method was used to account for dependence among effect sizes. A significant, but small, omnibus effect was observed (r = .082) in which greater cannabis use frequency or severity was associated with greater discounting. Incentive structure and outcome type were each significant moderators in a multiple moderator model such that incentivized tasks correlated with severity measures showed stronger associations (r = .234) than hypothetical tasks correlated with quantity-frequency measures (r = .029). Comparisons to historic effect size data supported the hypothesis that, at present, the relationship between cannabis use and delay discounting appears empirically smaller than for other substances. Future work should explore theoretical rationales explaining this modest relationship involving cannabis use and delay discounting, such as reflecting the smaller magnitude of perceived long-term clinical outcomes associated with cannabis compared to other substances. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Concurrent validity of the Alcohol Purchase Task for measuring the reinforcing efficacy of alcohol: an updated systematic review and meta-analysis

BACKGROUND AND AIMS

An early meta-analysis testing the concurrent validity of the Alcohol Purchase Task (APT), a measure of alcohol's relative reinforcing value, reported mixed associations, but predated a large number of studies. This systematic review and meta-analysis sought to: (1) estimate the relationships between trait-based alcohol demand indices from the APT and multiple alcohol indicators, (2) test several moderators and (3) analyze small study effects.

METHODS

A meta-analysis of 50 cross-sectional studies in four databases (n = 18 466, females = 43.32%). Sex, year of publication, number of APT prices and index transformations (logarithmic, square root or none) were considered as moderators. Small study effects were examined by using the Begg-Mazumdar, Egger's and Duval & Tweedie's trim-and-fill tests. Alcohol indicators were quantity of alcohol use, number of heavy drinking episodes, alcohol-related problems and hazardous drinking. APT indices were intensity (i.e. consumption at zero cost), elasticity (i.e. sensitivity to increases in costs), O_max (i.e. maximum expenditure), P_max (i.e. price associated to O_max ) and breakpoint (i.e. price at which consumption ceases).

RESULTS

All alcohol demand indices were significantly associated with all alcohol-related outcomes (r = 0.132-0.494), except P_max , which was significantly associated with alcohol-related problems only (r = 0.064)_. The greatest associations were evinced between intensity in relation to alcohol use, hazardous drinking and heavy drinking and between O_max and alcohol use. All the tested moderators emerged as significant moderators. Evidence of small-study effects was limited.

CONCLUSIONS

The Alcohol Purchase Task appears to have concurrent validity in alcohol research. Intensity and O_max are the most relevant indices to account for alcohol involvement.

Decreased cocaine demand following contingency management treatment

A hypothetical cocaine purchasing task (CocPT) was used to assess changes in cocaine demand in the context of contingency management (CM) treatment for cocaine use disorder (CUD). Participants (N = 89) were treatment-seeking individuals with CUD receiving 4 weeks of abstinence-based, high-magnitude CM. Treatment response (vs. non-response) was operationally defined as the submission of 6 consecutive cocaine-negative urine samples across two weeks. The CPT was assessed at baseline, week 2, and week 5. Demand data were well described by the exponentiated demand model, and baseline demand indices (Q0, Pmax, breakpoint, essential value) were significantly associated with self-report measures of cocaine use. The probability of being a zero-responder reporting zero cocaine consumption at all prices significantly increased over the course of treatment, and was greater among treatment responders vs. non-responders. Among non-zero demand data, decreases in Omax, Pmax, breakpoint, and essential value were observed over the course of CM treatment, favoring responders. To our knowledge, this is the first study to assess change in cocaine demand in the context of CM treatment targeting cocaine abstinence. Our results support the utility of cocaine demand as a measure for both identifying individuals with greater treatment need and tracking relapse risk over the course of treatment.

Enhanced Brief Motivational Intervention for College Student Drinkers With ADHD: Goal-Directed Activation as a Mechanism of Change

College students with attention-deficit/hyperactivity disorder (ADHD) are at risk for alcohol-related problems and disorders relative to their typically developing peers. Despite risk, the optimal therapeutic approach for reducing problem alcohol use in students with ADHD, and mechanisms of change underlying treatment effects in this population, are largely unknown. The current study evaluated putative mechanisms of change in a randomized controlled trial of two harm reduction interventions for college student drinkers with ADHD (N = 113; 49% male): brief motivational intervention plus supportive counseling (BMI + SC) versus brief motivational intervention plus behavioral activation (BMI + BA). Results showed that participants in the BMI + BA condition engaged in more goal-directed activation and less avoidant behavior over the course of treatment compared to those in the BMI + SC condition, in turn predicting reductions in alcohol-related negative consequences. Effects were more robust 1 month following intervention, and diminished by 3 months. Sensitivity analyses revealed a significant indirect effect of treatment condition on alcohol-related negative consequence via reductions in avoidance over treatment. Post hoc moderated mediations showed that BMI + BA engaged target mechanisms more robustly for students with more severe ADHD and depressive symptoms compared to BMI + SC. These findings support the application of BMI + BA intervention, particularly in targeting goal-directed activation and avoidance/rumination in at-risk student drinkers with ADHD.

Assessment of demand for methamphetamine and cigarettes among individuals with methamphetamine use disorder

Methamphetamine (MA) is a highly addictive stimulant with recent upward trends in prevalence and associated public health problems. Drug demand, as assessed by hypothetical purchasing tasks, has been useful in addictions research and may help our understanding of the factors influencing MA use. However, no studies have assessed MA demand using current models of demand. The purpose of the current study was to assess demand for MA using a hypothetical drug purchasing task. Given high rates of cigarette smoking among MA users, it was of interest also to assess and compare demand for MA relative to cigarettes. Participants consisted of non-treatment-seeking volunteers with MA use disorder (N = 18), of whom 17 reported daily smoking. Results showed the exponentiated demand model provided a good fit to consumption data. Results from Bayesian generalized linear modeling demonstrated multiple positive relationships (posterior probability ≥75%) between self-reported drug use (days MA used in the past 30 days, cigarettes smoked per day) and indices of demand for each drug (Qo, Omax, Pmax, and break point). Comparing MA to cigarettes, results from Bayesian generalized linear mixed modeling revealed greater abuse liability for MA compared to cigarettes (posterior probability ≥99%) based on α and essential value. Overall, the findings of the current study support the feasibility and validity of the exponentiated demand model for assessing demand for drugs among individuals with MA use disorder. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Initial development of a brief assessment of cocaine demand

Cocaine demand is a behavioral economic measure assessing drug reward value and motivation to use drug. The purpose of the current study was to develop a brief assessment of cocaine demand (BACD). Results from the BACD were compared with self-report measures of cocaine use. Participants consisted of treatment-seeking individuals with cocaine use disorder (N = 22). Results revealed that indices of brief demand were significantly associated with various self-report measures of cocaine use. Overall, these results support the utility of a BACD for assessing cocaine demand.

Behavioral Economic Demand for Alcohol and Cigarettes in Heavy Drinking Smokers: Evidence of Asymmetric Cross-commodity Reinforcing Value

INTRODUCTION

Previous studies have highlighted a strong bidirectional relationship between cigarette and alcohol consumption. To advance our understanding of this relationship the present study uses a behavioral economic approach in a community sample (N = 383) of nontreatment seeking heavy drinking smokers.

AIMS AND METHODS

The aims were to examine same-substance and cross-substance relationships between alcohol and cigarette use, and latent factors of demand. A community sample of nontreatment seeking heavy drinking smokers completed an in-person assessment battery including measures of alcohol and tobacco use as well as the Cigarette Purchase Task and the Alcohol Purchase Task. Latent factors of demand were derived from these hypothetical purchase tasks.

RESULTS

Results revealed a positive correlation between paired alcohol and cigarette demand indices (eg, correlation between alcohol intensity and cigarette intensity) (rs = 0.18-0.46, p ≤ .003). Over and above alcohol factors, cigarette use variables (eg, Fagerström Test for Nicotine Dependence and cigarettes per smoking day) significantly predicted an additional 4.5% (p < .01) of the variance in Persistence values but not Amplitude values for alcohol. Over and above cigarette factors, alcohol use variables predicted cigarette Persistence values (ΔR2 = .013, p = .05), however, did not predict Amplitude values.

CONCLUSIONS

These results advance our understanding of the overlap between cigarette and alcohol by demonstrating that involvement with one substance was associated with demand for the other substance. This asymmetric profile-from smoking to alcohol demand, but not vice versa-suggests that it is not simply tapping into a generally higher reward sensitivity and warrants further investigation.

IMPLICATIONS

To our knowledge, no study to date has examined alcohol and cigarette demand, via hypothetical purchase tasks, in a clinical sample of heavy drinking smokers. This study demonstrates that behavioral economic indices may be sensitive to cross-substance relationships and specifically that such relationships are asymmetrically stronger for smoking variables affecting alcohol demand, not the other way around.

Value, drug addiction and the brain

Over the years, various models have been proposed to explain the psychology and biology of drug addiction, built primarily around the habit and compulsion models. Recent research indicates drug addiction may be goal-directed, motivated by excessive valuation of drugs. Drug consumption may initially occur for the sake of pleasure but may transition to a means of escaping withdrawal, stress and negative emotions. In this hypothetical paper, we propose a value-based neurobiological model for drug addiction. We posit that during dependency, the value-based decision-making system in the brain is not inactive but has instead prioritized drugs as the reward of choice. In support of this model, we consider the role of valuation in choice, its influence on pleasure and punishment, and how valuation is contrasted in impulsive and compulsive behaviours. We then discuss the neurobiology of value, beginning with the dopaminergic system and its relationship with incentive salience before moving to brain-wide networks involved in valuation, control and prospection. These value-based neurobiological components are then integrated into the cycle of addiction as we consider the development of drug dependency from a valuation perspective. We conclude with a discussion of cognitive interventions utilizing value-based decision-making, highlighting not just advances in recalibrating the valuation system to focus on non-drug rewards, but also areas for improvement in refining this approach.

Identifying Patterns of Alcohol Use and Obesity-Related Factors Among Emerging Adults: A Behavioral Economic Analysis

BACKGROUND

Although heavy alcohol consumption and maladaptive eating behaviors have been shown to co-occur among college students, less is known about the co-occurrence of these behaviors in a more diverse community-dwelling, emerging adult sample. The purpose of this study was to: (i) identify classes of emerging adults by their reported alcohol consumption patterns, food addiction symptoms, and body mass index; and (ii) determine whether these classes differed on indices of behavioral economic reinforcer pathology (e.g., environmental reward deprivation, impulsivity, alcohol demand).

METHOD

Emerging adult participants were recruited as part of a study on risky alcohol use (n = 602; 47% white, 41.5% Black; mean age = 22.63, SD = 1.03). Participants completed questionnaires on alcohol and food-related risk factors and underwent anthropometric assessment.

RESULTS

Latent profile analysis suggested a four-profile solution: a moderate alcohol severity, overweight profile (Profile 1; n = 424, 70.4%), a moderate alcohol severity, moderate food addiction + obese profile (Profile 2; n = 93, 15.4%), a high alcohol severity, high food addiction + obese profile (Profile 3; n = 44, 7.3%), and a high alcohol severity, overweight profile (Profile 4; n = 41, 6.8%). Individuals in Profile 1 reported significantly lower levels of environmental reward deprivation than either Profile 2 or 3, and participants in Profile 3 reported significantly higher environmental reward deprivation than those in Profile 4 (p < 0.001). Profile 4 demonstrated significantly higher alcohol demand intensity and Omax and lower demand elasticity than Profile 1, Profile 2, or Profile 3. Profile 4 also demonstrated significantly greater proportionate substance-related reinforcement than Profile 1 (p < 0.001) and Profile 2 (p = 0.004).

CONCLUSION

Maladaptive eating patterns and alcohol consumption may share common risk factors for reinforcer pathology including environmental reward deprivation, impulsivity, and elevated alcohol demand.

Statistically derived patterns of behavioral economic risk among heavy-drinking college students: A latent profile analysis

High levels of 3 behavioral economic indices (delay discounting, alcohol demand, and proportionate substance-related reinforcement) are consistently associated with greater alcohol misuse and alcohol-related problems. However, it is unclear whether and how these variables jointly increase the risk for alcohol-related outcomes among college students who engage in heavy episodic drinking (HED; 4/5+ drinks for women/men, respectively). The current study used a person-centered approach to identify similar patterns of behavioral economic domains among heavy-drinking college students and investigate the relationship between these empirically derived classes and alcohol-related outcomes. A sample of 393 college students (60.8% female, 78.9% White/Caucasian) reporting at least 2 heavy drinking episodes in the previous month completed measures of alcohol use and problems, demographics, delay discounting, and alcohol reward value (alcohol demand and proportionate substance-related reinforcement). Latent profile analyses revealed that a 3-class solution provided the best fit to the data: a low reward value, high discounting (LRHD) class (n = 53), a moderate reward value, low discounting (MRLD) class (n = 214), and a high reward value, high discounting (HRHD) class (n = 126). Members of the HRHD class reported significantly greater alcohol consumption, past-month HED episodes, alcohol-related problems, and symptoms of alcohol use disorder than those in the MRLD and LRHD classes. The results suggest that there are 3 constellations of behavioral economic processes and that, consistent with the reinforcer pathology model, students who overvalue alcohol-related reward and discount the future more steeply are at the greatest risk for alcohol misuse and alcohol-related problems. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Behavioral economic demand in opioid treatment: Predictive validity of hypothetical purchase tasks for heroin, cocaine, and benzodiazepines

BACKGROUND

Behavioral economics provides a framework in which to understand choice and motivation in the field of substance use disorders. Hypothetical purchase tasks (HPT), which indicate the amount or probability of purchasing substances at different prices, have been suggested as a clinical tool that can help predict future substance use and identify targets for intervention.

METHODS

Hypothetical demand for heroin, cocaine, and benzodiazepines was assessed at baseline and after six-months in 52 opioid-agonist treatment patients. The results were analyzed using a novel exponential demand equation (normalized zero-bounded exponential model [ZBEn]) that uses a log-like transform that accommodates zero consumption values.

RESULTS

Demand for these drugs was well described by the ZBEn model. After six months, demand intensity for heroin was decreased and demand metrics for cocaine and benzodiazepines increased. Multiple demand curve indices at baseline predicted the percentage of drug-positive urinalysis results at follow-up, even after controlling for covariates. Additionally, participants were divided into High and Low baseline demand groups for each drug based on demand indices. Participants with High demand at baseline for 8 out of 9 groups had significantly more drug-positive urine samples in the subsequent 6-month period.

CONCLUSIONS

This report provides evidence that demand assessment is predictive of future substance use and could help guide treatment planning at intake. These results also demonstrated that the ZBEn model provides good fits to consumption data and allows for sensitive statistical analyses.

Associations between the Brief Assessment of Alcohol Demand (BAAD) questionnaire and alcohol use disorder severity in UK samples of student and community drinkers

Value based choice and compulsion theories of addiction offer distinct explanations for the persistence of alcohol use despite harms. Choice theory argues that problematic drinkers ascribe such high value to alcohol that costs are outweighed, whereas compulsion theory argues that problematic drinkers discount costs in decision making. The current study evaluated these predictions by testing whether alcohol use disorder (AUD) symptom severity (indexed by the AUDIT) was more strongly associated with the intensity item (maximum alcohol consumption if free, indexing alcohol value) compared to the breakpoint item (maximum expenditure on a single drink, indexing sensitivity to monetary costs) of the Brief Assessment of Alcohol Demand (BAAD) questionnaire, in student (n = 579) and community (n = 120) drinkers. The community sample showed greater AUD than the student sample (p = .004). In both samples, AUD severity correlated with intensity (students, r = 0.63; community, r = 0.47), but not with breakpoint (students, r = -0.01; community, r = 0.12). Similarly, multiple regression analyses indicated that AUD severity was independently associated with intensity (student, ΔR² < 0.20, p < .001; community, ΔR² = 0.09, p = .001) but not breakpoint (student, ΔR² = 0.003, p = .118; community ΔR² = 0.01, p = .294). There was no difference between samples in the strength of these associations. The value ascribed to alcohol may play a more important role in AUD severity than discounting of alcohol-associated costs (compulsivity), and there is no apparent difference between student and community drinkers in the contribution of these two mechanisms.

Refining the marijuana purchase task: Using qualitative methods to inform measure development

Behavioral economic demand for cannabis (i.e., relative reinforcing value) can be measured via marijuana purchase tasks (MPTs). However, commodity ambiguities pose challenges and design concerns exist regarding current MPTs. The aim of this 2-phase study was to modify and improve a MPT using qualitative methods. Phase I: Focus groups were conducted with regular (i.e., average use ≥ once/week) cannabis users (n = 31; 6-7 per group M[SD] age = 26 [7]; 28% female). Focus groups followed a semistructured agenda, and executive summaries were made concerning key MPT themes. Feedback was used to refine the MPT. Phase II: Cognitive interviews using the refined MPT were conducted with regular cannabis users (n = 20; M[SD] age = 28 [8]; 50% female). Phase I: Focus group analyses highlighted 4 critical areas for MPT improvement: (a) unit of purchase, (b) cannabis quality, (c) time duration specified for use episode, and (d) price. Participants suggested using grams as the unit of purchase, tailoring cannabis quality to the individual, and clarifying intended episode length. Phase II: Cognitive interviewing indicated additional areas for task refinement, resulting in a second iteration of the MPT based on the 2 phases. Qualitative research in both phases suggested a number of substantive modifications to the MPT format. MPT modifications are expected to improve comprehension, ecological validity, and general construct validity. Findings highlight the importance of careful instructional set development for drug purchase tasks for heterogeneous products that do not have standard units of consumption. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Evaluation of the effectiveness of behavioural economic incentive programmes for the promotion of a healthy diet and physical activity: a protocol for a systematic review and network meta-analysis

INTRODUCTION

Obesity and being overweight are major risk factors for metabolic syndrome and non-communicable diseases. Despite the recommendation that a healthy diet and physical activity can reduce the severity of these diseases, many fail to adhere to these measures. From a behavioural economic perspective, adherence to such measures can be encouraged through financial incentives. However, additional related behavioural economic approaches may improve the effectiveness of an incentive programme. As such, we have developed a protocol for a systematic review and network meta-analysis to summarise the current evidence from financial incentive programmes with and without behavioural economic insights for promoting healthy diet and physical activity.

METHODS AND ANALYSIS

Previous systematic reviews, meta-analyses and individual studies were identified from Medline and Scopus in June 2020 and will be updated until December 2020. Individual studies will be selected and data extracted by two reviewers. Disagreement will be resolved by consensus or adjudicated by a third reviewer. A descriptive analysis will summarise the effectiveness of behavioural economic incentive programmes for promoting healthy diet and physical activity. Moreover, individual studies will be pooled using network meta-analyses where possible. I² statistics and Cochran's Q test will be used to assess heterogeneity. Risk of bias and publication bias, if appropriate, will be evaluated, as well as the overall strength of the evidence.

ETHICS AND DISSEMINATION

Ethics approval for a systematic review and meta-analysis is not required. The findings will be published in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42020198024.

Depression, Environmental Reward, Coping Motives and Alcohol Consumption During the COVID-19 Pandemic

Background: Increases in the incidence of psychological distress and alcohol use during the COVID-19 pandemic have been predicted. Behavioral theories of depression and alcohol self-medication theories suggest that greater social/environmental constraints and increased psychological distress during COVID-19 could result in increases in depression and drinking to cope with negative affect. The current study had two goals: (1) to examine self-reported changes in alcohol use and related outcomes after the introduction of COVID-19 social distancing requirements, and; (2) to test hypothesized mediation models to explain individual differences in self-reported changes in depression and alcohol use during the early weeks of the COVID-19 pandemic. Methods: Participants (n = 833) were U.S. residents recruited for participation in a single online survey. The cross-sectional survey included questions assessing environmental reward, depression, COVID-19-related distress, drinking motives, and alcohol use outcomes. Outcomes were assessed via retrospective self-report for two timeframes in the single survey: the 30 days prior to state-mandated social distancing ("pre-social-distancing"), and the 30 days after the start of state-mandated social distancing ("post-social-distancing"). Results: Depression severity, coping motives, and some indices of alcohol consumption (e.g., frequency of binge drinking, and frequency of solitary drinking) were significantly greater post-social-distancing relative to pre-social-distancing. Conversely, environmental reward and other drinking motives (social, enhancement, and conformity) were significantly lower post-social distancing compared to pre-social-distancing. Behavioral economic indices (alcohol demand) were variable with regard to change. Mediation analyses suggested a significant indirect effect of reduced environmental reward with drinking quantity/frequency via increased depressive symptoms and coping motives, and a significant indirect effect of COVID-related distress with alcohol quantity/frequency via coping motives for drinking. Discussion: Results provide early cross-sectional evidence regarding the relation of environmental reward, depression, and COVID-19-related psychological distress with alcohol consumption and coping motives during the early weeks of the COVID-19 pandemic. Results are largely consistent with predictions from behavioral theories of depression and alcohol self-medication frameworks. Future research is needed to study prospective associations among these outcomes.

Intravenous Alcohol Administration Selectively Decreases Rate of Change in Elasticity of Demand in Individuals With Alcohol Use Disorder

BACKGROUND

Alcohol demand is a key behavioral economic concept that provides an index of alcohol's relative reinforcing value. Initial studies have reported that alcohol demand increases during alcohol administration and in response to alcohol cues. However, the extent to which these effects are observed explicitly in samples composed of individuals with alcohol use disorder (AUD) and are operative in conjunction with each other has not been studied.

METHODS

To address this gap in the literature, we assessed alcohol demand during an alcohol challenge and subsequent alcohol cue-exposure paradigm in non-treatment-seeking, alcohol-dependent (i.e., DSM-IV criteria) participants (N = 27). Specifically, participants completed 2 counterbalanced intravenous, placebo-controlled, alcohol administration sessions followed by a controlled cue-exposure paradigm. At baseline and at breath alcohol concentration of 0.06 g/dl, participants completed the alcohol purchase task, assessing estimated alcohol consumption at escalating prices. Participants were also assessed for alcohol demand following each cue exposure.

RESULTS

During alcohol administration, there was a significant decrease in the rate of change in elasticity compared with placebo, and during the cue-reactivity paradigm, there was a significant main effect such that alcohol cues decreased the rate of change in elasticity relative to water cues. There were no statistically significant differences in other demand indices.

CONCLUSIONS

These findings provide further evidence that alcohol administration increases price insensitivity and extends the literature on alcohol's effects on demand by using a clinical sample with AUD and by adding a placebo-alcohol condition.

Sex Differences in the Neurobiology of Alcohol Use Disorder

Sex differences may play a critical role in modulating how chronic or heavy alcohol use impacts the brain to cause the development of alcohol use disorder (AUD). AUD is a multifaceted and complex disorder driven by changes in key neurobiological structures that regulate executive function, memory, and stress. A three-stage framework of addiction (binge/intoxication; withdrawal/negative affect; preoccupation/anticipation) has been useful for conceptualizing the complexities of AUD and other addictions. Initially, alcohol drinking causes short-term effects that involve signaling mediated by several neurotransmitter systems such as dopamine, corticotropin releasing factor, and glutamate. With continued intoxication, alcohol leads to dysfunctional behaviors that are thought to be due in part to alterations of these and other neurotransmitter systems, along with alterations in neural pathways connecting prefrontal and limbic structures. Using the three-stage framework, this review highlights examples of research examining sex differences in drinking and differential modulation of neural systems contributing to the development of AUD. New insights addressing the role of sex differences in AUD are advancing the field forward by uncovering the complex interactions that mediate vulnerability.

Latent Profile Analysis of Heavy Episodic Drinking in Emerging Adults: A Reinforcer Pathology Approach

BACKGROUND

Heavy episodic drinking (HED) is a major public health problem among emerging adults (individuals 18 to 25), but with considerable heterogeneity in concurrent substance use and psychopathology. The current study used latent profile analysis (LPA) to detect discrete subgroups of HED based on alcohol, other drug severity, and concurrent psychopathology. A reinforcer pathology approach was used to understand motivational differences among the latent subgroups.

METHODS

Participants were 2 samples of emerging adults reporting regular HED, 1 Canadian (n = 730) and 1 American (n = 602). Indicators for the LPA were validated dimensional self-report assessments of alcohol severity, cannabis severity, other drug severity, nicotine dependence, depression, anxiety, posttraumatic stress disorder, and attention-deficit/hyperactivity disorder. Reinforcer pathology indicators were measures of alcohol demand, proportionate substance-related reinforcement, and discounting of future rewards.

RESULTS

The LPA yielded parallel 3-class solutions in both samples. The largest subgroup was characterized by comparatively low substance severity and psychopathology (Low overall severity). The second largest subgroup was characterized by comparatively high alcohol and other drug severity (excluding tobacco) and high levels of psychopathology (Heavy alcohol & high psychiatric severity). The third subgroup exhibited high alcohol, smoking and intermediate levels of other substance use and psychopathology (Heavy alcohol, smoking, & intermediate psychiatric severity). The Heavy alcohol & high psychiatric severity and Heavy alcohol, smoking, & intermediate psychiatric severity subgroups exhibited significantly higher alcohol demand, greater proportionate substance-related reinforcement, and steeper delay discounting.

CONCLUSIONS

Parallel latent subgroups of emerging adults engaging in HED were present in both samples, and the high-risk subgroups were significantly differentiated by the reinforcer pathology indicators. These latent profiles may ultimately inform heterogeneity in the longitudinal course of HED in emerging adults.

Behavioral economic demand as a unifying language for addiction science: Promoting collaboration and integration of animal and human models

The intersection of pharmacological, psychological, and economic theory within behavioral economics has helped advance an understanding of substance use disorder. A notable contribution of this approach is the conceptualization of reinforcement from a behavioral economic demand perspective. Demand analyses provide a multidimensional view of reinforcement in which distinct behavioral mechanisms are measured that impact decision making and drug consumption. This review describes the state of research on behavioral economic demand as a common language for addiction science researchers across varied model systems and stages of a translational continuum. We first provide an overview of the theoretical concepts and procedures used to evaluate demand in animal and human models. The potential for demand to serve as a common language for diverse research groups in psychopharmacology and addiction science (e.g., those evaluating neurobehavioral outcomes, medications development, clinical practice) is then described. An overview is also provided of existing empirical studies that, while small in number, suggest good linguistic and conceptual overlap between animal and human demand models when studying biological, environmental, and pharmacological individual difference vulnerabilities underlying drug-taking behavior. Refinement of methodological procedures and incorporation of more nuanced environmental features should help improve correspondence between animal and human demand studies as well as clinical translation of such findings. Our hope is that this review and commentary ultimately serves as inspiration for new collaborative efforts involving behavioral economic demand between animal and human researchers who share a common goal of improving substance use treatment outcomes and broader psychological wellbeing. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

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

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.

Integrating Behavioral Economic and Social Network Influences in Understanding Alcohol Misuse in a Diverse Sample of Emerging Adults

BACKGROUND

Behavioral economic alcohol demand is a measure of motivation to consume alcohol and a robust risk factor for alcohol misuse. Social networks that are dense with alcohol are also associated with heavy drinking, but the intersection of these risk factors has not been investigated to date. This study examined these interrelationships with structural equation modeling using cross-sectional data from a diverse community sample of heavy-drinking emerging adults (N = 602).

METHODS

Latent variables for alcohol social network, alcohol demand, and alcohol misuse were constructed. Next, relations between the latent variables were examined, including the indirect effect of alcohol demand in the relation between alcohol social network and alcohol misuse. An alternative modeling testing the indirect effect of alcohol social network on the relation between alcohol demand and misuse was also tested.

RESULTS

When alone in the model, social network alcohol density significantly predicted alcohol misuse. When alcohol demand was included in the model, social network alcohol density predicted alcohol demand, alcohol demand predicted alcohol misuse, and an indirect effect on alcohol misuse through alcohol demand was present. In the alternative model, an indirect effect was not present between alcohol demand and alcohol misuse by social network alcohol density. Exploratory analyses revealed significant sex, race, and college status differences.

CONCLUSIONS

These results suggest that the influence of social network alcohol density on alcohol misuse may be, in part, through variance accounted for by alcohol reinforcing value. Longitudinal testing of this mechanistic pathway is warranted.

Addiction is driven by excessive goal-directed drug choice under negative affect: translational critique of habit and compulsion theory

Drug addiction may be a goal-directed choice driven by excessive drug value in negative affective states, a habit driven by strong stimulus-response associations, or a compulsion driven by insensitivity to costs imposed on drug seeking. Laboratory animal and human evidence for these three theories is evaluated. Excessive goal theory is supported by dependence severity being associated with greater drug choice/economic demand. Drug choice is demonstrably goal-directed (driven by the expected value of the drug) and can be augmented by stress/negative mood induction and withdrawal-effects amplified in those with psychiatric symptoms and drug use coping motives. Furthermore, psychiatric symptoms confer risk of dependence, and coping motives mediate this risk. Habit theory of addiction has weaker support. Habitual behaviour seen in drug-exposed animals often does not occur in complex decision scenarios, or where responding is rewarded, so habit is unlikely to explain most human addictive behaviour where these conditions apply. Furthermore, most human studies have not found greater propensity to habitual behaviour in drug users or as a function of dependence severity, and the minority that have can be explained by task disengagement producing impaired explicit contingency knowledge. Compulsion theory of addiction also has weak support. The persistence of punished drug seeking in animals is better explained by greater drug value (evinced by the association with economic demand) than by insensitivity to costs. Furthermore, human studies have provided weak evidence that propensity to discount cost imposed on drug seeking is associated with dependence severity. These data suggest that human addiction is primarily driven by excessive goal-directed drug choice under negative affect, and less by habit or compulsion. Addiction is pathological because negative states powerfully increase expected drug value acutely outweighing abstinence goals.