Reinforcer Pathologies Model Research Articles

Behavioral economic analysis of the comorbidity of alcohol problems and posttraumatic stress: Findings from high-risk young adults and general community adults.

A behavioral economic reinforcer pathology model theorizes that alcohol problems are influenced by steep delay discounting, overvaluation of alcohol reinforcement, and low reinforcement from alcohol-free activities. Extending this account to the comorbidity of alcohol problems and posttraumatic stress disorder (PTSD), the present study tested the hypothesis that alcohol problems and PTSD symptom severity would interact and be positively associated with indicators from these three domains. High-risk emerging adults from North America (Study 1, n = 1,311, Mage = 22.13) and general community adults from Canada (Study 2, n = 1,506, Mage = 36.80) completed measures of alcohol problems, PTSD symptoms, delay discounting, alcohol demand, and proportionate alcohol-related reinforcement. Across studies, regression analyses revealed significant main effects of alcohol problems and PTSD symptoms in relation to selected reinforcer pathology indicators, but no significant interactions were present for delay discounting or proportionate alcohol-related reinforcement. Interactions were observed for alcohol consumption at $0 (intensity) and the rate of change in consumption across the demand curve (elasticity; Study 1) and for elasticity and maximum alcohol expenditure (Omax; Study 2), but not in the predicted directions. Higher synergistic severity was associated with lower alcohol reinforcing value in each case. These findings reveal expected relations between reinforcer pathology indicators and both alcohol problems and PTSD symptomatology in general but did not support the hypothesized synergistic relationship. The relation between alcohol problems and PTSD is more complex than predicted by existing extensions of the reinforcer pathology model, warranting further investigation. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Food Cue Reactivity Meets the Reinforcer Pathology Model: Behavioral Economic Measures of Cue-Induced Changes in Food Reinforcer Efficacy

Food cue reactivity, or behavioral sensitivity to conditioned food cues, is an eating pattern observed in those with obesity and binge-eating disorder. The reinforcer pathology model, which characterizes overconsumption of a reinforcer such as food may be relevant to food cue reactivity, especially in those with obesity and binge-eating disorder. The reinforcer pathology model posits that steep delay discounting (DD) and demand elasticity are processes involved in the overconsumption of food. Two of our recent studies examine the extent to which reactivity to conditioned food cues may be involved in food reinforcer pathologies. First, food cues were conditioned with Oreo cookies with binge-eating prone (BEP) and binge-eating resistant (BER) rats. Delay discounting was compared before and after conditioning. Food cues induced steeper DD for rats, though BEP rats showed some evidence for greater sensitivity to this effect than BER rats, albeit this difference was not significant. Second, healthy-weight humans and humans with overweight/obese BMI underwent conditioning of visual cues paired with M&M candies. After acquisition, cues induced greater demand intensity and inelasticity for food compared to baseline. Participants with overweight/obese BMI, compared to controls, also showed some evidence for greater sensitivity to this change ininelasticity compared to healthy-weight participants, but this difference was also not significant. Food cues, then, may induce changes in DD and economic demand, supporting the relevance of reinforcer pathologies.

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 drugreinforcing 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-andreview 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.

Reinforcer pathology, probabilistic choice, and medication adherence in patients with multiple sclerosis.

The reinforcer pathology model posits that core behavioral economic mechanisms, including delay discounting and behavioral economic demand, underlie adverse health decisions and related clinical disorders. Extensions beyond substance use disorder and obesity, however, are limited. Using a reinforcer pathology framework, this study evaluates medical adherence decisions in patients with multiple sclerosis. Participants completed behavioral economic measures, including delay discounting, probability discounting, and a medication purchase task. A medical decision-making task was also used to evaluate how sensitivity to mild side effect risk and efficacy contributed to the likelihood of taking a hypothetical disease-modifying therapy. Less steep delay discounting and more intense (greater) medication demand were independently associated with greater adherence to the medication decision-making procedure. More generally, the pattern of interrelations between the medication-specific and general behavioral economic metrics was consistent with and contributes to the reinforcer pathology model. Additional research is warranted to expand these models to different populations and health behaviors, including those of a positive health orientation (i.e., medication adherence).

Reinforcer pathology of internet-related behaviors among college students: Data from six countries.

Research has demonstrated that repeated engagement in low-effort behaviors that are associated with immediate reward, such as Internet use, can result in a pathological reinforcement process in which the behavior is increasingly selected over other activities due, in part, to a low availability of alternative activities and to a strong preference for immediate rather than delayed rewards (delay discounting). However, this reinforcer pathology model has not been generalized to other Internet-related behaviors, such as online gaming or smartphone use. Given the widespread availability of these technologies, it is also important to examine whether reinforcer pathology of Internet-related behaviors is culturally universal or culture-specific. The current study examines relations between behavioral economic constructs (Internet demand, delay discounting, and alternative reinforcement) and Internet-related addictive behaviors (harmful Internet use, smartphone use, online gaming, and Internet sexual behavior) in a cross-sectional sample of college students (N = 1,406) from six different countries (Argentina, Australia, India, Malaysia, the United Kingdom, and the United States). Using structural equation modeling, Internet demand was associated with harmful Internet use, smartphone use, and online gaming; delay discounting was associated with harmful smartphone use; and alternative reinforcement was associated with harmful Internet and smartphone use. The models were partially invariant across countries. However, mean levels of behavioral economic variables differed across countries, country-level gross domestic product, person-level income, and sex at birth. Results support behavioral economic theory and highlight the importance of considering both individual and country-level sociocultural contextual factors in models for understanding harmful engagement with Internet-related behaviors. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Reinforcer pathology predicts relapse in smokers.

The purpose of this secondary analysis is to analyze whether both of the processes of the reinforcer pathology model (delay discounting and demand) are predictors of relapse up to 12-month follow-up in a sample of abstinent smokers who received a smoking cessation treatment. Participants were 202 abstinent smokers who completed the delay discounting task and the cigarette purchase task. In order to analyze the smoking relapse predictors and the impact of time to relapse, Kaplan-Meier curves, log-rank test, and Cox regression analysis were carried out. Fewer years of regular smoking (HR = .79, p = .014), as well as higher delay discounting (HR AUClogd = .80, p = .019) and intensity of demand (HR = 1.26, p = .019) were associated with a higher likelihood of smoking relapse. These variables were associated with a faster relapse. High delay discounting and intensity of demand were associated with a higher risk of relapse after quitting smoking. These findings highlight the importance of adapting treatment strategies for these two variables (delay discounting and cigarette demand), which might confer protective risk against smoking relapse. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

"Dual use of alcohol and cannabis among college students: A reinforcer pathologies approach." Correction to Reed et al. (2021).

Reports an error in "Dual use of alcohol and cannabis among college students: A reinforcer pathologies approach" by Gideon P. Naudé, Derek D. Reed, Tyler J. Thornton and Michael Amlung (Experimental and Clinical Psychopharmacology, 2021[Aug], Vol 29[4], 407-417). In the original article, in the Method section under Principal Components Analyses, it reads "We used a loading of ≥ 4.0 ... " when it should read "≥ 0.40." The correct loading criterion is listed in the Table 3 note. Analyses were run using the correct criterion. In Table 3, the loading for BP1 under the alcohol amplitude factor is "-0.4" when it should be "-0.04." The online version of this article has been corrected. (The following abstract of the original article appeared in record 2020-25392-001). The reinforcer pathologies model proposes 2 behavioral economic constructs interact in addiction: operant demand and delay discounting. These constructs manifest as behavioral markers of addiction in the form of excessive reinforcer value and strong preference for immediate access and consumption of this reinforcer despite suboptimal long-term outcomes. The first aim of this investigation was to identify the degree to which delay discounting (of money and alcohol) and demand for alcohol differ between college student drinkers (N = 185) who do and do not co-use cannabis. As a second aim, we sought to replicate the 2-factor solution for alcohol and cannabis demand within a college sample. Results suggest dual users have significantly stronger Persistence and Amplitude for alcohol, demonstrate steeper delay discounting of alcoholic drinks, and are at greater risk for alcohol use disorder than individuals who drink yet do not use cannabis. These results provide further support for the reinforcer pathologies model and contribute to the literature on dual-substance use in the college population. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

INCREASED VALUE OF SUBSTANCES OR DECREASING ALTERNATIVES? BEHAVIORAL ECONOMICS IN THE TIME OF COVID-19

COVID-19 offers a chance to test the Reinforcer Pathology (RP) model through the effects of social constraints on the motivation to use drugs. Aims. This study aimed to empirically assess the RP model in the context of a cross-sectional online survey in Spain. Method. During the strictest period of confinement (14th March-12th April 2020), 203 participants provided measures on past 30-day use of legal and illegal substances and responded to hypothetical alcohol and cigarette purchase tasks. Univariate and bivariate analyses were conducted to inform on pre- and intra-pandemic substance use patterns. Breakpoint (i.e., price at which consumption ceases), elasticity (i.e., sensitivity of demand to rises in costs) and intensity (i.e., unrestricted consumption) were used as indicators of substance use demand. Results. Past 30-day alcohol use decreased from 71.4% (145/203) to 50.7% (103/203), tobacco from 14.3% (30/203) to 12.8% (26/203), and cannabis from 8.9% (18/203) to 4.4% (9/203). Predictably, illegal substance use went from 1% (2/203) to 0%. Conclusions. Despite reductions in substance use, alcohol and tobacco reinforcement, as measured by intensity and breakpoint, slightly increased within the first month of confinement. Potentially beneficial nudges and intervention strategies are discussed from the preventive and treatment standpoint.

Dual use of alcohol and cannabis among college students: A reinforcer pathologies approach.

The reinforcer pathologies model proposes 2 behavioral economic constructs interact in addiction: operant demand and delay discounting. These constructs manifest as behavioral markers of addiction in the form of excessive reinforcer value and strong preference for immediate access and consumption of this reinforcer despite suboptimal long-term outcomes. The first aim of this investigation was to identify the degree to which delay discounting (of money and alcohol) and demand for alcohol differ between college student drinkers (N = 185) who do and do not co-use cannabis. As a second aim, we sought to replicate the 2-factor solution for alcohol and cannabis demand within a college sample. Results suggest dual users have significantly stronger Persistence and Amplitude for alcohol, demonstrate steeper delay discounting of alcoholic drinks, and are at greater risk for alcohol use disorder than individuals who drink yet do not use cannabis. These results provide further support for the reinforcer pathologies model and contribute to the literature on dual-substance use in the college population. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

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).

Reinforcer pathology II: Reward magnitude, reward delay, and demand for alcohol collectively relate to college students' alcohol related problems.

The reinforcer pathologies model of addiction posits that two characteristic patterns of operant behavior characterize addiction. Specifically, individuals suffering from addiction have elevated levels of behavioral economic demand for their substances of abuse and have an elevated tendency to devalue delayed rewards (reflected in high delay discounting rates). Prior research has demonstrated that these behavioral economic markers are significant predictors of many of college students' alcohol-related problems. Delay discounting, however, is a complex behavioral performance likely undergirded by multiple behavioral processes. Emerging analytical approaches have isolated the role of participants' sensitivity to changes in reinforcer magnitude and changes in reinforcer delay. The current study uses these analytic approaches to compare participants' discounting of money versus alcohol, and to build regression models that leverage these new insights to predict a wider range of college students' alcohol related problems. Using these techniques, we were able to 1) demonstrate that individuals differed in their sensitivity to magnitudes of alcohol versus money, but not sensitivity to delays to those commodities and 2) that we could use our behavioral economic measures to predict a range of students' alcohol related problems.

A reinforcer pathology model of health behaviors in individuals with obesity.

Objective: Research concerning trans-disease processes aims to ascertain an underlying mechanism of several seemingly dissonant behaviors, pathological conditions, or both. The theory of reinforcer pathology posits that excessive delay discounting and the maladaptive overvaluation of a particular commodity underlie a variety of dysfunctional health behavior ranging from substance abuse to overeating and financial responsibility. The present study extends recent health behavior research by examining the extent delay discounting and food valuation correlate with engagement in a latent factor model of health and financial behaviors among healthy-weight participants and participants with obesity using the Health Behaviors Questionnaire. Method: A total of 700 participants (n = 340, body mass index [BMI] < 30; n = 360, BMI > 30 kg/m2) were recruited using Amazon Mechanical Turk. Participants completed a monetary delay discounting assessment, the Health Behaviors Questionnaire, and 2 measures of food valuation: Behavioral economic demand and the Power of Food Scale (PFS). Results: Utilizing structural equation modeling, both delay discounting and food valuation significantly correlated with engagement in health and financial behavior for both groups. The comparison of latent factors between groups indicated that participants with obesity were less likely to engage in multiple health behaviors and that these differences can be partially attributed to differences in delay discounting and food valuation. Conclusion: These results replicate previous research and further support the role of delay discounting as a trans-disease process. Given these results, trans-disease interventions, such as episodic future thinking, designed to specifically target reinforcer pathology may have a profound effect on overall functioning. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Supplemental Material for A Reinforcer Pathology Model of Health Behaviors in Individuals With Obesity

Supplemental Material for A Reinforcer Pathology Model of Health Behaviors in Individuals With Obesity

Behavioral economic demand and delay discounting are differentially associated with cigarette dependence and use in adolescents

IntroductionThe Reinforcer Pathology Model describes how two behavioral economic processes, increased sensitivity to immediate rewards (delay discounting) and excessive reward derived from a substance (demand), both contribute to problematic patterns of substance use. In a novel application of this model, the current cross-sectional study examined how these distinct processes relate to different facets of cigarette use in adolescents. MethodsAdolescent daily cigarette smokers ages 15 to 19 (Mean age 17.7, N = 50) completed a laboratory assessment of demand using a Cigarette Purchase Task for their usual brand cigarettes and an adjusting-amount delay discounting task. Demand was conceptualized as two factors (Amplitude and Persistence) and delay discounting was calculated as Area Under the Curve (log AUC). The two factors of demand and discounting AUC were included as statistical predictors of level of cigarette dependence and average number of cigarettes smoked per day in linear regression models. ResultsAmplitude of demand was marginally significant predictor (p = .06) of cigarettes smoked per day whereas neither Persistence of demand nor delay discounting significantly predicted this outcome. Both Amplitude of demand and delay discounting, but not Persistence, were associated with level of cigarette dependence. The effects of amplitude of demand and delay discounting on cigarette dependence or use did not significantly interact. ConclusionsResults of this study suggest that amplitude of cigarette demand may be a risk factor for both cigarette consumption and dependence, while discounting – a known risk factor for cigarette initiation – may relate specifically to level of dependence.

Evaluating Behavioral Economic Models of Heavy Drinking Among College Students

Heavy drinking among college students is a significant public health concern that can lead to profound social and health consequences, including alcohol use disorder. Behavioral economics posits that low future orientation and high valuation of alcohol (alcohol demand) combined with deficits in alternative reinforcement increase the likelihood of alcohol misuse. Despite this, no study has examined the incremental utility of all 3 variables simultaneously in a comprehensive model. This study uses structural equationmodeling to test the associations between behavioral economic variables-alcohol demand (latent), future orientation (measured with a delay discounting task and the Consideration of Future Consequences [CFC] scale), and proportionate substance-related reinforcement-and alcohol consumption and problems among 393 heavy drinking college students. Two models are tested as follows: (i) an iteration of the reinforcer pathology model that includes an interaction between future orientation and alcohol demand; and (ii) an alternative model evaluating the interconnectedness of behavioral economic variables in predicting problematic alcohol use. The interaction effects in Model 1 were nonsignificant. Model 2 suggests that greater alcohol demand and proportionate substance-related reinforcement are associated with greater alcohol consumption and problems. Furthermore, CFC was associated with alcohol-related problems and lower proportionate substance-related reinforcement but was not significantly associated with alcohol consumption or alcohol demand. Finally, greater proportionate substance-related reinforcement was associated with greater alcohol demand. Our results support the validity of the behavioral economic reinforcer pathology model as applied to young adult heavy drinking.

Behavioral Economic Predictors of Alcohol and Sexual Risk Behavior in College Drinkers

Heavy alcohol use among college students is a major public health concern. Alcohol use commonly occurs with sexual risk behaviors, but etiology remains unclear. Behavioral economics has yielded insights into decision-making processes underlying problematic health choices, including alcohol use and sexual risk behavior. In particular, the reinforcer pathologies framework has integrated behavioral economic demand and delay discounting to improve our understanding of addiction, but has yet to be extended to the study of sexual risk. In order to account for past sexual risk behavior and alcohol consumption, the current study examined college students’ demand for alcohol, money delay discounting, alcohol delay discounting, and sexual partners delay and probability discounting. Results revealed that behavioral economic variables (i.e., demand intensity, sexual partners delay discounting, alcohol delay discounting, and money delay discounting) were significant predictors of sexual risk and alcohol consumption levels. Additionally, consistent with the reinforcer pathologies model, an inability to delay sexual gratification (sexual delay discounting) and overvaluation of alcohol (demand intensity) interacted to account for significant variance in alcohol consumption and sexual risk. These findings highlight the importance of considering both sexual and alcohol decision making in research and intervention with college students.

Interrelationships between marijuana demand and discounting of delayed rewards: Convergence in behavioral economic methods

BackgroundDistinct behavioral economic domains, including high perceived drug value (demand) and delay discounting (DD), have been implicated in the initiation of drug use and the progression to dependence. However, it is unclear whether frequent marijuana users conform to a “reinforcer pathology” addiction model wherein marijuana demand and DD jointly increase risk for problematic marijuana use and cannabis dependence (CD). MethodsParticipants (n=88, 34% female, 14% cannabis dependent) completed a marijuana purchase task at baseline. A delay discounting task was completed following placebo marijuana cigarette (0% THC) administration during a separate experimental session. ResultsMarijuana demand and DD were quantified using area under the curve (AUC). In multiple regression models, demand uniquely predicted frequency of marijuana use while DD did not. In contrast, DD uniquely predicted CD symptom count while demand did not. There were no significant interactions between demand and DD in either model. ConclusionsThese findings suggest that frequent marijuana users exhibit key constituents of the reinforcer pathology model: high marijuana demand and steep discounting of delayed rewards. However, demand and DD appear to be independent rather than synergistic risk factors for elevated marijuana use and risk for progression to CD. Findings also provide support for using AUC as a singular marijuana demand metric, particularly when also examining other behavioral economic constructs that apply similar statistical approaches, such as DD, to support analytic methodological convergence.

Reinforcer pathologies: Predicting alcohol related problems in college drinking men and women

BackgroundAlcohol use in college is common, and problematic consequences of alcohol may affect college men and women differently. Approaches within behavioral economics have been used to improve our understanding of alcohol use in college students. MethodsThe current study assessed relations between college students' delay discounting, demand for alcohol, and alcohol problems as measured by the Young Adult Alcohol Consequences Questionnaire (YAACQ). In this study, 80 college drinkers completed a monetary choice questionnaire that assessed delay discounting of money, a novel beer choice questionnaire that evaluated delay discounting of beer, and an alcohol purchase task that measured demand for alcohol. ResultsBehavioral economic measures associated with the reinforcer pathologies model (i.e., demand and discounting) predicted alcohol consequences as measured by the YAACQ. For men, these significant predictor variables included money discounting, beer discounting, and intensity of alcohol demand, whereas for women money discounting and essential value were significant predictors. ConclusionsThese findings highlight the utility of the reinforcer pathologies approach for the study of alcohol use and the importance of considering gender differences in examining college drinking.