Reinforcer Pathology Research Articles

Examining the role of reinforcing activities and time horizon in recovery: Commentary on Bickel, Witkiewitz, Athamneh, Kuhlemeier-"Recovery from alcohol use disorder: Reinforcer pathology theory, measurement, and methods".

Examining the role of reinforcing activities and time horizon in recovery: Commentary on Bickel, Witkiewitz, Athamneh, Kuhlemeier-"Recovery from alcohol use disorder: Reinforcer pathology theory, measurement, and methods".

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).

Recovery from alcohol use disorder: Reinforcer pathology theory, measurement, and methods.

Recovery from alcohol use disorder (AUD) is a dynamic process that often entails periods of drinking but has been defined primarily by abstinence. Recently, a broader interpretation of recovery was developed, including meeting the Diagnostic and Statistical Manual of Mental Disorders (DSM) remission criteria and improved psychosocial functioning. This new understanding of recovery has facilitated the development of novel theories and methodologies. This paper reviews a new theoretical perspective of recovery, Reinforcer Pathology, and two novel methodological approaches in light of this broader view of recovery. Using this theoretical framework as a foundation, we propose an alternative perspective to explain the recovery process as it relates to environmental factors and valuation of the future; we suggest that changing the environment in which substances are available (e.g., increasing non-alcohol-related activities) and extending one's temporal window are associated with improved recovery outcomes (e.g., remission and quality of life). In this review, we discuss two novel methodological approaches. The first uses latent profile analysis to show that using a measure of Relative Reinforcement Value of Alcohol-Free Activities is associated with a greater likelihood of belonging to a high functioning/infrequent heavy drinking recovery profile. The second developed an online national sample and used an accelerated longitudinal design to study longer-term recovery of up to 12 years over a 5-year study period. Reinforcer Pathology theory, novel methods, and measures may further our understanding of recovery and begin to address critical questions for future studies. Subsequent randomized clinical trials should examine whether the suggested targets and interventions based on the theoretical model improve recovery outcomes prospectively. Measuring and promoting alcohol-free activity engagement may facilitate improved recovery outcomes, while novel methodologies permit an understanding of returning to use or remission across different recovery durations.

S142 - Delay Discounting, Pain Catastrophizing, and Quality of Life Among Individuals in Recovery From Substance Use Disorder: A Reinforcer Pathology Perspective

S142 - Delay Discounting, Pain Catastrophizing, and Quality of Life Among Individuals in Recovery From Substance Use Disorder: A Reinforcer Pathology Perspective

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.

Episodic Future Thinking as a Promising Intervention for Substance Use Disorders: a Reinforcer Pathology Perspective

Episodic Future Thinking as a Promising Intervention for Substance Use Disorders: a Reinforcer Pathology Perspective

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).

Critical appraisal of the discussion on delay discounting by Bailey et al. and Stein et al.: A scientific proposal for a reinforcer pathology theory 3.0

Delay discounting is one of the most studied phenomena in Psychology in the last decades. Recently, it has been proposed as a transdiagnostic variable accounting for several psychopathological problems. A review of current practices and clinical application (Bailey et al., 2021) and a response article (Stein et al., 2022) have been recently published. Despite both of them being stimulating, the articles raise issues needing further discussion. The first part of the present article critically appraises both publications by highlighting their strengths/limitations and offers an alternate perspective that clarifies some theoretical issues and allows new lines in research. In the second part, one of these new lines of research is presented by describing a research proposal based on the analysed critiques and current developments in both psychopathology and addiction research. This article contributes to the discussion on delay discounting suggesting alternative interpretations and future studies to improve theoretical models.

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).

A reinforcer pathology approach to cannabis misuse: Evaluation of independent and interactive roles of cannabis demand and delay discounting in a sample of community adults.

Cannabis use is prevalent and concerns about cannabis misuse are increasing. A reinforcer pathology approach emphasizes the roles of drug reinforcing value (demand) and overvaluation of immediate rewards (delay discounting [DD]) in drug use but has been applied to a lesser extent to cannabis. The present study investigated the independent and interactive roles of these processes in relation to cannabis misuse in a community sample of adult cannabis users (N = 324; 44.8% female; Mage = 33.25). Participants completed a Marijuana Purchase Task (MPT), the Monetary Choice Questionnaire (MCQ), and the Cannabis Use Disorder Identification Test-Revised (CUDIT-R) to assess demand, DD, and cannabis misuse, respectively. Zero-order correlations revealed significant associations between CUDIT-R scores and both the demand indices (|rs | = .21-.56, p < .01-.001) and DD (r = .21, p < .01). In multivariate analyses, lower elasticity (i.e., price insensitivity) was robustly associated with higher CUDIT-R scores, while other demand indicators did not explain additional unique variance. However, as elasticity, intensity, and Omax exhibited robust zero-order intercorrelations, shared variance appeared to drive the association. An interactive relationship between elasticity and DD was not significant. These findings indicate that cannabis misuse is associated with both cannabis demand, particularly as measured by insensitivity to escalating costs, and immediate reward orientation, but the relationship was not synergistic. These results support a reinforcer pathology approach to cannabis misuse and, although causality cannot be inferred cross-sectionally, suggest that evaluating the longitudinal significance of these indicators is warranted. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Effect of Financial Scarcity on Reinforcer Pathology: A Dyadic Developmental Examination.

This study investigated the effects of experimentally manipulated scarcity on the reinforcing value of food (RRVfood) and delay discounting (DD), which, together, create reinforcer pathology (RP) among parents and offspring. A stratified sample of 106 families (53 parent/child aged 7–10 dyads & 53 parent/adolescent aged 15–17 dyads) from high- and low-income households visited our laboratory for three appointments. Each appointment included an experimental manipulation of financial gains and losses and DD and RRV tasks. The results showed that, regardless of food insecurity or condition, children had greater RP (β = 1.63, p < 0.001) than adolescents and parents. DD was largely unaffected by acute scarcity in any group, but families with food insecurity had greater DD (β = −0.09, p = 0.002) than food-secure families. Food-insecure parents with children responded to financial losses with an increase in their RRVfood (β = −0.03, p = 0.011), while food-secure parents and food-insecure parents of adolescents did not significantly change their responding based on conditions. This study replicates findings that financial losses increase the RRVfood among adults with food insecurity and extends this literature by suggesting that this is strongest for parents of children.

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).

Future thinking to decrease real-world drinking in alcohol use disorder: Repairing reinforcer pathology in a randomized proof-of-concept trial.

Reinforcer Pathology theory proposes that expanding the temporal window of reinforcement (i.e., reducing delay discounting) using episodic future thinking (EFT) would decrease alcohol consumption. However, evidence of effectiveness in real-world settings is lacking. Using a randomized proof-of-concept field trial, the current study examined the effect of expanding the temporal window of reinforcement, using remotely delivered EFT, on decreasing real-world alcohol consumption among individuals with alcohol use disorder (AUD). Fifty-two individuals (9 females) aged 18-65 years who met the DSM-5 criteria for moderate or severe AUD and aimed to drink in moderation or abstain from drinking completed the study and were included in analysis. EFT significantly (p = .031) reduced alcohol consumption (mean change of consumption pre-post intervention = -2.18 drinks/day) compared to control episodic recent thinking (ERT; mean change of -0.52 drinks/day). Changes in discounting rates pre-post intervention significantly predicted changes in alcohol consumption (coef. = .424, 95% CI [.043-.813], p = .030) even after controlling for age, gender, race, income, education, marital status, and family history of addiction. Overall satisfaction across groups was rated as 3.92 on a 1 to 5-point scale, suggesting that the current remote approach is feasible and acceptable. The current findings were congruent with the theory, Reinforcer Pathology, that EFT expands the temporal window and decreases alcohol consumption, and the remote approach was considered feasible and acceptable. We believe the present study contributes new knowledge with tangible benefits for scientifically understanding and better defining novel interventions that may be clinically deployed to improve treatment outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The associations between posttraumatic stress disorder and delay discounting, future orientation, and reward availability: A behavioral economic model.

The theoretical framework of behavioral economics, a metatheory that integrates operant learning and economic theory, has only recently been applied to posttraumatic stress disorder (PTSD). A behavioral economic theory of PTSD reflects an expansion of prior behavioral conceptualization of PTSD, which described PTSD in terms of respondent and operant conditioning. In the behavioral economic framework of PTSD, negatively reinforced avoidance behavior is overvalued, in part due to deficits in environmental reward, and may be conceptualized as a form of reinforcer pathology (i.e., excessive preference for and valuation of an immediate reinforcer). We investigated cross-sectional relationships between PTSD severity and several constructs rooted in this behavioral economic framework, including future orientation, reward availability, and delay discounting in a sample of 110 military personnel/veterans (87.2% male) who had served combat deployments following September 11, 2001. Total PTSD severity was inversely related to environmental reward availability, β = -.49, ΔR2 = 0.24, p < .001; hedonic reward availability, β = -.32, ΔR2 = 0.10, p = .001; and future orientation, β = -.20, ΔR2 = 0.04, p = .032, but not delay discounting, r = -.05, p = .633. An examination of individual symptom clusters did not suggest that avoidance symptoms were uniquely associated with these behavioral economic constructs. The findings offer support for a behavioral economic model of PTSD in which there is a lack of positive reinforcement as well as a myopic focus on the present.

Reinforcer pathology's alternative reinforcer hypothesis: A preliminary examination.

The novel theory of Reinforcer Pathology states that the temporal window of integration, measured by delay discounting (DD), determines the value of reinforcers. Based on the Reinforcer Pathology theory, the valuation of alternative reinforcers is positively associated with the length of the temporal window (negatively with rates of discounting). The objective of this article is to test the Reinforcer Pathology theory by reanalyzing data from a prior report (Carr & Epstein, 2018) in order to examine the association between the reinforcing value of alternative reinforcement and the length of the measured temporal window. Participants (N = 250) who completed an adjusting delay discounting task and the Pleasant Events Schedule (PES) were included in the study. PES provides a measurement of a reinforcement score (a cross-product of PES measures of frequency and pleasantness) for 45 noneating alternative activities. Analysis of Variance and Spearman product-moment correlations were completed. Delay discounting was significantly positively correlated with sedentary reinforcement and significantly negatively correlated with cognitively enriching activities. A significant interaction was observed in the preference for between food and cognitive-enriching context as a function ln(k) in predicting the cognitive-enriching activity class. Nonsignificant relationships were also observed with the correlation of delay discounting to the reinforcement of social and physical activities. These findings provide initial support for Reinforcer Pathology theory and indicate that the temporal window over which reinforcers are integrated may be a factor contributing to a preference for some healthy or unhealthy alternative reinforcers. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Behavioral economic cigarette demand among individuals who smoke with and without obesity.

Obesity and cigarette smoking are leading preventable causes of mortality, with greater mortality risk when these disorders occur together. Comorbid obesity and cigarette smoking may affect the valuation of cigarettes. The present study examines the demand for cigarettes between obese and nonobese smokers. Participants (N = 187) from four in-laboratory studies completed the hypothetical cigarette purchase task. According to self-reported height and weight, participants were assigned to either the obese group (body mass index [BMI] ≥ 30) or to the nonobese group (BMI < 30). Significant differences in demand intensity were observed between individuals with and without obesity, F(1, 168) = 9.284, p = .003, with individuals who smoke and are obese showing higher demand intensity (product purchasing when free). These differences in demand intensity between groups remained after adjusting for the number of cigarettes consumed per day. No differences were observed in elasticity of demand, F(1, 168) = 1.033, p = .311. The results reported here suggest that individuals who smoke and are obese may value brief, intense, and immediate reinforcers more than individuals who smoke and are not obese. Further research may suggest reinforcer pathology as a basis for this result. (PsycInfo Database Record (c) 2021 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.

Behavioral economics and safe sex: Examining condom use decisions from a reinforcer pathology framework.

Condom use substantially reduces unwanted pregnancies and sexually transmitted infections. While condom availability is a significant public health priority, effects of condom availability constraints remain relatively under-researched. The limited research on condom availability suggests two major barriers to use: (1) effort/costs and (2) delay to access. To date, we are aware of no study that explores both demand for and discounting of condom availability; the focus of this study was to account for condom decisions using a reinforcement pathology framework. This study used a condom purchase task and the Sexual Delay Discounting Task to quantify behavioral economics of condom use. Low sexual discounting was associated with higher willingness to engage unprotected sex. Demand metrics suggest participants indicating abstinence at condom breakpoint were willing to pay nearly double for condoms relative to individuals indicating unprotected sex at breakpoint. Finally, we grouped participants into reinforcement pathology risk groups based on their discounting and demand indices; these groups significantly differed in self-reported number of sexual partners, unprotected sexual partners, and Sexual Desire scores. This study demonstrates the value of behavioral economic approaches to public health concerns, and further underscores the translational benefits of quantitative metrics to shed novel light on risky health decisions.

Supplemental Material for A Reinforcer Pathology Approach to Cannabis Misuse: Evaluation of Independent and Interactive Roles of Cannabis Demand and Delay Discounting in a Sample of Community Adults

Supplemental Material for A Reinforcer Pathology Approach to Cannabis Misuse: Evaluation of Independent and Interactive Roles of Cannabis Demand and Delay Discounting in a Sample of Community Adults