Theories Of Addiction Research Articles

The theory of Rational Addiction.

The Theory of Rational Addictions, by Gary Becker & Kevin Murphy (1988), was a rational choice model that became a standard tool for economists modeling addictive behavior. The approach differs from other theories of addiction by modeling addictive behavior as the gradual implementation of a rational, forward-looking plan, where consumption at any point in time is partly motivated by the immediate payoff of consumption and partly by the effects this consumption has on the individual in the future. This makes addictive behavior a subset of rational behavior, requiring no more specific government policies or attention than any other consumption choice. Later work by economists extended the theory in different ways, allowing it to match an increasing number of consumption patterns, and searched for ways to test the forward-looking assumption in different types of market data. While the work was successful as a contribution to rational choice theory, with possible statistical applications, there are several reasons to dismiss its usefulness as an explanation of real-world addictive behavior and its ability to assess the welfare effects of addictions.

A Neurobehavioral Approach to Addiction: Implications for the Opioid Epidemic and the Psychology of Addiction

Two major questions about addictive behaviors need to be explained by any worthwhile neurobiological theory. First, why do people seek drugs in the first place? Second, why do some people who use drugs seem to eventually become unable to resist drug temptation and so become “addicted”? We will review the theories of addiction that address negative-reinforcement views of drug use (i.e., taking opioids to alleviate distress or withdrawal), positive-reinforcement views (i.e., taking drugs for euphoria), habit views (i.e., growth of automatic drug-use routines), incentive-sensitization views (i.e., growth of excessive “wanting” to take drugs as a result of dopamine-related sensitization), and cognitive-dysfunction views (i.e., impaired prefrontal top-down control), including those involving competing neurobehavioral decision systems (CNDS), and the role of the insula in modulating addictive drug craving. In the special case of opioids, particular attention is paid to whether their analgesic effects overlap with their reinforcing effects and whether the perceived low risk of taking legal medicinal opioids, which are often prescribed by a health professional, could play a role in the decision to use. Specifically, we will address the issue of predisposition or vulnerability to becoming addicted to drugs (i.e., the question of why some people who experiment with drugs develop an addiction, while others do not). Finally, we review attempts to develop novel therapeutic strategies and policy ideas that could help prevent opioid and other substance abuse.

Narcotics Drug Use in West Africa and Its Impact on Human Security

The West African sub-region has increasingly become a consumer and a final destination market for all types of drugs of abuse attributed to regional drug trafficking that has caused a supply-driven increase of narcotic drugs. This paper therefore reviewed the impact of narcotic drug use on human security of states in the West African sub-region and adopted the theory of rational addiction as theoretical framework for analysis. The paper also employed a desk-review research approach with the reports and evaluations obtained from secondary sources of data analyzed through content analysis. The paper found that narcotic drug use is associated with several drug problems that include biological, environmental, behavioral, cognitive and emotional risk factors. The study concluded that narcotic drug use has negative impact on the human security of West African states and recommended that ECOWAS Commission and member states should address the structural, political and socio-economic weaknesses facing states in the region by adopting policy measures aimed at improving human security. Furthermore, drug supply reduction strategies which primarily focus on interdiction actions should be complemented with harm reduction policies that will address public health and developmental challenges.

Testing a Neuro-Evolutionary Theory of Social Bonds and Addiction: Methadone Associated With Lower Attachment Anxiety, Comfort With Closeness, and Proximity Maintenance.

Evidence from non-human mammals for the involvement of the endogenous opioid system in prosocial behavior is reasonably extensive and robust; however, studies in humans are lacking. This study tests the neuro-evolutionary hypothesis that exogenous opiates, including morphine, heroine, and methadone, decrease separation anxiety and proximity by hijacking the neuro-peptide endogenous opioid system modulating social bonds. Participants were 486 subjects, 43% male, with ages between 18 and 62 years (M = 26.4; SD = 9.4), divided in three naturalistic groups: 1: addicts in drug-free treatment; 2: addicts in methadone programs; 3: normative non-clinical controls. Instruments: 1) Adult Attachment Scale (AAS) composed of three subscales: Anxiety about being rejected (α = 0.83), Comfort with Intimacy (α = 0.68), and Comfort Depending on Others (α = 0.70). 2) Caregiving Questionnaire composed of four subscales: Proximity Maintenance: (α = 0.83), Sensitivity: (α = 0.76), Controlling Caregiving (α = 0.77) and Compulsive Caregiving (α = 0.68). Results: Multivariate Analysis of Co-variance (MANCOVA) models were computed; gender, age, and education were included in the models. Methadone patients and drug-free treatment addicts were equivalent and reported significantly lower Comfort Depending on Others, Comfort with Intimacy, and Caregiving Proximity. However, methadone users reported significantly lower Anxiety about being rejected than drug-free addicts and were equivalent to non-clinical controls. In addition, correlations between the methadone intake dose and the questionnaires’ scales showed that dose was significantly and negatively correlated with Comfort with Closeness (rs = −0.36; p < 0.01) and with Caregiving Proximity (rs = −0.28; p < 0.05).

Impaired subjective self-control in alcohol use: An ecological momentary assessment study

BackgroundWhile both theory and empirical findings have supported impaired self-control as a crucial factor in understanding problem drinking, little is known about the relationship of self-control and drinking in naturalistic settings. The present study uses Ecological Momentary Assessment (EMA) to examine the predictive relationships between impaired subjective self-control, craving and alcohol use in everyday life. MethodsA sample of 172 regular drinkers responded on their smartphone to three random prompts each day for seven days in which amount of perceived self-control and craving were measured with self-report. In the meantime, participants were instructed to initiate an EMA report when they started drinking alcohol. ResultsFindings supported the hypotheses that impaired self-control and higher craving levels were prospectively related to the likelihood that people will drink. That is, on random assessments that preceded drinking (i.e., were within two hours of drinking), perceived self-control was lower and craving was higher compared to random assessments that were not followed by drinking. Additionally, during drink consumption, impaired self-control and craving were associated with a higher amount of expected alcohol consumption. Findings further indicated that subjective self-control acted as a moderator of the relationship between craving and alcohol consumption during drinking occasions. ConclusionsBy using a smartphone mobile application, this study showed that impaired subjective self-control and craving are prospectively related to alcohol use in the real-world. Furthermore, findings are consistent with theories of addiction that substance use might be associated with the interplay of control processes and increased motivation.

Comparing the reward value of cigarettes and food during tobacco abstinence and nonabstinence

BackgroundSome addiction theories propose that nicotine dependence is characterized by an imbalance between motivation for cigarettes compared to non-drug rewards. This imbalance may become increasingly polarized during abstinence, which further potentiates smoking. The present study evaluated motivation for cigarettes and food during abstinence and nonabstinence in daily smokers. This study modified a previously validated cue-reactivity procedure to include food as a cue condition, thereby allowing the comparison of cigarettes to food and neutral cues. The Choice Behavior Under Cued Conditions (CBUCC) procedure, in which participants are presented with cues and spend money in order to gain immediate access to that cue, generates multiple variables to evaluate motivational factors and drug use behaviors including reward value, craving, seeking, choice time, and consumption. MethodsFifty daily cigarette smokers underwent two CBUCC sessions under overnight abstinent and nonabstinent conditions. ResultsAs an index of reward value, participants spent more money to access cigarettes than food or water and more for food relative to water. Abstinence increased the reward value of cigarettes but did not significantly affect the reward value of food or water. Participants also demonstrated cue-specific craving for cigarettes and food, although overall cigarette craving was greater than food craving. ConclusionsThis study indicated that motivation was greater for cigarettes than food. Abstinence increased motivation for cigarettes but had little impact on motivation for food. This suggests that heavy smokers do not reallocate motivational resources towards cigarettes during abstinence; rather, motivational processes for food remain constant from nonabstinent to abstinent sessions.

Cannabis Stock Behavior and Investor’s Expectations on the TSX: A Mixed Method Approach

This study examines the behavior of cannabis stock on the Toronto Stock Exchange and why investors are interested in cannabis stock. The theory of heterogeneous beliefs, bounded rationality theory and the theory of addiction grounded the study. We employed basic descriptive statistics and the Kruskal-Wallis test including an in-depth interview of investors using convenience sampling methods. The study findings showed that cannabis stocks exhibit a higher-level of risk volatility when compared to speculative and growth stocks on the Toronto Stock Exchange within the period under investigation. Other findings show that cannabis stocks share similar characteristics with other speculative stocks but also possess unique features. Finally, investors are interested in cannabis stocks because of its potential for future strong earnings on the platform of the theory of addiction as discussed in the study.

What Drives Work Addicts to Action? The Extended Model of Work Craving

The theory of work craving highlights three pathological components of work addiction: the behavioral wanting component (an obsessive-compulsive desire for work), the hedonic liking components (the reduction of negative emotions and compensation for low self-worth), and the cognitive learning component (neurotic perfectionism). In this article, I link the theory of work craving with the theory of motivation and the incentive-sensitization theory of addiction and discuss three major issues: (a) obsessive-compulsive symptoms are not sufficient to diagnose workaholism; (b) two hedonic components of work craving, namely, activity-related and purpose-related incentives, should be considered; and (c) incentive-sensitization is an additional mechanism that may be prepotent for addictive working.

Borderline personality disorder: from understanding ontological addiction to psychotherapeutic revolution.

Bypassing a reductionist view of existing diagnostic categories, ontological addiction theory (OAT) is a new psychological model of human functioning. Borderline Personality Disorder (BPD), defined as "a pattern of instability in interpersonal relationships, self-image and affects, and marked impulsivity", is not only common (up to 20% of psychiatric inpatients), but also strongly associated with suicide attempts and death by suicide. Therefore, BPD constitutes a major public health concern. As a consequence of an underlying condition of ontological addiction, self-harming behaviors can be conceptualized as addictions, suicidal acts reflecting an experiential avoidance strategy against unbearable psychological pain. The present paper aims at: (1) understanding BPD daily life experiences from the perspective of OAT; (2) offering psychotherapeutic perspectives for this mental disorder. The diagnostic category of BDP may be understood as a simple label reflecting several extreme types of manifestations resulting from the Self-grasping ignorance that underpins ontological addiction. Therefore, development of psychotherapeutic interventions targeting ontological addiction appears to be a promising future direction.

Multi-Level Approach to Theories of Addiction: A Critical Review

: Policies, in general, determine the approach of interventions in society and, in turn, they are supposed to be influenced by theories. Theories are based on evidence and data; therefore, the methodology used to produce evidence and data plays a decisive influence on the final theory. In the field of addiction, addiction theories rely on the product of studies conducted on different individual, group, and environmental levels. Addiction, however, is a multi-dimensional (biological, psychological, and sociological) phenomenon. In this review article, we argue the pieces of evidence by which we build up a matrix structure in the theoretical model in order to provide a comprehensive understanding of this phenomenon. One axis of the matrix consists of the biological, psychological, and sociological dimensions of addiction, while the other axis, consists of individual, group, and environmental levels. We further discuss how such a multilevel and multi-dimensional approach does not exist in most addiction theories, and each of the theories has only explained single or limited elements of this matrix. This mono-level approach to the phenomenon of addiction can lead to major fallacies in the research and studies of the addiction.

Weaker Memory Performance Exacerbates Stress-Induced Cannabis Craving in Youths' Daily Lives.

Theories of addiction posit that stimuli associated with drug use, including both exteroceptive (e.g., paraphernalia) and interoceptive (e.g., feeling tense or "stressed"), evoke craving and contribute to the pathogenesis of substance misuse. Control over drug cue response and stress is essential for moderating use. Building from laboratory data supporting associations between cue exposure, stress, and craving, this study tested whether these associations generalize to real-world settings and examined whether a well-vetted neurocognitive control capacity, i.e., working memory (WM), moderated associations. Youth (N = 85; 15-24 years) completed baseline and ecological momentary assessments. Cue exposure and participants' average stress predicted higher craving. Youth with weaker WM experienced stronger craving at higher-stress moments but not when faced with cues. Interactions were present for both previous-moment and same-moment stress. Craving among adolescents with stronger WM was not swayed by momentary stress. Findings suggest stronger WM protects against craving at more stressful moments.

Life after opioid-involved overdose: survivor narratives and their implications for ER/ED interventions.

Numerous states in the United States are working to stem opioid-involved overdose (OD) by engaging OD survivors before discharge from emergency departments (EDs). This analysis examines interactions between survivors and medical care providers that may influence opioid risk behaviors post-OD. Qualitative stakeholder analysis involving in-depth interviews with samples from three groups. Two hospitals in high OD-mortality neighborhoods in New York City (NYC), USA. Total N=35: emergency medical services personnel (EMS; n=9) and ED medical staff (EDS; n=6) both working in high OD-mortality neighborhoods in NYC; recent opioid-involved OD survivors who had been administered naloxone and transported to a hospital ED (n=20). EMS and EDS interviews examined content of verbal interactions with survivors and attitudes related to people who use opioids. Survivor interviews addressed healthcare experiences, OD-related behavioral impacts and barriers to risk-reduction post-OD. Both EMS and EDS stakeholders described frequent efforts to influence survivors' subsequent behavior, but some acknowledged a loss of empathy, and most described burnout related to perceived ingratitude or failure to influence patients. Survivors reported being motivated to reduce opioid risk following a non-fatal OD and many described successful risk-reduction efforts post-OD. Intentions to cease opioid use or reduce risk were complicated by unmanaged, naloxone-related withdrawal, lack of social support and perceived disrespect from EMS and/or EDS. Emergency department interventions with opioid-involved overdose (OD) survivors may benefit from training emergency medical staff to assure a continuity of non-judgmental, socially supportive remediation attempts throughout contacts with different care-givers. Brief interventions to educate emergency medical staff about current theories of addiction and evidence-based treatment may achieve this goal while reducing care-giver burnout and improving the uptake and efficacy of post-OD interventions delivered in emergency departments.

Addiction theory matters-Why there is no dependence on caffeine or antidepressant medication.

With the development of the ICD-11, the debate about classifying certain psychoactive substances such as antidepressant medication and caffeine as drugs of dependence is ignited again. We argue that any coherent theory of addiction needs to identify the neurobiological processes elicited by a potentially addictive substance and to clearly define the clinical symptoms associated with these processes, which can then be used to guide diagnosis. Tolerance development and withdrawal symptoms can occur with any pharmacologically active agent, and their presence is not a sufficient criterion for the clinical diagnosis of an addictive disorder. Drug craving, drug seeking, and drug consumption in spite of harmful consequences are further key criteria for the diagnosis of substance dependence. Even though these symptoms have been associated with dopamine release in the ventral striatum, ventral striatal dopamine release alone is not a sufficient criterion of the addictive property of a drug. For example, common reinforcers such as food and sex increase dopamine transmission in the nucleus accumbens, but unlike in addictive substances, their effect is regulated by reward predictability and habituation. We emphasize the importance to integrate neurobiological as well as behavioral and clinical effects of a substance to assess its addictive liability. We provide a number of widely discussed examples and a list of key criteria as a conceptual guideline for addiction research and clinical practice.

Traumatic landscapes: Two geographies of addiction

The confluence of the contemporary opioid crisis and the Great Recession has renewed interest in theories of addiction that can account for the relationship between individual symptoms and large-scale socio-political forces. Gesler's (1992) theory of ‘therapeutic landscapes’ examines the ways that social, political, and cultural forces, embedded in place, contribute to health and wellbeing. This article considers the inverse of the therapeutic landscape: the traumatic landscape that harms its inhabitants, proposing it as one way of understanding how addiction is related to place. I draw on research in health geography, medical anthropology, and critical psychology to develop a novel theorization of the relationship between place, trauma, and addiction. Drawing on eighteen months of ethnographic fieldwork with drug users exiting the prison system in Chicago, Illinois, the article considers the life histories of two men whose addictions to drugs and alcohol are profoundly related to place. Through close readings of these cases, I develop two readings of addiction-in-place, one in which addiction is the result of environmental stresses that produce a need to use drugs as a form of self-medication, and another in which the landscape acts as a container for histories of trauma and produces an addiction resembling a psychoanalytic symptom, expressed in self-destructive acts. Finally, through my use of the case history method, I contribute to methodological debates about how to research experiences of place and health, arguing that close attention to lived experience is necessary to draw links between macro-level arguments about structural violence and the subjective experience of trauma that lies at the heart of addiction.

Neurobiology of opioid dependence

Opioid dependence is achronic mental disease with multifactorial etiology. The neurobiological theory of addiction focuses on the manipulation of the dopaminergic reward system as abasic property of substances with addictive potential including opioids. With regular opioid intake, the manipulation of the reward system results in acognitive bias towards drug-related stimuli. In addition, opioids inhibit the locus caeruleus, resulting in symptoms of sympathetic rebound during opioid detoxification. The pharmacokinetics of opioids also influence the risk of addiction. These biological factors are independent of the legal status of the individual opioid. Genetics also significantly influence the etiology. However, the assignment of this genetic influence is difficult because not only basic biological functions, but also personality traits and mental illnesses are genetically determined.

A Computational Modeling Approach Supports Negative Reinforcement Theories of Addiction

A Computational Modeling Approach Supports Negative Reinforcement Theories of Addiction

Abstract OT3-06-02: An initial safety study of gedatolisib plus PTK7-ADC for metastatic triple-negative breast cancer

Abstract Background: The PI3K pathway is dysregulated in the majority of triple-negative breast cancer (TNBCs). Contrary to the theory of oncogene addiction, single agent inhibition of the PI3K pathway in TNBC has had only modest activity. Our group has demonstrated preclinically that when PI3K is inhibited, an immediate compensatory up-regulation of the Wnt pathway occurs. The Wnt pathway is known known for its role in cancer metastases and can confer resistance to initial PI3K inhibition. Simultaneous dual targeting of both pathways is highly synergistic against TNBC models in vitro and in vivo. We have initiated a Phase I clinical trial using Gedatolisib (PI3K/mTOR inhibitor) and PTK7-ADC (Wnt pathway) for patients with metastatic TNBC (NCT03243331). Gedatolisib is a pan-class I isoform PI3K/mTOR inhibitor, and PTK7-ADC is an antibody-drug conjugate against the cell-surface PTK7 protein (Wnt pathway co-receptor) with an Auristatin payload. PTK7 is an attractive second target due to its up-regulation after PI3K inhibition and its known overexpression in TNBC. Further data has shown that the PTK7-payload, Auristatin, is in itself synergistic with Gedatolisib. The combination of using both of these drugs suggests a unique concept of “double synergy”. Where Gedatolisib increases the expression of the target of PTK7-ADC leading to one mechanism of synergy, and the Auristatin payload on PTK7-ADC is synergistic with Gedatolisib providing a second mechanism. Study Design: This is an open-label, Phase I, dose-escalation study with a 3 + 3 cohort design. The trial will enroll 12-18 patients. 3 cohorts of at least 3 patients will receive Gedatolisib (weekly) &amp; PTK-ADC (q3w) at 110mg+1.4mg/kg, 180mg+1.4mg/kg, and 180mg+2.8mg/kg dose levels. Eligibility Criteria: This trial enrolls patients with metastatic triple negative (ER-, PgR-, HER2-) or low estrogen expressing (ER and PgR &amp;lt;5%, HER2-) breast cancer. Patients must have received at least one prior chemotherapy for advanced disease and have adequate hematologic, renal, and hepatic function. Patients with previously treated CNS involvement are eligible. Patients with uncontrolled diabetes are excluded, given the potential for hyperglycemia with Gedatolisib. Patients must have disease amenable and consent to biopsy for correlative endpoints. Objectives: The primary objective is to evaluate the safety of Gedatolisib plus PTK7-ADC. The secondary objective is to evaluate efficacy as determined by objective response rate, clinical benefit at 18 weeks, and progression free survival (PFS). Exploratory objectives will evaluate efficacy in patients with genomic aberrations in the PI3K pathway; and association of tumor DNA, RNA, plasma and circulating tumor cell sequencing with clinical efficacy to identify putative biomarkers. Correlative Sciences: We are collecting matched pre-/post-treatment tumor biopsies and serial blood samples to determine biomarkers of clinical response to inform subsequent trials. We plan to evaluate: 1) PI3K activity; 2) genomic aberrations in the PI3K pathway; 3) baseline PTK7 expression; 4) PTK7 upregulation after Gedatolisib treatment; and 5) mutations in plasma circulating tumor DNA. Supported by the BCRF, 100 Voices of Hope, Catherine Peachey Foundation, and Pfizer. Citation Format: Radovich M, Solzak JP, Hancock BA, Storniolo AMV, Schneider BP, Miller KD. An initial safety study of gedatolisib plus PTK7-ADC for metastatic triple-negative breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT3-06-02.

Knowledge about the predictive value of reward conditioned stimuli modulates their interference with cognitive processes.

Stimuli conditioned with a substance can generate drug-approach behaviors due to their acquired motivational properties. According to implicit theories of addiction, these stimuli can decrease cognitive control automatically. The present study (n = 49) examined whether reward-associated stimuli can interfere with cognitive processes in the absence of knowledge about stimulus–outcome contingencies. Conditioned stimuli (CS) were paired with high-reward (HR) or low-reward (LR) probabilities of monetary reward using a Pavlovian learning task. Participants were categorized as Aware or Unaware of contingencies using a Bayesian analysis. CS were then used as task-irrelevant distractors in modified flanker and N-back tasks. Results show HR CS can generate increased interference in the flanker task for participants Unaware of contingencies, contributing further evidence for the existence of implicit Pavlovian conditioning. For the N-back task, working memory performance was affected by HR CS, albeit only for Aware participants. These results suggest that CS can interfere implicitly with cognitive processes in a similar way to drug-related stimuli. Such an effect could occur in a stimulus-driven fashion, devoid of top-down goal-directedness. These findings have implications for the conceptualization and study of implicit processes in addiction and highlights the necessity to reconsider the measurement of such phenomena.

From Pain Patient to Junkie: An Economic Theory of Painkiller Consumption and its Impact on Wellbeing and Longevity

In this paper, I propose a life cycle model of painkiller consumption that combines the theory of health deficit accumulation with the theory of addiction. Chronic pain is conceptualized as a persistent negative shock to lifetime utility that can be treated by pain relief medication. Individuals treated with opioid pain relievers (OPR) develop addiction, which increases their demand for opioids and reduces their welfare and life expectancy through side effects and potential overdose. I calibrate the model for a benchmark American and investigate the comparative dynamics of alternative drug characteristics, pain intensities, and ages of onsets of pain and their implications for welfare and life expectancy. Computational experiments are used to identify fully rational and imperfectly rational addiction behavior. Fully rational addicts quickly quit OPR use when new information about their addictive potential arrives. Imperfectly rational addicts further develop their addiction and switch to illicit opioid use. Likewise, a discontinued prescription helps fully rational addicts to quit quickly while it induces imperfectly rational individuals to take up heroin. I also discuss treatment of OPR addiction and the use of opioids in palliative care.

Cannabis Stock behavior and Investor’s Expectations on the TSX: A Mixed Method Approach

This study examines the behavior of cannabis stock on the Toronto Stock Exchange and why investors are interested in cannabis stock. The theory of heterogeneous beliefs, bounded rationality theory and the theory of addiction grounded the study. We employed basic descriptive statistics and the Kruskal-Wallis test including an in-depth interview of investors using convenience sampling methods. The study findings showed that cannabis stocks exhibit a higher-level of risk volatility when compared to speculative and growth stocks on the Toronto Stock Exchange within the period under investigation. The descriptive statistics result suggest potential diversification benefits between cannabis stocks and growth stocks as both stocks classifications are likely to respond to macroeconomic shocks differently. Other findings show that cannabis stocks share similar characteristics with other speculative stocks but also possess unique features. Finally, investors are interested in cannabis stocks because of its potential for future strong earnings on the platform of the theory of addiction as discussed in the study.