BEHAVIOURAL CHOICE THEORIES OF ADDICTION

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BEHAVIOURAL CHOICE THEORIES OF ADDICTION

• Nick Heather PhD,
• Centre for Alcohol Drug Studies,
• Newcastle, North Tyneside Northumberland Mental
  Health NHS Trust,
• University of Northumbria

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THE LANGUAGE OF CHOICE

• Behavioural economics a merging of
  micro-economic theory and a revolution in
  behavioural psychology beginning in the 1960s
  (the matching law)
• Addiction is a real phenomenon, not merely a
  series of causal attributions
• Addicts choices are predictable
• Addicts choose to consume drugs etc. but do not
  choose to be addicted
• Addicts choices are constrained like all
  choices

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A DEFINITION OF ADDICTION

• (addiction is shown by) a demonstrated failure
  to refrain from a behaviour despite attempts to
  do so or a complaint by the person that the
  behaviour is out of his or her control.
• Heather, N. (in press). Comments on O-J. Skog,
  Addiction definitions and mechanisms. In R.E.
  Vuchinich N. Heather (Eds.), Choice,
  Behavioural Economics and Addiction. Oxford, UK
  Pergamon Press.

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CONCEPTUAL FRAMEWORK FOR EXPLAINING ADDICTION
Not Sufficient
Not Sufficient
NEUROADAPTION OR PRE-EXISTING DIFFERENCES IN
NEURAL RESPONSE
From Heather, N. (1998) A conceptual framework
for explaining drug addiction, Journal of
Psychopharmacology, 12, 3 - 7
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GEORGE AINSLIES THEORY

• Ainslie, G. (1992). Picoeconomics The Strategic
  Interaction of Successive Motivational States
  Within The Person. Cambridge, UK Cambridge
  University Press.
• Ainslie, G. (2000). Breakdown of Will. Cambridge,
  UK Cambridge University Press.
• Anslie, G. Monterosso, J. (in press).
  Hyperbolic discounting as a factor in addiction
  a critical analysis. In R.E. Vuchinich N.
  Heather (Eds.), Choice, Behavioural Economics and
  Addiction. Oxford, UK Pergamon Press.

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HYPERBOLIC DISCOUNT CURVES BEHAVIOURAL CHOICE
THEORIES
Hyperbolic discount curves from two rewards of
different sizes available at different times
(vertical dashed lines). The smaller-sooner
reward is temporarily valued higher (preferred)
for a period just before its available, as shown
by the portion of its curve that projects above
that of the later-larger reward. Where V is
value, A is the undiscounted reward value, D is
delay and k is a constant describing the
individual subjects degree of impatience.
Functions in this class are referred to as
hyperbolic as contrasted with exponential
functions which model temporal discounting as
occurring at a fixed rate over time.
A 1 kD
V
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FOUR WAYS TO MAKE THE SELF-CONTROLLED CHOICE

• Extrapsychic mechanisms (e.g. precommitment)
• Control of attention
• Preparation of emotion
• Personal rules (i.e., will-power)

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THE MELIORATION THEORY OF ADDICTION

• Herrnstein, R.J., Prelec, D. (1992). A theory
  of addiction. In G. Loewenstein J. Elster
  (Eds.), Choice Over Time (pp. 331-360). New
  York Russell Sage Foundation.
• Heyman, G.M. (in press). Consumption dependent
  changes in reward value a framework for
  understanding addiction. In R.E. Vuchinich N.
  Heather (Eds.), Choice, Behavioural Economics and
  Addiction. Oxford, UK Pergamon Press.

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MELIORATION ADDICTION BEHAVIOURAL CHOICE THEORIES

• Melioration Addiction

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Local Utility of Drug Consumption
Overall Utility
1
3
Local Utility of Other Activities
4
Abstinence
Heavy drug use
Relative Behavioural Allocation to Drug
Consumption Drug Consumption/ (Drug Consumption
Other Activities)
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RATIONAL ADDICTION

• Becker, G.S., Murphy, K.M. (1988). A theory
  of rational addiction. Journal of Political
  Economy, 96, 675-700.
• Skog, O.-J. (1999). Rationality, irrationality
  and addiction notes on Becker and Murphy's
  theory of addiction. In J. Elster and O.-J. Skog
  (Eds.), Getting Hooked Rationality and
  Addiction. Cambridge, Cambridge University Press
  173-207.
• Chaloupka, F.J., Emery, S. Liang, L. (in
  press). Evolving models of addictive behavior
  from neoclassical to behavioral economics. In
  R.E. Vuchinich N. Heather (Eds.), Choice,
  Behavioural Economics and Addiction. Oxford, UK
  Pergamon Press.

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RATIONAL ADDICTION BEHAVIOURAL CHOICE THEORIES

• Rational Addiction

Utility of Drug Consumption
2
1
3
Utility of Other Activities
Marginal Utility of Drug Consumption
4
Abstinence (No Stock)
Heavy Drug Use (High Stock)
Stock of Addictive Capital
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RACHLINS RELATIVE THEORY OF ADDICTION

• Rachlin, H. (1997). Four teleological theories
  of addiction. Psychonomic Bulletin and Review,
  4, 462-473.
• Rachlin, H. (2000). The Science of
  Self-control. Cambridge, MA Harvard University
  Press.
• Rachlin, H. (in press). Economic concepts in the
  behavioural study of addiction. In R.E. Vuchinich
  N. Heather (Eds.), Choice, Behavioural
  Economics and Addiction. Oxford, UK Pergamon
  Press.

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RELATIVE ADDICTION BEHAVIOURAL CHOICE THEORIES

• Relative Addiction

Relative Behavioural Allocation to Drug
Consumption and Social Interaction
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APPLICATIONS TO TREATMENT (1)

• Ainslies theory obviously relevant to
  self-control or self-management techniques
  developed in early 1970s (e.g., Mahoney and
  Thoresen 1974 Thoresen and Mahoney 1974)
• Also relevant to cognitive therapy (e.g., Beck et
  al. 1993)
• May also be relevant to the mechanism of
  motivational interviewing
• Several aspects of modern cognitive-behavioural
  approaches to treatment can be interpreted within
  a behavioural economics framework (e.g.
  self-efficacy, relapse prevention)

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APPLICATIONS TO TREATMENT (2)

• Behavioural economic principles more generally
  have been applied successfully to contingency
  management programs (e.g. Community Reinforcement
  Approach) see work of Bickel, Higgins and
  colleagues
• But can these reframings of existing treatment
  modalities lead to improvements in effectiveness?
• And can the behavioural economic perspective lead
  to quite novel methods of treatment?

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APPLICATIONS TO PUBLIC HEALTH AND THE
ORGANISATION OF TREATMENT SERVICES (1)

• Tucker, J.A. Simpson, C.A. (in press). Merging
  behavioural economic and public health approaches
  to the delivery of services for substance abuse
  concepts and applications. In R.E. Vuchinich N.
  Heather (Eds.), Choice, Behavioural Economics and
  Addiction. Oxford, UK Pergamon Press.
• Ways of closing the currently existing gap
  between need and utilization and policies for
  allocating limited intervention resources in a
  more cost-effective manner across the population
  in need.
• Perhaps the main advantage of the behavioural
  economic perspective over other perspectives on
  service provision is its inherent emphasis on
  behavioural alternatives to addiction.

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APPLICATIONS TO PUBLIC HEALTH AND THE
ORGANISATION OF TREATMENT SERVICES (2)

• Applying the behavioural economic perspective to
  the organization of treatment services views
  care-seeking and adherence as choice processes.
• To facilitate care-seeking and adherence one
  should attempt to make services more attractive
  and easier to access, and thus very different
  from the intense, high-threshold services that
  have dominated addiction treatment in the past.

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APPLICATIONS TO PREVENTION AND PUBLIC POLICY

• McCoun, R. (in press). Is the addiction concept
  useful for drug policy? In R.E. Vuchinich N.
  Heather (Eds.), Choice, Behavioural Economics and
  Addiction. Oxford, UK Pergamon Press.
• McCouns answer is No and that applies too to
  behavioural choice theories of addiction.
• Behavioural choice theories have the implication
  that increases in the price of addictive
  substances will lead to lower levels of use and
  therefore harm. But that again is hardly novel.

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POTENTIAL USEFULNESS OF BEHAVIOURAL CHOICE
THEORIES

• There is nothing so useful as a good theory
  (Kurt Lewin, 1951)
• i.e., if a theory provides an accurate and
  adequate explanation for the occurrence of an
  observable phenomenon, it must, by definition,
  contain within it the means of changing that
  phenomenon
• It may be that the main influence of behavioural
  choice theories will be, not on the technology
  of treatment or public health and prevention
  policies, but on the way addiction is generally
  understood