BEHAVIOURAL CHOICE THEORIES OF ADDICTION

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BEHAVIOURAL CHOICE THEORIES OF ADDICTION

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Title: BEHAVIOURAL CHOICE THEORIES OF ADDICTION


1
BEHAVIOURAL CHOICE THEORIES OF ADDICTION
  • Nick Heather PhD,
  • Centre for Alcohol Drug Studies,
  • Newcastle, North Tyneside Northumberland Mental
    Health NHS Trust,
  • University of Northumbria

2
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

3
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.

4
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
5
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.

6
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
7
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)

8
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.

9
MELIORATION ADDICTION BEHAVIOURAL CHOICE THEORIES
  • Melioration Addiction

2
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)
10
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.

11
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
12
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.

13
RELATIVE ADDICTION BEHAVIOURAL CHOICE THEORIES
  • Relative Addiction

Relative Behavioural Allocation to Drug
Consumption and Social Interaction
14
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)

15
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?

16
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.

17
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.

18
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.

19
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
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