task 4 lecture (5) Addiction as a choice

Question 1

What is the critism on viewing addiction as a brain disease?

Answer 1

 Many addicts recover without professional help
 Natural recovery
 Most people who become addicted to an illicit drug are “ex‐addicts” by age 30
 Correlates of quitting: practical and moral concerns
 No physiological malfunction, normal brain functioning (plasticity)

Question 2

Operant conditioning Skinner (repeating briefly)

Answer 2

Behavior is a function of environmental consequences
A specific behavioral response R causes outcome O
R is associated with O

Question 3

Law of effect (operant conditioning skinner)

Answer 3

 A behavioral response increases in strength and frequency when it has positive rewarding consequences
 A behavioral response decreases in strength and frequency when it has negative aversive consequences

Question 4

THE REINFORCING EFFECT OF DRUGS (positive and negative)

Answer 4

 Drug use increases in strength and frequency,
because drugs of abuse have a strong hedonic,
rewarding effect
(positive reinforcement)
 Drug use in the addict is further maintained, becauseit alleviates withdrawal symptoms
(negative reinforcement)

Question 5

PARADOX OF ADDICTION AS OPERANT
BEHAVIOR

Answer 5

 Addictive behavior has negative consequences that increase in number, magnitude, immediacy and duration
 With the development of drug tolerance the
rewarding effect of drugs diminishes
- Not easily countered by using more drugs
 Why then does the frequency of addictive behavior not eventually decrease?

Question 6

OPERANT ADDICTION explains… and does not explain…

Answer 6

 Operant conditioning can explain why drug use
initially increases in strength and frequency
 Operant conditioning view cannot explain why
excessive drug use persists

Question 7

CHOICE BEHAVIOR

Answer 7

 Behavior is not restricted to specific R‐O contingencies
 People constantly have to make choices between different options:
“Shall I go to the movies or stay at home and study?”
 Dynamic choices

Question 8

2 possible answers on restaurant problem:

Answer 8

Local choice: decide by day
global choice: decide for multiple days

Question 9

WHAT’S SPECIAL ABOUT DRUG REINFORCEMENT
AS OPPOSED TO NATURAL REINFORCERS?

Answer 9

1. Drugs deliver more immediate reward than natural reinforcers
2. Drug reinforcement is more salient (e.g. intoxication)
3. Drug use affects motivational reward systems
   subverting the rewarding properties of natural
   reinforcers

Question 10

Heyman statements:

Answer 10

• Addiction is not a disease
• Addiction is a disorder of choice:
   Constrained choice;
   Voluntary behavior;
   Does not mean one chooses to be an addict;
   Someone chooses for the current best option
  (local choice)

Question 11

ADDICTION AS REINFORCEMENT PATHOLOGY Bickel

Answer 11

• Addictive behaviors can be explained as reinforcementpathologies
• 2 principles: demand and discounting

Question 12

DEMAND

Answer 12

 Refers to resources allocated to obtaining substance
 Time, money, effort
 Demand = amount purchased at given price
 Elasticity of demand: Inelastic = insensitive to price change

Question 13

Delay discounting

Answer 13

 Decrease in reinforcer value as function of time
 Smaller immediate rewards vs larger delayed rewards

 Chronic exposure to drugs is associated with increased delay discounting
 Steep delay discounting is associated with
 Severity of substance misuse and dependence
 Reduced treatment success
 Etiological factor: Individual differences in discounting
predict initiation of substance use and development of addictive behaviour

Question 14

Heyman VS Bickel

Answer 14

rewarding value of drugs VS demand
Local bookkeeping VS delay discounting

Addiction develops and persists because
 Substances are valued more than other reinforcers
 People in general and addicts in particular have a preference for immediate gain compared to long‐term consequences (impulsive decision making)

Question 15

TREATMENT AND POLICY

Answer 15

 Constrain unhealthy choice
 Reduce availability (increase effort)
 Increase price (cost)
 Reduce constraints on healthy choice
 Provide healthy alternatives (reduce effort)
 Reduce cost
 Promote global bookkeeping / decrease discount rate
 Improve executive functions

Question 16

CONTINGENCY MANAGEMENT

Answer 16

 Constraint on unhealthy choice
 Increased opportunity cost due to loss of reinforcement
 Escalating reinforcement schedules
> opportunity cost increases over time
 Reduced constraint healthy choice
 Increase availability of drug‐free reinforcers
 Reinforcement of healthy alternatives

Question 17

relapse according to Heyman

Answer 17

Heyman: Relapse is the result of a switch from an global to a local value function

Question 18

PAVLOVIAN ADDICTION relapse (cues)

Answer 18

 Cues are associated with drug use/effect
 Cues elicit conditioned drug responding:
1. subjective craving, physiological responses
2. drug‐seeking behavior
3. cues may ALSO elicit local bookkeeping

Question 19

CONCLUDING COMMENTS:
operant conditioning,
behavioural economics and
povlovian conditioning

Answer 19

 Operant conditioning
 Explains initial increase in drug use

 Behavioral economics
 Explains the persistence of drug use

 Pavlovian conditioning
 Pavlovian conditioning is likely to underlie relapse