The Behavioral Economics of Substance Abuse
Alcohol and other drugs have always been around and with how fast-paced the world is, their use and abuse have grown. Have you ever wondered what got us to this point?
The Behavioral Economic Theory
To understand the reasoning behind substance abuse, we have to look at it from economic and psychological aspects, which brings us to the behavioral economic theory of substance abuse. It represents the reinforcers and contingencies, whether endogenous, as a subjective response to drugs, stress or arousal, or exogenous, which are the environmental factors such as low availability of alternatives, low prices of substances, social contexts that promote substance use, as well as life events that cause stress or dysphoria, that push the individual toward making cost-benefit decisions (Murphy & Dennhardt, 2016).
What Pushes the Individual Towards Substance Abuse?
One opts for substance use when the substance in question is highly valued as a reinforcer, which makes it a reinforcer pathology, where one chooses immediate smaller rewards over delayed larger ones. Another factor is the relative availability and their benefit-cost ratio compared to other substance-free alternatives. In other words, substance abuse is an inverse function of constraints on the substance and a direct function of constraints on access to alternative rewards (Acuff et al., 2020).
Substance Abuse Determinants
Demand:
Demand is the amount of a commodity purchased at a given price, which could be a monetary cost, effort, or time to obtain a commodity or combination of commodities (Bickel et al., 2014). With the substance in question, it means the extent to which it is sought or consumed under condition of prices. This is measured by the unit price. In behavioral studies, unit price is often modeled with response requirement (ex: with a fixed-ratio schedule of reinforcement) and is defined as the cost divided by the reinforcer magnitude. Different types of demand determine substance abuse (Gray & MacKillop, 2015), and the effects of changing price on purchasing behavior can be meandered by measuring the demand’s elasticity, where it is inelastic when insensitive to price change and vice versa.
Trait-Based Demand
This form of demand is the estimated typical consumption level at varying price levels. Consumption level is consistently associated with an increase in symptoms of depression, post-traumatic stress disorder, and other aversive psychological symptoms. In addition, there is a correlation between substance abuse, specifically alcohol, and smoking.
State-Based Demand
This form of demand is the demand in varying conditions, primarily assessed through craving, which shows a dynamic increase in substance cue reactivity paradigm (experimental paradigm from addiction research where cues are conditioned stimuli related to reward anticipation) and may complement existing measures of acute motivation, such as affect, stress, and arousal.
Behavioral Theories of Choice
Behavioral theories of choice compare the substance demand to other commodities. With substance-free commodities like exercise, food, and sex, its reward isn’t as instantaneous as substance use but it is more beneficial in the longer term. With frequent substance abuse, substance-free commodities are no longer as rewarding as the substances used, and the individual grows more insensitive to them, which makes the vicious cycle of addiction ongoing.
Delayed Reward Discounting (DRD):
DRD is the reinforcer pathology, as mentioned above, which is measured through inter-temporal choice tasks made of dichotomous choices between smaller immediate and larger delayed rewards. In individuals suffering from substance abuse, they have greater impulsive DRD than healthy individuals. It is also associated with addiction severity, quantity, and frequency, and it mediates the relationship between reduced working memory capacity and increased drinking frequency over time. However, it is not known whether it is a risk factor or a consequence of prolonged use, but DRD can predict earlier onset of substance misuse symptoms and severity (Gray & MacKillop, 2015).
Substance Abuse in Young Adults
Studies showed higher rates of heavy episodic drinking (32% consume 4-5 drinks in a sitting for women and men) and illicit drug use (22% more than any other age group). Also, more than half of those who attend college report slightly higher rates of current episodic drinking and drug use than those who don’t attend college (Murphy & Dennhardt, 2016). Additionally, substance use increases their risk of unsafe sexual activity and assault, blackouts, arrests, injuries, and fatal accidents.
This is because young adulthood is characterized by a neuro-developmentally mediated tendency towards excessive reward-seeking behavior, impulsivity, dysphoria, mood instability, and risk-taking. Moreover, substance use occurs in social contexts among young adults, where it is accepted and not stigmatized and can effectively ease social and sexual relationships when it is developmentally critical. On top of that, they have less structured time and fewer responsibilities, and all this makes the reward of substance-free behavior increase the opportunity cost (values or benefits lost when you choose one option or alternative over the other) of drinking or drug use.
Measure of Substance Abuse
Substance abuse can be measured through alcohol and drug purchase tasks, which are useful indices for the strength of motivation for substance use among young adults, given that they control for contextual variables that might generate discrepancies between actual recent and desired consumption levels (for instance, age, legal restrictions, and limited income) (Murphy & Dennhardt, 2016). Additionally, there is the intensity variable, which is the ability to modulate use when substances are available with minimal or no constraints.
Such indices are useful since they assess price sensitivity and may model a person’s ability to regulate drinking in response to contingencies that may be ultimately protective against substance abuse. Also, it can assess beyond price, for example, the presence of employment, college classes, volunteer activities the morning after a drinking event, or specific drinking decisions in high-risk situations, like drinking while having to drive. Add to that the fact that it can show meaningful relations to the real-world patterns of substance abuse and problems and can model the impact of potential prevention efforts and identify those at risk of substance abuse in response to important contingencies.
Clinical Applications of Behavioral Economics and Preventive Measures for Substance Abuse
Such applications aim to alter the reinforcement contingencies in an individual’s life and push him to value sobriety more, and increase the substance use’s cost (Gray & MacKillop, 2015). Such interventions should encourage thinking about future desired outcomes and view their daily behaviors as part of a larger behavior pattern necessary to achieve them. There are several approaches and reinforcements that can be done to reach our aim.
Community Reinforcement Approach (CRA):
The CRA targets the environmental contingencies in a patient’s life so that abstinence and sobriety become more valuable and reinforcing than substance abuse. Such an approach has shown very positive outcomes for various groups of people.
Community Reinforcement Approach Family Training (CRAFT):
It is a modification of the CRA that aims to change the home environmental contingencies to positively reinforce not drinking and encourage the individual to seek treatment since more people are involved in the process.
Contingency Management (CM)
It reinforces pro-treatment outcomes through the use of direct incentives. For instance, the use of compliance tests to measure the levels of ethyl glucuronide (EtG) in urine and breath alcohol content (BrAC) substantially increased the individuals’ abstinence in a CM feasibility trial.
Brief Motivational Intervention (BMI) Combined with Behavioral Economic Supplements:
BMI with behavioral economic supplements was proven to be more beneficial than BMI alone as it emphasizes the importance of academic contingencies, increasing involvement in substance-free activities, and examining the discrepancies between the individual’s drinking behavior and his goals.
Targeting Delay Discounting:
Such an approach is better than CRA and CM since they require substantial resources from both the provider and the participant, making it difficult to implement with most individuals since they already have little motivation to seek treatment. It aims at reducing impulsive choices by increasing the salience of delayed outcomes and the behaviors leading to the rewards or punishers as part of a coherent pattern. It also aims to plant the concept of episodic future thinking, which can reduce delay discounting and may promote positive, healthy outcomes.
Substance-Free Activity Sessions (SFAS):
It is a single-session intervention supplementing a standard alcohol or drug-focused motivational interview (MI). Motivational interviewing targets behavioral economic mechanisms of substance-free reinforcement and DRD. The best results were found when MI was applied with elements from CBT or CRA and behavioral activation.
Other Approaches:
For one thing, colleges and universities should increase the cost of substances used by scheduling more early morning and Friday classes and decrease the cost of substance-free activities by making them free of charge and at suitable times and locations. The same applies to workplaces, where they should make schedules that make their people active in the morning (Murphy & Dennhardt, 2016).
Moreover, there should be a focus on social capital (patterns of engagement, trust, and mutual obligation among people with social structures), as individuals with increased social capital have shown a reduced risk of binge-using. This can be achieved by encouraging participation in worksites, church, and community efforts to encourage mentoring or service and community programs that promote access to higher education and awareness of economic benefits associated with completing higher education, especially 4-year college degrees.
Finally, with alcohol and drugs with little stigma around them, such as marijuana, one can make advertising campaigns that highlight the harms of their heavy use or increase their prices. Additionally, one can push cities to make licensing requirements stricter in areas where colleges and universities reside and limit the extreme drink specials found close to campuses.
Conclusion
Substance use and abuse are all around us and one should understand the reasoning behind it to protect oneself from it or help loved ones around you suffering from it.
Works Cited
Acuff, S. F., Tucker, J. A., & Murphy, J. G. (2020). Behavioral economics of substance use: Understanding and reducing harmful use during the COVID-19 pandemic. Experimental and Clinical Psychopharmacology, 29(6). https://doi.org/10.1037/pha0000431
Bickel, W. K., Johnson, M. W., Koffarnus, M. N., MacKillop, J., & Murphy, J. G. (2014). The Behavioral Economics of Substance Use Disorders: Reinforcement Pathologies and Their Repair. Annual Review of Clinical Psychology, 10(1), 641–677. https://doi.org/10.1146/annurev-clinpsy-032813-153724
Gray, J. C., & MacKillop, J. (2015). Using Behavior Economics to Understand Alcohol Use Disorders: a Concise Review and Identification of Research Priorities. Current Addiction Reports, 2(1), 68–75. https://doi.org/10.1007/s40429-015-0045-z
Murphy, J. G., & Dennhardt, A. A. (2016). The behavioral economics of young adult substance abuse. Preventive Medicine, 92, 24–30. https://doi.org/10.1016/j.ypmed.2016.04.022
