Behavioral Economic Mechanisms of Behavior Change ... · Behavioral economics studies the transactions people make with the world Macroeconomics: analysis of whole economies Microeconomics:

Behavioral Economic Mechanisms of Behavior Change: Conceptual Relevance and Delay Discounting as a Candidate

James MacKillop, PhDAssociate Professor, Department of Psychology

Associate Director, Owens Institute for Behavioral Research

Overview

Brief introduction to behavioral economics

Delay discounting as a candidate mechanism of behavior change

Definition and measurement

Cross-sectional association with AUDs

Prospective and clinical studies

What is Behavioral Economics?


Behavioral economics studies the transactions people make with the world

Macroeconomics: analysis of whole economies

Microeconomics: analysis of individual companies and households

Behavioral economics: analysis of person-level consumption and choice

Behavioral economics is a hybrid of psychology and microeconomics

Formalized study of values, preferences, and decision-making

Rational vs. irrational choices

homo economicus vs. homo irrationalis

Systematic causes of irrationality


Application to addiction

Addiction as a disorder of persistent irrationality

Decision making as a final common pathway of risk and recovery

Decision-making processes of interest

Cost-benefit decision making

Risk decision making

Intertemporal choice

Delay Discounting as a Candidate Mechanism of Behavior Change

Delay of Gratification

Now Later

Which would you prefer?

e.g., Mischel et al., 1958, 1989, 1999, 2011


Now Later


e.g., Mischel et al., 1958, 1989, 1999, 2011


Now Later


e.g., Mischel et al., 1958, 1989, 1999, 2011


Now Later


e.g., Mischel et al., 1958, 1989, 1999, 2011


Now Later


e.g., Mischel et al., 1958, 1989, 1999, 2011


Now Later


e.g., Mischel et al., 1958, 1989, 1999, 2011


Now Later


e.g., Mischel et al., 1958, 1989, 1999, 2011

Delay Discounting

Behavioral economic index of impulsivity

Delay discounting refers to the amount that a reward is discounted based on its delay in time

Smaller-Sooner vs. Larger-Later Preferences

Delay Discounting Task

Would you rather have $A today or $B in C days?

Points of indifference gathered across time periods

Temporal Discounting Function(s):

V = A/(1 + kD)

Ainslie, 1975; Bickel & Marsh, 2000; Mazur, 1987; Rachlin & Green, 1972; Reynolds, 2006

Delay Discounting



Smaller-Sooner vs. Larger-Later Preference


Would you rather have $99 today or $100 in 21 days?



V = A/(1 + kD)


Delay Discounting



Smaller-Sooner vs. Larger-Later Preference


Would you rather have $1 today or $100 in 21 days?



V = A/(1 + kD)


Points of Indifference

$0

$20

$40

$60

$80

$100

0 20 40 60 80 100

Delay in Days

Subj

ectiv

e Va

lue

Temporal Discounting Function

$0

$20

$40

$60

$80

$100

0 20 40 60 80 100

Delay in Days

Subj

ectiv

e Va

lue

Relative Level of Impulsivity

de Wit and Richards (2004)

Links with Alcoholism and Other Addictive Disorders

Discounting and Addictive Behavior

Clinical presentation

AUD+ individuals manifestly exhibit high present orientation

Hyperbolicity may explain loss of control

Cross-sectional studies

Categorical studies

Dimensional studies

Longitudinal studies

Etiological

Clinical

Delay Discounting and Alcohol Use Disorders

MacKillop et al. (2010)

Cross-Sectional Discounting Curves

Bickel et al., 1999; Coffey et al., 2003; MacKillop et al., 2010; Madden et al., 1997; Petry, 2001

p <.05 p <.10 p >.10 MacKillop et al. (2011)

Meta-Analysis of Dimensional Studies

Drug k r Z p

All Addiction Variables 79 .16 9.51 <.00001

Quantity-Frequency 38 .14 5.89 <.00001

Clinical Severity 41 .17 7.74 <.00001

Alcohol Studies 31 .17 5.98 <.00001

Tobacco Studies 27 .19 5.96 <.00001

MacKillop et al. (in progress)

Meta-Analysis of Diverse Facets of Impulsivity

Cyders & Coskunpinar (2011)

Longitudinal Evidence

Longitudinal Risk Studies

Poor delay of gratification in pre-schoolers is associated with drug use at 20 years follow-up

Impulsive delay discounting predicts smoking onset but does not itself significant change over 5 years of adolescence

Impulsive delay discounting mediates the significant association between working memory and escalating alcohol use from age 11-16

Impulsive delay discounting predicts alcohol involvement from age 12-15 but is not itself affected by drinking

Audrain-McGovern et al. (2009); Ayduk et al. (2000) Fernie et al., (2013); Khurana et al. (2013)


Longitudinal Risk Studies

Audrain-McGovern et al. (2009); Ayduk et al. (2000) Fernie et al., (2013); Khurana et al. (2013)

Animal Models of Drug Use Acquisition

Parallel evidence in rodent models

Impulsive discounting is associated with acquisition of drug self-administration

Alcohol

Methylphenidate

Cocaine

Gipson & Bardo (2009); Marusich & Bardo (2009); Poulos et al. (1995); Perry et al. (2005, 2006)


Prospective Clinical Studies

Krishnan-Sarin et al. (2007); MacKillop & Kahler (2009); Tucker et al. (2002, 2006, 2009); Shaffer et al., in press; Yoon et al. (2007)

Discounting and Smoking Cessation

Impulsivity is inversely associated with days to smoking lapseMacKillop & Kahler (2009)

Discounting and Smoking Cessation

Impulsivity is inversely associated with days to smoking lapseMacKillop & Kahler (2009)

Discounting and Treatment Response

Study Condition

Tucker et al. (2002) Alcohol dependence


MacKillop & Kahler (2007) Nicotine dependence

Krishnan-Sarin et al. (2007) Nicotine dependence

Yoon et al. (2007) Nicotine dependence


Passetti et al. (2011) Opiate Dependence

Washio et al. (2011) Cocaine dependence

Stanger et al. (2012) Marijuana abuse

Sheffer et al. (2012) Nicotine dependence

Best et al. (2012) Obesity

Peters et al. (2013)* Marijuana Dependence

MacKillop et al. (in preparation) Nicotine Dependence

Interventions to Ameliorate Discounting

Promising initial findings

Working memory training

Viewing a virtual reality future self

Episodic future thinking

Advisor-Teller Money Manager

Reward bundling training

Credible mechanism for existing interventions

Motivational Interviewing change plans implicitly extend time perspective into the future

Escalating contingency management regimens reinforce larger-later preferences

Black & Rosen (2011); Bickel et al. (2011); Epstein et al., (2011); Hofmeyr et al. (2011)

Conclusions

Convincing evidence of an etiological role

Associated with AUDs and other addictive disorders

Evidence of specificity

Predictive of onset and escalation of drug use in humans and animals

Predictive of poor treatment prognosis

MOBC status

Amenable to positive modification

Parallels to existing treatments

Promising candidate

Acknowledgments

Collaborators

University of Georgia

Steven Beach, PhD; Gene Brody, PhD; Adam Goodie, PhD; Steve Kogan, PhD; Paul Roman, PhD; Lawrence Sweet, PhD

Brown University

Peter Monti, PhD; Damaris Rohsenow, PhD; Robert Swift, MD, PhD; Jennifer Tidey, PhD, Robert Miranda, Jr., PhD; John McGeary, PhD; Valerie Knopik, PhD

University of Memphis: Jim Murphy, PhD

UCLA: Lara Ray, PhD

University of Illinois, Chicago: Frank Chaloupka, PhD

Virginia Tech: Warren Bickel, PhD

University of Missouri: Michael Amlung, PhD

UGA Experimental and Clinical Psychopharmacology Lab

Acknowledgments

National Institute on Alcohol Abuse and Alcoholism

K23 AA016936 (MacKillop)

R21 AA017696 (MacKillop)

R01AA018129 (Cook)

National Institute on Drug Abuse

P30 DA027827 (Brody)

R01 DA 032015 (de Wit)

R21 DA031269 (Sweet)

R01 DA028188 (Eby)

R01 DA034739 (Obasi)

National Heart, Lung, and Blood Institute - R21 HL113742-01 (Schmidt)

National Center for Responsible Gaming (Goodie)

Alcoholic Beverage Medical Research Foundation (MacKillop)

Global Research Advances in Nicotine Dependence (MacKillop)

Robert Wood Johnson Foundation (MacKillop)

Thank You

Documents

Behavioral Economic Mechanisms of Behavior Change ... · Behavioral economics studies the transactions people make with the world Macroeconomics: analysis of whole economies Microeconomics: