Change in alcohol demand following a brief intervention predicts change in alcohol use: A latent growth curve analysis.

BACKGROUND: The association between behavioral economic demand and various alcohol use outcomes is well established. However, few studies have examined whether changes in demand occur following a brief alcohol intervention (BAI), and whether this change predicts alcohol outcomes over the long term. METHODS: Parallel process piecewise latent growth curve models were examined in a sample of 393 heavy drinking emerging adults (60.8% women; 85.2% white; Mage  = 18.77). In these models, two linear slopes represented rates of change in alcohol use, heavy drinking episodes, alcohol-related problems, and demand (intensity and highest expenditure across all price points or Omax ) from baseline to 1 month (slope 1) and 1 month to 16 months (slope 2). Mediation analyses were conducted to estimate the effect of a BAI on 16-month alcohol outcomes through slope 1 demand. RESULTS: A two-session BAI predicted significant reductions in all five outcomes from baseline to 1-month follow-up. Although no further reduction was observed from the 1-month to the 16-month follow-up, there was no regression to baseline levels. Slope 1 demand intensity, but not Omax , significantly mediated the association between BAI and both outcomes-heavy drinking episodes (Est. = -0.23, SE = 0.08, p < 0.01) and alcohol-related problems (Est. = -0.15, SE = 0.07, p < 0.05)-at the 16-month follow-up. CONCLUSIONS: Reducing high valuation of alcohol among heavy drinking emerging adults within the first month following BAI is critical for the long-term efficacy of the intervention. A two-session BAI was associated with enduring reductions in alcohol demand, and the change in demand intensity, but not Omax , was associated with sustained reductions in heavy drinking and alcohol-related problems.

Trajectories of reward availability moderate the impact of brief alcohol interventions on alcohol severity in heavy-drinking young adults.

BACKGROUND: Behavioral economic theory predicts that low access to environmental reward is a risk factor for alcohol use disorder (AUD). The Substance-Free Activity Session (SFAS) is a behavioral economic supplement to standard brief alcohol interventions that attempts to increase environmental reward and may therefore have beneficial effects, particularly for individuals with low levels of environmental reward. METHODS: Participants were 393 college students who reported at least 2 heavy-drinking episodes in the past month. Participants were randomly assigned to 1 of 3 conditions following a baseline assessment: a standard alcohol-focused brief motivational intervention plus relaxation training session (BMI + RT), BMI plus Substance-Free Activity Session (BMI + SFAS), or an assessment-only control condition (AO). In a secondary analysis of the data from this study, we used person-centered statistical techniques to describe trajectories of alcohol severity and environmental reward over a 16-month follow-up and examined whether environmental reward levels moderated the effectiveness of the interventions. RESULTS: Piecewise growth mixture modeling identified 2 trajectories of reward availability: low increasing (LR; n = 120) and high stable (HR; n = 273). Depressive symptoms, cannabis use, sensation seeking, and low life satisfaction were associated with a greater probability of classification in the LR trajectory. Alcohol severity was greater in the LR trajectory than the HR trajectory. For students in the LR trajectory, at 1, 6, and 12 months, BMI + SFAS led to greater increases in reward availability and reduced levels of alcohol severity compared with the BMI + RT and AO conditions and at 16 months compared with AO. CONCLUSIONS: Young adults with low levels of environmental reward are at heightened risk for greater alcohol severity and may show greater benefit from brief alcohol interventions that focus on increasing substance-free reward than individuals who are not deficient in reward availability.

Brief Motivational Interventions Are Associated with Reductions in Alcohol-Induced Blackouts Among Heavy Drinking College Students.

BACKGROUND: Alcohol-induced blackouts, a form of anterograde amnesia that restricts the encoding of short-term memories into long-term ones, are among the most severe alcohol-related consequences. College students are at high risk of experiencing alcohol-induced blackouts, and there is a need to determine whether alcohol interventions can effectively reduce blackouts in this population. The current study uses data from 3 randomized clinical trials to examine the effect of various intervention approaches on alcohol-induced blackouts. METHODS: Four interventions were compared over 3 studies: (i) a computerized feedback intervention (electronic Check-Up To Go [e-Chug]; Study 1); (ii) a single-session brief motivational intervention (BMI; Study 1); (iii) a BMI plus behavioral economic session focused on increasing substance-free activities (BMI + Substance-Free Activity Session [SFAS]; Studies 2 and 3); and (iv) a BMI plus supplemental Relaxation Training session (BMI + Relaxation Training; Studies 2 and 3). Studies 1 and 3 also included an assessment-only control condition. For each study, participants reported whether they had experienced an alcohol-induced blackout at each time point; binary logistic regressions examined differential likelihood of experiencing an alcohol-induced blackout over time. RESULTS: Neither the single-session BMI nor e-Chug reduced alcohol-induced blackouts over assessment only; however, participants in the BMI + SFAS or BMI + Relaxation Training condition were significantly less likely to experience an alcohol-induced blackout compared to assessment only at 1-month (Wald = 4.77, odds ratio [OR] = 0.53, p = 0.03) and 6-month follow-ups (Wald = 5.72, OR = 0.52, p = 0.02). Study 2 also revealed a larger effect for the BMI + SFAS over the BMI + Relaxation Training condition at 6 months (Wald = 4.11 OR = 0.22, p = 0.043), although this was not replicated in Study 3. The effects for the 2-session BMIs lasted 6 months, at which point maturation effects diminished differences between assessment-only and intervention conditions. CONCLUSIONS: Two sessions of BMI are a substantial enough dose to result in reductions in alcohol-induced blackouts among college student heavy drinkers.

High Opportunity Cost Demand as an Indicator of Weekday Drinking and Distinctly Severe Alcohol Problems: A Behavioral Economic Analysis.

INTRODUCTION: Behavioral economic theory views addiction as a reinforcer pathology characterized by excessive demand for drugs relative to alternatives. Complementary to this theory, Lamb and Ginsburg (Pharmacology Biochemistry and Behavior, 164, 2018, 62) describe addiction as a behavioral allocation disorder and predict that decisions to drink under increasingly stringent constraints are a central indicator of addiction. This study used a modified demand-curve paradigm to examine alcohol demand in the context of a next-day contingency (high opportunity cost demand) as a specific indicator of a severe pattern of alcohol problems. METHODS: Participants were 370 undergraduates (61.1% female, 86.5% white, Mage  = 18.8) reporting multiple past-month heavy drinking episodes (5/4 drinks per occasion for men/women) who completed 2 versions of an alcohol purchase task (APT), along with measures of past-month alcohol use and problems. In 1 APT (low opportunity cost), students imagined they had no next-day responsibilities, and in the other APT (high opportunity cost), they imagined having a 10:00 am test the next day. Item-response theory analyses were used to determine mild and severe alcohol problems from the Young Adult Alcohol Consequences Questionnaire (Journal of Studies on Alcohol, 67, 2006, 169), and the most and least severe binge drinking days throughout the week. RESULTS: Low opportunity cost demand (ß = 0.15, p = 0.02) significantly predicted beyond high opportunity cost demand for the least severe problems, and high opportunity cost demand (ß = 0.17, p = 0.009) significantly predicted beyond low opportunity cost demand for the most severe problems. Similarly, low opportunity cost demand (ß = 0.26, p < 0.001) was more highly associated with weekend drinking, whereas high opportunity cost demand (ß = 0.21, p = 0.001) was more highly associated with weekday drinking. CONCLUSIONS: The current results suggest high opportunity cost alcohol demand is a distinct marker of severe alcohol problems among college student heavy drinkers.

Evaluating Behavioral Economic Models of Heavy Drinking Among College Students.

BACKGROUND: Heavy drinking among college students is a significant public health concern that can lead to profound social and health consequences, including alcohol use disorder. Behavioral economics posits that low future orientation and high valuation of alcohol (alcohol demand) combined with deficits in alternative reinforcement increase the likelihood of alcohol misuse. Despite this, no study has examined the incremental utility of all 3 variables simultaneously in a comprehensive model. METHODS: This study uses structural equation modeling to test the associations between behavioral economic variables-alcohol demand (latent), future orientation (measured with a delay discounting task and the Consideration of Future Consequences [CFC] scale), and proportionate substance-related reinforcement-and alcohol consumption and problems among 393 heavy drinking college students. Two models are tested as follows: (i) an iteration of the reinforcer pathology model that includes an interaction between future orientation and alcohol demand; and (ii) an alternative model evaluating the interconnectedness of behavioral economic variables in predicting problematic alcohol use. RESULTS: The interaction effects in Model 1 were nonsignificant. Model 2 suggests that greater alcohol demand and proportionate substance-related reinforcement are associated with greater alcohol consumption and problems. Furthermore, CFC was associated with alcohol-related problems and lower proportionate substance-related reinforcement but was not significantly associated with alcohol consumption or alcohol demand. Finally, greater proportionate substance-related reinforcement was associated with greater alcohol demand. CONCLUSIONS: Our results support the validity of the behavioral economic reinforcer pathology model as applied to young adult heavy drinking.

Deficits in Access to Reward Are Associated with College Student Alcohol Use Disorder.

BACKGROUND: Reward deprivation has been implicated in major depressive disorder and severe substance abuse, but its potential relation to alcohol use disorder (AUD) symptoms in non-treatment-seeking young adult drinkers is less clear. Depression is often comorbid with alcohol misuse, so relations of AUD with reward deprivation might be due in part to the presence of depressive symptoms in young adults. Behavioral economic theory views addiction as a state that is related in part to deficits in drug-free rewards, and therefore requires an investigation into whether reward deprivation has a direct relation to alcohol misuse that is, at least partially, independent of mood. METHODS: This study evaluates the contribution of 2 facets of reward deprivation (reward availability and experience) to alcohol use, AUD symptoms, and depression in a sample of young adult heavy episodic drinkers. Data were collected from 392 undergraduates (60.4% female, 85.1% Caucasian) who reported recent heavy drinking (83.7% with at least 1 AUD symptom). RESULTS: Low reward availability (environmental suppression) was significantly associated with both DSM-5 AUD symptoms and alcohol-related problems after controlling for age, gender, depressive symptomatology, and drinking level. CONCLUSIONS: This study provides support for behavioral economic models that emphasize reward deprivation as a unique risk factor for AUD that is independent of mood and drinking level. Limited access to natural rewards may be a risk and/or maintaining factor for AUD symptoms in college student drinkers.

The behavioral economics of young adult substance abuse.

Alcohol and drug use peaks during young adulthood and can interfere with critical developmental tasks and set the stage for chronic substance misuse and associated social, educational, and health-related outcomes. There is a need for novel, theory-based approaches to guide substance abuse prevention efforts during this critical developmental period. This paper discusses the particular relevance of behavioral economic theory to young adult alcohol and drug misuse, and reviews of available literature on prevention and intervention strategies that are consistent with behavioral economic theory. Behavioral economic theory predicts that decisions to use drugs and alcohol are related to the relative availability and price of both alcohol and substance-free alternative activities, and the extent to which reinforcement from delayed substance-free outcomes is devalued relative to the immediate reinforcement associated with drugs. Behavioral economic measures of motivation for substance use are based on relative levels of behavioral and economic resource allocation towards drug versus alternatives, and have been shown to predict change in substance use over time. Policy and individual level prevention approaches that are consistent with behavioral economic theory are discussed, including brief interventions that increase future orientation and engagement in rewarding alternatives to substance use. Prevention approaches that increase engagement in constructive future-oriented activities among young adults (e.g., educational/vocational success) have the potential to reduce future health disparities associated with both substance abuse and poor educational/vocational outcomes.

Elevated alcohol demand is associated with driving after drinking among college student binge drinkers.

BACKGROUND: Alcohol-impaired driving among college students represents a significant public health concern, yet little is known about specific theoretical and individual difference risk factors for driving after drinking among heavy drinking college students. This study evaluated the hypothesis that heavy drinkers with elevated alcohol demand would be more likely to report drinking and driving. METHOD: Participants were 207 college students who reported at least 1 heavy drinking episode (4/5 or more drinks in 1 occasion for a woman/man) in the past month. Participants completed an alcohol purchase task that assessed hypothetical alcohol consumption across 17 drink prices and an item from the Young Adult Alcohol Consequences Questionnaire that assessed driving after drinking. RESULTS: In binary logistic regression models that controlled for drinking level, gender, ethnicity, age, and sensation seeking, participants who reported higher demand were more likely to report driving after drinking. CONCLUSIONS: These results provide support for behavioral economics models of substance abuse that view elevated/inelastic demand as a key etiological feature of substance misuse.

Correspondence between the alcohol-P3 event-related potential and alcohol reward phenotypes among young adults.

BACKGROUND: Behavioral economic theory suggests that the value of alcohol depends upon elements of the choice context, such that increasing constraints on alternatives (e.g., price) or increasing the benefits of alcohol (e.g., social context) may result in greater likelihood of heavy drinking. The P3 event-related potential elicited by alcohol-related cues, a proposed marker of incentive salience, may be an electrophysiological parallel for behavioral economic alcohol demand. However, these indices have not been connected in prior research, and studies typically do not disaggregate social influences in the context of alcohol cue reactivity. METHOD: The current study recruited heavy drinking young adults (N = 81) who completed measures of alcohol use and alcohol demand, in addition to a 2 (social/nonsocial) × 2 (alcohol/nonalcohol) visual oddball task to elicit the P3. RESULTS: In multilevel models controlling for demographic characteristics, P3 reactivity was greater to alcohol (p < 0.001) and social (p < 0.001) cues than to nonalcohol and nonsocial cues, but without a significant interaction. Higher alcohol consumption (p = 0.02) and lower elasticity of demand (p = 0.01) were associated with greater P3 response to alcohol than nonalcohol cues. CONCLUSIONS: The results highlight a brain-behavior connection that may be an important marker for alcohol reward across units of analysis and may be sensitive to changes in the economic choice contexts that influence the likelihood of alcohol use.

Behavioral Economic and Wellness-based Approaches for Reducing Alcohol Use and Consequences Among Diverse Non-Student Emerging Adults: Study Protocol for Project BLUE, a Randomized Controlled Trial.

Background: Emerging adults (EAs) who are not 4-year college students nor graduates are at elevated risk for lifetime alcohol use disorder, comorbid drug use, and mental health symptoms, compared to college graduates. There is a need for tailored brief alcohol intervention (BAI) approaches to reduce alcohol risk and to facilitate healthy development in this high-risk population. Most BAIs include a single session focused on discussing risks associated with drinking and correcting normative beliefs about drinking rates. EAs may benefit from additional elements that enhance general wellness. The Substance-Free Activity Session (SFAS) aims to clarify life goals and values and increase goal-directed activities that provide alternatives to alcohol use, and the Relaxation Training (RT) session teaches relaxation and stress reduction skills. Methods: The present study is a randomized 3-group (BAI+SFAS vs. RT+SFAS vs. education control) trial with 525 EAs (175 per group; estimated 50% women & 50% African American) who report recent risky drinking and who are not students or graduates of 4-year colleges. Participants will have the option of completing the intervention sessions in person or via a secure video teleconference. Levels of drinking and alcohol-related problems will be evaluated at baseline and 1, 3, 6, and 12-months post-intervention. The primary hypothesis is that both BAI+SFAS and RT+SFAS participants will report significantly greater reductions in alcohol use and problems relative to education control participants, with no differences in outcomes between the two active treatment conditions. Discussion: The results of this study will inform alcohol prevention efforts for high-risk community dwelling emerging adults. ClinicalTrialsgov Identifier: NCT04776278.

Behavioral economic and wellness-based approaches for reducing alcohol use and consequences among diverse non-student emerging adults: study protocol for Project BLUE, a randomized controlled trial.

BACKGROUND: Emerging adults (EAs) who are not 4-year college students nor graduates are at elevated risk for lifetime alcohol use disorder, comorbid drug use, and mental health symptoms, compared to college graduates. There is a need for tailored brief alcohol intervention (BAI) approaches to reduce alcohol risk and to facilitate healthy development in this high-risk population. Most BAIs include a single session focused on discussing risks associated with drinking and correcting normative beliefs about drinking rates. EAs may benefit from additional elements that enhance general wellness. The substance-free activity session (SFAS) aims to clarify life goals and values and increase goal-directed activities that provide alternatives to alcohol use, and the relaxation training (RT) session teaches relaxation and stress reduction skills. METHODS: The present study is a randomized 3-group (BAI + SFAS vs. RT + SFAS vs. education control) trial with 525 EAs (175 per group; estimated 50% women and 50% African American) who report recent risky drinking and who are not students or graduates of 4-year colleges. Participants will have the option of completing the intervention sessions in person or via a secure video teleconference. Levels of drinking and alcohol-related problems will be evaluated at baseline and 1, 3, 6, and 12 months post-intervention. The primary hypothesis is that both BAI + SFAS and RT + SFAS participants will report significantly greater reductions in alcohol use and problems relative to education control participants, with no differences in outcomes between the two active treatment conditions. DISCUSSION: The results of this study will inform alcohol prevention efforts for high-risk community dwelling emerging adults. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04776278.

A pilot trial of a brief intervention for cannabis use supplemented with a substance-free activity session or relaxation training.

OBJECTIVE: Cannabis use is increasing among college students and commonly co-occurs with anxiety symptoms in this age group. Interventions that reduce anxiety may also reduce cannabis use. Behavioral economic theory suggests that substance use reductions are most likely when there is an increase in substance-free reinforcement. This randomized pilot trial evaluated the efficacy of a brief motivational intervention (BMI) for cannabis supplemented by either a substance-free activity session (SFAS) or a relaxation training (RT) session for reducing cannabis use, problems, craving, and anxiety symptoms. METHOD: One hundred thirty-two college students (Mage = 19.9; 54% female; 67% White, 31% Black) who reported five or more past-month cannabis use days were randomized to: (a) assessment-only (AO); (b) BMI plus SFAS; or (c) BMI plus RT. Participants in the BMI conditions received two individual counselor-administered sessions plus a brief phone booster session. Outcomes were evaluated 1- and 6-months postintervention. RESULTS: Relative to assessment, both BMI + SFAS and BMI + RT were associated with significant reductions in cannabis problems and craving at 1-month follow-up, and significant reductions in anxiety at 6-month follow-up. Relative to AO, BMI + RT was associated with significant reductions in cannabis use at 1-month follow-up. There were no differences between BMI conditions. CONCLUSIONS: This pilot trial was not adequately powered to conclusively evaluate relative efficacy but provides preliminary support for the short-term efficacy of both two-session interventions for reducing anxiety and cannabis-related risk among nontreatment seeking emerging adults. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A behavioral economic supplement to brief motivational interventions for college drinking.

Basic behavioral and neurobiological research has demonstrated that deficiencies in naturally occurring substance-free rewards are both a cause and a consequence of substance abuse that are due in part to the systematic discounting of delayed substance-free rewards. Existing brief motivational interventions (BMIs) for alcohol abuse do not target this mechanism of change. The goal of this uncontrolled pilot study was to evaluate a behavioral economic Substance-Free Activity Session (SFAS) to traditional alcohol BMIs. Participants were 13 college freshmen who reported two or more heavy drinking episodes (>5/4 drinks in an occasion for men/ women) in the past month. All participants completed a baseline assessment and a BMI that addressed alcohol use. In addition, participants received the SFAS, a 50-min individual session that attempts to increase engagement in constructive alternatives to drinking by enhancing the salience of delayed rewards (academic and career success) and the patterns of behavior (academic and extracurricular engagement) leading to these outcomes. At the 1-month follow-up assessment, participants reported significant reductions in heavy drinking, and moderate to large effect size reductions in weekly drinking and peak blood alcohol levels. The results of this pilot study provide preliminary support for the efficacy of this behavioral economic intervention session as a supplement to traditional alcohol BMIs.

Alcohol-related consequences in African American and European American college students.

Approximately 50% of college students report a heavy drinking episode in the past 2 weeks. This pattern of heavy episodic drinking places them at risk for experiencing alcohol-related problems. In addition, important ethnic differences exist between European American and African American college students in terms of drinking. European American college students report consuming more alcohol than African American college students, but little research exists on the differences in types and rates of problems. The current study sought to examine the differences in problems among 451 African American and European American college students using a comprehensive measure of alcohol-related problems. The effect of gender was also examined as research has found consistent gender differences in drinking. European American students experienced more problems overall and greater levels of social/interpersonal problems and risky behaviors even after controlling for drinking level. In addition, women reported significantly greater levels of problems in all domains except physical dependence, risky behaviors, and self-perception when drinking was controlled for.

Beyond BASICS: A scoping review of novel intervention content to enhance the efficacy of brief alcohol interventions for emerging adults.

OBJECTIVE: Brief motivational interventions (BMIs) that include personalized drinking feedback delivered in a motivational interviewing (MI) style have demonstrated reductions in drinking across numerous clinical trials with emerging adults (EAs) ages 18-25. However, effect sizes for these BMIs are generally small to moderate and drinking reductions are often not maintained beyond short-term follow-ups. Additionally, EAs may be more interested in approaches that highlight wellness, mood enhancement, or goal pursuit rather than programs focused exclusively on reducing alcohol-related risk. Thus, there is a need to evaluate novel intervention content as an alternative or supplement to BMIs in this high-risk population. METHOD: This scoping review examined studies of novel intervention elements to reduce alcohol consumption among EAs. Eligible studies were published in peer-reviewed journals in English from January 2015 to September 2021 and evaluated novel brief interventions, operationalized as one to five sessions focused on alcohol-related outcomes with key content beyond what has typically been included in alcohol BMIs. Results were categorized as additions to BMIs or stand-alone interventions and were synthesized within these categories by theoretical approach. RESULTS: Although standard in-person BMIs have the greatest empirical support, there are a variety of alternative intervention approaches that might enhance health and wellness and that can be feasibly integrated with BMIs or offered as an appealing "gateway" to increase help-seeking among EAs who drink alcohol. CONCLUSIONS: More research is needed to empirically evaluate both the relative efficacy of supplements and stand-alone alternatives to BMI among higher risk EAs and their potential for widespread dissemination. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Psychometric evaluation of the Reward Probability Index in emerging adult drinkers.

OBJECTIVE: Diminished access to environmental rewards is an established risk factor for addiction and a focus of many effective treatment approaches. Nevertheless, there is inconsistency in measurement approaches and a need for a psychometrically sound measure. The Reward Probability Index (RPI; Carvalho, Behavior Therapy, 42, 2011, pp. 249-262) is a 20-item self-report rating scale that measures access to and ability to experience psychosocial reward. METHOD: The current studies sought to evaluate the psychometric properties of the RPI in 2 samples of emerging adult heavy drinkers. RESULTS: In Study 1, exploratory factor analysis in a sample of 393 college student drinkers supported a 2-factor model of the RPI (Reward Probability and Environmental Suppressors) after removal of redundant items, and corresponding subscales demonstrated good internal consistency. In Study 2, confirmatory factor analysis with 602 emerging adult drinkers recruited from the community supported the 2-factor model as best fitting after removal of one poor indicator, although absolute fit was only adequate. This 2-factor model demonstrated configural, metric, and scalar invariance across non-college and college subgroups as well as Black and White subgroups. Study 2 also demonstrated that the revised RPI subscales showed significant associations with measures of substance-free activity participation and enjoyment, anhedonia, and depressive symptoms. Furthermore, the study revealed the RPI Environmental Suppressors subscale predicted alcohol-related problems (ß = .25, p < .001) beyond demographic covariates, weekly drinking, and depressive symptoms. CONCLUSIONS: These studies provide evidence for the validity of the RPI as an efficient measure of access to reward among emerging adult heavy drinkers. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Statistically derived patterns of behavioral economic risk among heavy-drinking college students: A latent profile analysis.

High levels of 3 behavioral economic indices (delay discounting, alcohol demand, and proportionate substance-related reinforcement) are consistently associated with greater alcohol misuse and alcohol-related problems. However, it is unclear whether and how these variables jointly increase the risk for alcohol-related outcomes among college students who engage in heavy episodic drinking (HED; 4/5+ drinks for women/men, respectively). The current study used a person-centered approach to identify similar patterns of behavioral economic domains among heavy-drinking college students and investigate the relationship between these empirically derived classes and alcohol-related outcomes. A sample of 393 college students (60.8% female, 78.9% White/Caucasian) reporting at least 2 heavy drinking episodes in the previous month completed measures of alcohol use and problems, demographics, delay discounting, and alcohol reward value (alcohol demand and proportionate substance-related reinforcement). Latent profile analyses revealed that a 3-class solution provided the best fit to the data: a low reward value, high discounting (LRHD) class (n = 53), a moderate reward value, low discounting (MRLD) class (n = 214), and a high reward value, high discounting (HRHD) class (n = 126). Members of the HRHD class reported significantly greater alcohol consumption, past-month HED episodes, alcohol-related problems, and symptoms of alcohol use disorder than those in the MRLD and LRHD classes. The results suggest that there are 3 constellations of behavioral economic processes and that, consistent with the reinforcer pathology model, students who overvalue alcohol-related reward and discount the future more steeply are at the greatest risk for alcohol misuse and alcohol-related problems. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Experimental manipulations of behavioral economic demand for addictive commodities: a meta-analysis.

BACKGROUND AND AIMS: Reinforcing value, an index of motivation for a drug, is commonly measured using behavioral economic purchase tasks. State-oriented purchase tasks are sensitive to phasic manipulations, but with heterogeneous methods and findings. The aim of this meta-analysis was to characterize the literature examining manipulations of reinforcing value, as measured by purchase tasks and multiple-choice procedures, to inform etiological models and treatment approaches METHODS: A random-effects meta-analysis of published findings in peer-reviewed articles. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocol, studies were gathered through searches in PsycINFO and PubMed/MEDLINE (published 22 May 2018). Searches returned 34 unique studies (aggregate sample n = 2402; average sample size = 68.94) yielding 126 effect sizes. Measurements included change (i.e. Cohen's d) in six behavioral economic indices (intensity, breakpoint, Omax , Pmax , elasticity, cross-over point) in relation to six experimental manipulations (cue exposure, stress/negative affect, reinforcer magnitude, pharmacotherapy, behavioral interventions, opportunity cost). RESULTS: Cue exposure (d range = 0.25-0.44, all Ps < 0.05) and reinforcer magnitude [d = 0.60; 95% confidence interval (CI) = 0.18, 1.01; P < 0.005] manipulations resulted in significant increases in behavioral economic demand across studies. Stress/negative affect manipulations also resulted in a small, significant increase in Omax (d = 0.18; 95% CI = 0.01, 0.34; P = 0.03); all other effect sizes for negative affect/stress were non-significant, albeit similar in size (d range = 0.14-0.18). In contrast, pharmacotherapy (d range = -0.37 to -0.49; Ps < 0.04), behavioral intervention (d = -0.36 to -1.13) and external contingency (d = -1.42; CI = -2.30, -0.54; P = 0.002) manipulations resulted in a significant decrease in intensity. Moderators (substance type) explained some of the heterogeneity in findings across meta-analyses. CONCLUSIONS: In behavioral economic studies, purchase tasks and multiple-choice procedures appear to provide indices that are sensitive to manipulations found to influence motivation to consume addictive substances in field experiments.

Menthol cigarette smoking is associated with greater subjective reward, satisfaction, and "throat hit", but not greater behavioral economic demand.

AIMS: The cooling and minty flavor of menthol in cigarettes has been hypothesized to mask the harshness of inhaled cigarette smoke, contributing to menthol's appeal and subjective reinforcement and linking menthol use to smoking initiation, progression, nicotine dependence, and difficulty quitting. This study examined differences between menthol and non-menthol smokers on behavioral economic indices of reinforcing efficacy (i.e., demand) and subjective response to smoking (i.e., satisfaction, reward, "throat hit," aversion) and the association between measurements of reinforcement and subjective response. DESIGN: 600 current adult smokers were recruited from an online smoking cessation program. Following website enrollment, individuals completed a self-report measurement of subjective response to smoking (reward, satisfaction, aversion, "throat hit"), and a modified cigarette purchase task (CPT) to assess behavioral economic cigarette demand. FINDINGS: In bivariate and adjusted ANOVA models, menthol smokers reported greater subjective reward, satisfaction, and positive sensations in the throat ("throat hit") from smoking compared to non-menthol smokers; and those outcomes were also correlated with greater nicotine dependence and lower likelihood of a past-year quit attempt. Although cigarette demand was associated with smoking level, subjective smoking reward, and nicotine dependence, there were no differences in smoking demand between menthol vs. non-menthol smokers. CONCLUSIONS: The pleasurable aspects of menthol vs non-menthol smoking may be a mechanism linking it to greater nicotine dependence and difficulty quitting. A menthol ban could decrease population-level cigarette consumption by restricting smokers' access to a highly rewarding cigarette flavoring.

Measurement of substance-free reinforcement in addiction: A systematic review.

A robust body of theoretical and experimental work highlights the influence of alternative, substance-free rewards on decisions to use alcohol and other drugs. However, translational applications have been limited in part by the lack of consensus on how to measure substance-free reinforcement in applied and clinical settings. The current study summarizes extant research utilizing self-report reinforcement or reward methodologies, and critically reviews the psychometric properties of the available measures. These studies (N = 50) fell into three categories: measures of recent substance-related and substance-free activity participation and enjoyment (n = 32), measures of time or monetary resource allocation (n = 15), and rating scale measures of reward availability and experience (n = 8). The available research suggests that, consistent with experimental laboratory research and with behavioral economic predictions, there is an inverse relation between substance-free reinforcement and substance use. These studies also support the clinical utility of these measures in predicting substance use severity and course. Reinforcement measures could be improved by enhancing content validity, multimethod convergent validity, and generalizability.