Deprivation in Rewards and Alcohol Misuse

C H A P T E R

31 Deprivation in Rewards and Alcohol Misuse Ashley A. Dennhardt1, Samuel F. Acuff1, Ali M. Yurasek2 and James G. Murphy1 1

Department of Psychology, The University of Memphis, Memphis, TN, United States 2Department of Health Education & Behavior, The University of Florida, Gainesville, FL, United States

LIST OF ABBREVIATIONS SFAS RE RPI LET’S ACT

substance-free activity session reinforcing efficacy reward probability index life enhancement treatment for substance use

DEPRIVATION IN REWARDS AND ALCOHOL MISUSE In the late 1970s, psychologist Bruce Alexander conducted the Rat Park experiments that provided a powerful experimental test of the role of environmental reward deprivation as a risk factor for drug selfadministration. The Rat Park studies showed that when compared to rats that were put in an enriched environment in which they had access to food, sex, and leisure activities such as running wheels, rats who were solitarily caged without access to these rewards consumed more morphine, suggesting that environmental reward deprivation is related to drug use (Alexander, Beyerstein, Hadaway, & Coambs, 1981). Vuchinich and Tucker (1988, 1983) extended the finding by demonstrating an inverse relation between choice for alcohol versus monetary alternative rewards among humans. These findings have been widely replicated and led to theoretical models of addiction such as the reinforcement pathology model (Bickel, Jarmolowicz, Mueller, & Gatchalian, 2011; Bickel, Johnson, Koffarnus, MacKillop, & Murphy, 2014) in which alcohol addiction is thought to result from interactions between physiologically mediated subjective response to alcohol, and environmental factors such as low availability of alternative rewards (i.e., reward

Neuroscience of Alcohol. DOI: https://doi.org/10.1016/B978-0-12-813125-1.00031-3

deprivation). The process is self-perpetuating because repeated use of alcohol and other addictive substances will often have negative effects on the availability of alternatives, which will, in turn, increase the relative degree of preference for the drug. This behavior is represented mathematically with the matching law (Herrnstein, 1974), which demonstrates that the relative reinforcing efficacy of a particular behavior is a ratio between the response rate of the behavior and the response rates of other possible reinforcing behaviors. Thus, repeated substance use will be more likely in environments that are deprived of viable drug-free alternative reinforcers.

Measurement of Reward Deprivation/SubstanceFree Reinforcement Behavioral economic theory posits that substance use is related to the under-engagement in substance-free activities that are associated with delayed reinforcement (Bickel, Marsch, & Carroll, 2000) and substance use will generally decrease if access to alternative reinforcers is increased (Higgins, Heil, & Lussier, 2004). The term reinforcing efficacy (RE), which is also known as reward value or relative reinforcing efficacy is used to describe the level of preference for a reinforcer, such as alcohol or marijuana (Hursh & Silberberg, 2008) and refers to the behavior strengthening or maintaining properties of a substance (Griffiths, Brady, & Bradford, 1979). The RE of a drug is dynamic and contextually determined by the direct reinforcing effects of the drug, individual difference factors related to decisionmaking, and the availability of alternative reinforcers (Bickel et al., 2000).

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Measuring this preference for substance use is based on the relative levels of resource allocation towards substances versus alternatives and can be accomplished across different settings using a variety of assessment tools. In laboratory settings, RE is quantified by the amount of effort or resources allocated towards obtaining a reinforcer (Vuchinich & Tucker, 1983), with substances that elicit higher rates of responding or preference having greater RE than those with lower response rates (Bickel et al., 2000; Murphy & MacKillop, 2006). Different aspects of RE can also be measured by self-reported assessments (Table 31.1).

Demand Demand for a substance and sensitivity to reinforcement from that substance can be assessed via Hypothetical Purchase Tasks ( Murphy & MacKillop, 2006). Purchase tasks are simulation measures that calculate substance demand by quantifying the relationship between drug consumption and cost (see Table 31.2). Demand curve indices of RE can be created by assessing how much of a particular substance (e.g., alcohol, cigarettes, marijuana) an individual will purchase across a range of prices. The indices generated from demand curves include intensity (reported consumption at the lowest price), breakpoint (first price at which consumption is zero), Omax (maximum TABLE 31.1

expenditure on the substance), Pmax (price at maximum expenditure), and elasticity (sensitivity to increase in price).

Substance-Free Reinforcement There are several self-report approaches to assessing substance-free reinforcement. The most common approach uses reinforcement surveys to assess the frequency of participation in different activities and the amount of enjoyment or pleasure obtained from those activities within a certain timeframe (e.g., the past 30 days) (see Table 31.3). The frequency and enjoyment ratings of each activity are then multiplied to calculate the level of reinforcement obtained. Participants completing these schedules are often asked to endorse frequency and enjoyment for each activity twice: once for activities while sober, and once for activities engaged in while under the influence of substances. An index score, capturing the reinforcement from substance-related activities relative to alternative substance-free activities, can then be determined by dividing the total substance-related reinforcement score by the sum of the total (e.g., reinforcement ratio). The Pleasant Events Schedule (PES; Correia, Simons, Carey, & Borsari, 1998), initially used in research for depression (Lewinsohn & Graf, 1973), was the first measure modified to capture substance-free versus

Example of Alcohol Purchase Task

Imagine that you and your friends are at a bar from 9 p.m. to 2 a.m. to see a band. The following questions ask how many drinks you would purchase at various prices. The available drinks are standard size beer (12 oz), wine (5 oz), shots of hard liquor (1.5 oz), or mixed drinks with one shot of liquor. Assume that you did not drink alcohol before you went to the bar and will not go out after. How many drinks would you consume if they were free? How many drinks would you consume if they were $0.25 each? How many drinks would you consume if they were $0.50 each? How many drinks would you consume if they were $1.50 each? How many drinks would you consume if they were $2.00 each? How many drinks would you consume if they were $2.50 each? How many drinks would you consume if they were $3.00 each? How many drinks would you consume if they were $4.00 each? How many drinks would you consume if they were $5.00 each? How many drinks would you consume if they were $6.00 each? How many drinks would you consume if they were $7.00 each? How many drinks would you consume if they were $8.00 each? How many drinks would you consume if they were $9.00 each? How many drinks would you consume if they were $10.00 each? The table shows an example purchase task. Unpublished.

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TABLE 31.2

Example of Reinforcement Schedule

Activities

Frequency with alcohol Frequency without or drugs alcohol or drugs

Enjoyment with alcohol Enjoyment without or drugs alcohol or drugs

Frequency

Enjoyment

0 5 0 times

0 5 unpleasant or neutral

1 5 once a week or less

1 5 mildly pleasant

2 5 2 4 times per week

2 5 moderately pleasant

3 5 about once a day

3 5 very pleasant

4 5 more than once a day

4 5 extremely pleasant

1. Go places with siblings or family members 2. Talk with friends 3. Read a book 4. Go on a date

Frequency 3 Enjoyment 5 Obtained Reinforcement The table shows an example measure of reinforcement derived from alcohol or drugs and substance-free sources. Unpublished.

TABLE 31.3

Key Measures Assessing Reward Deprivation and Related Constructs Sample item

Item quantity

Substance-free and substance-related?

Key citation

Adolescent Reinforcement Survey Schedule

How often did you go out to eat with friends? How enjoyable was it?

32 54

Yes

Murphy et al. (2005)

Alcohol Purchase Task

How many drinks would you consume if they were $1.00?

14

No

Murphy & MacKillop (2006)

Modified Pleasant Events Schedule

How often have you watched TV? How pleasant was it?

42 320

Yes

Correia et al. (1998)

Reward Probability Index

A lot of activities in my life are pleasurable

20

No

Carvalho et al. (2011)

The table lists the key measures used to assess reward deprivation and related constructs. Unpublished data.

substance-related reinforcement. The PES contains 330 items, many of which were time-specific and have since become outdated. More recently, these reinforcement schedules have been modified to more accurately capture the experiences of individuals. The Adolescent Reinforcement Survey—Substance Use Version (ARSSSUV; Murphy, Correia, Colby, & Vuchinich, 2005) is an adapted version of the PES with greater degradation of response options within rating scales, less items (32 45), and a focus on items relevant to adolescent and young adult experience. Other reinforcement schedules have been developed, such as the Pleasant Activities List (PAL; Roozen et al., 2008), although their use has been limited. The Reward Probability Index (RPI; Carvalho et al., 2011) is a 20-item measure assessing reward deprivation by examining the availability of rewards in the

environment and the likelihood of obtaining reinforcement from available rewards. The RPI was also a tool originally intended for use with depressed populations. Specifically, the RPI was an attempt to measure response-contingent positive reinforcement using self-report rating scale questions. Unlike reinforcement survey approaches, it does not ask about specific activities or explicitly distinguish between substance-related and substance-free activities, but instead includes items that assess general reward functioning. Items include “I have had many unpleasant experiences,” and “There are many activities that I find satisfying.” The RPI produces a total score and two subscales that reflect an ability to experience reward (Reward Probability) and the availability of rewarding stimuli in one’s environment (Environmental Suppressors).

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ALTERNATIVE REINFORCEMENT AMONG TEENAGERS AND ADOLESCENTS Research supports the theoretical claims connecting reward deprivation and alcohol misuse at various points across the lifespan. Several studies have employed variations of the pleasant event schedule (Lewinsohn & Graf, 1973) to study this relation by asking individuals to report the frequency of engagement in and enjoyment associated with activities and whether the activity is associated with alcohol or drug use. In a cross-sectional study, Leventhal et al. (2015) tested whether greater engagement with activities associated with substance use would mediate the relation between socioeconomic status (SES) and substance use with a sample of over 2800 9th grade students. Socioeconomic status was inversely associated with lifetime alcohol consumption, and alternative reinforcement mediated this relation, such that lower SES was associated with lower alternative reinforcement, which was in turn associated with both greater total lifetime alcohol consumption. A longitudinal follow-up study found that 6-month alternative reinforcement mediated the relation between baseline SES and 12-month alcohol consumption (past 6 months; Andrabi, Khoddam, & Leventhal, 2017). For the follow-up study, all three elements of reinforcement (frequency, enjoyment, and frequency 3 enjoyment) were examined and found to be separate mediators, although the crossproduct accounted for the most variance, suggesting that frequently engaging in enjoyable drug-free activities is an important protective factor against alcohol misuse among teens. In the same sample, alternative reinforcement was examined as a mediator of the relation between another predictor of substance misuse, conduct problems (e.g., getting into fights, skipping school, etc.), and both past 6-month alcohol use (yes or no) and frequency among high school students (Khoddam & Leventhal, 2016). In addition to alternative reinforcers, participants could designate activities as complementary reinforcers, or activities that the individual associates with alcohol use, which were also examined as mediators. Interestingly, greater levels of complementary reinforcers did not mediate the relation between conduct problems and both past 6-month alcohol use (yes or no) and alcohol use frequency (alcohol use status not tested), but diminished levels of alternative reinforcers did, suggesting that diminished alternative activity, rather than simply increased substance-related activity, plays a vital role in alcohol engagement.

ALTERNATIVE REINFORCEMENT AMONG COLLEGE STUDENTS AND EMERGING ADULTS Reward deprivation is also a robust predictor of alcohol misuse among college students. Several crosssectional studies have demonstrated that greater levels of substance-related reinforcement relative to substancefree reinforcement are associated with lower alcohol use and related problems (Correia et al., 1998; MacKillop & Murphy, 2007). Consistent with these studies, Joyner et al. (2016) demonstrated that reward deprivation (measured with the RPI) was cross-sectionally associated with alcohol use disorder among college students, further evidence that reward deprivation may be an important early risk factor for developing problematic alcohol misuse. Due to a greater number of studies on the topic, the link between reward deprivation and alcohol misuse is understood with greater precision among heavy-drinking college students.

RELATION BETWEEN GENDER AND ALTERNATIVE REINFORCEMENT Several studies have examined the moderating role of gender and have found that women typically report greater substance-free reinforcement than men. In one study, women reported greater peer, family, and total substance-free reinforcement than men regardless of alcohol use level (Skidmore & Murphy, 2010). This may be because men generally report engaging in fewer substance-free activities that include peers, limiting their social interactions to drinking occasions (Murphy & MacKillop, 2006). Another study found that women reported higher overall enjoyment from substance-free activities compared to men, and that gender moderated the relation between substance-free enjoyment and past 3-month alcohol use. In other words, women who reported greater enjoyment while engaging in substance-free activities reported lower levels of past 3-month alcohol use, while there was not a significant relation between substance-free enjoyment and alcohol use among men (Murphy, Barnett, Goldstein, & Colby, 2007).

RELATION BETWEEN SOCIAL CONTEXT AND ALTERNATIVE REINFORCEMENT Heavy drinking in college most often occurs in a social context and several studies have reported that heavy-drinking college students typically report

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RELATION BETWEEN SOCIAL CONTEXT AND ALTERNATIVE REINFORCEMENT

greater social reinforcement, both substance-free and substance-related, compared to light drinkers. One study comparing reinforcement for substance-free and substance-related activities among binge (4/5 drinks in one occasion for females/males) versus light-drinking college students found that binge drinkers reported greater frequency, and enjoyment of substance-related activities, and light drinkers reported greater frequency and enjoyment for introverted, nonsocial, and passive outdoor substance-free activities (Correia, Carey, Simons, & Borsari, 2003). Light drinkers also reported greater enjoyment of several other substancefree activities, including social, solitary, and moodrelated substance-free activities. Interestingly, light drinkers primarily obtained greater reinforcement in nonsocial domains, except for obtaining greater enjoyment from substance-free social activities. Partially consistent with this finding, another study found that heavy drinking college students reported greater substance-free social and sex reinforcement (frequency and enjoyment cross-product) than light drinkers (Skidmore & Murphy, 2010). Murphy, Barnett, and Colby (2006) examined reports of enjoyment over the past 30 evenings as a function of drinking frequency, quantity, and the nature of activity participation in a sample of college student drinkers who violated a campus alcohol policy. Although overall participants rated their drinking evenings as more enjoyable than their abstinent evenings, several substance-free activities (e.g., watching movies, eating at restaurants, and hanging out with friends) were reported to be as enjoyable as substance-related activities, and the number of peers present for an activity was a more powerful predictor of enjoyment than was drinking level. Further, consistent with the gender differences described above, women reported greater overall

substance-free activity enjoyment than men. Despite substance-free peer activities being more enjoyable than solitary activities, males reported less engagement in substance-free peer activities, suggesting that college men may be especially reliant on alcohol to facilitate social interactions. Although no study has examined the natural relation between diminished alternative reinforcement and alcohol use prospectively, one study has used alternative reinforcement as a predictor of alcohol use outcomes following a brief intervention. The results of this study generally correspond to the gender and social findings addressed above. The authors randomized participants to personalized drinking feedback conditions delivered with or without motivational interviewing style counseling. Drinking outcomes did not differ by intervention condition. In this study, proportionate substance-related reinforcement predicted drinking outcomes at 6 months (Murphy et al., 2005). Further, those with moderate to large reductions in drinking (. 1 SD) at 6-month follow-up also reported significantly lower substance-free peer reinforcement, greater substance-free school reinforcement, and overall lower proportionate substance-related reinforcement (see Table 31.4). An important aspect of future interventions for this population should, thus, attempt to bolster substance-free peer reinforcement, as the deficits in social interaction that follows reductions in drinking may prevent long-term change from occurring. It is important to note that, although no study has examined the naturalistic relation between alternative reinforcement and alcohol misuse, one study has demonstrated a relation with cigarette smoking onset and duration among teens (Audrain-McGovern et al., 2012), and naturalistic studies with heavy-drinking populations may demonstrate similar results.

TABLE 31.4 Changes in Substance-Free Reinforcement and Reinforcement Ratio Scores Among Participants With Moderate to Large Drinking Reductions Baseline ARSS-SUV reinforcement scale

M

SD

Follow-up M

SD 

Peer interaction

8.42

2.87

7.24

2.91

Dating

9.08

3.13

8.38

3.29

Sexual activity

5.33

3.31

4.54

3.26



School

4.17

3.03

6.00

3.37

Substance-free (total)

6.43

1.65

5.83

1.88

Reinforcement ratio

0.33

0.11



0.28



0.12

p , .05 p , .01 The table shows means and standard deviations in reinforcement scores among participants who reduced their drinking (n 5 26). From Murphy, J. G., Correia, C. J., Colby, S. M., & Vuchinich, R. E. (2005). Using behavioral theories of choice to predict drinking outcomes following a brief intervention. Experimental and Clinical Psychopharmacology, 13(2), 93 101. https://doi.org/10.1037/1064-1297.13.2.93. Reprinted with permission from the American Psychological Association.



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ALTERNATIVE REINFORCEMENT AMONG ADULTS Relatively few studies have examined reward deprivation among heavy-drinking adults. However, the few studies available are consistent with the research with high school and college students and suggest that reward deprivation is implicated in alcohol misuse among this population as well. One study collected cross-sectional data on a sample of drinking adults (M 5 32.85, SD 5 11.15) using crowdsourcing through Amazon’s Mechanical Turk website (Morris et al., 2017). Controlling for gender, age, race, and income, proportionate alcohol-related reinforcement significantly predicted alcohol use disorder severity and accounted for 18% of the variance. In this study, proportionate alcohol-related reinforcement was also significantly correlated with alcohol demand indices. Another study (N 5 609; Magidson, Robustelli, SeitzBrown, & Whisman, 2016) separately examined the frequency and enjoyment of alternative activities among adults (M 5 54.10, SD 5 11.80) and found that activity enjoyment, but not frequency, was correlated with alcohol-related problems and heavy drinking after statistically adjusting for depression scores. Adults in this study reported low levels of drinking (M 5 0.26, SD 5 0.71); despite this, the results are consistent with previous research and suggest that enjoyment of an alternative activity may have a greater impact on alcohol use than frequency of alternative activities.

ALTERNATIVE REINFORCEMENT AS A TRANSDIAGNOSTIC RISK FACTOR FOR COMORBID PSYCHOPATHOLOGY Despite recent calls to consider reward deprivation as a transdiagnostic risk factor for psychopathology

(Vujanovic, Wardle, Smith, & Berenz, 2016), only two studies have examined the relation between reward deprivation and alcohol misuse among psychiatric patients (Correia & Carey, 1999). The study (N 5 34) found that proportionate substance-related reinforcement predicts substance use better than reinforcement from substance-related activities alone after adjusting for gender, age, and psychiatric diagnosis. Although the sample size was relatively small, these initial findings are encouraging and suggest that more research should specifically examine reward deprivation as a transdiagnostic risk factor for comorbidity.

Treatment Targeting Reward Deprivation The Substance-Free Activity Session (SFAS) (Murphy et al., 2012). The SFAS developed by Murphy and colleague utilizes behavioral economic elements in the context of motivational interviewing-based brief intervention. Specifically, the SFAS attempts to increase the individual’s commitment to important goals, engagement in substance-free activities, and general degree of future orientation; thus, directly targeting reward deprivation (see Fig. 31.1 for sample intervention content). Individuals who participate in a SFAS session can work towards these goals without an expressed desire to reduce substance use, but tend to reduce substance use as a function of achieving these goals. Theoretically, this is because increases in future orientation and engagement in substance-free activities will indirectly increase the likelihood of reductions in alcohol and drug use (e.g., Correia, Benson, & Carey, 2005) Research to date suggests that the SFAS may increase the efficacy a standard brief motivational alcohol intervention, which is a recognized efficacious intervention, particularly with college students (Murphy et al., 2012) (Fig. 31.2). The SFAS is an ideal intervention for college students because they are a high-risk group in terms of

35

FIGURE 31.1 Intervention element from

30

Substance-Free Activity Session. The figure shows an example of one element that is provided as personalized feedback in the Substance-Free Activity session (SFAS)

25

Family Studying

20 15

Exercising Drinking/Drug use Volunteer

10

Working

5 0

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MINI-DICTIONARY OF TERMS

FIGURE 31.2 Reduction in alcohol problems by students who participated in Substance-Free Activity Session (SFAS). Source: This figure shows drinking reductions in college students (N 5 82) by intervention condition from Murphy et al. (2012). Reprinted with permission from the American Psychological Association.

18 16

Alcohol problems

14 12 10 Relaxation

8

SFAS

6 4 2 0 preintervention

1-Month post intervention

6-Months post intervention

alcohol and drug use, and such use is generally incompatible with successful completion of college and career-development goals. However, the SFAS may also be a useful intervention for noncollege young adults and certain at-risk groups, such as military veterans who may be prone to experiencing reward deprivation after relinquishing substance-free rewards and relationships while deployed. Future research should investigate the SFAS as an adjunct to substance-use interventions with these other populations. Empirically supported interventions, such as community reinforcement therapy or contingency management (Higgins et al., 2004), are examples of intensive intervention approaches that target some of the same theoretical mechanisms as the SFAS (e.g., increasing substance-free reinforcement and reducing impulsive decision-making). Individuals with severe substance abuse and or cognitive impairment may require these intensive approaches, but the SFAS may be a more viable approach with individuals with mild to moderate substance-use problems. In addition to college students, we suspect that there are other potential populations of substance abusers who might benefit from the SFAS. In particular, young adults who are not college students might also benefit from an approach that helps them to address drinking/drug use in the context of developing a greater consideration of the future and identifying patterns of goaldirected substance-free activities. Similarly, military veterans are a high-risk group that might also lack viable alternatives to drinking and require an approach that attempts to specifically address this issue (McDevitt-Murphy et al., 2014). The SFAS may also be especially helpful for individuals with psychiatric comorbidity, which is often associated with diminished engagement in rewarding alternatives to substance use (Murphy et al., 2012).

Life enhancement treatment for substance use (LETS ACT) (Daughters, Magidson, Lejuez, & Chen, 2016). LETS ACT is a behavioral activation-based treatment program that was developed to be conducted in an inpatient setting in small groups with three to five group members. The authors describe their treatment as focusing on the treatment rationale and generating, scheduling, engaging in, and recording substance-free activities to increase positive reinforcement. The increase in substance-free activities also helps to reduce reward deprivation. Each session focuses on identifying areas of value for the participants and activities that are compatible with these life values. The aim is that participants will be able to reduce the tendency to respond to a negative mood with harmful behaviors (e.g., substance use) and instead increase behaviors that facilitate positive reinforcement. Research has shown that LET’S ACT is more successful in obtaining abstinence outcomes and results in experiencing fewer alcohol-related problems compared to a time and group size-matched control condition delivered in a residential treatment (Daughters et al., 2016). The SFAS and LET’S ACT are two recently developed treatments that appear to have promise in reducing alcohol use and the related consequences and appear to do so, at least in part, by targeting reward deprivation. This suggests that reward deprivation may be a key construct to consider when treating alcohol abuse and should be considered in the development and study of future treatments.

MINI-DICTIONARY OF TERMS Reward Deprivation A concept in addictions literature that refers to the lack of access to, and ability to experience reward.

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Behavioral Economics A theory that combines behavioral psychology and microeconomics to describe, understand and predict behavior, and is widely utilized in understanding substance use. Matching Law A quantitative relationship that holds between the relative rates of response and the relative rates of reinforcement in choice situations. An implication is that the rate of response for a given behavior (e.g., drug use) is a product of both the reinforcement associated with that behavior as well as the reinforcement associated with available alternative behaviors (e.g., prosocial activities). Reinforcing efficacy The behavior strengthening or maintaining properties of a substance that can be quantified by the level of preference or degree of resource allocation for a reinforcer, such as alcohol or marijuana (Hursh & Silberberg, 2008). Hypothetical Purchase Tasks Purchase tasks are simulation measures that calculate reinforcing efficacy by plotting hypothetical levels of consumption (demand) across a range of prices. Substance-Free Activity Session (SFAS) A brief one-session intervention that was designed as a supplement to a standard brief motivation intervention for substance use that utilizes behavioral economic elements to attempt to increase an individual’s commitment to important goals, engagement in substance-free activities, and general degree of future orientation. LET’S ACT A 5 8 session behavioral activation-based treatment for substance abuse that is conducted in small groups and aims to increase substance-free rewards.

• Reward deprivation fits with the behavioral economic view of substance use that considers context/environment of the use in addition to individual factors • Deprivation of alternative reinforcers is a robust predictor of alcohol misuse among high school and college students. • Research with general adult populations also suggests that various proxies for reward deprivation (poverty, unemployment, social isolation) predict increased risk for substance misuse. There has been little research on the role of reward deprivation and substance use in noncollege adults. • Reward deprivation can be measured using various methods including calculating substance-free activity participation and the ability to experience substance-free rewards. • Several recently developed treatments, the Substance-Free Activity Session (SFAS) and LET’S ACT, target reward deprivation in order to reduce substance use.

References

KEY FACTS Reward Deprivation • The Rat Park experiments of the 1970s provided a powerful experimental test of the role of environmental reward deprivation as a risk factor for drug self-administration. • In the reinforcement pathology model, alcohol or drug addiction are thought to result from interactions between physiologically mediated subjective response to drugs and environmental factors, such as low availability of alternative rewards (i.e., reward deprivation). • The matching law demonstrates that the relative reinforcing efficacy of a particular behavior is a ratio between the response rate of the behavior and the response rates of other possible reinforcing behaviors. • Reward deprivation can be measured in several ways including calculating substance-free activity participation and the ability to experience substance-free rewards. • Several promising treatments for alcohol misuse target reward deprivation by aiming to increase enjoyable and goal-directed substance-free activities.

SUMMARY POINTS • This chapter focuses on the role of reward deprivation, the inability to experience or access reward, in substance abuse.

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III. PSYCHOLOGY, BEHAVIOR, AND ADDICTION