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Novel Therapeutics for Addiction: Behavioral Economic and Neuroeconomic Approaches

  • Substance Use Disorders (FG Moeller, Section Editor)
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Opinion statement

Behavioral economic and neuroeconomic understandings of addiction offer both established and empirically supported treatments as well as a foundation from which promising new treatment options are emerging. Addiction must be understood and treated as a state of pathological overvaluation of the reinforcement of drug use fueled by an imbalance of the competing neurobehavioral decision systems that govern decision making (CNDS theory). The CNDS theory presents two systems, the executive and impulsive, which are dysregulated in reinforcer pathology by greater relative control of the impulsive, hedonic system, and lesser relative control of the executive, regulatory system. This leads to a reinforcer pathology where drug use is maladaptively overvalued in comparison to other reinforcers, leading to a chronic and often relapsing state of addiction. Some treatments which directly alter economic variables associated with drug use have already been empirically supported, including contingency management (which increases the short-term price of drug use) and drug agonist therapies (which decrease the short-term value of drug use compared to other reinforcers). New, promising treatments which bring the fundamental CNDS dysregulation of addiction into balance include episodic future thinking, which increases the temporal window over which the opportunity costs of drug use are integrated by engaging executive control, and TMS therapies which directly increase activity, and therefore relative control, in the executive system. The maturing fields of behavioral economics and neuroeconomics provide conceptual understanding of the competing neurobehavioral decision systems theory (CNDS) and reinforcer pathology (i.e., high valuation of and excessive preference for drug reinforcers), allowing us to coherently categorize treatments into a theoretically comprehensive framework of addiction. In this chapter, we identify and clarify how existing and novel interventions can ameliorate reinforcer pathology in light of the CNDS and be leveraged to treat addiction.

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Notes

  1. We note that dominant control by the executive system may produce pathologies other than addiction, such as those characterized by excessive concern over future events (e.g., anorexia nervosa and obsessive-compulsive disorder). However, our focus in this chapter is on dominant control by the impulsive system and the resulting risk for addiction.

  2. For further discussion of contingency management in the other subtype of reinforcer pathology and the executive decision system of the CNDS, see [13].

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Acknowledgments

The following grants contributed to the support of the authors during the development of this work: NIH grants R01AA021529, R01DA034755, U19CA157345, UH2DK109543, and F31AA024368-01.

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  1. Virginia Tech Carilion Research Institute, Addiction Recovery Research Center, 2 Riverside Circle, Roanoke, VA, 24016, USA

    Warren K. Bickel Ph.D, Alexandra M. Mellis B.S., Sarah E. Snider Ph.D., Lara Moody M.S., Jeffrey S. Stein Ph.D. & Amanda J. Quisenberry Ph.D.

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  1. Warren K. Bickel Ph.D
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Bickel, W.K., Mellis, A.M., Snider, S.E. et al. Novel Therapeutics for Addiction: Behavioral Economic and Neuroeconomic Approaches. Curr Treat Options Psych 3, 277–292 (2016). https://doi.org/10.1007/s40501-016-0088-3

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