Current Psychiatry Reports

, 13:406 | Cite as

The Behavioral Economics and Neuroeconomics of Reinforcer Pathologies: Implications for Etiology and Treatment of Addiction

  • Warren K. Bickel
  • David P. Jarmolowicz
  • E. Terry Mueller
  • Kirstin M. Gatchalian


The current paper presents a novel approach to understanding and treating addiction. Drawing from work in behavioral economics and developments in the new field of neuroeconomics, we describe addiction as pathological patterns of responding resulting from the persistently high valuation of a reinforcer and/or an excessive preference for the immediate consumption of that reinforcer. We further suggest that, as indicated by the competing neurobehavioral decision systems theory, these patterns of pathological choice and consumption result from an imbalance between two distinct neurobehavioral systems. Specifically, pathological patterns of responding result from hyperactivity in the evolutionarily older impulsive system (which values immediate and low-cost reinforcers) and/or hypoactivity in the more recently evolved executive system (which is involved in the valuation of delayed reinforcers). This approach is then used to explain five phenomena that we believe any adequate theory of addiction must address.


Addiction Treatment Pathology Behavioral economics Neuroeconomics Neural systems Theory Impulsivity Reinforcer Executive function Human 



Dr. Bickel has received grant support from the National Institutes of Health/National Institute on Drug Abuse (grant nos. 5 R01 DA012997-11 [principal investigator], 1 R01 DA024080-01A1 [principal investigator], 1 R01 DA026817-01A1 [co–principal investigator], and 1 R01 DA022386-01A1 [co-investigator]) and the National Institute on Alcohol Abuse and Alcoholism (grant no. 3R01DA024080-02S1).


Dr. Bickel has received honoraria for presentations made at the Providence Regional Medical Center’s 13th Annual Fundamentals of Addiction Medicine Conference, the Duke Institute for Brain Sciences Addiction Research Group Seminar Series, the Association for Behavioral Analysis International Behavioral Economics Conference, and at Texas A&M University (colloquia speaker).

Dr. Jarmolowicz, Dr. Mueller, and Ms. Gatchalian reported no potential conflicts of interest relevant to this article.


Papers of particular interest, published recently, have been highlighted as: ••Of major importance

  1. 1.
    •• Bickel WK, Jarmolowicz DP, MacKillop J, et al. The behavioral economics of reinforcement pathologies. In: Shaffer HJ, editor. Addiction syndrome handbook. Washington, DC: American Psychological Association; 2011. This chapter provides an extended description of the concept of reinforcer pathologies as applied to addiction.Google Scholar
  2. 2.
    Hursh SR. Economic concepts for the analysis of behavior. J Exp Anal Behav. 1980;34:219–38.PubMedCrossRefGoogle Scholar
  3. 3.
    Rachlin H. Diminishing marginal value as delay discounting. J Exp Anal Behav. 1992;57:407–15.PubMedCrossRefGoogle Scholar
  4. 4.
    Bickel WK, DeGrandpre RJ, Higgins ST. Behavioral economics: a novel experimental approach to the study of drug dependence. Drug Alcohol Depend. 1993;33:173–92.PubMedCrossRefGoogle Scholar
  5. 5.
    Bickel WK, DeGrandpre RJ, Hughes JR, Higgins ST. Behavioral economics of drug self-administration. II. A unit-price analysis of cigarette smoking. J Exp Anal Behav. 1991;55:145–54.PubMedCrossRefGoogle Scholar
  6. 6.
    Johnson MW, Bickel WK. Replacing relative reinforcing efficacy with behavioral economic demand curves. J Exp Anal Behav. 2006;85:73–93.PubMedCrossRefGoogle Scholar
  7. 7.
    Bickel WK, DeGrandpre RJ, Higgins ST. The behavioral economics of concurrent drug reinforcers: a review and reanalysis of drug self-administration research. Psychopharmacology. 1995;118:250–9.PubMedCrossRefGoogle Scholar
  8. 8.
    DeGrandpre RJ, Bickel WK, Higgins ST, Hughes JR. A behavioral economics analysis of concurrently available money and cigarettes. J Exp Anal Behav. 1994;64:191–201.CrossRefGoogle Scholar
  9. 9.
    Johnson MW, Bickel WK. The behavioral economics of cigarette smoking: the concurrent presence of a substitute and an independent reinforcer. Behav Pharmacol. 2003;14:137–44.PubMedCrossRefGoogle Scholar
  10. 10.
    Saelens BE, Epstein LH. Reinforcing value of food in obese and non-obese women. Appetite. 1996;27:41–50.PubMedCrossRefGoogle Scholar
  11. 11.
    Epstein LH, Wright SM, Paluch RA, et al. Food hedonics and reinforcement as determinants of laboratory food intake in smokers. Physiol Behav. 2004;81:511–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Petry NM. Effects of increasing income on polydrug use: a comparison of heroin, cocaine and alcohol abusers. Addiction. 2000;95:705.PubMedCrossRefGoogle Scholar
  13. 13.
    Bickel WK, Madden GJ, DeGrandpre RJ. Modeling the effects of combined behavioral and pharmacological treatment on cigarette smoking: behavioral-economic analyses. Exp Clin Psychopharmacol. 1997;5:334–43.PubMedCrossRefGoogle Scholar
  14. 14.
    Shahan TA, Bickel WK, Badger GJ, Giordano LA. Sensitivity of nicotine-containing and de-nicotinized cigarette consumption to alternative non-drug reinforcement: a behavioral economic analysis. Behav Pharmacol. 2001;12:277–84.PubMedCrossRefGoogle Scholar
  15. 15.
    Baker F, Johnson MW, Bickel WK. Delay discounting in current and never-before cigarette smokers: similarities and differences across commodity, sign, and magnitude. J Abnorm Psychol. 2003;112:382–92.PubMedCrossRefGoogle Scholar
  16. 16.
    Bickel WK, Pitcock JA, Yi R, Angtuaco EJC. Congruence of BOLD response across intertemporal choice conditions: fictive and real money gains and losses. J Neurosci. 2009;29:8839–46.PubMedCrossRefGoogle Scholar
  17. 17.
    Johnson MW, Bickel WK. Within-subject comparison of real and hypothetical money rewards in delay discounting. J Exp Anal Behav. 2002;77:129–46.PubMedCrossRefGoogle Scholar
  18. 18.
    Johnson MW, Bickel WK, Baker F. Moderate drug use and delay discounting: a comparison of heavy, light, and never smokers. Exp Clin Psychopharmacol. 2007;15:187–94.PubMedCrossRefGoogle Scholar
  19. 19.
    Madden GJ, Begotka AM, Raiff BR, Kastern LL. Delay discounting of real and hypothetical rewards. Exp Clin Psychopharmacol. 2003;11:139–45.PubMedCrossRefGoogle Scholar
  20. 20.
    Madden GJ, Raiff BR, Laforio CH, et al. Delay disocounting of potentially real and hypothetical rewards: II. Between-and within-subject comparison. Exp Clin Psychopharmacol. 2004;12:251–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Lagorio CH, Madden GJ. Delay discounting of real and hypothetical rewards III: steady-state assessments, forced-choice trials, and all real rewards. Behav Process. 2005;69:173.CrossRefGoogle Scholar
  22. 22.
    Kirby KN, Petry NM, Bickel WK. Heroin addicts have higher discount rates for delayed rewards than non-drug using controls. J Exp Psychol Gen. 1999;128:78–87.PubMedCrossRefGoogle Scholar
  23. 23.
    Weller RE, Cook III EW, Avsar KB, Cox JE. Obese women show greater delay discounting than healthy-weight women. Appetite. 2008;51:563–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Alessi SM, Petry NM. Pathological gambling severity is associated with impulsivity in a delay discounting procedure. Behav Process. 2003;64:345–54.CrossRefGoogle Scholar
  25. 25.
    Petry NM, Casarella R. Excessive discounting of delayed rewards in substance abusers with gambling problems. Drug and Alcohol Depend. 1999;56:25–32.CrossRefGoogle Scholar
  26. 26.
    Coffey SF, Gudleski GD, Saladin ME, Brady KT. Impulsivity and rapid discounting of delayed hypothetical rewards in cocaine-dependent individuals. Exp Clin Psychopharmacol. 2003;11:18–25.PubMedCrossRefGoogle Scholar
  27. 27.
    Bickel WK, Christensen DR, Landes RD, et al.: Single and cross commodity among cocaine addicts: the commodity and its temporal location determine discounting rate. Psychopharmacology 2011 (2011).Google Scholar
  28. 28.
    Petry NM. Delay discounting of money and alcohol in actively using alcoholics, currently abstinent alcoholics, and controls. Psychopharmacology. 2001;154:243–50.PubMedCrossRefGoogle Scholar
  29. 29.
    Vuchinich RE, Simpson CA. Hyperbolic temporal discounting in social drinkers and problem drinkers. Exp Clin Psychopharmacol. 1998;6:292–305.PubMedCrossRefGoogle Scholar
  30. 30.
    Bickel WK, Odum AL, Madden GJ. Impulsivity and cigarette smoking: delay discounting in current, never, and ex-smokers. Psychopharmacology. 1999;146:447–54.PubMedCrossRefGoogle Scholar
  31. 31.
    MacKillop J, Tidey JW: Cigarette demand and delayed reward discounting in nicotine-dependent individuals with schizophrenia and controls: an initial study. Psychopharmacology 2011;216:91–9.Google Scholar
  32. 32.
    Madden GJ, Petry NM, Badger GJ, Bickel WK. Impulsive and self-control choices in opioid-dependent patients and non-drug-using control participants: drug and monetary rewards. Exp Clin Psychopharmacol. 1997;5:256–62.PubMedCrossRefGoogle Scholar
  33. 33.
    McClure SM, Ericson KM, Laibson DI, et al. Time discounting for primary rewards. J Neurosci. 2007;27:5796–804.PubMedCrossRefGoogle Scholar
  34. 34.
    MacKillop J, Miranda R, Monti PM, et al. Alcohol demand, delayed reward discounting, and craving in relation to drinking and alcohol use disorders. J Abnorm Psychol. 2010;119:106–14.PubMedCrossRefGoogle Scholar
  35. 35.
    Rollins BY, Dearing KK, Epstein LH. Delay discounting moderates the effect of food reinforcement on energy intake among non-obese women. Appetite. 2010;55:420–5.PubMedCrossRefGoogle Scholar
  36. 36.
    Raichle ME. A brief history of human brain mapping. Trends Neurosci. 2009;32:118–26.PubMedCrossRefGoogle Scholar
  37. 37.
    Glimcher PW, Camerer C, Poldrack RA, Fehr E, editors. Neuroeconomics decision making and the brain. London: Academic; 2008.Google Scholar
  38. 38.
    McClure SM, Laibson DI, Loewenstein G, Cohen JD. Separate neural systems value immediate and delayed monetary rewards. Science. 2004;306:503–7.PubMedCrossRefGoogle Scholar
  39. 39.
    Bechara A. Decision making, impulse control and loss of willpower to resist drugs: a neurocognitive perspective. Nat Neurosci. 2005;8:1458–63.PubMedCrossRefGoogle Scholar
  40. 40.
    Jentsch JD, Taylor JR. Impulsivity resulting from frontostriatal dysfunction in drug abuse: implications for the control of behavior by reward-related stimuli. Psychopharmacology. 1999;146:373–90.PubMedCrossRefGoogle Scholar
  41. 41.
    •• Bickel WK, Mueller ET, Jarmolowicz DP: What is addiction? In Addictions: A Comprehensive Guidebook, Second Edition. Edited by McCrady B, Epstein E. 2011 (2011). This chapter provides an extended description of the competing neurobehavioral decisions systems theory, its genesis, and its adequacy in explaining relevant features of addiction. Google Scholar
  42. 42.
    Kable JW, Glimcher PW. The neural correlates of subjective value during intertemporal choice. Nat Neurosci. 2007;10:1625–33.PubMedCrossRefGoogle Scholar
  43. 43.
    Kable JW, Glimcher PW. An “as soon as possible” effect in human intertemporal decision making: behavioral evidence and neural mechanisms. J Neurophysiol. 2010;103:2513–31.PubMedCrossRefGoogle Scholar
  44. 44.
    Bickel WK, Miller ML, Yi R, et al. Behavioral and neuroeconomics of drug addiction: competing neural systems and temporal discounting processes. Drug Alcohol Depend. 2007;90S:S85–91.CrossRefGoogle Scholar
  45. 45.
    Croxson PL, Walton ME, O’Reilly JX, et al. Effort-based cost-benefit valuation and the human brain. J Neurosci. 2009;29:4531–41.PubMedCrossRefGoogle Scholar
  46. 46.
    Monterosso JR, Ainslie G, Xu JS, et al. Frontoparietal cortical activity of methamphetamine-dependent and comparison subjects performing a delay discounting task. Hum Brain Mapp. 2007;28:383–93.PubMedCrossRefGoogle Scholar
  47. 47.
    Xu L, Liang ZY, Wang K, et al. Neural mechanism of intertemporal choice: from discounting future gains to future losses. Brain Res. 2009;1261:65–74.PubMedCrossRefGoogle Scholar
  48. 48.
    Prevost C, Pessiglione M, Metereau E, et al. Separate valuation subsystems for delay and effort decision costs. J Neurosci. 2010;30:14080–90.PubMedCrossRefGoogle Scholar
  49. 49.
    Wunderlich K, Rangel A, O’Doherty JP. Neural computations underlying action-based decision making in the human brain. Proc Natl Acad Sci USA. 2009;106:17199–204.PubMedCrossRefGoogle Scholar
  50. 50.
    Pezawas LM, Fischer G, Diamant K, et al. Cerebral CT findings in male opioid-dependent patients: stereological, planimetric and linear measurements. Psychiatr Res. 1998;83:139–47.CrossRefGoogle Scholar
  51. 51.
    Liu H, Hao Y, Kaneko Y, et al. Frontal and cingulate gray matter volume reduction in heroin dependence: optimized voxel-based morphometry. Psychiatry Clin Neurosci. 2009;63:563–8.PubMedCrossRefGoogle Scholar
  52. 52.
    Bechara A, Damasio AR. The somatic marker hypothesis: a neural theory of economic decision. Games Econ Behav. 2005;52:336–72.CrossRefGoogle Scholar
  53. 53.
    Risinger RC, Salmeron BJ, Ross TJ, et al. Neural correlates of high and craving during cocaine self-administration using BOLD fMRI. NeuroImage. 2005;26:1097–108.PubMedCrossRefGoogle Scholar
  54. 54.
    Giordano L, Bickel WK, Loewenstein G, et al. Mild opioid deprivation increases the degree that opioid-dependent outpatients discount delayed heroin and money. Psychopharmacology. 2002;163:174–82.PubMedCrossRefGoogle Scholar
  55. 55.
    Hinson JM, Jameson TL, Whitney P. Impulsive decision making and working memory. J Exp Psychol Learn Mem Cogn. 2003;29:298–306.PubMedCrossRefGoogle Scholar
  56. 56.
    •• Bickel WK, Yi R, Landes RD, et al. Remember the future: working memory training decreases delay discounting among stimulant addicts. Biol Psychiatr. 2011;69:260–5. This recent paper provides an example of a novel treatment approach derived from the competing neurobehavioral decisions systems appraoch to addiction.CrossRefGoogle Scholar
  57. 57.
    Monterosso JR, Luo S. An argument against dual valuation system competition: cognitive capacities supporting future orientation mediate rather than compete with visceral motivation. Journal of Neuroscience, Psychology, and Economics. 2010;3:1–14.CrossRefGoogle Scholar
  58. 58.
    Edwards G, Lader M, editors. The nature of drug dependence. Oxford: Oxford University Press; 1990.Google Scholar
  59. 59.
    Peele S. What treatment for addiction can do and what it can’t; what treatment for addiction should do and what it shouldn’t. J Subst Abuse Treat. 1985;2:225–8.PubMedCrossRefGoogle Scholar
  60. 60.
    Volkow ND, Fowler JS, Wang GJ, et al. Dopamine in drug abuse and addiction: results of imaging studies and treatment implications. Arch Neurol. 2007;64:1575–9.PubMedCrossRefGoogle Scholar
  61. 61.
    Mueller ET, Bickel WK, Landes RD: Smoker’s delay discounting indifference points are associated with changes in opportunity-cost-informed price. In 72nd Annual Meeting of The College on Problems of Drug Dependence. 2010: Scottsdale, Arizona.Google Scholar
  62. 62.
    MacKillop J, Kahler CW. Delayed reward discounting predicts treatment response for heavy drinkers receiving smoking cessation treatment. Drug Alcohol Depend. 2009;104:197–203.PubMedCrossRefGoogle Scholar
  63. 63.
    Aharonovich E, Hasin DS, Brooks AC, et al. Cognitive deficits predict low treatment retention in cocaine dependent patients. Drug Alcohol Depend. 2006;81:313–22.PubMedCrossRefGoogle Scholar
  64. 64.
    Steinberg L. A dual systems model of adolescent risk-taking. Dev Psychobiol. 2010;52:216–24.PubMedGoogle Scholar
  65. 65.
    Johnson RA, Gerstein DR. Initiation of use of alcohol, cigarettes, marijuana, cocaine, and other substances in US birth cohorts since 1919. Am J Public Health. 1998;88:27–33.PubMedCrossRefGoogle Scholar
  66. 66.
    Hintzen AK, Cramer J, Karagulle D, et al. Does alcohol craving decrease with increasing age? Results from a cross-sectional study. J Stud Alcohol Drugs. 2011;72:158–62.PubMedGoogle Scholar
  67. 67.
    Green L, Myerson J, Lichtman D, et al. Temporal discounting in choice between delayed rewards: the role of age and income. Psychol Aging. 1996;11:79–84.PubMedCrossRefGoogle Scholar
  68. 68.
    Shaffer HJ, LaPlante DA, LaBrie RA, et al. Toward a syndrome model of addiction: multiple expressions, common etiology. Harv Rev Psychiatr. 2004;12:367–74.CrossRefGoogle Scholar
  69. 69.
    Bickel WK, Mueller ET. Toward the study of trans-disease processes: a novel approach with special reference to the study of co-morbidity. Journal of Dual Diagnosis. 2009;5:131–8.PubMedCrossRefGoogle Scholar
  70. 70.
    Bickel WK, Jones BA, Landes RD, et al. Hypothetical intertemporal choice and real economic behavior: delay discounting predicts voucher redemptions during contingency-management procedures. Exp Clin Psychopharmacol. 2010;18:546–52.PubMedCrossRefGoogle Scholar
  71. 71.
    Mueller ET, Landes RD, Kowal BP, et al. Delay of smoking gratification as a laboratory model of relapse: effects of incentives for not smoking, and relationship with measures of executive function. Behav Pharmacol. 2009;20:461–73.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Warren K. Bickel
    • 1
  • David P. Jarmolowicz
    • 1
  • E. Terry Mueller
    • 1
  • Kirstin M. Gatchalian
    • 1
  1. 1.Advanced Recovery Research CenterVirginia Tech Carilion Research InstituteRoanokeUSA

Personalised recommendations