Discounting and Pathological Gambling

Pathological gambling is a disorder characterized by excessive gambling. It often occurs in conjunction with substance use disorders, and research is beginning to examine the association between these disorders, especially with regard to impulsivity and discounting. In this chapter, we initially review the diagnosis and prevalence rates of pathological gambling, including its comorbidity with substance use disorders. We then describe relations between personality measures of impulsivity and pathological gambling. Gamblers\u27 patterns of choices on the Iowa Gambling Task (IGT) and measures of delay and probability discounting are covered in depth, and we discuss the degree to which these choices are uniquely associated with a gambling disorder rather than a comorbid substance use disorder. Recent theories regarding the role of discounting in the etiology of pathological gambling are described, as are suggestions for future research

The Impact of Contingency Management on Quality of Life Among Cocaine Abusers With and Without Alcohol Dependence

The use of quality of life measures (QOL) in substance abuse treatment research is important because it may lead to a broader understanding of patients’ health status and effects of interventions. Despite the high rates of comorbid cocaine and alcohol use disorders, little is known about the QOL of this population, and even less about the impact of an efficacious behavioral treatment, contingency management (CM), on QOL. In this study, data from three clinical trials were retrospectively analyzed to examine QOL in outpatient cocaine abusers with and without alcohol dependence (AD) and the impact of CM on QOL over time as a function of AD status. Patients were randomized to standard care (n = 115) or standard care plus CM (n = 278) for 12 weeks. QOL was assessed at baseline and Months 1, 3, 6, and 9. At treatment initiation, AD patients had lower QOL total scores and they scored lower on several subscale scores than those without AD. CM treatment was associated with improvement in QOL regardless of AD status. These data suggest that CM produces benefits that go beyond substance abuse outcomes, and they support the use of QOL indices to capture information related to treatment outcomes

Increased Drinking in a Trial of Treatments for Marijuana Dependence: Substance Substitution?

This report examines whether participants in a study of treatments for marijuana dependence may have increased their use of alcohol when they reduced or ceased marijuana use. Participants were randomly assigned to one of four psychosocial treatments and followed at 3-month intervals for one-year. Findings are from 207 cases with data at posttreatment and at least one other follow-up. 73% of cases reported an increase of at least 10% in drinking days over their level at intake, and 65% reported an increase of at least 10% in drinks per drinking day. Drinking increases were not related to treatment condition nor to change in marijuana use, but were related to baseline drinking: those with less baseline drinking tended to increase their drinking during treatment and those with more baseline drinking reported less drinking during treatment. Thereafter, drinking levels remained fairly stable throughout the follow-up year. The results are most likely reflective of a regression to the mean effect, and indicate that use of alcohol and marijuana are independent of one another

A Behavioral Economic Analysis of Polydrug Abuse in Heroin Addicts

Polydrug abuse is common among substance abusers, but few empirical or theoretical methods accurately characterize this phenomenon. This chapter describes a simulation paradigm that was developed to apply a behavioral economic analysis to understanding polydrug abuse. Heroin abusers 'purchased' drugs as the price of drugs or income varied. In Experiment 1, heroin price rose while prices of other drugs and income remained constant. Heroin purchases significantly decreased as heroin prices increased. As price of heroin rose, valium and cocaine purchases increased and cross-price elasticity coefficients indicated these drugs substituted for heroin. In Experiment 2, prices of both heroin and valium increased separately to determine symmetry of the substitution effect. While valium substituted for heroin, heroin purchases were independent of valium prices. Marijuana and alcohol purchases were independent of valium price, but both these drugs were weak substitutes for heroin. In Experiment 3, income rose while prices remained constant. At some changes in income, demand for heroin and cocaine was income elastic, with purchases rising in greater proportion than income. Marijuana, alcohol, and valium purchases did not vary significantly as a function of income. Choices in this simulation were reliable both between and within subjects. Moreover, drug choices in the simulation were correlated with drug use as determined by urinanalysis testing. These results are discussed in terms of the utility of a behavioral economics approach for characterizing polydrug abuse.

DSM-5 criteria for substance use disorders: recommendations and rationale.

Since DSM-IV was published in 1994, its approach to substance use disorders has come under scrutiny. Strengths were identified (notably, reliability and validity of dependence), but concerns have also arisen. The DSM-5 Substance-Related Disorders Work Group considered these issues and recommended revisions for DSM-5. General concerns included whether to retain the division into two main disorders (dependence and abuse), whether substance use disorder criteria should be added or removed, and whether an appropriate substance use disorder severity indicator could be identified. Specific issues included possible addition of withdrawal syndromes for several substances, alignment of nicotine criteria with those for other substances, addition of biomarkers, and inclusion of nonsubstance, behavioral addictions.This article presents the major issues and evidence considered by the work group, which included literature reviews and extensive new data analyses. The work group recommendations for DSM-5 revisions included combining abuse and dependence criteria into a single substance use disorder based on consistent findings from over 200,000 study participants, dropping legal problems and adding craving as criteria, adding cannabis and caffeine withdrawal syndromes, aligning tobacco use disorder criteria with other substance use disorders, and moving gambling disorders to the chapter formerly reserved for substance-related disorders. The proposed changes overcome many problems, while further studies will be needed to address issues for which less data were available