The behavioral economics of young adult substance abuse

doi:10.1016/j.ypmed.2016.04.022

Preventive Medicine

Volume 92, November 2016, Pages 24-30

https://doi.org/10.1016/j.ypmed.2016.04.022 Get rights and content

Highlights

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A review of how behavioral economic models apply to young adult substance use.
•
Low substance-free rewards and future time orientation predict substance abuse.
•
Measures of substance reward value may identify the most at-risk young adults.
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Interventions informed by behavioral economics are promising.
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Environmental and policy-level changes are important for prevention.

Abstract

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.

Section snippets

Young adult substance use

Young adults between the ages of 18–25 have higher rates of past-month heavy episodic drinking (32% consume 4/5 drinks in a sitting for women/men) and illicit drug use (22%) than any other age group (Center for Behavioral Health Statistics and Quality, 2015). Approximately half of all young adults attend college, and although completing college is protective against lifetime substance abuse (Gilman et al., 2008), young adults who attend college report slightly higher rates of current heavy

Overview of behavioral economic models of substance misuse

Behavioral economic theory assumes that decisions to use alcohol and other drugs are a function of the benefit/cost ratio of substance use in relation to the benefit/cost ratios of other available activities (Rachlin, 2000, Vuchinich and Tucker, 1988). Addiction is understood as a continuous phenomenon that is defined as a pattern of fairly consistent preference for drug rewards relative to other activities. Reinforcement pathologies such as alcohol or drug addiction are presumed to result from

Implications for prevention

Three primary implications of behavioral economic models for the prevention of young adult substance misuse are: 1) the assessment of substance abuse, including response to treatment, should include measurement of the relative valuation of drug-related and drug-free rewards, as well as the degree to which delayed rewards are discounted, and 2) that treatment should attempt to reduce the overvaluation of current relative to future rewards and increase engagement in regular patterns of behavior

Young adult treatment and brief intervention

Contingency management, community reinforcement therapy, and coping skills training attempt to help individuals increase substance-free sources of reinforcement (Petry et al., 2000) and may be especially helpful with treatment seeking young adults. However, these treatments require substantial resources on the part of the treatment provider (counselors, money for vouchers) and the participant (attending frequent counseling sessions and drug tests) and would be difficult to implement with the

Environmental/policy level risk factors and prevention implications

There are a number of environmental factors specific to young adults that convey additional risk for problematic substance use patterns. As noted above, many young adults, particularly those enrolled in college, have ample free time and few responsibilities that prohibit them from spending excessive time drinking and using drugs such as a demanding work schedule or family responsibilities (Schulenberg and Maggs, 2002), and report that they would drink less when faced with a next-day

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The first year of college is often marked by increased levels of alcohol consumption; first-year students also vary in their sense of fitting in on campus. Research has amply documented the links between social and enhancement drinking motives with various alcohol outcomes among college students. However, it is unclear how perceived levels of fitting in on campus potentially buffers or amplifies the relationship between drinking motives and drinking behavior. We explored whether perceptions of fitting in on campus moderated effects of social and/or enhancement drinking motives on drinks per week. A sample of 121 heavy drinking first year college students (50 % female, 58 % non-Latinx White, M = 18 years of age) were assessed twice in their first semester (baseline, 3 months) in the context of an alcohol-specific intervention. Hierarchical linear regressions were conducted to test whether drinking motives (social and enhancement) at baseline prospectively predicted drinks per week at 3 months. We hypothesized a positive association between both drinking motives and drinks per week; whether fitting in moderates these relationships was exploratory. Regression analyses yielded non-significant main effects of social motives, enhancement motives, and feelings of fitting in on drinks per week. There was no significant interaction for social motives, but the interaction between enhancement motives and fitting in was significant. Participants with a low sense of fitting in had a strong positive relationship between enhancement motives and drinks per week. Improving perceptions of fitting in for first-year college students may potentially reduce the association between enhancement drinking motives and drinks per week.
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Parenting practices, especially those characterized by harsh and neglectful behaviors, have a significant impact on child development. Despite the importance of parenting, little attention has been paid to personality-linked constructs that may guide how parents make decisions regarding their interactions with their children. For instance, parents who focus on getting their child to do something immediately may engage in behaviors that yield rapid compliance (e.g., hitting, yelling) at the expense of longer-term parent-child relationship quality. Building on literatures examining the effects of time horizon on behavior, this series of studies examined the development of a measure of parental time horizon to evaluate whether parents who focus on short-term (immediate) consequences of their actions experience higher rates of parenting distress and engage in more negative parenting behaviors. Study 1 examined the psychometric properties of a parenting-adapted Consideration of Future Consequences Scale, finding that more immediate time orientation was associated with greater parenting stress. Study 2 replicated these results and relations to parenting distress, suggesting that time orientation was associated with positive and negative parenting behaviors in a socioeconomically distressed sample. Together, these studies demonstrate support for further evaluating parental time orientation and its effects on parent and child outcomes.
The association between meaning in life and harmful drinking is mediated by individual differences in self-control and alcohol value
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Citation Excerpt :
Meaning in life (defined as the pursuit of intrinsically valued goals) is inversely associated with harmful drinking (Csabonyi & Phillips, 2017; Schnetzer, Schulenberg, & Buchanan, 2013), and reductions in harmful drinking are preceded by increased self-control (Quinn & Fromme, 2010) and reduced valuation of alcohol (Murphy & Dennhardt, 2016).
The adoption of adult roles that provide meaning in life is associated with reduced harmful drinking. The current study examined whether this relationship is mediated by increased self-control and reduced value of alcohol.
Cross-sectional design. 1043 adults (786 females) ≥18 years old completed an online survey. The outcome variable was scores on the Alcohol Use Disorders Identification Test (AUDIT), predictor variables were presence of and search for meaning in life (Meaning in Life Questionnaire), and mediating variables were trait self-control (Brief Self-Control Scale) and the value of alcohol (Brief Assessment of Alcohol Demand).
Presence of meaning in life had a significant negative association (B = −0.01, SE = 0.00, 95% CI −0.02 to −0.00, p = .015), whilst search for meaning in life had a significant positive association (B = 0.01, SE = 0.00, 95% CI 0.01 to 0.02, p = .001) with AUDIT scores. The negative association was mediated by increased self-control (B = −0.09, SE = 0.01, 95% CI −0.12 to −0.06) and decreased value of alcohol (B = −0.02, SE = 0.01, 95% CI −0.04 to 0.00), whilst the positive association was mediated by decreased self-control (B = 0.05, SE = 0.01, 95% CI 0.03 to 0.07) and increased value of alcohol (B = 0.02, SE = 0.01, 95% CI 0.00 to 0.04), thereby supporting our hypotheses.
The relationships between presence and search for meaning in life and harmful drinking are mediated by individual differences in both trait self-control and the value of alcohol.
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Interventions focused on changing delay discounting rates have been conducted primarily with executive functioning training and related cognitive interventions [41], and our test of change in delay discounting from a behavioral activation intervention is new. Given that high delay discounting is associated with poor response to brief interventions typically administered to college freshmen, the therapeutic potential of BA for individuals high in delay discounting is important, and the proposed research may contribute new information about ways in which delay discounting may be modified [41,42]. The study will also contribute knowledge regarding the efficacy of BA in addressing additional clinical outcomes that are influenced by the reinforcement system.
The transition from high school to college is a developmentally sensitive period that is high-risk for the escalation of alcohol use. Although risky drinking is a common problem among freshmen, engagement in treatment services is very low. College alcohol interventions target drinking directly at a time when students may be uninterested in changing their drinking. Approaches that indirectly target drinking may be particularly effective. Behavioral activation (BA) is an intervention that indirectly addresses mental health conditions by guiding individuals to engage in reinforcing activities that align with their values (Lejuez et al., 2001). A pilot study of a BA intervention administered in a semester-long freshman orientation course reported a significant decrease in drinking-related problems compared to students in standard orientation course (Reynolds et al., 2011).
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^☆: The authors declare there is no conflict of interest.

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The behavioral economics of young adult substance abuse☆

Highlights

Abstract

Section snippets

Young adult substance use

Overview of behavioral economic models of substance misuse

Implications for prevention

Young adult treatment and brief intervention

Environmental/policy level risk factors and prevention implications

Transparency document

Drug Alcohol Depend.

Addict. Behav.

J. Am. Acad. Child Adolesc. Psychiatry

Addict. Behav.

Addict. Behav.

Addict. Behav.

Addict. Behav.

Addict. Behav.

Drug Alcohol Depend.

Addict. Behav.

Am. J. Public Health

Addict. Behav.

Addict. Behav.

Drug Alcohol Depend.

Addict. Behav.

Drug Alcohol Depend.

J. Adolesc. Health

Drug Alcohol Depend.

Health Place

J. Adolesc. Health

Greater discounting of delayed rewards in young adults with family histories of alcohol and drug use disorders: studies from the Oklahoma family health patterns project

Alcohol. Clin. Exp. Res.

Clarifying the relationship between impulsive delay discounting and nicotine dependence

Psychol. Addict. Behav.

Increased behavioral economic demand and craving for alcohol following a laboratory alcohol challenge

Addiction

Drug use patterns and continuous enrollment in college: results from a longitudinal study

Addiction

Smoking, Drinking, and Drug Use in Young Adulthood: the Impacts of New Freedoms and New Responsibilities

Decision making, impulse control and loss of willpower to resist drugs: a neurocognitive perspective

Nat. Neurosci.

Problem drinking from young adulthood to adulthood: patterns, predictors and outcomes

J. Stud. Alcohol

The behavioral economics of substance use disorders: reinforcement pathologies and their repair

Annu. Rev. Clin. Psychol.

Therapeutic opportunities for self-control repair in addiction and related disorders change and the limits of change in trans-disease processes

Clin. Psychol. Sci.

The short and long term consequences of adolescent alcohol use

Demand curves for hypothetical cocaine in cocaine-dependent individuals

Psychopharmacology

Understanding naltrexone mechanism of action and pharmacogenetics in Asian Americans via behavioral economics: a preliminary study

Exp. Clin. Psychopharmacol.

Help-seeking for alcohol-related problems in college students: correlates and preferred resources

Psychol. Addict. Behav.

Combining cognitive behavioral therapy and contingency management to enhance their effects in treating cannabis dependence: less can be more, more or less

Addiction

Behavioral health trends in the United States: results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15-4927, NSDUH Series H-50)

A behavioral economic approach to assessing demand for marijuana

Exp. Clin. Psychopharmacol.

Use of a multiple-choice procedure with college student drinkers

Psychol. Addict. Behav.

Change in delay discounting and substance reward value following a brief alcohol and drug use intervention

J. Exp. Anal. Behav.

Reduced sensitivity to immediate reward during decision-making in older than younger adults

PLoS One

Engaging communities to prevent underage drinking

Alcohol Res. Health

Multivariate analyses of predictors of heavy episodic drinking and drinking-related problems among college students

J. Coll. Stud. Dev.

Delay discounting and the alcohol Stroop in heavy drinking adolescents

Addiction

Academic constraints on alcohol consumption in college students: a behavioral economic analysis

Exp. Clin. Psychopharmacol.

A behavioral economic analysis of the effect of next-day responsibilities on drinking

Psychol. Addict. Behav.

Education and race-ethnicity differences in the lifetime risk of alcohol dependence

J. Epidemiol. Community Health

Alcohol involvement and developmental task completion during young adulthood

J. Stud. Alcohol

Discounting of delayed rewards: a life-span comparison