A hierarchical instrumental decision theory of nicotine dependence

Mechanisms underlying performance in a cued go/no-go Pavlovian-to-instrumental transfer paradigm

Environmental cues that remind us of rewarding outcomes (drugs, food) play a significant role in addiction relapse. In the lab the Pavlovian-to-instrumental transfer (PIT) task has been used to formally examine how cues associated with reward or punishment can bias ongoing instrumental responding. Using a version of this paradigm that integrates PIT with a go/no-go task many studies have related stronger PIT effects (with non-drug rewards) to problematic alcohol use including risky alcohol users relative to non-risky drinkers, individuals with alcohol dependence versus healthy controls and individuals in recovery from alcohol use disorder who are more likely to relapse. However the theoretical importance of these findings and the implications for models of addiction was previously not clear. Understanding if this task indexes the general motivating effects of reward cues on instrumental responding (and whether this is sensitive to shifts in motivation for those outcomes) is critical for understanding these previous results within the context of addiction. Thus, in the current study we aimed to delineate the associative mechanisms that drive the stimulus effects observed in this PIT task. Specifically, we wished to examine whether the cueing effects observed in the cued-go/no-go task were selective in their effect on action, insofar as Pavlovian cues specifically invigorated (or suppressed) responding only if they were associated with congruent outcomes. We conclude that the PIT measured with this task is general in nature. Surprisingly however, the biasing effects of Pavlovian cues on instrumental responding did not appear to be sensitive to outcome devaluation.

Instrumental and Pavlovian Mechanisms in Alcohol Use Disorder

Purpose of Review

Current theories of alcohol use disorders (AUD) highlight the importance of Pavlovian and instrumental learning processes mainly based on preclinical animal studies. Here, we summarize available evidence for alterations of those processes in human participants with AUD with a focus on habitual versus goal-directed instrumental learning, Pavlovian conditioning, and Pavlovian-to-instrumental transfer (PIT) paradigms.

Recent Findings

The balance between habitual and goal-directed control in AUD participants has been studied using outcome devaluation or sequential decision-making procedures, which have found some evidence of reduced goal-directed/model-based control, but little evidence for stronger habitual responding. The employed Pavlovian learning and PIT paradigms have shown considerable differences regarding experimental procedures, e.g., alcohol-related or conventional reinforcers or stimuli.

Summary

While studies of basic learning processes in human participants with AUD support a role of Pavlovian and instrumental learning mechanisms in the development and maintenance of drug addiction, current studies are characterized by large variability regarding methodology, sample characteristics, and results, and translation from animal paradigms to human research remains challenging. Longitudinal approaches with reliable and ecologically valid paradigms of Pavlovian and instrumental processes, including alcohol-related cues and outcomes, are warranted and should be combined with state-of-the-art imaging techniques, computational approaches, and ecological momentary assessment methods.

Addiction is driven by excessive goal-directed drug choice under negative affect: translational critique of habit and compulsion theory

Drug addiction may be a goal-directed choice driven by excessive drug value in negative affective states, a habit driven by strong stimulus-response associations, or a compulsion driven by insensitivity to costs imposed on drug seeking. Laboratory animal and human evidence for these three theories is evaluated. Excessive goal theory is supported by dependence severity being associated with greater drug choice/economic demand. Drug choice is demonstrably goal-directed (driven by the expected value of the drug) and can be augmented by stress/negative mood induction and withdrawal-effects amplified in those with psychiatric symptoms and drug use coping motives. Furthermore, psychiatric symptoms confer risk of dependence, and coping motives mediate this risk. Habit theory of addiction has weaker support. Habitual behaviour seen in drug-exposed animals often does not occur in complex decision scenarios, or where responding is rewarded, so habit is unlikely to explain most human addictive behaviour where these conditions apply. Furthermore, most human studies have not found greater propensity to habitual behaviour in drug users or as a function of dependence severity, and the minority that have can be explained by task disengagement producing impaired explicit contingency knowledge. Compulsion theory of addiction also has weak support. The persistence of punished drug seeking in animals is better explained by greater drug value (evinced by the association with economic demand) than by insensitivity to costs. Furthermore, human studies have provided weak evidence that propensity to discount cost imposed on drug seeking is associated with dependence severity. These data suggest that human addiction is primarily driven by excessive goal-directed drug choice under negative affect, and less by habit or compulsion. Addiction is pathological because negative states powerfully increase expected drug value acutely outweighing abstinence goals.

Preclinical and clinical research on the discriminative stimulus effects of nicotine

Across species, nicotine can produce robust discriminative stimulus (DS) effects, as with other drugs of abuse, a feature that has been harnessed to advance our understanding on the neuropharmacological mechanisms of nicotine's actions. With the crucial role played by nicotine in supporting tobacco dependence, nicotine DS effects have presented an ideal platform to develop novel generation of smoking cessation compounds. Findings from preclinical strands of research have invigorated the field of human discrimination research to objectively assess nicotine's interoceptive stimulus effects. As such, translation studies provide proof of concept for nicotine DS research as a method to assess the subjective effects of nicotine per se, separate from non-nicotine stimuli involved in smoking. Recent clinical studies with low doses have demonstrated that perceiving nicotine's DS effects is necessary, yet not sufficient, for that dose to be reinforcing. These measures have been instrumental in developing novel strategies with regards to establishing threshold doses of nicotine contained in tobacco products, to then determine subthreshold doses that cannot be discriminated and, therefore, fail to maintain reinforcement. Findings from preclinical and clinical nicotine DS research could substantially inform public health policies aimed at regulating nicotine content of consumer products so that they minimize risks of dependency. This article is part of the special issue on 'Contemporary Advances in Nicotine Neuropharmacology'.

Can the discriminative stimulus effects of nicotine function concurrently as modulatory opponents in operant and pavlovian occasion setting paradigms in rats?

Nicotine promotes interoceptive changes in the nervous system. Such interoceptive stimuli play important roles in modulating addictive behavior. Operant and Pavlovian stimulus control modulate responsiveness to environmental stimuli related to drug-seeking and self-administration. Nicotine functions as a discriminative stimulus in modulating operant behavior as well as Pavlovian feature stimuli in modulating the conditional responding (CR) to exteroceptive CS→US contingencies. Elucidation of the interaction of these interoceptive stimulus control functions is vital for a comprehensive understanding of nicotine use/abuse, which might lead to better behavioral treatment strategies. This experiment evaluated the interaction among Pavlovian feature positive (FP) and feature negative (FN) effects of nicotine on concurrently occurring operant S^D and S^Δ effects. Sixteen rats were trained in a Pavlovian and operant bidirectional contingency paradigm, using nicotine (0.3 mg/kg) and non-drug (saline) states as interoceptive cues for operant discriminative stimulus conditions (S^D and S^Δ) as well as Pavlovian FP and FN for a light-CS, either leading to a shared food pellet outcome or non-outcome. Nicotine and saline sessions were intermixed. For one group of rats (n = 8), nicotine served as an S^D for lever pressing (variable interval 60 s) and simultaneously functioned as an FN for CS-light→noUS relation on the same sessions. On intermixed sessions, saline served as the S^Δ for lever pressing (non-reinforced) and FP, during which the 8-sec light preceded delivery of the food pellet (variable time ITI = 60 s). For the other group (n = 8) nicotine served as the S^Δ (lever pressing non-reinforced) and FP for the CS, with saline serving in the reverse roles. Consecutive brief non-reinforcement tests revealed that: A) rates of lever pressing were significantly greater in S^D than S^Δ with nicotine and saline suggesting strong operant discriminative stimulus control; B) FP responding to the light CS with nicotine and saline was evident; and C) FN suppression of the CR with nicotine was not evident but weak under saline. These data suggest that nicotine can function as an interoceptive context that hierarchically can enter into concurrently opposing modulatory relations in Pavlovian and operant drug discrimination procedures.

A Functional-Cognitive Perspective on the Relation Between Conditioning and Placebo Research

From a functional-cognitive perspective, conditioning is relevant for placebo research because it (a) highlights stimulus pairings (e.g., taking a pill that contains an active pharmacological substance causing a drop in blood pressure) as a potential environmental cause of creating or boosting placebo effects (e.g., reduction in blood pressure after taking a similar pill that no longer contains the active substance) and (b) orients researchers to potential mental mechanisms that might underlie those effects (e.g., the formation of associations or propositions). After describing the functional-cognitive perspective on conditioning, I provide a brief overview of three generations of conditioning theories (stimulus-response, stimulus-stimulus, and propositional theories) and evaluate different ways in which conditioning and placebo research can be related. Finally, I discuss the implications of the functional-cognitive perspective on conditioning for the status of the placebo phenomenon.

Cigarette smoking and depression comorbidity: systematic review and proposed theoretical model

BACKGROUND AND AIMS

Despite decades of research on co-occurring smoking and depression, cessation rates remain consistently lower for depressed smokers than for smokers in the general population, highlighting the need for theory-driven models of smoking and depression. This paper provides a systematic review with a particular focus upon psychological states that disproportionately motivate smoking in depression, and frame an incentive learning theory account of smoking-depression co-occurrence.

METHODS

We searched PubMed, Scopus, PsychINFO and CINAHL to December 2014, which yielded 852 papers. Using pre-established eligibility criteria, we identified papers focused on clinical issues and motivational mechanisms underlying smoking in established, adult smokers (i.e. maintenance, quit attempts and cessation/relapse) with elevated symptoms of depression. Two reviewers determined independently whether papers met review criteria. We included 297 papers in qualitative synthesis.

RESULTS

Our review identified three primary mechanisms that underlie persistent smoking among depressed smokers: low positive affect, high negative affect and cognitive impairment. We propose a novel application of incentive learning theory which posits that depressed smokers experience greater increases in the expected value of smoking in the face of these three motivational states, which promotes goal-directed choice of smoking behavior over alternative actions.

CONCLUSIONS

The incentive learning theory accounts for current evidence on how depression primes smoking behavior and provides a unique framework for conceptualizing psychological mechanisms of smoking maintenance among depressed smokers. Treatment should focus upon correcting adverse internal states and beliefs about the high value of smoking in those states to improve cessation outcomes for depressed smokers.

The propositional basis of cue-controlled reward seeking

Two experiments examined the role of propositional and automatic (ideomotor) processes in cue-elicited responding for rewarding outcomes (beer and chocolate). In a training phase, participants earned either chocolate or beer points by making one of two button-press responses. Rewards were indicated by the presentation of chocolate and beer pictures. On test, each trial began with a picture of beer or chocolate, or a blank screen, and choice of the beer versus chocolate response was assessed in the presence of these three pictures. Participants tended to choose the beer and chocolate response in the presence of the beer and chocolate pictures, respectively. In Experiment 1, instructions signalling that the pictures did not indicate which response would be rewarded significantly reduced the priming effect. In Experiment 2, instructions indicating that the pictures signified which response would not be rewarded resulted in a reversed priming effect. Finally, in both experiments, the priming effect correlated with self-reported beliefs that the cues signalled which response was more likely to be reinforced. These results suggest that cue-elicited response selection is mediated by a propositional belief regarding the efficacy of the response–outcome relationship, rather than an automatic ideomotor mechanism.

The Relationship Between Specific Pavlovian Instrumental Transfer and Instrumental Reward Probability

Goal-directed behavior is influenced by environmental cues: in particular, cues associated with a reward can bias action choice toward actions directed to that same reward. This effect is studied experimentally as specific Pavlovian-instrumental transfer (specific PIT). We have investigated the hypothesis that cues associated to an outcome elicit specific PIT by rising the estimates of reward probability of actions associated to that same outcome. In other words, cues reduce the uncertainty on the efficacy of instrumental actions. We used a human PIT experimental paradigm to test the effects of two different instrumental contingencies: one group of participants had a 33% chance of being rewarded for each button press, while another had a 100% chance. The group trained with 33% reward probability showed a stronger PIT effect than the 100% group, in line with the hypothesis that Pavlovian cues linked to an outcome work by reducing the uncertainty of receiving it. The 100% group also showed a significant specific PIT effect, highlighting additional factors that could contribute to specific PIT beyond the instrumental training contingency. We hypothesize that the uncertainty about reward delivery due to testing in extinction might be one of these factors. These results add knowledge on how goal-directed behavior is influenced by the presence of environmental cues associated with a reward: such influence depends on the probability that we have to reach a reward, namely when there is less chance of getting a reward we are more influenced by cues associated with it, and vice versa.