Alcohol demand assessed daily: Validity, variability, and the influence of drinking-related consequences

An experimental investigation into the effect of negative affect on the behavioral economic demand for alcohol

Influential theoretical models hypothesize that alcohol use is an especially potent reinforcer when used as a strategy to cope with negative affect. Although the evidence for this idea in observational data is weak, some experimental evidence suggests that the behavioral economic demand for alcohol increases immediately following a negative emotional event. Because existing studies testing the effect of negative mood inductions on the demand for alcohol have several methodological limitations and do not take inter- and intraindividual variability into account, we developed an improved experimental design to increase our confidence in any potential within-person effect of negative mood inductions on alcohol demand as well as to test whether this effect exhibits systematic inter- and intraindividual variability. We hypothesize that people will show a higher demand for alcohol following negative compared to neutral mood inductions and that this effect is stronger in heavy compared to light drinkers as well as stronger on days characterized by higher coping motives and negative urgency. Three hundred twenty college students will complete the alcohol purchase task (APT) after being subjected to 100 mood inductions (six negative, six neutral) on 20 separate days. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Reliability and validity of behavioral-economic measures: A review and synthesis of discounting and demand

This review sought to synthesize the literature on the reliability and validity of behavioral-economic measures of demand and discounting in human research, introduce behavioral-economic research methodologies for studying addictive behaviors, discuss gaps in the current literature, and review areas for future research. A total of 34 studies was included in this review. The discounting literature showed similar responding regardless of whether hypothetical or actual outcomes were used, though people tended to discount the outcome presented first more steeply, suggesting order effects. Although delay-discounting measures seem to show temporal stability, exceptions were found for probability- and experiential-discounting tasks. The demand literature also demonstrated similar responding regardless of outcome type; however, some demand indices showed exceptions. Randomized price sequences tended to show modest increases in Omax and α and modestly higher rates of inconsistent or nonsystematic responses compared with sequential price sequences. Demand indices generally showed temporal stability, although the stability was weaker the larger the time interval between test sessions. Future studies would benefit by examining addictive commodities beyond alcohol, nicotine, and money; examining temporal stability over longer time intervals; using larger delays in discounting tasks; and using larger sample sizes.

Associations between alcohol demand, delayed reward discounting, and high-intensity drinking in a diverse emerging adult sample

The high-intensity drinking threshold (HID; 8+/10+ drinks for women/men) is more strongly associated with significant alcohol-related health consequences than the more common heavy episodic drinking threshold (HED; 4+/5+ drinks for women/men). Behavioral economic measures of alcohol reward value (demand) and delayed reward discounting (DRD) have shown associations with other alcohol-related risk behaviors and may contribute to efforts to identify individuals who are at risk for HID from the larger subgroup of at-risk drinkers who engage in HED. Logistic regression analyses tested if alcohol demand and DRD were associated with HID in a sample of 477 emerging adults who reported recent heavy drinking. Receiver operating curve (ROC) analyses were conducted to test these variables' ability to classify HID group membership and to select an optimal cutoff score. In logistic regression analyses controlling for typical weekly drinking, demographics, and other variables associated with HID, participants reporting higher demand intensity (amount of alcohol purchased when price is zero; Adjusted Odds Ratio (AOR) = 20.27, 95% CI [5.71, 71.91]) and lower demand elasticity (sensitivity of alcohol consumption to increases in cost; AOR = .29, 95% CI [.11, 72]) were more likely to report HID relative to HED. Omax (maximum alcohol expenditure) and DRD were associated with HID in bivariate, but not in multivariate models. The ROC analysis provided support for an intensity cutoff of 7.5 or higher. These findings suggest that brief alcohol demand curve measures, in particular demand intensity and elasticity, may have utility in identifying individuals who are at risk for HID. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A contextualized reinforcer pathology approach to addiction

Behavioural economic accounts of addiction conceptualize harmful drug use as an operant reinforcer pathology, emphasizing that a drug is consumed because of overvaluation of smaller immediate rewards relative to larger delayed rewards (delay discounting) and high drug reinforcing value (drug demand). These motivational processes are within-individual determinants of behaviour. A third element of learning theory posits that harmful drug use depends on the relative constraints on access to other available activities and commodities in the choice context (alternative reinforcers), reflecting the substantial influence of environmental factors. In this Perspective, we integrate alternative reinforcers into the contemporary behavioural economic account of harmful drug use - the contextualized reinforcer pathology model - and review empirical literature across the translational spectrum in support of this model. Furthermore, we consider how increases in drug-related mortality and health disparities in addiction can be understood and potentially ameliorated via a contextualized reinforcer pathology model in which lack of alternative reinforcement is a major risk factor for addiction.

Alcohol demand assessed daily as a predictor of same day drinking

OBJECTIVE

In this investigation, baseline (trait) and daily (brief) alcohol purchase task (APT) indices (intensity: consumption at zero cost; Omax: maximum expenditure; breakpoint: cost suppressing consumption to zero) were used to investigate the influence of morning demand on subsequent alcohol consumption.

METHOD

Heavy drinking college students (n = 92, age 18-20, 50% female) completed 28 daily morning reports including demand and prior day drinking. Hierarchical linear modeling, with days (Level 1) nested within-person (Level 2) were used to test the effect of morning demand on number of drinks consumed on planned drinking days, with Level 1 (study day, survey time, weekend/weekday) and Level 2 (spending money, typical drinks) covariates. Subsequently, the relative impact on daily drinking of (a) the average of each daily demand index on planned drinking days versus (b) the matched trait demand index was assessed.

RESULTS

Higher morning intensity was related to increased alcohol consumption later that night. This finding held in sensitivity analyses wherein demand was assumed to be zero on unplanned drinking days. When tested individually, both aggregate daily and baseline trait intensity were significantly associated with average drinks measured daily. However, in the same model, only aggregate daily intensity was significant. Neither daily aggregate nor trait breakpoint or Omax were significant.

CONCLUSIONS

Findings replicate previous work suggesting that brief demand (intensity) can predict same day drinking. Elevation in intensity in particular may denote greater risk for elevated alcohol consumption at subsequent episodes, thus intervention among at-risk drinkers may be possible prior to drinking initiation. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Addictive behavior as molar behavioral allocation: Distinguishing efficient and final causes in translational research and practice

OBJECTIVE

Translational research on addictive behaviors viewed as molar behavioral allocation is critically reviewed. This work relates rates of behavior to rates of reinforcement over time and has been fruitfully applied to addictive behaviors, which involve excessive allocation to short-term rewards with longer term costs.

METHOD

Narrative critical review.

RESULTS

This approach distinguishes between final and efficient causes of discrete behaviors. The former refers to temporally extended behavior patterns into which the act fits. The latter refers to environmental stimuli or internal psychological mechanisms immediately preceding the act. Final causes are most clear when addictive behaviors are studied over time as a function of changing environmental circumstances. Discrete acts of addictive behavior are part of an extended/molar behavior pattern when immediate constraints on engagement are low and few rewarding alternatives are available. Research framed by efficient causes often use behavioral economic simulation tasks as individual difference variables that precede discrete acts. Such measures show higher demand for addictive commodities and steeper discounting in various risk groups, but whether they predict molar addictive behavior patterning is understudied.

CONCLUSIONS

Although efficient cause analysis has dominated translational research, research supports viewing addictive behavior as molar behavioral allocation. Increasing concern with rate variables underpinning final cause analysis and considering how study methods and temporal units of analysis inform an efficient or final cause analysis may advance understanding of addictive behaviors that occur over time in dynamic environmental contexts. This approach provides linkages between behavioral science and disciplines that study social determinants of health. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Change in alcohol demand following a brief intervention predicts change in alcohol use: A latent growth curve analysis

BACKGROUND

The association between behavioral economic demand and various alcohol use outcomes is well established. However, few studies have examined whether changes in demand occur following a brief alcohol intervention (BAI), and whether this change predicts alcohol outcomes over the long term.

METHODS

Parallel process piecewise latent growth curve models were examined in a sample of 393 heavy drinking emerging adults (60.8% women; 85.2% white; M_age  = 18.77). In these models, two linear slopes represented rates of change in alcohol use, heavy drinking episodes, alcohol-related problems, and demand (intensity and highest expenditure across all price points or O_max ) from baseline to 1 month (slope 1) and 1 month to 16 months (slope 2). Mediation analyses were conducted to estimate the effect of a BAI on 16-month alcohol outcomes through slope 1 demand.

RESULTS

A two-session BAI predicted significant reductions in all five outcomes from baseline to 1-month follow-up. Although no further reduction was observed from the 1-month to the 16-month follow-up, there was no regression to baseline levels. Slope 1 demand intensity, but not O_max , significantly mediated the association between BAI and both outcomes-heavy drinking episodes (Est. = -0.23, SE = 0.08, p < 0.01) and alcohol-related problems (Est. = -0.15, SE = 0.07, p < 0.05)-at the 16-month follow-up.

CONCLUSIONS

Reducing high valuation of alcohol among heavy drinking emerging adults within the first month following BAI is critical for the long-term efficacy of the intervention. A two-session BAI was associated with enduring reductions in alcohol demand, and the change in demand intensity, but not O_max , was associated with sustained reductions in heavy drinking and alcohol-related problems.

Craving, stimulation, and sedation as predictors of alcohol demand under intoxication

Objective: Alcohol demand has been evaluated predominately as a trait-like construct, reflecting individual differences in alcohol's reinforcement value. Increases in state-dependent alcohol demand under intoxication have been demonstrated, indicating a potential mechanism that may influence drinking behavior. This study evaluated the roles of craving and subjective alcohol response (stimulation, sedation) in this process, testing whether increases in craving and stimulation, and reductions in sedation, predicted increased alcohol demand during a laboratory-based drinking episode. Method: Young adults (N = 90; 53% male; M age = 22.2) attended two sessions in a within-subjects alcohol/placebo design. Craving, stimulation, sedation, and alcohol demand (breakpoint, O_max, intensity) were assessed once before beverage consumption and at multiple points afterward at varying blood alcohol concentrations (M peak BrAC = 0.102 g%). Multilevel models tested associations between momentary and between-person predictors (craving, stimulation, sedation) and alcohol demand after accounting for sex, time trends, and baseline covariates. Results: When intoxicated, participants reported higher alcohol demand across the majority of the ascending limb and decreasing demand across the descending limb. Participants reported increased demand at moments when experiencing higher craving, ps ≤ .001, and stimulation, with momentary stimulation incrementally predicting demand above craving, ps ≤ .04. Between-persons, higher alcohol-induced craving was associated with increased demand, ps ≤ .001, whereas between-person stimulation and sedation were less robustly associated with demand indicators. Conclusions: Results indicate that within-person craving and stimulation during intoxication are independently associated with changes in alcohol's reinforcing value. Findings suggest the potential for state-dependent alcohol demand to serve as an additional motivational index of processes underlying ongoing drinking behavior. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Associations between alcohol demand and both the experience and subjective evaluation of positive and negative alcohol-related consequences

BACKGROUND

Considerable variation exists in the extent to which alcohol-related consequences are evaluated as positive or negative. These evaluations, in turn, predict subsequent drinking behavior. Understanding the etiological pathways to positive and negative alcohol-related consequences is essential to the design of interventions aimed at reducing drinking consequences. Behavioral economic models posit that excessive alcohol valuation contributes to problematic use. Elevated alcohol demand (i.e., relative alcohol value) is associated with negative alcohol-related consequences; however, it is unclear whether demand is related to positive consequences or subjective consequence evaluations.

METHODS

College student drinkers (n = 114; 74.6% female) completed an online survey. Participants indicated whether they had ever experienced any of 24 negative and 14 positive consequences and subjectively evaluated their most recent experience of each consequence endorsed. An alcohol purchase task assessed hypothetical alcohol consumption across 14 prices and three observed demand indices were calculated: intensity (i.e., consumption at zero cost), O_max (i.e., maximum expenditure), and P_max (i.e., price associated with maximum expenditure). Bivariate correlations and hierarchical regressions were used to test associations between observed demand indices and the number and subjective evaluations of positive and negative (researcher- and participant-defined) consequences.

RESULTS

Intensity and O_max , but not P_max , were bivariately associated with researcher- and participant-defined negative and positive consequences. However, in hierarchical regression models that controlled for the maximum number of drinks consumed in a single day over the past month, only intensity was significantly associated with more negative and positive consequences. Intensity was associated with positive consequence evaluations in bivariate but not regression models.

CONCLUSION

Students with higher intensity reported more prior alcohol consequences (positive and negative), independent of drinking level. However, subjective evaluations of recent consequences did not vary as a function of demand. Results support using behavioral economic models to facilitate identifying etiologic pathways to alcohol consequences and suggest that novel interventions incorporating demand manipulation may reduce drinking consequences.

Concurrent validity of the Alcohol Purchase Task for measuring the reinforcing efficacy of alcohol: an updated systematic review and meta-analysis

BACKGROUND AND AIMS

An early meta-analysis testing the concurrent validity of the Alcohol Purchase Task (APT), a measure of alcohol's relative reinforcing value, reported mixed associations, but predated a large number of studies. This systematic review and meta-analysis sought to: (1) estimate the relationships between trait-based alcohol demand indices from the APT and multiple alcohol indicators, (2) test several moderators and (3) analyze small study effects.

METHODS

A meta-analysis of 50 cross-sectional studies in four databases (n = 18 466, females = 43.32%). Sex, year of publication, number of APT prices and index transformations (logarithmic, square root or none) were considered as moderators. Small study effects were examined by using the Begg-Mazumdar, Egger's and Duval & Tweedie's trim-and-fill tests. Alcohol indicators were quantity of alcohol use, number of heavy drinking episodes, alcohol-related problems and hazardous drinking. APT indices were intensity (i.e. consumption at zero cost), elasticity (i.e. sensitivity to increases in costs), O_max (i.e. maximum expenditure), P_max (i.e. price associated to O_max ) and breakpoint (i.e. price at which consumption ceases).

RESULTS

All alcohol demand indices were significantly associated with all alcohol-related outcomes (r = 0.132-0.494), except P_max , which was significantly associated with alcohol-related problems only (r = 0.064)_. The greatest associations were evinced between intensity in relation to alcohol use, hazardous drinking and heavy drinking and between O_max and alcohol use. All the tested moderators emerged as significant moderators. Evidence of small-study effects was limited.

CONCLUSIONS

The Alcohol Purchase Task appears to have concurrent validity in alcohol research. Intensity and O_max are the most relevant indices to account for alcohol involvement.

Qualitative examination of simultaneous alcohol and cannabis use reasons, evaluations, and patterns among heavy drinking young adults

Use of alcohol and cannabis together so their effects overlap (simultaneous use) is common among college students and associated with numerous negative consequences. The aim of this study was to gain insight into college students' recent simultaneous use events in order to inform future studies (i.e., generate hypotheses, inform measures/assessments of simultaneous use, and identify factors influencing simultaneous use). Qualitative interviews of simultaneous use experiences among heavy drinking college students (n = 38) were conducted to better understand reasons for simultaneous use, evaluations of simultaneous use events, and patterns of substance use during simultaneous use events. Findings indicated that students' reasons for simultaneous use included traditional four-factor motive types (i.e., social, conformity, enhancement, and coping), cross-fading motives, harm reduction motives (e.g., to drink less), and reactive/situational reasons (e.g., because it was offered/available). There was variability in participants' subjective evaluations of how positive versus negative simultaneous use events were and how this compared to single-substance events. Evaluation of simultaneous use events depended on patterns of use, external and internal context, and consequences experienced. Additionally, patterns of simultaneous use including order of substances, timing of using each substance, and quantities of substances used were highly variable across participants. Notably, participants endorsed patterns of use they perceived to reduce negative consequences during simultaneous use events. Further research on reasons for simultaneous use and patterns of use may help identify simultaneous use occasions that result in greater risk; identification of high-risk simultaneous use occasions and evaluation of these occasions can then help inform targeted interventions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Do alcohol-related consequences and how they are evaluated predict consumption during and days until the next drinking event?

Objective: Alcohol-related consequences are most often examined as outcomes of alcohol use. However, it is also possible that experiencing consequences may predict future drinking behavior. The predictive power of consequences on future drinking behavior may involve both objective experiences of consequences and subjective evaluations of those consequences (i.e., how positive, how negative). The purpose of the present study was to understand how positive and negative alcohol-related consequences-and evaluations of those consequences-predict elements of the next drinking event among college students. Method: 96 participants reported alcohol use and related consequences over a 28-day daily assessment period. Results: Survival analysis and multilevel modeling were used to examine the influence of positive and negative consequences from a given drinking event on latency to and number of drinks consumed at the next drinking event. Contrary to hypotheses, subsequent drinking was not impacted by recent consequences nor how they were perceived. Conclusions: Though theoretically, experiencing alcohol consequences may impact proximal drinking behavior, findings suggest that, in the current sample, other factors have greater importance in the latency between drinking events and amount of alcohol consumed. Future work should continue to identify event-level predictors that impact behavior at the next drinking event, and ways drinkers attempt to avoid repetition of drinking consequences other than simply drinking less (e.g., protective behavioral strategies), as such factors would be valuable targets for intervention. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Initial development of a brief assessment of cocaine demand

Cocaine demand is a behavioral economic measure assessing drug reward value and motivation to use drug. The purpose of the current study was to develop a brief assessment of cocaine demand (BACD). Results from the BACD were compared with self-report measures of cocaine use. Participants consisted of treatment-seeking individuals with cocaine use disorder (N = 22). Results revealed that indices of brief demand were significantly associated with various self-report measures of cocaine use. Overall, these results support the utility of a BACD for assessing cocaine demand.

Behavioral economics and the aggregate versus proximal impact of sociality on heavy drinking

BACKGROUND

Behavioral economic theory predicts decisions to drink are cost benefit analyses, and heavy episodic drinking occurs when benefits outweigh costs. Social interaction is a known benefit associated with alcohol use. Although heavy drinking is typically considered more likely during more social drinking events, people who drink heavily in isolation tend to report greater severity of use. This study explicitly disaggregates between-person and within-person effects of sociality on heavy episodic drinking and examines behavioral economic moderators.

METHODS

We used day-level survey data over an 18-week period in a community adult sample recruited through crowdsourcing (mTurk; N = 223). Behavioral economic indices were examined to determine if macro person-level variables (alcohol demand, delay discounting, proportionate alcohol-related reinforcement [R-ratio]) interact with event-level social context to predict heavy drinking episodes.

RESULTS

Mixed effect models indicated significant between-person and within-person social context associations. Specifically, people with a higher proportion of total drinking occasions in social contexts had decreased odds of heavy drinking, whereas being in a social context for a specific drinking occasion was associated with increased odds of heavy drinking. Person-level R-Ratio, demand elasticity, and breakpoint variables interacted with social context to predict heavy episodic drinking, such that the event-level social context association was stronger when R-Ratios, alcohol price insensitivity, and demand breakpoints were high.

CONCLUSIONS

These results demonstrate an ecological fallacy, in which the size and direction of effects were divergent at different levels of analysis, and highlight the potential for merging behavioral economic variables with proximal contextual effects to predict heavy drinking.

Intravenous Alcohol Administration Selectively Decreases Rate of Change in Elasticity of Demand in Individuals With Alcohol Use Disorder

BACKGROUND

Alcohol demand is a key behavioral economic concept that provides an index of alcohol's relative reinforcing value. Initial studies have reported that alcohol demand increases during alcohol administration and in response to alcohol cues. However, the extent to which these effects are observed explicitly in samples composed of individuals with alcohol use disorder (AUD) and are operative in conjunction with each other has not been studied.

METHODS

To address this gap in the literature, we assessed alcohol demand during an alcohol challenge and subsequent alcohol cue-exposure paradigm in non-treatment-seeking, alcohol-dependent (i.e., DSM-IV criteria) participants (N = 27). Specifically, participants completed 2 counterbalanced intravenous, placebo-controlled, alcohol administration sessions followed by a controlled cue-exposure paradigm. At baseline and at breath alcohol concentration of 0.06 g/dl, participants completed the alcohol purchase task, assessing estimated alcohol consumption at escalating prices. Participants were also assessed for alcohol demand following each cue exposure.

RESULTS

During alcohol administration, there was a significant decrease in the rate of change in elasticity compared with placebo, and during the cue-reactivity paradigm, there was a significant main effect such that alcohol cues decreased the rate of change in elasticity relative to water cues. There were no statistically significant differences in other demand indices.

CONCLUSIONS

These findings provide further evidence that alcohol administration increases price insensitivity and extends the literature on alcohol's effects on demand by using a clinical sample with AUD and by adding a placebo-alcohol condition.