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.

Presentation and validation of the Abbreviated Self Completion Teen-Addiction Severity Index (ASC T-ASI): A preference-based measure for use in health-economic evaluations

Economic evaluations of new youth mental health interventions require preference-based outcome measures that capture the broad benefits these interventions can have for adolescents. The Abbreviated Self Completion Teen-Addiction Severity Index (ASC T-ASI) was developed to meet the need for such a broader measure. It assesses self reported problems in seven important domains of adolescents' lives, including school performance and family relationships, and is intended for use in economic evaluations of relevant interventions. The aim of the current study was to present the ASC T-ASI and examine its validity as well as its ability to distinguish between adolescents with and without problems associated with substance use and delinquency. The validation study was conducted in a sample of adolescents (n = 167) aged 12-18 years, who received in- or outpatient care in a youth mental health and (enclosed) care facility in the Netherlands. To examine its feasibility, test-retest reliability, and convergent validity, respondents completed the ASC T-ASI, as well as the EQ-5D-3L and SDQ at baseline and after a two-week interval using a counterbalanced method. The ASC T-ASI descriptive system comprises seven domains: substance use, school, work, family, social relationships, justice, and mental health, each expressing self reported problems on a five-point Likert scale (ranging from having 'no problem' to having a 'very large problem'). The majority of respondents (>70%) completed the ASC T-ASI within 10 minutes and appraised the questions as (very) easy and (very) comprehensible. Test-retest reliability was adequate (Kw values 0.26-0.55). Correlations with the supplementary measures were moderate to high (rs 0.30-0.50), suggesting convergent validity. The ASC T-ASI is a promising and valid measure for assessing self reported problems in important domains in adolescents' lives, allowing benefits beyond health and health-related quality of life to be included in economic evaluations of youth mental health interventions. Future studies of the ASC T-ASI should consider the comprehensiveness of its domains and sensitivity to change.

Role of Gambling in Payback Failure in Consumer Credit-Data from a Large Body of Material Regarding Consumer Loan Recipients in Sweden

Indebtedness is associated with poor health outcomes, and problem gambling may contribute to indebtedness through consumer credits related to gambling expenses. The assessment of consumers’ applications for loans may be an opportunity to detect and prevent further problem gambling. The present study analyzed a number of variables including gambling-related transactions and their association with payback failure in 48,197 loans to 20,750 individuals in Sweden. Sums and frequency of gambling deposits or withdrawals generally did not predict failure to pay back loans. Instead, having a loan defaulted at some time was associated with a baseline pattern describing a theoretical loss-of-control gambling pattern (short-term intense gambling), with a higher ratio of gambling deposits or withdrawals per occasion, and with several instances of gambling in close association with a loan. While several group differences were modest, signs of rapid, short-term and intense gambling, rather than gambling itself, may identify risk of payback failure and risk of indebtedness. Implications for early problem-gambling detection and prevention, such as by gambling operators and financial institutes, are discussed and may promote better public health in relation to gambling indebtedness.

Behavioral economic demand assessments in the addictions

Behavioral economics in the addictions is the application of both economics and psychology to study multifaceted components of substance use decision-making behavior. One such component is demand: the relative value of a substance for a user (i.e., the association between drug use and cost). The degree to which a user values a substance can be measured via performance on hypothetical purchase tasks which replicate drug purchase and consumption. Demand has been evaluated across substances, including alcohol, marijuana, tobacco, and alternative tobacco products. Recent advances in the study of demand have greatly improved the assessment of drug value, including application to novel products, selection of optimal task unit, assessment of demand in naïve or potential future users, and the importance of instructional set specificity.

Preliminary findings on cryptocurrency trading among regular gamblers: A new risk for problem gambling?

Cryptocurrencies are emerging digital currencies that allow anonymity in accessing various risk-taking activities through the Internet (e.g., drugs, gambling). However, given conceptual links to high-risk stocks, the present study sought to assess the association between trading cryptocurrencies and problem gambling. Data was collected through a cross-sectional online survey. Advertisement for the survey was posted on Amazon's Mechanical Turk. Participants were adults who had gambled at least monthly in the past year (N = 876; 58.33% male; M = 33.74 years, SD = 9.73). Participants completed the Problem Gambling Severity Index, Patient Health Questionnaire (2-item version), and Generalized Anxiety Disorder scale (2-item version). Trading cryptocurrencies is strongly associated with problem gambling severity (r = 0.53, p < .001). Results from a linear regression with backwards elimination revealed that sports betting, daily fantasy sports, high-risk stock trading, and problem gambling severity contribute to trading cryptocurrencies more frequently in the past year, whereas gambling in on-land casinos contributed to less cryptocurrency trading. Finally, trading cryptocurrencies overlapped strongly with trading high-risk stocks. Moreover, gamblers who engaged in both forms of trading reported greater problem gambling and depression and anxiety symptoms relative to those trading either cryptocurrencies or high-risk stocks, but not both. The present results suggest that trading cryptocurrencies may be appealing to gamblers that are exhibiting greater problem gambling severity. Future research should begin to include cryptocurrency trading in screening, assessment, and treatment protocols, particularly with regular gamblers.

The Mental Health Parity and Addiction Equity Act (MHPAEA) evaluation study: Did parity differentially affect substance use disorder and mental health benefits offered by behavioral healthcare carve-out and carve-in plans?

BACKGROUND

To assess whether implementation of the Mental Health Parity and Addiction Equity Act (MHPAEA) was associated with: 1. Reduced differences in financial requirements (i.e., copayments and coinsurance) for substance use disorder (SUD) versus specialty mental health (MH) care and 2. Reductions in the level of cost-sharing for SUD-specific services.

METHODS

MH and SUD copayments and coinsurance, 2008-2013, were obtained from benefits databases for carve-in and carve-out plans from Optum®. Linear regression was used to estimate the association of MHPAEA with differences between MH and SUD care financial requirements among carve-in and carve-out plans. A two-part regression model investigated whether MHPAEA was associated with changes in the use or level of financial requirements for SUD-specific services among carve-out plans.

RESULTS

MHPAEA was not associated with significant changes in the difference between SUD and MH copayments or coinsurance levels among either carve-in or carve-out plans. MHPAEA was associated with decreases in the levels of inpatient (in-network: -$51.17; out-of-network: -$34.39) and outpatient (in-network: -$10.26) detox copayments, but increases in the levels of in-network outpatient detox coinsurance (6 percentage points) among all carve-out plans.

CONCLUSION

Even if SUD benefits had been historically less generous than MH benefits, SUD financial requirements were already at parity with MH financial requirements by the time MHPAEA was passed, among Optum® plans. MHPAEA's SUD parity mandate reduced cost-sharing for detox services via copayments, but, for outpatient detox, the law simultaneously increased cost-sharing via coinsurance.

Is the Rational Addiction model inherently impossible to estimate?

The Rational Addiction (RA) model is increasingly often estimated using individual level panel data with mixed results; in particular, with regard to the implied rate of time discount. This paper suggests that the odd values of the rate of discount frequently found in the literature may in fact be a consequence of the saddle-point dynamics associated with individual level inter-temporal optimization problems. We report the results of Monte Carlo experiments estimating RA-type difference equations that seem to suggest the possibility that the presence of both a stable and an unstable root in the dynamic process may create serious problems for the estimation of RA equations.

The Impact of Disordered Gambling Among Older Adults

The current study is a secondary analysis that describes the mental, social, and economic health impacts of disordered gambling in older adults recovering from pathological gambling. The study sought to answer the following research questions: (a) What are the problem behaviors in the mental, social, and economic health dimensions?; and (b) What is the association between mental, social, and economic health impact dimensions and the South Oaks Gambling Screen score? The study population comprised a convenience sample of 40 older adults recovering from pathological gambling in the Midwestern United States. Participants were originally recruited from Gamblers Anonymous(®) meetings and gambling treatment centers. Significant findings for the current study population were: gambling causing depression, being fired from a job due to gambling, and still paying off gambling debt. Nurses should evaluate effects of disordered gambling, assess for disordered gambling, and include a financial assessment in routine care of this patient population.

"Every 'never' I ever said came true": transitions from opioid pills to heroin injecting

This qualitative study documents the pathways to injecting heroin by users in Philadelphia and San Francisco before and during a pharmaceutical opioid pill epidemic. Data was collected through in-depth, semi-structured interviews (conducted between 2010 and 2012) that were, conducted against a background of longer-term participant-observation, ethnographic studies of street-based drug users and dealers in Philadelphia (2007-12) and San Francisco (1994-2007, 2012). Philadelphia and San Francisco were selected for their contrasting political economies, immigration patterns and source type of heroin. In Philadelphia the ethnographers found heroin injectors, usually white users, who had started their opiate using careers with prescription opioids rather than transitioning from other drugs. In both Philadelphia and San Francisco, most of the young heroin injectors interviewed began, their drug-use trajectories with opioid pills--usually Percocet (oxycodone and acetaminophen), generic short acting oxycodone or, OxyContin (long-acting oxycodone)--before transitioning to heroin, usually by nasal inhalation (sniffing) or smoking at first, followed by injecting. While most of the Philadelphia users were born in the city or its suburbs and had started using both opioid pills and heroin there, many of the San Francisco users had initiated their pill and sometimes heroin use elsewhere and had migrated to the city from around the country. Nevertheless, patterns of transition of younger injectors were similar in both cities suggesting an evolving national pattern. In contrast, older users in both Philadelphia and San Francisco were more likely to have graduated to heroin injection from non-opiate drugs such as cannabis, methamphetamine and cocaine. Pharmaceutical opioid initiates typically reported switching to heroin for reasons of cost and ease-of-access to supply after becoming physically and emotionally dependent on opioid pills. Many expressed surprise and dismay at their progression to sniffing and subsequently to injecting heroin. Historically and structurally these users found themselves caught at the intersection of two major developments in the opiate supply: (1) an over 500% increase in opiate pill prescription from 1997 to 2005 resulting in easy access to diverted supplies of less stigmatized opiates than heroin and (2) a heroin supply glut, following the US entry of Colombian-sourced, heroin in the early 1990s, that decreased cost and increased purity at the retail level. A nationwide up-cycle of heroin use may be occurring among young inner city, suburban and rural youth fueled by widespread prescription opioid pill use.

BDNF Val(66)Met genotype is associated with drug-seeking phenotypes in heroin-dependent individuals: a pilot study

Brain-derived neurotrophic factor (BDNF) Val(66)Met genotype has been associated with neurobehavioral deficits. To examine its relevance for addiction, we examined BDNF genotype differences in drug-seeking behavior. Heroin-dependent volunteers (n = 128) completed an interview that assessed past-month naturalistic drug-seeking/use behaviors. In African Americans (n = 74), the Met allele was uncommon (carrier frequency 6.8%); thus, analyses focused on European Americans (n = 54), in whom the Met allele was common (carrier frequency 37.0%). In their natural setting, Met carriers (n = 20) reported more time- and cost-intensive heroin-seeking and more cigarette use than Val homozygotes (n = 34). BDNF Val(66)Met genotype predicted 18.4% of variance in 'weekly heroin investment' (purchasing time × amount × frequency). These data suggest that the BDNF Met allele may confer a 'preferred drug-invested' phenotype, resistant to moderating effects of higher drug prices and non-drug reinforcement. These preliminary hypothesis-generating findings require replication, but are consistent with pre-clinical data that demonstrate neurotrophic influence in drug reinforcement. Whether this genotype is relevant to other abused substances besides opioids or nicotine, or treatment response, remains to be determined.

Pathways linking socioeconomic status and postpartum smoking relapse

BACKGROUND

Low socioeconomic status (SES) exacerbates the high rate of smoking relapse in women following childbirth.

PURPOSE

This study examined multiple models of potential mechanisms linking SES and postpartum smoking relapse among women who quit smoking due to pregnancy.

METHODS

Participants were 251 women enrolled in a randomized clinical trial of a new postpartum smoking relapse prevention intervention. Four models of the prepartum mechanisms linking SES and postpartum smoking relapse were evaluated using a latent variable modeling approach.

RESULTS

Each of the hypothesized models were a good fit for the data. As hypothesized, SES indirectly influenced postpartum smoking relapse through increased prepartum negative affect/stress, reduced sense of agency, and increased craving for cigarettes. However, the model that included craving as the sole final pathway between SES and relapse demonstrated superior fit when compared with all other models.

CONCLUSIONS

Findings have implications for future interventions that aim to reduce postpartum relapse.

Modelling a two-tier tobacco excise tax policy to reduce smoking by focusing on the addictive component (nicotine) more than the tobacco weight

AIM

To determine whether adding a low tax category for very-low nicotine content (denicotinised or Denic) cigarettes would facilitate higher excise and reduced consumption of addictive cigarettes (AddictiveCigs, defined as containing =2 mg nicotine per cigarette).

METHOD

Nicotine content was laboratory-tested to classify cigarettes into two tiers for excise. PubMed was searched for studies of low nicotine content cigarettes. Nicotine delivery studies and estimated current and future cigarette prices provided the basis for estimating the effect of smoking a mix of AddictiveCigs and Denics.

RESULTS

The test results indicated that mean nicotine content per cigarette for the 22 most popular New Zealand brands was 8.7 mg (range 5.6-12.4 mg); only AddictiveCigs were sold. Annual 10% excise increases now legislated are estimated to increase price to $17.60 per 20s packet by 2016. A minority of smokers will quit, by abstaining from AddictiveCigs. Continuing smokers if able to buy lower-priced Denics ($11 a packet), could partly switch to these, which although no less toxic would relieve cravings, reduce nicotine inhaled by 68-86%, and contain smoking costs, without reducing total cigarettes smoked per day.

CONCLUSION

Introducing a lower excise rate for Denics would: (1) allow smokers to select their own mix of AddictiveCigs and Denics; (2) make Denics available to reduce cravings, reduce addiction, and reduce smoking costs of continuing smokers; (3) increase the political feasibility of increasing excise on AddictiveCigs sufficiently to greatly reduce addictive smoking; and (4) enable smokers to reduce their addiction before they quit, and therefore probably become more likely to succeed when they do so.

Relations among delay discounting, addictions, and money mismanagement: implications and future directions

BACKGROUND

Delay discounting is a reduction in the subjective value of a delayed outcome. Elevated delay discounting is a type of impulsivity that is associated with harmful behaviors, including substance abuse and financial mismanagement.

METHODS

Elevated delay discounting as related to addiction and financial mismanagement was reviewed from psychological, neurobiological, and behavioral economic perspectives.

RESULTS

Addiction and financial mismanagement frequently co-occur, and elevated delay discounting may be a common mechanism contributing to both of these problematic behaviors.

CONCLUSIONS

Future research on the relationships between delay discounting, substance abuse, and financial mismanagement can provide important insights for developing improved prevention and treatment strategies.

Addiction treatment outcomes, process and change: Texas Institute of Behavioral Research at Texas Christian University

For more than 40 years the Texas Institute of Behavioral Research (IBR) has given special attention to assessment and evaluation of drug user populations, addiction treatment services and various cognitive and behavioral interventions. Emphasis has been on studies in real-world settings and the use of multivariate methodologies to address evaluation issues within the context of longitudinal natural designs. Historically, its program of addiction treatment research may be divided into three sequential epochs-the first era dealt mainly with client assessment and its role in treatment outcome and evaluation (1969-89), the second focused upon modeling the treatment process and the importance of conceptual frameworks (1989-2009) in explaining the relationships among treatment environment, client attributes, treatment process and outcome, and the third (and current) era has expanded into studying tactical deployment of innovations and implementation. Recent projects focus upon adapting and implementing innovations for improving early engagement in adolescent residential treatment settings and drug-dependent criminal justice populations. Related issues include the spread of human immunodeficiency virus/acquired immune deficiency syndrome and other infectious diseases, organizational and systems functioning, treatment costs and process related to implementation of evidence-based practices.

A money management-based substance use treatment increases valuation of future rewards

OBJECTIVE

A positive association between delay discounting and substance use has been documented; substance users tend to discount future rewards more than non-users. However, studies detailing the responsiveness of delay discounting to interventions are lacking, and few have examined how any behavioral intervention affects delay discounting and whether these effects moderate changes in substance abuse. This study assesses the effectiveness of a money management intervention, Advisor-Teller Money Manager (ATM), in reducing delay discounting over time and the relationship of these effects to changes in cocaine use.

METHOD

Ninety psychiatric patients with histories of cocaine and/or alcohol use were randomly assigned to 36-weeks of ATM treatment or to a minimal-attention control condition. Delay discounting and cocaine use were measured throughout the intervention with a 52-week follow up measure of cocaine use. Analyses were conducted of (a) the effect of ATM on slopes of delay discounting and cocaine abstinence and (b) the relationship between change in delay discounting and change in cocaine abstinence.

RESULTS

The ATM intervention was associated with significantly less delay discounting and less cocaine use over time relative to controls. Increases in delay discounting were associated with decreased abstinence from cocaine.

CONCLUSIONS

ATM treatment decreased delay discounting rates and these effects extended to cocaine use. Concrete conceptualizations of future events, as occur in financial planning, with higher perceived probability may account for higher valuation of future rewards in counseled patients.

[The mobile: a new addiction upon adolescents]

AIM

This survey was conducted to investigate mobile phone use and dependence in Tunisian high school students.

METHODS

Questionnaires were anonymously distributed to 120 adolescents looking for the modalities of use of mobiles. SMS dependency was assessed with the French version of the Igarashi scale.

RESULTS

The two most used means for communication were SMS and missing calls. 83.2% of the sample sent more than 6 missing calls per day. According to the Igarashi scale, adolescents reported perception of excessive use in 31. Seven percent of cases, emotional reaction in 33.4% of cases and exclusive relationship maintenance thanks to mobile in 18% of cases.

CONCLUSION

This study demonstrated a anew addictgion to mobile phone among tunisian high school students.

Animal models of substance abuse and addiction: implications for science, animal welfare, and society

Substance abuse and addiction are well recognized public health concerns, with 2 NIH institutes (the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism) specifically targeting this societal problem. As such, this is an important area of research for which animal experiments play a critical role. This overview presents the importance of substance abuse and addiction in society; reviews the development and refinement of animal models that address crucial areas of biology, pathophysiology, clinical treatments, and drug screening for abuse liability; and discusses some of the unique veterinary, husbandry, and IACUC challenges associated with these models.

Cost-benefit analysis involving addictive goods: contingent valuation to estimate willingness-to-pay for smoking cessation

The valuation of changes in consumption of addictive goods resulting from policy interventions presents a challenge for cost-benefit analysts. Consumer surplus losses from reduced consumption of addictive goods that are measured relative to market demand schedules overestimate the social cost of cessation interventions. This article seeks to show that consumer surplus losses measured using a non-addicted demand schedule provide a better assessment of social cost. Specifically, (1) it develops an addiction model that permits an estimate of the smoker's compensating variation for the elimination of addiction; (2) it employs a contingent valuation survey of current smokers to estimate their willingness-to-pay (WTP) for a treatment that would eliminate addiction; (3) it uses the estimate of WTP from the survey to calculate the fraction of consumer surplus that should be viewed as consumer value; and (4) it provides an estimate of this fraction. The exercise suggests that, as a tentative first and rough rule-of-thumb, only about 75% of the loss of the conventionally measured consumer surplus should be counted as social cost for policies that reduce the consumption of cigarettes. Additional research to estimate this important rule-of-thumb is desirable to address the various caveats relevant to this study.

[Addictive diseases and finances--relevant relationships]

Alcohol, other addictive substances and gambling are economically clearly disadvantageous. The financial losses caused by addictive problems should be more compensated by taxation. There are also compelling health reasons for higher taxation. Uncontrolled and accessible financial resources and also poverty represent the risk factors especially for adolescents. Poverty also limits the affordability of psychotherapeutic and medical services for the large segments of population. Material and financial aspects often motivate people to seek treatment for their addictive problems. We also mention the fact that the treatment and especially prevention are economically profitable for individuals, families and societies.

Replication of low-risk gambling limits using canadian provincial gambling prevalence data

A set of low-risk gambling limits were recently produced using Canadian epidemiological data on the intensity of gambling behavior and related consequences (Currie et al. Addiction 101:570-580, 2006). The empirically derived limits (gambling no more than two to three times per month, spending no more than $501-$100o CAN per year or no more than 1% of gross income spent on gambling) accurately predicted risk of gambling-related harm after controlling for other risk factors. The present study sought to replicate these limits on data collected in three independently conducted Canadian provincial gambling surveys. Dose-response curves and logistic regression analyses were applied to gambling prevalence data collected in surveys conducted in 2001-2002 within the provinces of Alberta, British Columbia, and Ontario (combined sample N = 7,675). A comparable dose-response relationship between gambling intensity and risk of harm was found in each province. The optimal thresholds for defining an upper limit of low-risk gambling were similar across the three provinces despite variations in the availability and organization of legalized gambling opportunities within each region. These results provide additional evidence supporting the validity of the low-risk gambling limits. Quantitative limits could be used to augment existing responsible gambling guidelines.

The population mean and the proportion of frequent gamblers: is the theory of total consumption valid for gambling?

The study looks at three representative samples of Norwegians in different age groups with the aim of finding evidence for the validity of the total consumption model for the area of gambling. The results show that gambling was distributed in the population in a way consistent with the predictions of the total consumption theory. Populations with a low mean gambling frequency had a lower proportion of frequent gamblers than populations with a high mean gambling frequency. It was also shown that in a population with a low mean gambling frequency, consumers along the whole consumption continuum gambled less frequently, than in a population with a high mean gambling frequency. It is concluded that the total consumption model seems to be valid for gambling, and that gambling consequently needs to be understood as a public health issue. The actions and behaviours of the normal majority can then not be regarded as irrelevant for the development in problem gambling prevalences.

The influence of gaming expenditure on crime rates in South Australia: a local area empirical investigation

Although there has been much speculation about the possible links between gambling and crime rates, relevant quantitative evidence has been practically non-existent in Australia to date. This paper reports the results of research that utilised a model designed to investigate the potential relationship between electronic gaming machine expenditures and property (income-generating) crime rates reported to police in local areas in South Australia in 2002-2003. The research found that the higher the expenditures on gaming machines in a particular local area per adult, the higher the income-generating crime rate in that area. No such relationship was found between gaming machine expenditure and non-income-generating crime rates. However, further research is required before any policy-relevant conclusions can be drawn.

Assessing the playing field: a prospective longitudinal study of internet sports gambling behavior

Internet gambling is growing rapidly, as is concern about its possible effect on the public's health. This paper reports the results of the first prospective longitudinal study of actual Internet sports gambling behavior during eight study months. Data include recorded fixed-odds bets on the outcome of sporting contests and live-action bets on the outcome of events within contests for 40,499 Internet sports gambling service subscribers who enrolled during February 2005. We tracked the following primary gambling behaviors: daily totals of the number of bets made, money bet, and money won. We transformed these variables into measures of gambling involvement. We analyzed behavior for both fixed-odds and live-action bets. The median betting behavior of the 39,719 fixed-odds bettors was to place 2.5 bets of 4 euro (approximately $5.3 US) every fourth day during the median 4 months from first to last bet. This typical pattern incurred a loss of 29% of the amount wagered. The median betting behavior of the 24,794 live-action bettors was to place 2.8 wagers of 4 euro every fourth day during the median duration of 6 weeks at a loss of 18% of the amount wagered. We also examined the behavior of empirically determined groups of heavily involved bettors whose activity exceeded that of 99% of the sample.

Behavioral economic analysis of opioid consumption in heroin-dependent individuals: effects of unit price and pre-session drug supply

Behavioral economic analysis has been used to investigate factors underlying drug consumption in laboratory animals and, increasingly, in human drug abusers. However, there are few studies in heroin abusers, especially those who are not in treatment; such studies may be valuable for understanding the mechanisms of persistent drug use. This study investigated effects of unit price (UP) and pre-session supply of hydromorphone (HYD) on choice and consumption of HYD. Heroin-dependent research volunteers (n=13) stabilized on buprenorphine 8 mg/day completed this eight-session inpatient study. In sessions 1-2, participants sampled two total HYD doses (12 and 24 mg IM) that could be earned in later sessions. In each of the final six sessions, volunteers were given access to a 12-trial choice progressive ratio schedule lasting 3h. On each trial, volunteers could earn a HYD unit dose (1 or 2 mg, for a maximum of 12 or 24 mg, respectively) or money (US dollars 2, for a maximum of US dollars 24). Fixed ratio requirements increased exponentially, generating 24 unit prices for behavioral economic analysis. Before some choice sessions, volunteers could choose (FR 1) to receive extra HYD (12 or 24 mg; at 0915), whereas on other days no supplement was available. HYD choice and peak responding (breakpoint, O(max)) measures increased with unit dose, decreased with pre-session supplements, and were greater among volunteers who used cocaine prior to the experiment. Taking pre-session supplements decreased P(max) and made group-percent HYD consumption more demand-elastic. Consumption was functionally equivalent at differing FR/unit dose combinations. Thus, opioid demand in heroin-dependent individuals not in treatment is a function of drug supply, unit price, and cocaine use.

Risk of harm among gamblers in the general population as a function of level of participation in gambling activities

AIMS

To examine the relationship between gambling behaviours and risk of gambling-related harm in a nationally representative population sample.

DESIGN

Risk curves of gambling frequency and expenditure (total amount and percentage of income) were plotted against harm from gambling.

SETTING

Data derived from 19, 012 individuals participating in the Canadian Community Health Survey-Mental Health and Well-being cycle, a comprehensive interview-based survey conducted by Statistics Canada in 2002.

MEASUREMENT

Gambling behaviours and related harms were assessed with the Canadian Problem Gambling Index.

FINDINGS

Risk curves indicated the chances of experiencing gambling-related harm increased steadily the more often one gambles and the more money one invests in gambling. Receiver operating characteristic analysis identified the optimal limits for low-risk participation as gambling no more than two to three times per month, spending no more than 501-1,000 CAN dollars per year on gambling and investing no more than 1% of gross family income on gambling activities. Logistic regression modelling confirmed a significant increase in the risk of gambling-related harm (odds ratios ranging from 2.0 to 7.7) when these limits were exceeded.

CONCLUSIONS

Risk curves are a promising methodology for examining the relationship between gambling participation and risk of harm. The development of low-risk gambling limits based on risk curve analysis appears to be feasible.

Addictive disorders

In conclusion, complex medical and psychiatric comorbidity is com-mon in individuals with substance use disorders. It is important to assess comorbidity because of the implications for prevention and treatment. Studies of the neurobiology of substance use and psychiatric disorders are accumulating rapidly and informing treatment development. Information about the prevention and treatment of infectious diseases and other medical conditions associated with substance use disorders also is growing, and it is important that patients are able to benefit from this. The articles in this issue provide state-of-the-art information about several issues related to comorbidity in substance use disorders.

The medicalization of compulsive buying

Compulsive buying has recently been the subject of numerous articles from both consumer research and psychiatric perspectives. Identified by some researchers as a compulsion and by others as an addiction, common solutions to the problem have included drug treatments, participation in self-help groups and cognitive behaviour therapy. The purpose of this article is to examine critically the labelling of compulsive buying in terms of medicalization from the perspective of both medical and non-medical social control of "deviant" consumers. We suggest that the attempt to categorize compulsive buying as an illness represents the ongoing trend to medicalize behavioural problems which may be better understood within the wider context of related phenomena such as the fiscal crisis of the 1980s and 1990s and the consumption-driven economy of North America.

Methodological issues in the social cost of gambling studies

The appropriate way to classify and measure the "social costs" of gambling is a very important, unresolved methodological issue that has been addressed by Collins and Lapsley (2000); Thompson, Gazel, and Rickman (1999); and Walker and Barnett (1999), among others. What should be included and excluded from social cost studies continues to be a controversial issue, as illustrated in the literature and recent conferences. This paper is an attempt to explain the "economics" conception of social costs in accessible language. By using a simple economic model and everyday examples, it shows that the economics methodology is better than the other methodologies currently available. There are four specific goals of the paper: (1) Discuss the importance of the social cost methodological debate and the state of research in the area; (2) Explain the Walker-Barnett definition of social cost in the context of a simple production possibilities frontier and indifference curve model; (3) Use simple illustrative examples to show why many of the alleged social costs should not be classified as such; and (4) Suggest a new method for analyzing the social costs and effects attributable to pathological gambling.

The social costs and benefits of gambling: an introduction to the economic issues

This paper surveys the range of economic issues that need to be addressed in attempting to evaluate the social costs and benefits of gambling. It considers, inter alia, the nature of private and social costs and benefits and their policy significance, the important distinction between real and pecuniary costs, the incidence of gambling costs and benefits and the sources of gambling costs and benefits. Similarities and differences between the analysis of gambling and alcohol are considered. The paper concludes with a consideration of why various estimates of the social costs of gambling have produced such divergent results.

Measuring costs from permitted gaming: concepts and categories in evaluating gambling's consequences

This paper addresses the methodology of cost-benefit analysis as applied to policy alternatives regarding legally sanctioned gambling in its various forms. Existing economic studies regarding the social costs of gambling are reviewed and critiqued. Distinctions are made between definitions of social costs that are defined as actions which result in negative changes in aggregate social wealth (the "narrow" definition), and those which also include internal nonmarket costs that are borne by individual gamblers and their immediate families and acquaintances (the "broader" definition). This distinction is important because of its bearing on economic policies that are primarily concerned with economic efficiency versus policies that are more paternalistic, which attempt to protect individuals from self-damage or self-destruction by restricting their ranges of choice. Whether societies choose to prohibit or severely restrict permitted gambling, or allocate substantial resources to mitigate its negative side effects, rests largely on which of these perspectives regarding social costs they find more appropriate. Finally, the issue of social protection through restrictions on the availability of gambling to the entire population, versus a strategy tailored toward identifiable "problem" gamblers, is discussed.

The behavioral economics of cigarette smoking: The concurrent presence of a substitute and an independent reinforcer

The present study examined the consumption of cigarettes and two alternative reinforcers in dependent smokers. Cigarette price (response requirement) increased across sessions while alternatives were available at a fixed price in four phases of availability: (1). cigarettes alone; (2). cigarettes and nicotine gum; (3). cigarettes and money; and (4). cigarettes, nicotine gum, and money. Cigarette consumption decreased with increasing price throughout. In the cigarette and nicotine gum phase, nicotine gum consumption increased with cigarette price, indicating nicotine gum to be a substitute for cigarettes. In the cigarette and money phase, money consumption increased slightly with cigarette price, indicating money to be an independent reinforcer for cigarettes. When all three reinforcers were present, money again served as an independent reinforcer. During this phase, nicotine gum consumption increased marginally, but the small magnitude of increase suggests that nicotine gum functioned as an independent reinforcer rather than a substitute. Cigarette consumption decreased modestly when nicotine gum was available, and to a larger extent when money or both alternatives were available. The results highlight the potential for an independent reinforcer such as money to be more effective at reducing drug use than a pharmacological substitute.

Rational addiction to alcohol: panel data analysis of liquor consumption

Utilizing a panel data set of 42 states over the period 1959-1994, this paper estimates a rational addiction model for liquor consumption for the US. The empirical evidence is consistent with the rational addiction hypothesis proposed by Becker and Murphy. However, the results are sensitive to the assumption of homogeneity across states or over time.

Effects of bremazocine on self-administration of smoked cocaine base and orally delivered ethanol, phencyclidine, saccharin, and food in rhesus monkeys: a behavioral economic analysis

There is increasing evidence that kappa-opioid receptor agonists modulate cocaine-maintained behavior, and limited findings implicate the involvement of kappa-opioid receptors in ethanol-maintained behaviors. The purpose of the present study was to investigate the effects of bremazocine, a kappa-opioid agonist, on the self-administration of smoked cocaine base and oral ethanol in rhesus monkeys (Macaca mulatta). To determine the selectivity of bremazocine, the effects of bremazocine pretreatment on the oral self-administration of phencyclidine (PCP), saccharin, and food were also examined. Adult male rhesus monkeys were trained to self-administer oral ethanol, PCP, saccharin (n = 8), food (n = 6), or smoked cocaine base (n = 6) and water during daily sessions. Bremazocine (0.00032-, 0.001-, and 0.0025-mg/kg i.m.) injections were given 15 min before session. The 4 days of stable behavior before pretreatment served as baseline. Demand curves (consumption x fixed ratio; FR) were obtained for smoked cocaine base, ethanol, and PCP by varying the cost (FR) of drug deliveries and measuring consumption (deliveries). Bremazocine (0.001 mg/kg) was administered at each FR value in nonsystematic order. Results indicate that bremazocine dose dependently reduced cocaine, ethanol, PCP, and saccharin intake. Food intake was affected less by bremazocine than the other substances in five of the six monkeys. Generally, bremazocine treatment reduced the demand for cocaine, ethanol, and PCP as well as other measures of response strength. These results extend the findings that kappa-agonists reduce the self-administration of drug and nondrug reinforcers to smoked cocaine base and oral ethanol, PCP, and saccharin in rhesus monkeys.

Benefit-cost analysis of addiction treatment: methodological guidelines and empirical application using the DATCAP and ASI

OBJECTIVE

To provide detailed methodological guidelines for using the Drug Abuse Treatment Cost Analysis Program (DATCAP) and Addiction Severity Index (ASI) in a benefit-cost analysis of addiction treatment.

DATA SOURCES/STUDY SETTING

A representative benefit-cost analysis of three outpatient programs was conducted to demonstrate the feasibility and value of the methodological guidelines.

STUDY DESIGN

Procedures are outlined for using resource use and cost data collected with the DATCAP. Techniques are described for converting outcome measures from the ASI to economic (dollar) benefits of treatment. Finally, principles are advanced for conducting a benefit-cost analysis and a sensitivity analysis of the estimates.

DATA COLLECTION/EXTRACTION METHODS

The DATCAP was administered at three outpatient drug-free programs in Philadelphia, PA, for 2 consecutive fiscal years (1996 and 1997). The ASI was administered to a sample of 178 treatment clients at treatment entry and at 7-months postadmission.

PRINCIPAL FINDINGS

The DATCAP and ASI appear to have significant potential for contributing to an economic evaluation of addiction treatment. The benefit-cost analysis and subsequent sensitivity analysis all showed that total economic benefit was greater than total economic cost at the three outpatient programs, but this representative application is meant to stimulate future economic research rather than justifying treatment per se.

CONCLUSIONS

This study used previously validated, research-proven instruments and methods to perform a practical benefit-cost analysis of real-world treatment programs. The study demonstrates one way to combine economic and clinical data and offers a methodological foundation for future economic evaluations of addiction treatment.

Compensating behaviors, regret, and heterogeneity in the dynamics of smoking behavior

This paper studied smoking behavior in the context of the interactions among health, smoking, exercise and seeking medical care using a microeconomic model. Based on a dynamic optimal choice theory, a simultaneous equation system was used in the empirical estimation. This study found that smokers with longer smoking history tend to have extra incentives to maintain or improve their health. It was found that they tend to use more medical services and to be more active in exercise than smokers with shorter smoking history. Health status nonlinearly affects smoking decisions. Quitting incentives can be "curative" or "preventive", depending on one's health status. Light smokers' addiction is qualitatively and quantitatively different from heavy smokers'.

Youth tobacco control: reconciling theory and empirical evidence

Youth smoking is an important target for public policy. The implicit assumption behind targeting youth is that policies that reduce youth smoking initiation will reduce lifetime smoking propensities. This assumption has never been tested empirically. I use data from the National Longitudinal Survey of Youth (NLSY) to follow the smoking pattern of one cohort of teenagers. I examine how smoking rates in youth and young adulthood are affected by the taxes individuals faced at age 14. In panel data analysis, I find that the effects of taxes at age 14 are considerably attenuated by adulthood. I find some evidence suggesting that this result is a consequence of delayed smoking initiation that is correlated with taxes. These results suggest that reducing smoking among teens through tax policy may not be sufficient to substantially reduce smoking in adulthood.

Does cigarette price influence adolescent experimentation?

The economics literature generally agrees that state and federal excise taxes can play an important role in deterring adolescent smoking. Teens' apparent responsiveness to cigarette prices is puzzling, since the majority of adolescent smokers do not buy their cigarettes. Teens typically do not begin to purchase cigarettes until they have developed an established pattern of smoking. Previous studies have not had adequate measures of smoking experience to explore whether adolescents' price responsiveness may vary by smoking experience. This paper uses data from a 1993 national survey of youth smoking to explore this hypothesis.

Gambling use disorders--a public health problem

The growing availability of state-owned and sponsored gambling has been associated with an increased prevalence of pathological gambling that has been linked to mounting social costs. In 1999 the State of Connecticut generated 811 million dollars from legalized gambling. However, only about one million dollars was allocated to clinical and preventive interventions. In order to strike an effective balance between economic benefits and social costs attributed to the expansion of the gambling industry, states should devote sufficient resources designed to: 1) assess the magnitude of the gambling behavior spectrum; 2) evaluate its social and economic consequences; 3) develop a primary prevention curriculum in schools and a secondary prevention curriculum for youth at high risk, 4) develop outreach programs to increase public awareness of the symptoms of problem/pathological gambling, and 5) provide and/or fund treatment services for problem and pathological gamblers including social service support systems for their families. States should then perform periodic cost-benefit analyses to decide if, when, to what extent, and how to regulate the gambling industry.

Interpreting the rational addiction model

The rational addiction (RA) model of Becker and Murphy (Becker GS, Murphy KM. A theory of rational addiction. J Pol Econ 1988; 96(4): 675-700) has rapidly become one of the standard models in the literature on addictive behaviour. This paper reviews some theoretical issues surrounding its use, and indicates areas in which caution should be used in applying this model.

Addiction as a market failure: using rational addiction results to justify tobacco regulation

Tobacco regulation efforts have been criticized by some academic economists for failing to provide adequate welfare-analytic justification. This paper attempts to address these criticisms. Unlike previous research that has discussed second-hand smoke and health care financing externalities, this paper develops the logic for identifying the much larger market failures attributable to the failure of smokers to fully internalize the costs of their addictive behavior. The focus is on teen addiction as a form of "intrapersonal" externality and observed adult consumption behavior consistent with partial myopia. The importance of peer effects, in the consideration of welfare impacts, is also emphasized.

[Drug use: a life choice or health threat]

The term "enjoyment" is used to denote a pleasurable, utility-creating activity or an act of consumption, which, however, may often be accompanied by subsequent risks, health-care costs or reduction in the quality of life. If viewed from the vantage point of health policy, we may quote several examples of consumer behaviour of this type, ranging first and foremost from the consumption of alcohol and nicotine to the use of "hard" drugs. But certain sports activities or sexual behaviour that may prove damaging to other persons must also be mentioned in this context. All these forms of consumption often lead to direct or indirect consequences to health and thereby result in increased health spending amounting to several thousand million DM. The decline in quality of life resulting from the above-mentioned forms of behaviour could be avoided through health promotion and prevention or, at the very least, through measures of rehabilitation, above all, information, counselling, and education, which represent medium- or long-term measures to that effect. Financial incentives or disincentives, for example, via an increase in co-payment in case of illness caused by risky behaviour, have not been as effective as had been expected by many proponents. Product-specific levies, risk-related payments and other financial incentives and disincentives are generally also not as effective as desired. Health policy measures aimed at influencing behaviour via financial measures are particularly ineffective in case of persons addicted to particular types of consumables, especially to drugs: Information, counselling and education represent non-financial forms of influencing and guiding behaviour with a greater scope for success.

Working and "drugging" in the city: economics and substance use in a sample of working addicts

Employment status is often treated as a "risk factor" in epidemiologic studies of drug use. The process that underlies the supposed relationship has remained, however, essentially unexamined. This article uses life history data to look at the relationship between work and drug use in a sample of addicts from Baltimore City, Maryland. The narratives constructed by these individuals demonstrate that the processes involved in creating and maintaining drug- and nondrug-related identities are neither linear nor straightforward. Rather, managing complex, emergent identities is a product of the economic situation, the organization of the drug scene, and the larger milieu in which these addicts operate.

An economic theory of cigarette addiction

In this paper we present a model in which individuals act in their own best interest, to explain many behaviors associated with cigarette addiction. There are two key features of the model. First, there is an explicit representation of the withdrawal effects experienced when smokers attempt to quit smoking. Second, there is explicit recognition that the negative effects of smoking generally appear late in an individual's life. Among the things we use the model to explain are: (1) how individuals can become trapped in their decision to smoke; (2) the conditions under which cold-turkey quitting and gradual quitting may occur; and (3) a reason for the existence of quit-smoking treatments.