Relapse poses significant challenges to the treatment of a broad array of behavioral disorders, especially for addictions like cigarette smoking. Relapse can be considered a reversal in preference. Unfortunately, the behavioral phenomena that contribute to or underlie relapse are generally not well understood. One such process is delay discounting (DD), which refers to the reduced value or worth of a delayed reinforcer compared to the value of an immediate reinforcer. Importantly, DD predicts the preference reversals (PR) inherent in relapse by providing a mechanistic account for a change in preference. Preferences reverse from the larger, more temporally distant reinforcer to a smaller, more immediate reinforcer as the immediate one becomes closer temporally. DD also predicts circumstances where the likelihood of PR are low;that is, Individuals with very low discount rates will tend to prefer larger, delayed reinforcers and those with very high discount rates will prefer smaller, sooner reinforcers. The understanding of PR are important because these reversals 1) provide a mechanism to understand relapse (a reversal from preferring abstinence to preferring a return to the addictive activity) and 2) may explain the three distinct subgroups that collectively produce the typical relapse curve: that is, (a) the small number of individuals who do not respond to treatment or relapse immediately post-treatment, (b) the small portion individuals who do not relapse during the post-treatment measurement period and (c) the vast majority of individuals who respond to treatment, but later relapse at one of the post-treatment measurement periods. We propose to determine if discounting can predict relapse when viewed as a continuum and whether it predicts relapse when viewed categorically. Additionally, we will compare whether the continuum or categorical approach accounts for more of the variance associated with the data. We will also compare theoretically derived logistic models composed of DD, dependence, impulsivity, and negative affect measures as predictors of relapse and/or success following treatment. To complete these aims will collect pre-treatment measures of discounting and other measures and examine their relationship to relapse among tobacco smokers. This population is ideal because tobacco smoking is a major public health problem, tobacco smokers demonstrate considerable relapse and exhibit extreme discounting. Identifying these phenotypes and achieving these aims will have important theoretical and practical implications, including 1) clarifying our understanding of neurobehavioral mechanisms and processes that underlie relapse and its inverse-successful abstinence-and 2) suggest novel ways to tailor treatments for enhanced outcomes among phenotypic subgroups.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
5R01DA022386-04
Application #
7881578
Study Section
Biobehavioral Regulation, Learning and Ethology Study Section (BRLE)
Program Officer
Grossman, Debra
Project Start
2007-09-01
Project End
2012-06-30
Budget Start
2010-07-01
Budget End
2012-06-30
Support Year
4
Fiscal Year
2010
Total Cost
$344,350
Indirect Cost
Name
University of Arkansas for Medical Sciences
Department
Psychiatry
Type
Schools of Medicine
DUNS #
122452563
City
Little Rock
State
AR
Country
United States
Zip Code
72205
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Pradhan-Bhatt, Swati; Harrington, Daniel A; Duncan, Randall L et al. (2014) A novel in vivo model for evaluating functional restoration of a tissue-engineered salivary gland. Laryngoscope 124:456-61
Sheffer, Christine E; Christensen, Darren R; Landes, Reid et al. (2014) Delay discounting rates: a strong prognostic indicator of smoking relapse. Addict Behav 39:1682-9
Stanger, Catherine; Budney, Alan J; Bickel, Warren K (2013) A developmental perspective on neuroeconomic mechanisms of contingency management. Psychol Addict Behav 27:403-15
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Landes, Reid D; Christensen, Darren R; Bickel, Warren K (2012) Delay discounting decreases in those completing treatment for opioid dependence. Exp Clin Psychopharmacol 20:302-9
Bickel, Warren K; Jarmolowicz, David P; Mueller, E Terry et al. (2012) Are executive function and impulsivity antipodes? A conceptual reconstruction with special reference to addiction. Psychopharmacology (Berl) 221:361-87
Sheffer, Christine; Mackillop, James; McGeary, John et al. (2012) Delay discounting, locus of control, and cognitive impulsiveness independently predict tobacco dependence treatment outcomes in a highly dependent, lower socioeconomic group of smokers. Am J Addict 21:221-32
Bickel, Warren K; Jarmolowicz, David P; Mueller, E Terry et al. (2011) The behavioral economics and neuroeconomics of reinforcer pathologies: implications for etiology and treatment of addiction. Curr Psychiatry Rep 13:406-15
Bickel, Warren K; Yi, Richard; Landes, Reid D et al. (2011) Remember the future: working memory training decreases delay discounting among stimulant addicts. Biol Psychiatry 69:260-5

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