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Cocaine behavioral economics: from the naturalistic environment to the controlled laboratory setting.

ABSTRACT: We previously observed that behavioral economic factors predict naturalistic heroin seeking behavior that correlates with opioid seeking in the experimental laboratory. The present study sought to replicate and extend these prior findings with regular cocaine users.Participants (N=83) completed a semi-structured interview to establish income-generating and cocaine-purchasing/use repertoire during the past month. Questions addressed sources/amounts of income and expenditures; price (money and time) per purchase; and frequency/amounts of cocaine purchased and consumed. Naturalistic cocaine purchasing and use patterns were: (1) analyzed as a function of income quartile, (2) perturbed by hypothetical changes in cost factors to assess changes in purchasing/use habits, and (3) correlated with experimental cocaine seeking.Income was positively related to naturalistic cocaine seeking/use pattern (i.e., income elastic), and behaviors were cost-efficient and sensitive to supply chain. Income was unrelated to proportional expenditure on cocaine (?55%) but inversely related to food expenditure. In all hypothetical scenarios (changes in income or dealer, loss of income assistance from government or family/friends, and increasing arrest risk when purchasing), the high-income group reported they would continue to use more cocaine daily than other groups. Number of laboratory cocaine choices significantly correlated with cocaine purchase time (positively) and purity of cocaine (negatively) in the naturalistic setting.These results replicate and extend findings with regular heroin users, demonstrate the importance of income, cost-efficiency and supply-mindedness in cocaine seeking/use, and suggest that this interview-based approach has good external validity.

SUBMITTER: Greenwald MK

PROVIDER: S-EPMC5543982 | biostudies-literature | 2014 Aug

REPOSITORIES: biostudies-literature

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Cocaine behavioral economics: from the naturalistic environment to the controlled laboratory setting.

Greenwald Mark K MK Steinmiller Caren L CL

Drug and alcohol dependence 20140513

<h4>Background</h4>We previously observed that behavioral economic factors predict naturalistic heroin seeking behavior that correlates with opioid seeking in the experimental laboratory. The present study sought to replicate and extend these prior findings with regular cocaine users.<h4>Methods</h4>Participants (N=83) completed a semi-structured interview to establish income-generating and cocaine-purchasing/use repertoire during the past month. Questions addressed sources/amounts of income and ...[more]

PMID: 24878248

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Project description:BackgroundMany HIV-positive patients do not appropriately adhere to their antiretroviral medication (ART). This leads to higher viral loads and greater probability of HIV transmission. Present bias-a tendency to give in to short-term temptations at the expense of long-term outcomes-is a potential driver of low adherence. In this study we test a novel intervention rooted in behavioral economics that is designed to overcome present bias and increase ART adherence.Methods/designWe will enroll 330 HIV-positive patients at Mildmay Hospital in Kampala, Uganda, into a 2-year randomized controlled trial. Participants will be randomized to one of three groups. The first intervention group (T1, n = 110) will be eligible for small lottery prizes based on timely clinic visits and demonstration of viral suppression. Group 2 (T2, n = 110) will be eligible for the same lottery prizes conditional on high adherence measured by a medication event management system (MEMS) cap. The control group (n = 110) will receive the usual standard of care. Adherence will be measured continuously throughout the intervention period and for 12 months post-intervention to evaluate effect persistence. Surveys will be conducted at baseline and then every 6 months. Viral loads will be measured annually. Primary outcomes are whether the viral load is detectable and MEMS-measured adherence. Secondary outcomes are the log-transformed viral load as a continuous measure and a binary measure for whether the person took at least 90% of their ART pills.DiscussionOur study is one of the first to investigate the effectiveness of lottery incentives for improving ART adherence, and in addition, it compares the relative efficacy of using electronically measured adherence versus viral load to determine lottery eligibility. MEMS caps are relatively costly, whereas viral load testing is now part of routine clinical care in Uganda. BEST will test whether directly incentivizing viral suppression (which can be implemented using readily available clinic data) is as effective as incentivizing electronically measured adherence. Cost-effectiveness analyses of the two implementation modes will also be performed.Trial registrationClinicalTrials.gov, NCT03494777. Registered on 11 April 2018.

Project description:Repeated exposure to cocaine causes sensitized behavioral responses and increased dendritic spines on medium spiny neurons of the nucleus accumbens (NAc). We find that cocaine regulates myocyte enhancer factor 2 (MEF2) transcription factors to control these two processes in vivo. Cocaine suppresses striatal MEF2 activity in part through a novel mechanism involving cAMP, the regulator of calmodulin signaling (RCS), and calcineurin. We show that reducing MEF2 activity in the NAc in vivo is required for the cocaine-induced increases in dendritic spine density. Surprisingly, we find that increasing MEF2 activity in the NAc, which blocks the cocaine-induced increase in dendritic spine density, enhances sensitized behavioral responses to cocaine. Together, our findings implicate MEF2 as a key regulator of structural synapse plasticity and sensitized responses to cocaine, and suggest that reducing MEF2 activity (and increasing spine density) in NAc may be a compensatory mechanism to limit long-lasting maladaptive behavioral responses to cocaine. Mice were treated for 7 days with daily injections of cocaine (20 mg/kg) and sacrificed 24 hrs later. Chromatin from bilateral punches of NAc was immunoprecipitated with an antibody against MEF2A as described previously with minor modifications (Renthal et al., 2007). Chromatin was sonicated to an average of ~500 bp and immunoprepitated with antibody against MEF2A (Santa Cruz, sc-313) or an IgG control (Upstate/Millipore). Antibody-bound chromatin was precipitated using Protein A beads from Upstate (06-157), which were washed with low salt, high salt, and LiCl buffers to remove non-specific DNA binding. Eluted chromatin was reverse-crosslinked at 65oC in the presence of proteinase K and EDTA. DNA was purified by chloroform extraction/ethanol precipitation and the enrichment of specific promoters was amplified by ligation-mediated PCR for genome-wide analysis (Sikder et al., 2006). Amplified DNA was then labeled with Cy3 (input-enriched) or Cy5 (MEF2-enriched) and hybridized to Nimblegen (Madison, WI) MM8 mouse promoter arrays. Bilateral nucleus accumbens from eight mice were pooled for microarray analysis.

Project description:OBJECTIVE:Interventions informed by behavioral economics have the potential to change behaviors governed by underlying cognitive biases. This has been explored extensively for various use in healthcare including changing patient behavior and, more recently, physician behavior. We aimed to systematically review the literature on the use and effectiveness of behavioral economics-informed interventions in changing physician behavior. METHOD:We searched Medline, Cochrane Library, EBM Reviews, PsychINFO, EconLit, Business Source Complete and Web of Science for peer-reviewed studies published in English that examined the effectiveness of behavioral economics-informed interventions on physician behavioral change. We included studies of physicians in all care settings and specialties and all types of objectively measured behavioral outcomes. The reporting quality of included studies was appraised using the Effective Public Health Practice Project tool. RESULTS:We screened 6,439 studies and included 17 studies that met our criteria, involving at least 9,834 physicians. The majority of studies were conducted in the United States, published between 2014 and 2018, and were in the patient safety and quality domain. Reporting quality of included studies included strong (n = 7), moderate (n = 6) and weak (n = 4). Changing default settings and providing social reference points were the most widely studied interventions, with these studies consistently demonstrating their effectiveness in changing physician behavior despite differences in implementation methods among studies. Prescribing behavior was most frequently targeted in included studies, with consistent effectiveness of studied interventions. CONCLUSION:Changing default settings and providing social reference points were the most frequently studied and consistently effective interventions in changing physician behavior towards guideline-concordant practices. Additional theory-informed research is needed to better understand the mechanisms underlying the effectiveness of these interventions to guide implementation.

Dataset Information

Cocaine behavioral economics: from the naturalistic environment to the controlled laboratory setting.

Publications

Cocaine behavioral economics: from the naturalistic environment to the controlled laboratory setting.

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