The Behavioral Economics of Relapse

描述（由申请人提供）：复发对广泛的行为障碍的治疗提出了重大挑战，特别是对吸烟等成瘾。复发可以被认为是偏好的逆转。不幸的是，导致或导致复发的行为现象通常没有得到很好的理解。一个这样的过程是延迟折扣（DD），它是指与立即折扣的价值相比，延迟折扣的价值或价值减少。重要的是，DD通过提供偏好改变的机制来预测复发中固有的偏好逆转（PR）。偏好从较大的、在时间上更远的选择者反转到较小的、更直接的选择者，因为直接的选择者在时间上变得更近。DD还预测了PR可能性较低的情况;也就是说，具有非常低的贴现率的个人将倾向于更大，延迟的价格，而具有非常高的贴现率的个人将更喜欢较小，更快的价格。对PR的理解很重要，因为这些逆转1）提供了理解复发的机制（从偏好戒断到偏好回归成瘾活动的逆转）和2）可以解释共同产生典型复发曲线的三个不同亚组：也就是说，（a）少数人对治疗没有反应或在治疗后立即复发，（B）在治疗后测量期间不复发的小部分个体和（c）对治疗有反应但后来在治疗后测量期间之一复发的绝大多数个体。我们建议确定折扣是否可以预测复发时，被视为一个连续体，它是否预测复发时，被视为分类。此外，我们将比较连续统或分类方法是否占与数据相关的方差的更多。我们还将比较理论推导的逻辑模型组成的DD，依赖性，冲动性和负面影响的措施作为复发和/或治疗后的成功预测。为了完成这些目标，将收集治疗前的折扣措施和其他措施，并研究它们与吸烟者复吸的关系。这一人群是理想的，因为吸烟是一个主要的公共卫生问题，吸烟者表现出相当大的复吸和极端折扣。识别这些表型并实现这些目标将具有重要的理论和实践意义，包括1）澄清我们对复发及其逆成功戒断的神经行为机制和过程的理解，以及2）提出新的方法来定制治疗以增强表型亚组的结果。

DESCRIPTION (provided by applicant): 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.