Diagnostic and Statistical Manual of Mental Disorders, 4th ed

Health At A Glance

This Review presents basic facts regarding the long-run evolution of income and wealth inequality in Europe and the United States. Income and wealth inequality was very high a century ago, particularly in Europe, but dropped dramatically in the first half of the 20th century. Income inequality has surged back in the United States since the 1970s so that the United States is much more unequal than Europe today. We discuss possible interpretations and lessons for the future.

Inequality in the long run

Aims
To synthesize continuous associations between delayed reward discounting (DRD) and both addiction severity and quantity-frequency (QF); to examine moderators of these relationships; and to investigate publication bias.

Methods
Meta-analysis of published studies examining continuous associations between DRD and addictive behaviors. Published, peer-reviewed studies on addictive behaviors (alcohol, tobacco, cannabis, stimulants, opiates, and gambling) were identified via PubMed, MEDLINE, and PsycInfo. Studies were restricted to DRD measures of monetary gains. Random effects meta-analysis was conducted using Pearson's r as the effect size. Publication bias was evaluated using fail-safe N, Begg-Mazumdar and Egger's tests, meta-regression of publication year and effect size, and imputation of missing studies.

Results
The primary meta-analysis revealed a small magnitude effect size that was highly significant (r = 0.14, p < 10-14). Significantly larger effect sizes were observed for studies examining severity compared with QF (p = 0.01), but not between the type of addictive behavior (p = 0.30) or DRD assessment (p = 0.90). Indices of publication bias suggested a modest impact of unpublished findings.

Conclusions
Delayed reward discounting is robustly associated with continuous measures of addiction severity and quantity-frequency. This relation is generally robust across type of addictive behavior and delayed reward discounting assessment modality.

Steep delay discounting and addictive behavior: a meta‐analysis of continuous associations

The NIH Science of Behavior Change Program: Transforming the science through a focus on mechanisms of change.

The behavioral- and neuro-economic process of temporal discounting: A candidate behavioral marker of addiction

The burden of substance use and especially the unmatched rates of overdoses in rural Central Appalachia highlight the need for innovative approaches to curb the initiation to drug misuse and to address current substance use disorders. Effective substance use interventions involve a thorough understanding of the region. In Central Appalachia, many of the barriers to treatment are shared with other rural and impoverished areas, including a lack of access to health care and lack of health care providers with specialized training. Parts of Appalachia also present their own considerations, including the challenges of fostering trust and encouraging treatment-seeking in communities with dense, long-term, place-based social and family networks. Current policies and interventions for substance use have been largely inadequate in the region, as evidenced by continued increases in substance use and substance-related deaths, especially related to nonmedical prescription drug use and increasing heroin use. The authors discuss ways in which rural life, poverty, identity, and values in Appalachia have influenced substance use and treatment and propose strategies and interventions to improve outcomes.

/pdf/substance-use-in-rural-central-appalachia-current-status-and-4t1jihnsl4.pdf

Substance Use in Rural Central Appalachia: Current Status and Treatment Considerations

Contemporary neuroeconomic approaches hypothesize that self-control failure results from drugs annexing normal learning mechanisms that produce pathological reward processing and distort decision making as a result from the dysregulation of two valuation systems. An emphasis on processes shared across different diseases and disorders is at odds with the contemporary approach that assumes unique disease etiologies and treatments. Studying trans- disease processes can identify mechanisms that operate in multiple disease states and ascertain if factors that influence processes in one disease state may be applicable to all disease states. In this article we review the dual model of self- control failure, the Competing Neurobehavioral Decision System approach, the relationship of delay discounting to the relative control of these two systems, and evidence that the executive system can be strengthened. Future research that could result in more potent interventions for executive system improvement and potential constraints on the repair of self-control failure are discussed.

/pdf/therapeutic-opportunities-for-self-control-repair-in-56hfx7eqs3.pdf

Therapeutic Opportunities for Self-Control Repair in Addiction and Related Disorders: Change and the Limits of Change in Trans-Disease Processes.

Some current dimensions of the behavioral economics of health-related behavior change.

Understanding the association between polysubstance use and impulsivity is pertinent to treatment planning and efficacy. Delay discounting, a measure of impulsivity, supplies the rate at which a reinforcer loses value as the temporal delay to its receipt increases. Excessive delay discounting has been widely observed among drug-using individuals, though the impact of using more than 1 substance has been only minimally studied. Here, after controlling for demographic variables, we systematically compared delay discounting in community controls, heavy smokers, and alcohol- and cocaine-dependent individuals to assess the impact of non-, mono-, dual-, and trisubstance use. All substance-using groups discounted significantly more than did community controls (p < .05). Additionally, groups that smoked cigarettes in addition to another substance dependency discounted significantly more than did the group that smoked cigarettes only (p < .05). Last, trisubstance users who were alcohol-dependent, cocaine-dependent, and heavy cigarette smokers discounted significantly more than did heavy smokers (p < .01). However, trisubstance users did not discount significantly more than did any dual-substance group. Trisubstance use was associated with greater impulsivity than was monosubstance smoking but exhibited no greater impulsivity than did dual-substance use, suggesting a ceiling effect on discounting when more than 2 substances are in use. The present study suggests that smokers who engage in additional substance use may experience worse treatment outcomes, given that excessive discounting is predictive of poor therapeutic outcomes in several studies.

Lara Moody

Papers

The behavioral- and neuro-economic process of temporal discounting: A candidate behavioral marker of addiction

Substance Use in Rural Central Appalachia: Current Status and Treatment Considerations

Therapeutic Opportunities for Self-Control Repair in Addiction and Related Disorders: Change and the Limits of Change in Trans-Disease Processes.

Some current dimensions of the behavioral economics of health-related behavior change.

Impulsivity and polysubstance use: A systematic comparison of delay discounting in mono-, dual-, and trisubstance use.