Friends of the Behavioral Economics Club, this week we present the paper “Behavioral economics and coping-related drinking motives in trauma exposed drinkers: Implications for the self-medication hypothesis” by Luciano, M. T.; Acuff, S. F.; McDevitt-Murphy, M. E. and Murphy, J. G. (2021), in which authors apply the point of view of behavioral economics to investigate why people that have suffered traumatic experiences have a higher tendency to use alcohol to cope with them.

In the paper we presented last week we saw how important it is to look for explanations and solutions to help when it comes about addictions, and plus, how behavioral economics can be used in order to that.

This does not surprise us, because, as we already know, behavioral economics is a discipline that comes from economy and psychology.

Authors of this paper are aware of this and wonder how behavioral economics can help understand complex behaviors as addictions. Particularly, alcohol abuse as a method to cope with traumatic experiences.

Previous investigations have shown that people that suffer from post-traumatic stress disorder endorse higher levels of coping-related drinking motives when compared to trauma-exposed individuals without this mental illness.

This suggests that alcohol consumption may vary according to the stress and anxiety felted by individuals.

Authors mention the called “self-medication hypothesis”. This posits that alcohol is used as an avoidant coping mechanism when faced with psychological symptoms or other subjective states of distress.

Nevertheless, this hypothesis does not explore many factors that can also influence or modify the consumption, as the presence of alcohol-free reinforcers in one’s environment, changes in the economic value of alcohol or the devaluation of the future.

From behavioral economics’ point of view, alcohol misuse is considered a reinforcer pathology that develops as a result of a persistently high valuation for alcohol, and a lack or deficit in substance-free activities available in the environment or personal context.

Behavioral economics uses concepts such as value of alcohol and the effect of reward delay on the decision-making process. Therefore, authors recommend exploring these factors among people exposed to trauma with psychological pathologies, particularly, individuals that suffer from post-traumatic stress disorder.

For instance, heavy drinkers with symptoms of stress and/or depression report greater alcohol demand.

Some previous studies have found that coping-related drinking motives may partially explain the relation between alcohol demand and alcohol consumption problems. However, this has not been studied according to behavioral economics’ concepts and point of view.

Authors comment they want to achieve two purposes with this studio.

Former, explore how behavioral economics’ constructs (such as access to environmental reward, delayed reward discounting, consideration of future consequences or alcohol demand) are related to alcohol problems in a sample of trauma-exposed adults.

Latter, evaluate if these constructs can explain additional variance in alcohol problems above and beyond coping-related drinking motives.

Authors gathered a total of 91 participants, which answered a series of questionnaires related to events lived in the past, alcohol consumption and emotion management. After that, results were analyzed.

In the sample, 43% of participants endorsed moderate levels of depression and anxiety; while 52,7% of them referred extremely severe problems of this kind.

According to the obtained results, authors comment that individuals with a trauma history may experience alcohol problems, in part, because they tend to be more focused on the present and devalue the future and its outcomes.

This study suggests that drinking-to-cope is an important consideration in understanding why trauma-exposed individuals often develop harmful patterns, like alcohol use, and that behavioral economics may shed additional light on this problem.

These patterns of behavior may effectively reduce the availability of substance-free rewarding stimuli and may shift the perceived relative value of prosocial and positive activities.

Thus, these individuals are at risk of experiencing less overall reward from prosocial alternatives that require engagement with the environment and, instead, lead them to engage in impulsive behaviors, such as alcohol abuse.

Some limitations exist in this study. Authors point out that their interpretation of the findings could be stronger if they had more assurance that all the individuals in their sample had symptoms that they could potentially use alcohol to cope with.

Authors comment how important is to keep investigating about alcohol abuse and addictions and how beneficial it would be to do it following behavioral economics. This would help to understand how the experienced trauma affects negatively to our lives.

If you want to know more about Behavioral Economics and how to apply it to human behavior, take a look to our Certificate in Behavioral Economics, a formative program, in English or Spanish, 100% online and certified by Heritage University (USA). Now, with discounts for members of this club.

Friends of the Behavioral Economics Blog, this week we present the paper “Behavioral Economics and Tobacco Control: Current Practices and Future Opportunities” by Littman, D.; Sherman, S. E.; Toxel, A. B. and Stevens, E. R. (2022), in which authors think about how we could apply the seven basic principles of behavioral economics to prevention campaigns of tobacco use. 

Improving tobacco control and treatment remains a medical priority. Despite progress in recent years, smoking remains the leading preventable cause of death in the United States, causing 480,000 deaths annually and $300 billion in related economic losses.

Current behavioral and medical treatments have been successful, but not enough. To address the considerable health burden (even worse now as we continue fighting against Covid-19), there is a continuing need to develop better tobacco use control and prevention interventions. 

By combining elements of economics and psychology, behavioral economics provides a framework for designing novel solutions to help smokers quit when traditional interventions have failed to do so. 

The principles of behavioral economics, according to Dawnay and Shah, would be “other people’s behavior matters”, “habits matter”, “people are motivated to do the right thing”, “one’s own expectations influence behavior”, “people are loss averse”, “people are bad at calculating”, and “people want to feel involved and effective”. In total, 7. 

However, the full list of principles has not been widely used in the field of tobacco control and treatment or prevention. The vast majority of related studies focused on financial incentives and few were devoted to other principles. Therefore, this is what the authors propose: to expand the potential application of the 7 principles to tobacco control and treatment. 

In a quick compilation of behavioral economics articles applied to tobacco prevention and treatment, 198 articles out of 230 were about financial incentives. But what about the other possibilities?

The authors mention that other people’s behavior matters. That is, when making decisions, people tend to model their own behavior based on those around them. The extent of influence of others’ behavior also relates to who has the most influential personality. The ingroup bias suggests a predilection for modeling the behavior of those with a shared social identity. Even celebrities would influence normal people. 

Future research could evaluate the performance of campaigns by influential people who have quit smoking and their results, which may encourage viewers to follow their path.

The second principle mentions that habits matter. Behavior is habitual and we always follow routines. Relying on habits reduces the mental energy required to complete tasks, even if the habits are not efficient or healthy. Habits provide opportunities for behavior change, first by using current ones, and also by creating new ones.

Future research may evaluate replacing cigarettes with e-cigarettes, for example, so that the habit of smoking continues, but harm is reduced. 

Authors also mention that people are motivated to do the right thing. The perception that an action is carried out for the public good or for the good of others influences behavior. Appealing to people’s sense of altruism can be an effective and efficient approach to behavior change.

On the other hand, there is the idea that one’s own expectations influence behavior. This happens because people want their actions to be in line with their values and commitments. Engaging openly with friends, family and even strangers may increase the extent to which behavior change occurs, which could be used in this context. 

The fifth principle is that people are loss averse. Behavioral economics research suggests that losses produce more emotional reactions than gains. Developing and testing interventions that change the framing of economic incentives to exploit this principle could be interesting, focusing not so much on gaining something, but on losing it. 

On the other hand, people tend to be bad at math. Many studies suggest that humans have a poor understanding of probability and statistical concepts in general, which helps explain the popularity of playing the lottery. To exploit this lottery’s appeal, smokers could be told what they could have won if they had completed an action related to quitting smoking, for example.

Finally, the seventh principle: people want to feel involved. Classical economic theory posits that giving people more choices results in better decisions, as long as it doesn’t become overwhelming. Balancing the two ideas, increasing self-efficacy by helping smokers understand their options for quitting and emphasizing their ability to quit, makes people more likely to quit for good. 

Authors encourage the continued development of projects dedicated to the treatment of smoking from behavioral economics, as they believe that it provides very good ideas to achieve positive results for such a representative problem for the health of people around the world. 

If you want to know more about Behavioral Economics and how to apply it to human behavior, take a look to our Master of Science in Behavioral Economics, a 100% online program that you can take in Spanish or English, with special grants for readers of the Behavioral Economics Blog.

Friends of the Behavioral Economics Club, this week we present the paper “Behavioral Economic Demand and Delay Discounting are Differentially Associated with Cigarette Dependance and Use in Adolescents”, by Cassidy, R. N.; Aston, E. R.; Tidey, J. W. and Colby, S. M. (2020), in which authors study whether a relation between the use of cigarettes in adolescents and behavioral economics exists, and if it is so, how can the latter help to reduce the number of young addicts.

Smoking is one of the most accepted forms of drug addiction in society. However, like alcoholism, the dimension of its magnitude is growing.

A matter of particular concern is how young people acquire this habit from such an early age.

Although it may surprise us, cigarette smoking by teenagers has reduced its rate to the lowest in decades. Only 9% of teens reported smoking daily in 2016.

Authors believe that this decline in youth smoking rates is due to tobacco control interventions, such as educational campaigns in the media.

The key would be in a decreasement in the initiation of smoking and not in the cessation of smoking.

However, increased use of electronic cigarettes or vapers has been shown to be associated with the onset of smoking. Therefore, these rates that until now have been decreasing, may be reversed in the future.

For this reason, authors consider that research on the behavioral mechanisms of young people who smoke is still very important. In addition, they consider that it is possible from behavioral economics to obtain explanations to better understand these mechanisms.

There is the called “Reinforcing Pathology model”. This model describes how two economic behavioral processes, such as a greater sensitivity to immediate rewards (discount for delay) and an excessive reward derived from the consumption of a substance (demand), relate to problematic patterns such as substance use.

This model proposes that people with substance use disorders may continuously experience the effects of delay discounting and demand. This is manifested by giving a high value to the substance together with the preference to receive it and use it immediately to receive the reward of consumption as soon as possible.

However, how this relates to the different faces of youth cigarette smoking has not been established.

Authors consider it necessary to point out that there is a conceptual difference between cigarette consumption and dependence. Consumption is a characteristic of dependence, but dependence is not just consumption: it is characterized by physical tolerance, abstinence symptoms if consumption is discontinued, and so on.

Although the role of these elements in adolescent cigarette smoking has not been investigated, there is previous literature on cannabis use in adults. In those studies, the frequency of consumption was significantly associated with the demand for cannabis, and dependence was associated with the discount for delay (that is, with the preference to receive the reward of consumption immediately).

The objective of the authors with their study was to test the hypotheses that arise because of the Reinforcing Pathology model. This hypothesis says that higher demand would be associated with both higher dependence and higher smoking, and a more pronounced delay discount would be associated with higher dependence, but not necessarily with higher smoking.

To do this, they gathered a sample of 50 adolescents who use tobacco daily. These young people were recruited through online advertisements, advertisements on buses, and sessions in high schools. They were between 15 and 19 years old, with an average age of 17.7.

They had to report their cigarettes smoked per day during the last month. In addition, they carried out a series of tests whose origin is found in tools of behavioral economics.

The results were very interesting. Although demand for cigarettes was associated with severity and consumption, the delay discount was an important predictor only for dependence. That is, only those young people with a strong dependence on tobacco significantly looked for the immediate reward of consumption.

The delay discount is based on the preference for immediate rewards over delayed rewards, which do not necessarily have to be the result of cigarette smoking.

Authors’ study suggests that the discount is related to the level of dependency, and this is consistent with the idea that a higher discount for delay can predict poorer treatment outcomes for young people, and a greater severity of dependency for adults.

However, while the delay discount is not an important predictor for demand, it does influence it in some way. Therefore, the discount would affect dependency in the first instance and demand secondarily.

Finally, authors add some last information: a greater amplitude of demand was associated with a higher level of consumption.

One limitation of the study is that the sample size is relatively small. Future research should replicate these findings with a larger sample.

Because adolescent smokers may be more susceptible to changes in their smoking trajectory, since their behavior may be more malleable due to their developmental stage, it is critical that there are new ways of understanding the onset, maintenance, and progression of smoking in them.

Behavioral economics suggests ways of treating and understanding the phenomenon that would undoubtedly be very useful for intervening with these young people.

If you want to know more about Behavioral Economics and how to apply it to human behavior, take a look to our Certificate in Behavioral Economics, a formative program, in English or Spanish, 100% online and certified by Heritage University (USA). Now, with discounts for members of this club.

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