Application of Behavioral Economics to Behavior Change Azaher Molla H 571: Theory of Heath Behavior 1

Contents of my presentation A short introduction of general economics to health behavior Application of BE to health behavior change – Community Reinforcement approach (CRA) – Contingency Management (CM) BE enhances the efficacy of pharmacotherapy outcomes Discuss how BE predicts treatment response 2

Application of Gen. Economics in reducing health problems Behavioral Economics differs from conventional economics (Macro and Microeconomics – Macro and micro focus on group of peoples – BE focus on individual people Application of Gen Econ in reducing health problems – Microecon. approach= Modifying zoning laws to decrease the density of alcohol outlets – Macroecon. Approach= increasing cost of tobacco and alcohol via taxation reduces consumption – Increase tax for obesity prevention 3

1. Application of BE to behavior change 1.A. Community Reinforcement approach (CRA) – Trt. approaches for substance use disorders that focuses on developing alternative competing sources of reinforcement for not using substances. Rationale: – Psychological problems/ stressors Vocational Family Legal Financial Health problems 4

CRA addresses these issues by building alternative sources of mutually exclusive positive reinforcement Develop modules that personalize each individual needs – Couples counseling – Job club for employment – Recreational counseling for new form of social act. that do not depend on substance use. 5

Empirical evidences (CRA) Hunt and Azrin (1973). CRA clients spend less time drinking and more time with working and families than control Azrin (1976); Azrin, Sisson, Meyers, & Godley (1982) : Adjunctive medication trt highly favorable effects. Drank 2% as compared to 55%. Smith, Meyers, & Delaney (1998): Effective in Homeless-alcohol dependent population Meyers & Smith (1997); Sisson and Azrin (1986) developed a special type of CRA (CRAFT): More effective 6

1.B. Contingency Management (CM) Seeks to alter the relative value of the drugs. Micro incentives: Provides a clear, unambiguous reinforcement schedule Incentives increase gradually and at highest level there will be a “Jumbo” prize like TV set or DVD Player. 7

Empirical Evidences (CM) McCaul, Stitzer, Bigelow, & Liebson, 1984: Effective in the trt of opiates; Perty, Martin, Cooney, & Kranzler, 2000: Alcohol Shoptaw, Jarvik, Ling, & Rawson, 1996: Tobacco Higgins, Wong, Badger, Ogden, & Dantona, 2000: Stimulants. Higgins et al., (2003) conducted a number of clinical trials where CRA and CM were integrated and found +ve clinical effects. John et al., 2011; Volpp, John et al., 2008: Obesity Ghitza, Epstein, & Perston, 2008 : HIV-risk behaviors Hartz et al., 1999, Olmstead & Petry, 2009; Sindelar, Elbel, & Petry, 2007: Cost-effective 8

Comparison between CRA and CM CRA Macrocosmic (Individual+Family+ social+ environmental) Interpersonal relationship Employment Psychilogical problem solving Long term CM Microcosmic (Only individual) Incentive for attendance, abstinence, medical compliance Short-term Vouchers for consumers goods,/ meal, portable music player, including jumbo prizes. 9

2. BE enhances the efficacy of pharmacotherapy outcomes Objectives of CRA & CM are: Reduce the relative value of substances or other outcomes. Medication / drugs can also reduce the relative value as well. Drugs like naltrexone, nalmefene, gabapentin, aripiprazole, varenicline are used for alcohol dependence; transdermal nicotine for tobacco dependencey. Thus, BE can be used as intervention and as an experimental platform for better understanding for pharmacological interventions. Conclusion: BE approaches have considerable potential for enhancing the efficacy pharmacotherapy outcomes 10

3. BE predicts treatment response: A new domain BE variables serve as moderators of intervention outcomes ; Ex: For a heavy drinker receiving a brief intervention 2 different measures of relative value of alcohol predicted trt ourcomes after 6 months; – Greater relative value was a negative prognostic factor Alcohol trt relapse is associated with low availability of nondrinking activities Successful resolution of problems is associated with increased access to valued nondrinking related reinforcing activities 11

Delay discounting decision making has also been determined to be a prognostic factor An inverse relationship between impulsivity and successful resolution – Highly impulsive smokers are at greater risk of failing – Less impulsive or unimpulsive are more likely to be success to quit smoking. 12

Summary (Application of BE theory) Application in behavior change: – 1. CRA – 2. CM – Comparison of CRA and CM Application in pharmacotherapy Application in predicting treatment response 13

Let’s Have an Exercise Hypothetical obesity treatment Description: A 10 wk program with daily group session that are primarily focused on nutrition education. 10 persons. Each person is required to make a commitment of $250 at the start of the prog. How much they will get their money back and how much of it will be doubled depends on their weight loss compared to the previous day. They will get a gift card from a deprt. Store a non food recreational item. The $ will escalate for each consecutive day of wt loss. S5; $6; $8; $11; $20 The money loss goes to a lottery and is added to a baseline contribution of $100 from the program. Qualification for entry into lottery: Consecutive wt. loss for 2 wks. The money loss during these 2 weeks goes to the winer. 14

Questions What type of BE intervention is it? What type of incentives the participants are getting? 1. Coming to treatment and consistent weight loss and having daily $ incentives: Gift cards 2. Loss aversion 3. Lottery winnings 15

Thank you Questions?? 16