The Moderating Role of Family History on the

The Moderating Role of Family History on the Relationship between Substance-Free Rewards and Alcohol Problems Keanan J. Joyner, Samuel F. Acuff, Lidia Z. Meshesha, Christopher J. Patrick, James G. Murphy

Overview of Behavioral Economics • Focus on choice: behavior is allocated to an activity based on the cost/benefit ratio of that activity relative to other available activities • levels of drug use are sensitive to: • Drug price or availability • Presence of alternatives, reward delay • Strong preference for immediate relative to delayed reinforcers may be key feature of addiction • Addiction = drugs have greater reinforcing value than available alternatives Bickel, Johnson, Koffarnus, Mac. Killop, & Murphy (2014). Annual Review of Clinical Psychology. Hursh (1980). Journal of the Experimental Analysis of Behavior. Tucker & Vuchinich (1988). Journal of Abnormal Psychology.

Substance-Free Reinforcement and Alcohol Problems • In the DSM-5: o “A great deal of time is spent in activities necessary to obtain alcohol/drug or recover from its effects” o “Important social, occupational, or recreational activities are given up because of alcohol/drug use. ” • Substance-free alternatives aren’t actually measured in diagnostic criteria despite being implied as an important feature of addiction

Animal studies • We administer lots of drugs to rats, then they start to selfadminister drugs, and they become addicted • But one research group noticed that this animal model doesn’t really fit how humans work – there always alternatives to drug use for humans o We tend to not give these to rats

Rat Park studies Alexander et al. , 1978; 1981 o Rat Park: Full of alternative rewards • Exercise wheels, other rats, tunnels, etc. Skinner Box versus Rat Park • Almost impossible to get Rat Park rats to self-administer to addiction o Follow-up studies show higher environmental enrichment leads to lowered addictive potential (Ahmed et al. , 2005)

Humans drug use and alternative sources of reward • Drinking decreases as a function of increasing offers of alternative rewards (Vuchinich & Tucker, 1988) • Offers of alternative rewards even suppress human “hard” drug use (Hart et al. , 2000) • Difficulty accessing sources of natural reward is associated with more severe AUD in college students (Joyner et al. , 2016)

Implications of Family History • FH+ is associated with more positive alcohol expectancies (Pastor & Evans, 2003; La. Brie et al. , 2010) • Conditioned neural reward responses to alcohol higher in FH+ (Oberlin et al. , 2013) • Visual cues for alcohol elicit greater neural response (Dager et al. , 2013) • Substance-free alternatives particularly important for FH+?

Current study • Main Hypotheses: o 1) Less Substance-free Reinforcement is associated with more alcohol problems o 2) FH+ status is associated with more alcohol problems o 3) The effect of alternative reinforcers is most pronounced in FH+ individuals • 393 heavy drinking young adults (2+ HDEs past month), 331 included in final sample o Mean age = 18. 8, SD = 1. 1 o 60. 8% women o 78. 9% white, 8. 7% black, 7. 1% multiracial

Substance-free Reinforcement • Measured via the LAEQ (Leisure Activities in the Evening Questionnaire) o Most of young adult drinking happens in the evenings – thus, having substance-free alternatives is specifically important o Reinforcement survey schedule scoring (frequency x enjoyment) o Internal consistency is good (α =. 85; GLB =. 90)

Other Measures • Typical alcohol use (Daily Drinking Questionnaire) Collins et al. (1985) • Alcohol-related negative consequences (Young Adult Alcohol Consequences Questionnaire; α =. 89, GLB =. 94) Read et al. (2006) • Assessment of biological parents’ alcohol abuse o Counted as FH+ if at least one parent had alcohol problems o Only counted as FH- if both parents definitively did not have alcohol problems • People were dropped from analyses if: o They answered ‘maybe’ to one parent while answering no to the other o They did not know one or both of their biological parents o Final sample: N = 331

Results • Hypothesis 1: Less Evening Substance-free Reinforcement is associated with more alcohol problems • LAEQ significantly correlates with typical alcohol use (r =. 19, p =. 001) and alcohol problems (r = -. 13, p =. 020) o If you split up the reinforcement metric between enjoyment and frequency, Steiger-Z tests indicates no difference in predictive power for either typical alcohol use (Z =. 93, p =. 350) or alcohol problems (Z = -1. 12, p =. 262)

Results • Hypothesis 2: FH+ status is associated with more alcohol problems 16 14. 362 14 *** 11. 955 YAACQ Total 12 10 8 6 4 2 0 FH+ FH- o Not associated with evening substance-free reinforcement levels (in this sample) o Not associated with typical drinking level (in this sample)

Results 10 • Hypothesis 3: This effect is most pronounced in FH+ individuals 9 8 Alcohol Problems • FH- : substance-free reinforcement did not predict alcohol problems (β =. 04, p =. 54) • FH+ : substance-free reinforcement negatively related to alcohol problems (β = -. 19, p =. 015) FH+ FH- 7 6 5 4 3 2 1 0 Low Substance-Free Reinforcement High Substance-Free Reinforcement

Discussion • Sources of alternative reward in one’s environment alters susceptibility to addiction in both rats and humans • Current results suggest that these alternatives appear to be most protective for those at risk of developing alcohol problems in the first place (FH+ individuals) • Is this interaction possibly unique to the phenomenon of college student drinking?

Discussion • Future research should use continuous measures of liability factors conferred by family history High Disinhibition Low Disinhibition 0. 18 0. 16 0. 14 SUD Composite o Joyner et al. (under review) showed that people high in disinhibition (main liability conferred by a family history of alcohol problems) and simultaneously low in EEG-assessed reward sensitivity showed the most severe substance use problems 0. 2 0. 1 0. 08 0. 06 • Possible treatment implications? o Personalized treatment protocols 0. 04 0. 02 0 Low Reward Positivity High Reward Positivity

Conclusion • Individuals at risk for substance problems to begin with show particular vulnerability to substance abuse when they either don’t have, or aren’t sensitive to, substancefree (natural) rewards