Pharmacotherapies for decreasing maladaptive choice in drug addiction: Targeting the behavior and the drug

Abstract

Drug addiction can be conceptualized as a disorder of maladaptive decision making in which drugs are chosen at the expense of pro-social, nondrug alternatives. The study of decision making in drug addiction has focused largely on the role of impulsivity as a facilitator of addiction, in particular the tendency for drug abusers to choose small, immediate gains over larger but delayed outcomes (i.e., delay discounting). A parallel line of work, also focused on decision making in drug addiction, has focused on identifying the determinants underlying the choice to take drugs over nondrug alternatives (i.e., drug vs. nondrug choice). Both tracks of research have been valuable tools in the development of pharmacotherapies for treating maladaptive decision making in drug addiction, and a number of common drugs have been studied in both designs. However, we have observed that there is little uniformity in the administration regimens of potential treatments between the designs, which hinders congruence in the development of single treatment strategies to reduce both impulsive behavior and drug choice. The current review provides an overview of the drugs that have been tested in both delay-discounting and drug-choice designs, and focuses on drugs that reduced the maladaptive choice in both designs. Suggestions to enhance congruence between the findings in future studies are provided. Finally, we propose the use of a hybridized, experimental approach that may enable researchers to test the effectiveness of therapeutics at decreasing impulsive and drug choice in a single design.

Figure 1

Average normalized values of delayed food pellets as a function of the delay to food delivery for three monkeys that were tested in all three conditions. The symbols represent the predictions of the average discounting function for each condition. From Huskinson et al., 2015; Printed with permission from Elsevier.

Figure 2

The graph depicts an idealized choice study in which subjects choose between a range of doses of cocaine and a fixed amount of a nondrug alternative (represented by food here). Cocaine’s potency as a reinforcer is increased with delay to food delivery and decreased with amphetamine treatment. Amph = Amphetamine