Reinforcer pathology, probabilistic choice, and medication adherence in patients with multiple sclerosis.

Document Type

Article

Publication Date

3-2023

Identifier

DOI: 10.1002/jeab.830

Abstract

The reinforcer pathology model posits that core behavioral economic mechanisms, including delay discounting and behavioral economic demand, underlie adverse health decisions and related clinical disorders. Extensions beyond substance use disorder and obesity, however, are limited. Using a reinforcer pathology framework, this study evaluates medical adherence decisions in patients with multiple sclerosis. Participants completed behavioral economic measures, including delay discounting, probability discounting, and a medication purchase task. A medical decision-making task was also used to evaluate how sensitivity to mild side effect risk and efficacy contributed to the likelihood of taking a hypothetical disease-modifying therapy. Less steep delay discounting and more intense (greater) medication demand were independently associated with greater adherence to the medication decision-making procedure. More generally, the pattern of interrelations between the medication-specific and general behavioral economic metrics was consistent with and contributes to the reinforcer pathology model. Additional research is warranted to expand these models to different populations and health behaviors, including those of a positive health orientation (i.e., medication adherence).

Journal Title

Journal of the experimental analysis of behavior

Volume

119

Issue

2

First Page

275

Last Page

285

MeSH Keywords

Humans; Delay Discounting; Multiple Sclerosis; Medication Adherence; Substance-Related Disorders; Obesity

Keywords

delay discounting; demand; multiple sclerosis; probability discounting; reinforcer pathology

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