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Drug Alcohol Depend. 2015 Mar 1;148:62-8. doi: 10.1016/j.drugalcdep.2014.12.018. Epub 2014 Dec 30.

Using behavioral economics to predict opioid use during prescription opioid dependence treatment.

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Department of Family Medicine, University of California, Los Angeles, 10880 Wilshire Boulevard, Suite 1800, Los Angeles, CA 90024, United States. Electronic address:
Department of Family Medicine, University of California, Los Angeles, 10880 Wilshire Boulevard, Suite 1800, Los Angeles, CA 90024, United States.
Addiction Recovery Research Center (ARRC), Virginia Tech Carillion Research Institute, 2 Riverside Circle, Roanoke, VA 24016, United States.
Integrated Substance Abuse Program, University of California, Los Angeles, 1640 S. Sepulveda, Ste. 120, Los Angeles, CA 90024, United States.



Research grounded in behavioral economics has previously linked addictive behavior to disrupted decision-making and reward-processing, but these principles have not been examined in prescription opioid addiction, which is currently a major public health problem. This study examined whether pre-treatment drug reinforcement value predicted opioid use during outpatient treatment of prescription opioid addiction.


Secondary analyses examined participants with prescription opioid dependence who received 12 weeks of buprenorphine-naloxone and counseling in a multi-site clinical trial (N=353). Baseline measures assessed opioid source and indices of drug reinforcement value, including the total amount and proportion of income spent on drugs. Weekly urine drug screens measured opioid use.


Obtaining opioids from doctors was associated with lower pre-treatment drug spending, while obtaining opioids from dealers/patients was associated with greater spending. Controlling for demographics, opioid use history, and opioid source frequency, patients who spent a greater total amount (OR=1.30, p<.001) and a greater proportion of their income on drugs (OR=1.31, p<.001) were more likely to use opioids during treatment.


Individual differences in drug reinforcement value, as indicated by pre-treatment allocation of economic resources to drugs, reflects propensity for continued opioid use during treatment among individuals with prescription opioid addiction. Future studies should examine disrupted decision-making and reward-processing in prescription opioid users more directly and test whether reinforcer pathology can be remediated in this population.


Behavioral economics; Buprenorphine–naloxone; Prescription opioids; Treatment outcome

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