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Reinforcer pathology,probabilistic choice,and medication adherence in patients with multiple sclerosis |
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| Authors: | David P. Jarmolowicz Tadd D. Schneider Justin C. Strickland Amanda S. Bruce Derek D. Reed Jared M. Bruce |
| Affiliation: | 1. Department of Applied Behavioral Science, University of Kansas, Lawrence, KS, USA Cofrin-Logan Center for Addiction Research and Treatment, University of Kansas, Lawrence, KS, USA Healthcare Institute for Innovations in Quality, University of Missouri–Kansas City, Kansas City, MO, USA;2. Department of Applied Behavioral Science, University of Kansas, Lawrence, KS, USA Cofrin-Logan Center for Addiction Research and Treatment, University of Kansas, Lawrence, KS, USA;3. Behavioral Pharmacology Research Unit, Johns Hopkins School of Medicine, Baltimore, MD, USA;4. Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Hospital, Kansas City, MO, USA Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS, USA;5. Department of Applied Behavioral Science, University of Kansas, Lawrence, KS, USA;6. Department(s) of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA |
| 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). |
| Keywords: | delay discounting demand multiple sclerosis probability discounting reinforcer pathology |