Escaping the Tyranny of Small Decisions:

A P lA ProposalWarren K. Bickel, Ph.D.

University of Arkansas for Medical SciencesUniversity of Arkansas for Medical Sciences

•Supported by NIDA, Wilbur Mills Endowment, Tobacco Settlement Funds

OverviewOverview

• Briefly reflect on mechanisms of b h i l h tbehavioral change concept

• Describe a new conceptual model for understanding challenging behaviors

• Illustrate potential opportunities toIllustrate potential opportunities to exploit new mechanisms of behavioral change derived from this modelchange derived from this model

Mechanisms of BehavioralMechanisms of Behavioral Change

Noch, and Kazdin & Noch propose a , p pfundamentally sound approach– Existing treatments provide the mechanism– Existing treatments provide the mechanismPotential constraints may include:

Tx effects are small or modestTx effects are small or modestTx does not match current theory of

disease or disorder

An Alternative Approach for Mechanism of Behavior

ChangeChange• Treatments or interventions should be

supported by the theory of the disorder(Toplack et al., 2007)

• Changing conceptualization of the• Changing conceptualization of the disease or disorder should force the evaluation of the adequacy of ourevaluation of the adequacy of our treatments, and, in turn, our working theory of the disease/disorder should yimpact our treatment approaches. (Toplack et al., 2007)

“Thence is imposed the task of everywhere seeking out in the natural phenomena those pelements that are the same, and that amid all multiplicity areand that amid all multiplicity are ever present.”

Ernst Mach (1893)Ernst Mach (1893)

The Tyranny of Small y yDecisions

Refers to situations where anRefers to situations where an individual can be victimized by the narrowness of the temporalnarrowness of the temporal context in which he or she exercises choice.

The Tyranny of SmallThe Tyranny of Small Decisions (TSD)

CharacteristicsChoices favor the

Examples• AddictionChoices favor the

immediate valued choice

Addiction• Risky Behaviors (e.g.,

HIV)choiceIgnore long-term consequences

• Debt and the Failure to Save Money Gl b l Cli t Chconsequences • Global Climate Change

• Many Forms of Crime• Obesity• Obesity

T l H iTemporal Horizon

YearsYears

Controls

H i

00 01 02 0 04 05

Heroin

00 01 02 0 04 05

Delay DiscountingDelay Discounting

• Refers to the reduction in value of a reinforcer as a function of the delay to reinforcer delivery

• Psychophysical Titration Procedure– Developed by Mazur (1987) with p y ( )

pigeons– Used by Rachlin, Raineri, and Cross

(1991) i h h(1991) with humans

ImmediateAdjusting

Delayed ConstantAdjusting

$1 000 $1 000Procedure

with $1,000 $1,000

$990 $1 000Hypothetical

Money $990 $1,000

$960 $1 000

Money

$960 $1,000

Adjusting Procedure

XPoint of

SubjectiveE lit

XX X X XEquality X X X

Delay

Hyperbolic Decay ModelHyperbolic Decay Model (Mazur, 1987)

V A / (1 + kD)

( )

V = A / (1 + kD)V = Value of reinforcer

A = Amount of reinforcerD = Delay of reinforcerD Delay of reinforcerk = Discounting rate

Madden, Petry, Badger, & Bickel (1997)

Smoking vs. Non-Smokingg g)

100

perc

ent

60

80Money Discounting

CurrentExNever

Val

ue (p

40

60

esen

t V

20

40

Pre

00 2000 4000 6000 8000

Delay (days)Bickel et al. (1999)

TSD in 4 Dimensions: Tinbergen’s (1951)

4 explanations4 explanations1. Mechanism-relates specific1. Mechanism relates specific

behavior to brain regions or structures

2 Ontogenetic developmental2. Ontogenetic-developmental changes

3. Functional- how has the b h i d t d t thbehavior adapted to the current environment (culture)

4. Evolutionary-how this ybehavior evolved

Competing Neurobehavioral Decision Systems

Hypothesis:Hypothesis:• Mechanism of TSDMechanism of TSD

– Increased activity of the Impulsive System(motivational)(motivational)

• Limbic Region• Ventral Striatum

– Decreased activity of Executive System(rationality and valuation)

P f t l C t• Prefrontal Cortex • Dorsolaterial Prefrontal Cortex

Bechara 2005Bechara 2005Bechara 2005Bechara 2005

McClure et al.,,Science, 2004

QuickTime™ and aTIFF (LZW) decompressorTIFF (LZW) decompressor

are needed to see this picture.

Hagens 2007

Development

Galvan et al,. J Neurosci 2006

Developmental Pattern ofTemporal Horizon

1

0.1DiscountRate

0.01Rate

0.001

1111 25252020 4545 7070Age

Household SurveyIllicit Drug Use (month)

30

40

50

Marijuana Use (month)

15

20

25

Cocaine Use (month)

1 5

2.0

2.5

0

10

20

30

10 15 20 25 30 35 40 45 50 55 60 65 700

5

10

15

10 15 20 25 30 35 40 45 50 55 60 65 700.0

0.5

1.0

1.5

15 20 25 30 35 40 45 50 55 60 65 70Age

10 15 20 25 30 35 40 45 50 55 60 65 70Age

10 15 20 25 30 35 40 45 50 55 60 65 70Age

Heavy Alcohol Use (month)

20

25Binge Alcohol Use (month)

40

50Cigarette Use (month)

40

50

5

10

15

10

20

30

10

20

30

40

10 15 20 25 30 35 40 45 50 55 60 65 700

Age10 15 20 25 30 35 40 45 50 55 60 65 70

0

Age10 15 20 25 30 35 40 45 50 55 60 65 70

0

Age

Kowal, Gatchalian, Badger, & Bickel, In prep.

Crime

England and Wales 1842-1844 United States 1990

900 24000

England and Wales 1842 1844

600

700

800

Females 16000

20000

Females

300

400

500Males

8000

12000

Females

Males

0

100

200

0

4000

0 10 20 30 40 50 60 70 0 10 20 30 40 50 60 70

Homocides

60 900

Canada Chicago

40

50

Females 600

700

800

Females

20

30Males

300

400

500 Males

0

10

0 4 14 0 24 0 34 0 44 0 54 0 64 0 740

100

200

4 4 4 4 4 4 4 40-410.-14

20-2430-34

40-4450-54

60-6470-74

0-410.-14

20-2430-34

40-4450-54

60-6470-74

Wilson & Daly, 1994

Functional Adaptation of TSD

• Can Changes in Cultural Practices Influence Temporal Horizon?p– Homo Sapiens emerged about

500,000 yrs ago.500,000 yrs ago.– Hunter-Gathering was the sole

economic enterprise for all but theeconomic enterprise for all but the last 2.6% of our time on this planet.13 000 i lt d l d– 13,000 yrs ago agriculture developed

Income & DiscountingIncome & Discounting

3.5

4

2

2.5

3

K months

0

0.5

1

1.5 K months

FarmersHunter-Gathers

Tucker, 2006

Income and Discounting

• Econometric studies of U.S. data conclude that discounting is negatively correlated with labor income and education attainment (Lawrence, 1991)

A Component of the Fundamental Cause of HealthFundamental Cause of Health

Disparities

Phelan & Link, 2005

Social Factors Promoting theSocial Factors Promoting the Short Temporal

C lt f I di t G tifi ti• Culture of Immediate Gratification• Erosion of Civic-Community Bondsy• Erosion of the Family

E i D t i ti d• Economic Deterioration and Disorder

Cohort Analysis of Addiction1966-1975

1956-1965

1946-1955

1936-1945

Warner et al., 1995

Percentage OverweightPercentage Overweight

1416

101214

468 6-11 yrs

12-19 yrs

02

1963- 1971- 1976- 1988- 1999-1970 1974 1980 1994 2002

Ogden et al., JAMA 2000; Hedley et al., JAMA 2004

U S Household SavingsU.S. Household Savings

78

4567

1234

Saving Rate

-101

1960- 1980- 1990- 1995- 2000- 20051979 1989 1994 1999 2004

Bureau of Economic Analysis

Poor Planning

PlanningPunishedPre-existing

LessPlanningPlanning

IncreasesPunishedg

DamagePlanning

Drug SR+CorticalLimbic

Cortical Representation

Learned Disuse & Limbic p

Changes Use

Neurotox? Drug UseBehavior

Drug UseReinforced

Drug Use Increases

UnfavorableEnvironmentsEnvironments

Escaping the Tyranny ofEscaping the Tyranny of Small Decisions

Hyperactive Impulsive SystemLik lLikely

Contingency ManagementReplacement Medications

UnlikelyyCognitive Behavior TherapyOther MedicationsOther Medications

Escaping the Tyranny ofEscaping the Tyranny of Small Decisions

Hypoactive Executive SystemLikelyLikely

Other Medications?U lik lUnlikely

Contingency Management Cognitive Behavior Therapy Replacement Medications

PositiveExec Func.Increase SR+BehaviorMotivation

Exec. Func.

Use-dependentCorticalC ti l CorticalReorganization

CorticalLimbic

DecreaseDecreaseMotivationDrug Use

Drug Abstin.Reinforced

Drug Use Increases

Escaping the Tyranny ofEscaping the Tyranny of Small Decisions

Impulsive System Constraint

Executive FunctionImprovement

Conclusions

• Broaden our view of mechanismsBroaden our view of mechanisms to those relevant to multiple disordersdisorders

• Align our understanding of Disease/Disorder with TreatmentDisease/Disorder with Treatment and preventionTSD id h• TSD may provide one such mechanism

• Suggests new mechanisms of behavioral change to explore

“Time is both a medium and a perspective. It is a medium through which we live as the future becomes present. As the future becomes present, we become aware of duration and successionwe become aware of duration and succession. Also, by transcending the present and looking at it from the past or future we gain perspective on thefrom the past or future, we gain perspective on the present. These time processes are fundamental to our construction of reality. If they are disturbed, our view of reality may become distorted”.

-F.T. Melges (Time and the Inner Future, 1982)