Application of Behavioral
Economics to Behavior Change
Azaher Molla
H 571: Theory of Heath Behavior
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Contents of my presentation
• A short introduction of general economics to
health behavior
• Application of BE to health behavior change
– Community Reinforcement approach (CRA)
– Contingency Management (CM)
• BE enhances the efficacy of pharmacotherapy
outcomes
• Discuss how BE predicts treatment response
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Application of Gen. Economics in
reducing health problems
• Behavioral Economics differs from conventional
economics (Macro and Microeconomics
– Macro and micro focus on group of peoples
– BE focus on individual people
• Application of Gen Econ in reducing health
problems
– Microecon. approach= Modifying zoning laws to
decrease the density of alcohol outlets
– Macroecon. Approach= increasing cost of tobacco and
alcohol via taxation reduces consumption
– Increase tax for obesity prevention
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1. Application of BE to behavior change
1.A. Community Reinforcement approach (CRA)
– Trt. approaches for substance use disorders that
focuses on developing alternative competing
sources of reinforcement for not using substances.
• Rationale:
– Psychological problems/ stressors
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Vocational
Family
Legal
Financial
Health problems
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• CRA addresses these issues by building
alternative sources of mutually exclusive
positive reinforcement
• Develop modules that personalize each
individual needs
– Couples counseling
– Job club for employment
– Recreational counseling for new form of social act.
that do not depend on substance use.
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Empirical evidences (CRA)
• Hunt and Azrin (1973). CRA clients spend less
time drinking and more time with working and
families than control
• Azrin (1976); Azrin, Sisson, Meyers, & Godley
(1982) : Adjunctive medication trt highly
favorable effects. Drank 2% as compared to 55%.
• Smith, Meyers, & Delaney (1998): Effective in
Homeless-alcohol dependent population
• Meyers & Smith (1997); Sisson and Azrin (1986)
developed a special type of CRA (CRAFT): More
effective
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1.B. Contingency Management (CM)
• Seeks to alter the relative value of the drugs.
• Micro incentives:
• Provides a clear, unambiguous reinforcement
schedule
• Incentives increase gradually and at highest level
there will be a “Jumbo” prize like TV set or DVD
Player.
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Empirical Evidences (CM)
• McCaul, Stitzer, Bigelow, & Liebson, 1984: Effective in
the trt of opiates;
• Perty, Martin, Cooney, & Kranzler, 2000: Alcohol
• Shoptaw, Jarvik, Ling, & Rawson, 1996: Tobacco
• Higgins, Wong, Badger, Ogden, & Dantona, 2000:
Stimulants.
• Higgins et al., (2003) conducted a number of clinical
trials where CRA and CM were integrated and found
+ve clinical effects.
• John et al., 2011; Volpp, John et al., 2008: Obesity
• Ghitza, Epstein, & Perston, 2008 : HIV-risk behaviors
• Hartz et al., 1999, Olmstead & Petry, 2009; Sindelar,
Elbel, & Petry, 2007: Cost-effective
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Comparison between CRA and CM
CRA
• Macrocosmic
(Individual+Family+ social+
environmental)
• Interpersonal relationship
• Employment
• Psychilogical problem solving
• Long term
CM
• Microcosmic
(Only individual)
• Incentive for attendance,
abstinence , medical
compliance
• Short-term
• Vouchers for consumers
goods,/ meal , portable
music player, including
jumbo prizes.
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2. BE enhances the efficacy of
pharmacotherapy outcomes
• Objectives of CRA & CM are: Reduce the relative value
of substances or other outcomes.
• Medication / drugs can also reduce the relative value
as well.
• Drugs like naltrexone, nalmefene, gabapentin,
aripiprazole, varenicline are used for alcohol
dependence; transdermal nicotine for tobacco
dependencey.
• Thus, BE can be used as intervention and as an
experimental platform for better understanding for
pharmacological interventions.
• Conclusion: BE approaches have considerable potential
for enhancing the efficacy pharmacotherapy outcomes
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3. BE predicts treatment response: A
new domain
• BE variables serve as moderators of intervention
outcomes ;
• Ex: For a heavy drinker receiving a brief intervention
2 different measures of relative value of alcohol
predicted trt ourcomes after 6 months;
– Greater relative value was a negative prognostic factor
• Alcohol trt relapse is associated with low availability of
nondrinking activities
• Successful resolution of problems is associated with increased
access to valued nondrinking related reinforcing activities
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• Delay discounting decision making has also
been determined to be a prognostic factor
• An inverse relationship between impulsivity
and successful resolution
– Highly impulsive smokers are at greater risk of
failing
– Less impulsive or unimpulsive are more likely to
be success to quit smoking.
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Summary (Application of BE theory)
• Application in behavior change:
– 1. CRA
– 2. CM
– Comparison of CRA and CM
• Application in pharmacotherapy
• Application in predicting treatment response
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Let’s Have an Exercise
Hypothetical obesity treatment
• Description:
• A 10 wk program with daily group session that are primarily focused
on nutrition education.
• 10 persons. Each person is required to make a commitment of $250
at the start of the prog. How much they will get their money back
and how much of it will be doubled depends on their weight loss
compared to the previous day. They will get a gift card from a deprt.
Store a non food recreational item. The $ will escalate for each
consecutive day of wt loss.
• S5; $6; $8; $11; $20
• The money loss goes to a lottery and is added to a baseline
contribution of $100 from the program.
• Qualification for entry into lottery: Consecutive wt. loss for 2 wks.
• The money loss during these 2 weeks goes to the winer.
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Questions
• What type of BE intervention is it?
• What type of incentives the participants are
getting?
• 1. Coming to treatment and consistent weight
loss and having daily $ incentives: Gift cards
• 2. Loss aversion
• 3. Lottery winnings
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Thank you
Questions??
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