Heyman's target article contributes to our understanding of addictions by offering solutions to several paradoxes and by recognizing the stable nature of addictive behavior. Previous classical and operant conditioning models have emphasized molecular processes, such as acquisition and extinction, and have failed to address the aggregate effects of long-term exposure to the contingencies of drug and alcohol use.

Melioration is not superior and may be inferior to other extensions of behavioral choice theory to addiction studies. Progress in the addiction field will be accelerated by the demise of the disease model rather than by attempting to resolve the contradictions it has created.

Over the years, many theories have been proposed to account for the aberrant behavior of drug dependent individuals. Heyman posits that the existing theories of drug dependence are inadequate to explain the complex processes inherent in human drug-taking. He proposes that incongruous behaviors that comprise addiction, such as continued drug use in spite of adverse consequences, can be explained by application of the matching law approach. While the matching law theory of addiction explains certain aspects of human behavior, its application (...) to the area of addiction must be subjected to experimental verification. (shrink)

Heyman proposes that external stimuli can promote a switch from a local to a global frame of reference for evaluating the consequences of behavior and that such a change might be critical to breaking the grip of drag addiction. Could incentive stimuli promote a switch in the opposite direction and thus contribute to relapse in the recovered addict?

Extreme sensations – thirst, pain – can focus attention on local consequences at the expense of the overall, perhaps for good evolutionary reasons. Maybe the same phenomenon evolves from prolonged use of addictive substances. The matching law explains mistaken choice, not how a person who has confronted personal catastrophe manages to ignore it in making a locally induced choice.

Two issues are raised. (1) What is the nature of the drug effect Heyman thinks confers value to drugs? (2) What is the evidence that drug use decreases the value of drugs and of conventional incentives over the long-term? There is considerable evidence for the opposite; a persistent increase in the sensitivity of neural systems that mediate drug value.

Heyman s analysis of the relevant complex behavioral variables associated with addiction is evaluated in relation to identifying the appropriate variables in behavior analysis. The model of behavioral allocation and choice known as melioration, discussed by Heyman as a way to understand the complexities of addiction, is examined and contrasted with another model of matching called ratio invariance, which is offered in this commentary as another behavioral account with a significant potential for resolving the contradictions of addiction.

Heyman's target article seeks to resolve the apparent paradox surrounding the issue of control in relation to addictive behaviour. The present commentary argues that addiction is in fact less paradoxical and more easily understandable than Heyman supposes. A fully satisfactory model of addiction, however, requires a more multifaceted approach than that provided by the type of behavioural choice theory favoured by Heyman.

Heyman's analysis of addiction in terms of matching to local relative value can be supplemented by stimulus-control processes. Stimulus equivalence can broaden the set of situations that occasion addictive behavior, and the situation-reinforcer correlation can enhance its persistence. The joint effects of stimulus-control and reinforcement processes may complicate treatment.

Heyman's model, paradoxically, predicts that whereas a maximizing approach to drug choice will prevent escalation of drug use it will never yield complete abstinence. We suggest an alternative model that overcomes this difficulty by focusing on changes in drug tolerance. A small modification allows maximization to predict either abstinence or moderation (e.g., social drinking).

A link between mental disorder and freedom is clearly present in the introduction of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). It mentions “an important loss of freedom” as one of the possible defining features of mental disorder. Meanwhile, it remains unclear how “an important loss of freedom” should be understood. In order to get a clearer view on the relationship between mental disorder and (a loss of) freedom, in this article, I will explore (...) the link between mental disorder and free will. I examine two domains in which a connection between mental disorder and free will is present: the philosophy of free will and forensic psychiatry. As it turns out, philosophers of free will frequently refer to mental disorders as conditions that compromise free will and reduce moral responsibility. In addition, in forensic psychiatry, the rationale for the assessment of criminal responsibility is often explained by referring to the fact that mental disorders can compromise free will. Yet, in both domains, it remains unclear in what way free will is compromised by mental disorders. Based on the philosophical debate, I discuss three senses of free will and explore their relevance to mental disorders. I conclude that in order to further clarify the relationship between free will and mental disorder, the accounts of people who have actually experienced the impact of a mental disorder should be included in future research. (shrink)

Knowledge of specific instances of melioration does not imply knowledge of the variables controlling behavior. Drug self-administration has been successfully analyzed in terms of standard variables such as the immediacy and magnitude of the drug reinforcer. An appeal to melioration may not be necessary.

Addictive behavior has never seemed rational because it persists in spite of drastic aversive consequences. This is a particular problem for models of addiction such as operant psychology which hold that behavior is controlled by its consequences. Inspite of claims to the contrary, Heymans target article illustrates how operant psychology resolves this contradiction. By using the matching law, Heyman suggests a mechanism that explains why delayed aversive events may not control behavior, and a conceptual framework in which we can understand (...) successful therapies. (shrink)

Numerous individual differences determine the effectiveness of the multiple external reinforcement contingencies that control drug seeking behavior. Differences in the capacity to frame reinforcement and also the toxic effects of drugs modulate susceptibility to addiction. As a result, not all individuals are at the same degree of risk for addiction.

The conflict between drug and conventional rewards leads to a paradox: Sanctions against drug use decrease access to conventional rewards and push drug users toward drug abuse, whereas increased access to the rewards of family, friends, and work may help reduce drug abuse. Lack of control is not specific to drug addiction and is unlikely to yield to a shift in bookkeeping.

Heyman makes a convincing case that a melioration choice strategy is sufficient to produce addictive behavior. But given a plethora of addiction theories, the question is whether melioration theory is superior to rivals more sophisticated than a simple disease model or operant conditioning account. Heyman offers little direct evidence that melioration actually causes the addictions we observe.

Choosing the smaller, less delayed reinforcers of drug abuse (including cessation of withdrawal) over the larger, more delayed reinforcers of a healthy life can be described as impulsiveness (the opposite of self-control). Examination of drug abuse using a self-control/impulsiveness framework can help explain many of the puzzles about this behavior, while tying drug abuse into a large research database.

Centre for Applied Philosophy and Public Ethics University of Melbourne, Parkville, 3010, Australia and.

Whatever its implications for the other features of human agency at its best — for moral responsibility, reasons-responsiveness, self-realization, flourishing, and so on—addiction is universally recognized as impairing autonomy. But philosophers have frequently misunderstood the nature of addiction, and therefore have not adequately explained the manner in which it impairs autonomy. Once we recognize that addiction is not incompatible with choice or volition, it becomes clear that none of the Standard accounts of autonomy can satisfactorily explain the way in which (...) it undermines fully autonomous agency. In order to understand to what extent and in what ways the addicted are autonomy-impaired, we need to understand autonomy as consisting, essentially, in the exercise of the capacity forextended agency.It is because addiction undermines extended agency, so that addicts are not able to integrate their lives and pursue a Single conception of the good, that it impairs autonomy. (shrink)

Economic models of addiction are choice-based. These models push the choice paradigm too far by modeling addiction as rational, normative behavior. Heyman's target article provides a sensible alternative to this economic approach by emphasizing that addiction is characterized by ambivalence and a perceived loss of self control. However, matching may not be a satisfactory platform on which to build this alternative model. Matching experiments do not provide evidence of ambivalence or perceived loss of self control.

For use in applied settings, the melioration model will need to incorporate changes in the shapes of local value functions over time, treat current value as a continuous function of time since previous choices, and take into account discounting of the effects of current behavior on future value. The policy implications of the model for regulating drugs are limited.

Heyman's target article is an analytical tour de force, but it makes too hard a distinction between voluntary and driven behavior. It is more fruitful to think about brain and behavior as shifting, interacting “agents,” represented by multiple neural circuits. This has the virtue of better connecting behavioral analysis with wet neuroscience.

I discuss various theoretical issues concerning maximizing, matching, and melioration. The model of addiction based on melioration has the key feature that a reduction in drag use increases both the value of drag-taking and the value of conventional activities. I found Heyman's target article stimulating. I don't feel competent to comment on drags but I do have some thoughts, both general and specific, on the theoretical issues.

Heyman's analysis of addiction suggests that drug taking is irrational. The irrationality of drug taking, however, may depend on the acceptance of mainstream society's view of what is valuable. Consideration of the addict's viewpoint and cultural aspects of drug taking may be useful in trying to fathom the “rationality” of drug taking.

I support the major theme of Heyman's target article that behavioral choice theory can enhance our understanding of drug dependence, but I raise concerns about the critique of the operant model of drug dependence, the underscoring of melioration to the exclusion of other theories of choice, and assertions about the unique effects of drug reinforcement.

The target article emphasizes the relationship between a matching law-based theory of addiction and the disease model of addiction. In contrast, this response emphasizes the relationship between the matching law theory and other behavioral approaches to addiction. The basic difference, I argue, is that the matching law specifies that choice is governed by local reinforcement rates. In contrast, economics says that overall reinforcement rate controls choice, and for other approaches there are other measures or no clear prediction at all. The (...) response also differs from the target article in that there is more emphasis on the finding that stimulus conditions determine whether choice is under local or overall reinforcement rate control. (shrink)

Research findings on addiction are contradictory. According to biographical records and widely used diagnostic manuals, addicts use drugs compulsively, meaning that drug use is out of control and independent of its aversive consequences. This account is supported by studies that show significant heritabilities for alcoholism and other addictions and by laboratory experiments in which repeated administration of addictive drugs caused changes in neural substrates associated with reward. Epidemiological and experimental data, however, show that the consequences of drug consumption can significantly (...) modify drug intake in addicts. The disease model can account for the compulsive features of addiction, but not occasions in which price and punishment reduced drug consumption in addicts. Conversely, learning models of addiction can account for the influence of price and punishment, but not compulsive drug taking. The occasion for this target article is that recent developments in behavioral choice theory resolve the apparent contradictions in the addiction literature. The basic argument includes the following four statements: First, repeated consumption of an addictive drug decreases its future value and the future value of competing activities. Second, the frequency of an activity is a function of its relative (not absolute) value. This implies that an activity that reduces the values of competing behaviors can increase in frequency even if its own value also declines. Third, a recent experiment (Heyman & Tanz 1995) shows that the effective reinforcement contingencies are relative to a frame of reference, and this frame of reference can change so as to favor optimal or suboptimal choice. Fourth, if the frame of reference is local, reinforcement contingencies will favor excessive drug use, but if the frame of reference is global, the reinforcement contingencies will favor controlled drug use. The transition from a global to a local frame of reference explains relapse and other compulsive features of addiction. (shrink)

Heyman's two crucial theses are that people over-value immediate rewards, and that addictive substances “subvert the value of competing commodities.” These perennial ideas were discussed by Plato. Whereas Heyman provides scientific clarification and support for the first, the second remains problematic. I outline how this deficiency might be remedied via evolutionary considerations.

Heyman's target article makes a strong case for a behavioral approach to addiction, yet some important assumptions require justification, and promising behavioral alternatives to the author's melioration approach should be considered. In particular, the behavioral economic approach to addiction appears well developed and comprehensive. How does the melioration approach complement or improve on a behavioral economic account?

Heyman's view that addiction can be viewed as a natural outcome predictable by melioration and the matching law is provocative. Remaining to be explained more fully, however, are exactly how his view is an improvement on other reinforcement-based accounts. Included in these elaborations should be an account of how different “bookkeeping schemes” are developed and controlled and what new approaches to treatment and prevention of drug addiction are indicated.

It is difficult to accommodate compulsive drug use that destroys regulation by consequences in a unitary framework of melioration or maximization, especially as both are strategies of behavioral regulation. The “contradiction” of addictive behavior despite aversive consequences is an illusory issue because consequences that do not decrease addictive behavior cannot be considered punishing.

Heyman explains useful ways to bring addictive drug use under environmental control. We doubt that relapse is explained by drug features such as immediate reinforcement, clouding of judgment, and so forth. Relapse may require explanation in terms of enduring sensitization of incentive neural substrates, but even if its causal assumptions are wrong, Heyman's model makes useful predictions for behavioral control.

The American Journal of Bioethics, Volume 11, Issue 8, Page 17-18, August 2011.

The matching law accounts for both addictive behavior and the usefulness of a person's evaluating choices in overall categories. To explain why overall bookkeeping, once learned, does not easily win out over local bookkeeping, another implication of matching is needed: intertemporal bargaining. The role of melioration, though probably important for new addiction is separate.

Alcoholics Anonymous describes itself as a “fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism”. The fellowship has millions of members all around the world and the number of independent AA groups is counted in tens of thousands. In this article, I try to understand the recovery from alcoholism in the fellowship of AA as a meaning giving process where the (...) alcoholic is invited to interpret the founding text of AA, Alcoholics Anonymous: The Story of How More Than One Hundred Men Have Recovered from Alcoholism, and to appropriate the world that it opens in front of him. I focus on interpreting the symbolic language with which the Big Book of AA speaks of evil. I also explain how this symbolic language is related to recovery – i.e., how the alcoholic may find in the pages of the Big Book commonly shared symbols of stain, sin, and guilt which express his blind experience of evil. (shrink)