Elsevier

Journal of Health Economics

Volume 26, Issue 5, 1 September 2007, Pages 865-876
Journal of Health Economics

Altered states: The impact of immediate craving on the valuation of current and future opioids

https://doi.org/10.1016/j.jhealeco.2007.01.002Get rights and content

Abstract

Based on prior research showing that people underestimate the influence of motivational states they are not currently experiencing, we predicted and found that heroin addicts would value an extra dose of the heroin substitute Buprenorphine more highly when they were currently craving (right before receiving BUP) than when they were currently satiated (right after receiving BUP)—even when the extra BUP was to be received 5 days later. If addicts cannot appreciate the intensity of craving when they are not currently experiencing it, as these results suggest, it seems unlikely that those who have never experienced craving could predict its motivational force. Under-appreciation of craving by non-addicts may contribute to initial decisions to experiment with drugs.

Section snippets

Subjects

Subjects were 13 adult (8 male, 5 female) heroin addicts. Their mean age was 37.5 years (S.D. = 7.6 years), they reported an average of 11.9 years of addiction (S.D. = 8.7 years), and had used an average of five bags of heroin intravenously per day (S.D. = 3.4 bags) prior to treatment. Although this is an unusually small sample size, particularly for economics, it is a within-subjects design. Addicts are not being compared to one another, or to non-addicts, but to themselves in different experimental

Results

Three measures were taken to ensure that the deprivation manipulation was successful: (1) subjective ratings of symptoms associated with opiate ‘high’, (2) subjective ratings of symptoms associated with opiate craving, and (3) eye pupil radii (a common measure of opioid deprivation). Comparisons of these measures revealed differences in these measures that were consistent with the intent of the deprivation manipulation. Ratings of symptoms of opiate high were significantly increased (F1,12 = 

Conclusions

This is the first study, to the best of our knowledge, that examines the ability of addicts to anticipate the motivational strength of their own future drug craving. Our results suggest that addicts under-appreciate the effects of deprivation when they are not actually deprived.8

Acknowledgements

We thank Ted O’Donoghue, Antonio Rangel and Barbara Spellman for valuable comments.

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    The National Institutes of Health supported this research through grants 1R01DA11692, 1R01DA122997, R37DA06526 and T32DA07242 from the National Institute on Drug Abuse.

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