Essential Value of Drug and Alternative Reinforcers in Opioid Agonist Treatment Patients

The behavioral economics of substance abuse has been increasingly recognized as a method of determining the value of abused substances for individual users. It has been hypothesized that such analyses could serve as a clinical tool, and that demand functions can be targeted predictors for the level of intervention necessary. In the present study, demand for seven drugs and a control was assessed for patients in a medication assisted treatment program (methadone maintenance) who had used opioids in the last two months. These demand functions were compared with those from patients in the same treatment program who had not used opioids in at least eighteen months. Participants maintaining long-term abstinence had significantly decreased demand for all drugs except for methadone, and toilet paper. The dose of methadone prescribed was also significantly correlated with decreased heroin value and demand intensities for multiple other substances. These outcomes are likely due to a combination of pharmacological and behavioral substance-abuse treatments. These findings support the hypothesis that behavioral-economic measures have clinical utility as a marker of treatment progress or a target for treatment.