rev-111-1-33

rev-111-1-33 - Psychological Review 2004, Vol. 111, No. 1,...

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Addiction Motivation Reformulated: An Affective Processing Model of Negative Reinforcement Timothy B. Baker, Megan E. Piper, Danielle E. McCarthy, and Matthew R. Majeskie University of Wisconsin—Madison and University of Wisconsin Medical School Michael C. Fiore University of Wisconsin Medical School This article offers a reformulation of the negative reinforcement model of drug addiction and proposes that the escape and avoidance of negative affect is the prepotent motive for addictive drug use. The authors posit that negative affect is the motivational core of the withdrawal syndrome and argue that, through repeated cycles of drug use and withdrawal, addicted organisms learn to detect interoceptive cues of negative affect preconsciously. Thus, the motivational basis of much drug use is opaque and tends not to reflect cognitive control. When either stressors or abstinence causes negative affect to grow and enter consciousness, increasing negative affect biases information processing in ways that promote renewed drug administration. After explicating their model, the authors address previous critiques of negative reinforcement models in light of their reformulation and review predictions generated by their model. Despite negative health, economic, social, and functional con- sequences, the addicted individual uses drug frequently and in large amounts and, if drug use is interrupted, will likely return to drug use. Why do individuals persist in taking addictive drugs in the face of the high ultimate costs? According to early models of drug motivation (e.g., Wikler, 1948), negative reinforcement is a key motive for drug use. That is, addicted individuals take drugs to escape or avoid aversive states such as withdrawal or stress. Interestingly, in contrast to these early views, much recent research suggests that negative reinforcement is not, in fact, a potent influ- ence on drug motivation. In the present article, we attempt to show that when properly construed, cardinal features of addiction 1 do indeed reflect the pow- erful motivational impacts of negative reinforcement. We attempt to accomplish this by reformulating negative reinforcement accounts such that escape or avoidance of negative affect is the principal motive for addictive drug use. Our reformulation has been guided by data that elucidate the nature of affective processing. We believe that the properties of affective processing not only allow us to account for cardinal features of addictive behavior but, in addition, allow us to reconcile our negative reinforcement account with criticisms that have been lodged against such accounts. Negative Reinforcement Among motivational accounts of addiction, negative reinforcement ranks as one of the earliest and most venerable (Jellinek, 1960; Lindesmith, 1947; Wikler, 1948). For instance, half a century ago Wikler (1948) observed that addictive drugs such as opiates can produce physical dependence after a very small number of uses (see also Wikler, 1980). That is, after a few uses (perhaps after only a
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rev-111-1-33 - Psychological Review 2004, Vol. 111, No. 1,...

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