James G. Murphy

Background and aims: Contemporary behavioral economic theory conceptualizes addiction as an operant reinforcer pathology in which substance use is substantively influenced by reinforcement obtained through substance‐free sources. The aim of the current meta‐analysis was to quantitatively synthesize cross‐sectional associations between both substance‐related and substance‐free reinforcement in relation to substance use and substance‐related problems. Methods: Systematic bibliographic searches were conducted in PubMed and PsychINFO from 1998 to 20 March 2026. Main eligibility criteria included human, peer‐reviewed studies that measured substance use, the reinforcement ratio (proportionate substance‐related reinforcement), substance‐related reinforcement and/or substance‐free reinforcement, which yielded 28 studies and 31 samples. Pearson's r correlations were extracted for the reinforcement ratio, substance‐related reinforcement and substance‐free reinforcement in relation to substance use problem/severity and quantity/frequency outcomes. Six random effects meta‐analyses were conducted based on these key variables, with an average aggregated sample size of n = 5663 (range = 4344–7258). Results: The reinforcement ratio (RR) and substance‐related reinforcement (SR) were statistically significantly associated with both substance use problem/severity [RR r = 0.33, 95% confidence interval (CI) = 0.27–0.39, number of effect estimates ( k ) = 19, I ² = 85.06, SR r = 0.34, 95% CI = 0.29–0.60, k = 12, I ² = 94.28, P s < 0.001] and quantity/frequency (RR r = 0.38, 95% CI = 0.31–0.46, k = 17, I ² = 86.22, SR r = 0.34, 95% CI = 0.25–0.43, k = 10, I ² = 87.99, P s < 0.001). Substance‐free reinforcement was statistically significantly negatively associated with quantity/frequency ( r = −0.11, 95% CI = −0.17 to −0.04, k = 13, I ² = 81.57, P = 0.002) but not problem/severity of substance use ( r = −0.07, 95% CI = −0.14 to 0.00, k = 16, I ² = 83.38, P = 0.051). Continuous study moderators (% male, % White, study year) and categorical study moderators (reinforcement measurement tool) explained some heterogeneity across analyses. Overall, there was minimal evidence of publication bias. Summary: Substance‐related reinforcement and the reinforcement ratio appear to be moderately strong correlates of substance problems/severity and quantity/frequency outcomes.

Background and Aims: Alcohol choice is governed by its subjective value, which can be experimentally modified. However, less is known about the moment-to-moment dynamics through which experimental manipulations of value influence observable choice behaviour. We tested whether an experimental manipulation intended to elevate alcohol value would alter computational parameters of value-based decision-making (VBDM) and alcohol choice, and whether these outcomes would mediate ad libitum alcohol consumption. Design: Pre-registered, randomised between-subjects experiment comparing two personalised experimental conditions: alcohol value (exposure to alcohol memories and multisensory alcohol cues) vs. control (exposure to non-alcohol memories and multisensory soft-drink cues), conducted over two separate sessions with baseline measures included as covariates. Setting: University laboratory in the United Kingdom (UK). Participants: 129 adults (63% male; mean age = 44 years; mean Alcohol Use Disorders Identification Test [AUDIT] score = 16) who regularly consume alcohol (mean Estimated Weekly Alcohol Consumption [EWAC] = 42 UK units/week), randomised to alcohol value (n = 65) or control (n = 64) conditions. Measurements: At baseline and post-exposure, participants completed self-reported measures of alcohol craving and a value-based decision-making (VBDM) task where they chose between pairs of previously rated alcohol-related and non-alcohol images. A drift-diffusion model was fitted to behavioural data to estimate evidence accumulation rates (value sensitivity) and response thresholds (response caution). Participants also completed a concurrent choice task (alcohol vs. non-alcohol) that measured percentage alcohol relative to non-alcohol reward (enlargement; index of relative alcohol value), and a taste test to measure alcohol consumption. Findings: Some indices of subjective craving were responsive to the experimental manipulation, but there were no significant between-group differences at post-manipulation (ps ≥ .17). Baseline-adjusted analyses showed that response thresholds for non-alcohol decisions were higher in the alcohol value condition compared to control (p = .03, d = 0.40); however, Bayesian analysis quantified only anecdotal evidence for this effect (BF10 = 1.84). Other VBDM parameters, percentage alcohol choice, and alcohol consumed were unaffected by the manipulation (ps ≥ .19, BF10s ≤ 0.40). Furthermore, no value indices (computational or percentage choice) mediated the effect of the experimental manipulation on alcohol consumed. Conclusions: A personalised experimental manipulation intended to elevate alcohol value had modest effects on self-reported craving, but did not alter computational parameters of VBDM, relative alcohol choice, or ad-libitum alcohol consumption.

Alcohol use and suicide risk have a well‐established relation. In the United States, up to a third of suicide decedents have alcohol in their blood at the time of death and half of those have a blood alcohol level above the legal driving limit (i.e., 0.08% blood alcohol content). Despite the established relation, the mechanisms linking alcohol and suicide risk are unclear. The reinforcer pathology framework of addiction, pioneered by Warren Bickel, can be adapted to make predictions about suicide risk among those who use alcohol. To assess this, we conducted two crowdsourced studies (using Amazon Mechanical Turk and Prolific) that consisted of assessments of demand for alcohol, discounting of delayed monetary gains, and suicide risk (assessed by the Columbia‐Suicide Severity Rating Scale). Demand for alcohol was generally higher as suicide risk increased, and discounting for delayed gains was higher for recent suicide preparations but not suicidal ideation. Further formalization of reinforcer pathology frameworks will allow for more rigorous control of variables that affect alcohol use and suicide risk both individually and together.

Sports wagering is associated with alcohol use and alcohol-related harm, and gambling can increase alcohol consumption and drinking urges. However, the effect of sports wagering on alcohol reward value remains unclear. The present study explored the interactive effect of placing a single-event sports wager and social context on alcohol demand (a behavioral economic measure of alcohol reward value) using context-adapted alcohol purchase tasks in a sample of individuals reporting past-month alcohol use and sports wagering (n = 425; M_age = 31.28; 71.29% male). Contrary to hypotheses, there were no differences in alcohol demand between context-adapted alcohol purchase tasks as a function of concurrent sports wagering (p_adj = .876-.924) or social context (p_adj = .170-.667). Exploratory analyses investigated relations between gambling motives and alcohol demand and the relations between various behavioral economic constructs and problem gambling. O_max was associated with an increased likelihood of problem gambling (OR = 1.02, p_adj = .03). O_max and elasticity were associated with financial gambling motives, but less so during concurrent gambling events, with concurrent sports wagering attenuating the relation between elasticity and financial motives (b = 0.34, p_adj = .003). Financial motives for gambling were positively associated with alcohol use broadly, but not with simultaneous drinking while gambling. These findings suggest relations between sports wagering and alcohol demand are complex-highlighting the need for future research into the sports wagering experience, specific sports wagering forms, and alcohol's role in sports culture to better understand the relation between alcohol use and sports wagering. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Introduction: Understanding client behaviors and predicting their outcomes require coding Motivational interviewing (MI) sessions with intensive labor costs and time consumptions of MI professionals. The advances in audio language models (ALMs) open promising opportunities in automating coding process, capturing critical multimodal signals of behavioral patterns, and interactive collaborations with expert annotators. Materials and Methods: We experimented with 5 recorded sessions from de-identified MI audio tapes. We deployed audio-language models with four complementary analytic prompts to augment utterance-level reasoning: analytic (verbal cues), prosody-aware (acoustic cues), evidence-scoring (quantitative hypothesis test), and comparative (contrastive reasoning). Three stochastic samples were drawn per prompt, generating 12 independent reasoning trajectories per utterance, and majority votes of all trajectories decided predictions. Results: Performance was evaluated using accuracy, precision, recall, and macro-F1 scores. The proposed MM-SC approach achieved 52.56% accuracy, 54.03% precision, 47.45% recall, and a macro-F1 score of 46.40%, exceeding the performance of baseline methods. Systematic ablation removing individual modules consistently degraded performance on primary metrics. Conclusions: Multimodal self-consistency outperforms single-pass baseline prompting approaches. These findings suggest that incorporating both what clients say and how they say it can support more reliable MI coding.

Standard brief alcohol and drug use interventions focus on motivating reductions in use and associated harms and have shown reliable reductions in these outcomes. However, effect sizes are small, and dissemination is limited by low rates of help seeking. Incorporating intervention elements focused on enhancing wellness, mood, and goal pursuit might enhance efficacy and appeal. The substance-free activity session (SFAS) integrates behavioral economic and motivational interviewing elements to enhance goal-directed and mood-enhancing activity patterns that might provide alternatives to alcohol- and drug-related reward. We conducted a narrative review of 15 empirical studies that investigated the efficacy of the SFAS and evaluated mechanisms of behavior change. We then provide an overview of how to conduct the SFAS, including a session vignette. There is support for the efficacy of the SFAS when integrated with standard brief alcohol interventions for college students. There is also evidence that the SFAS reduces negative affective symptoms and increases self-regulation and proportionate reinforcement from substance-free activities. Evidence for cannabis use reductions is less robust. The SFAS has been successfully implemented as an adjunct to intensive alcohol and drug treatment for adults, but not in the context of adequately powered efficacy trials. The clinical vignette and intervention manual provides a model for how to motivate an individual to pursue reductions in substance use supported by increased engagement in goal-directed and enjoyable substance-free activities. The SFAS shows promise as a brief intervention that supports substance use reductions via motivating patterns of substance-free activities. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Background and aims: The tension reduction hypothesis suggests that people consume alcohol to alleviate stress. While previous studies showed stress increases alcohol's absolute value, alcohol's value relative to alternatives should be more relevant for drinking decisions. We aimed to test whether acute stress causes individuals to choose alcohol over appealing non‐alcoholic alternatives and to identify the cognitive mechanisms underlying this choice behavior. Design: Laboratory‐based randomized 2 × 2 experimental study. Setting: Controlled laboratory environment including a simulated bar setting. Participants: 160 adults [56% male; mean age = 31 years; median Alcohol Use Disorders Identification Test (AUDIT) score = 8] who regularly consume alcohol. Interventions: Participants first rated beverages and made repeated choices between alcoholic and non‐alcoholic options. They then received either alcoholic beverages [target breath alcohol concentration (BrAC) = 0.06%] or non‐alcoholic beverages, followed by either a personalized stress induction using autobiographical emotional memories or a neutral control procedure. Measurements: Primary outcomes were proportion of choices for alcoholic beverages and decision response times. Choice behavior was analyzed using drift diffusion modeling to decompose decisions into three mechanisms: decision carefulness (boundary parameter), sensitivity to prior preferences (drift rate) and bias toward alcohol regardless of preference (bias parameter). Findings: Stress moderately increased choices for alcohol [95% highest density interval (HDI) = 0.01–0.13], but only in sober participants. Drift diffusion modeling revealed that stress primarily affected decision‐making by inducing a bias toward alcohol during evidence accumulation (95% HDI = 0.19–0.76), without impacting decision carefulness or evidence sensitivity. This computational bias was stronger than observed in raw choice behavior, indicating that while stress consistently biased evaluation toward alcohol, this bias only sometimes overcame competing considerations (i.e. a person might reverse a preference from ‘a little bit’ to ‘not really’, but not from ‘a little bit’ to ‘not at all’). Conclusions: Our results support the tension reduction hypothesis by demonstrating that stress occasionally led individuals to choose alcohol even when they preferred the non‐alcoholic alternative; however, this effect only appeared in sober participants who had not yet consumed any alcohol, suggesting the hypothesis primarily explains decisions about initiating rather than continuing drinking episodes.

The tension reduction hypothesis posits that people consume alcohol to alleviate stress and negative emotions. Prior experimental studies supported this hypothesis by showing stress-induced increases in alcohol's absolute value. However, from a value-based decision-making perspective alcohol's value relative to alternatives should be more relevant for drinking decisions. We developed a novel experimental paradigm that subjected the hypothesis to a more stringent test by examining whether acute stress causes individuals to choose alcohol over appealing non-alcoholic alternatives, and the cognitive mechanisms that underpin this. Participants (N=160) rated various drinks and made repeated choices between alcoholic and non-alcoholic options before and after randomized manipulations of stress and alcohol intoxication (BrAC=.06%). Using drift diffusion modeling, we decomposed choices into three potential mechanisms: how carefully people make decisions, their sensitivity to prior drink prefer-ences, and their bias to choose alcohol regardless of preference. Results showed that stress moder-ately increased choices for alcohol, but only in sober participants. Stress primarily affected decision-making by inducing a bias toward alcohol during evidence accumulation, without impacting decision carefulness or general evidence sensitivity. This computational bias was stronger than observed in raw choice behavior, suggesting that while stress consistently biases evaluation toward alcohol, this bias only sometimes overcomes competing considerations. The boundary condition that stress effects appeared only in sober participants suggests the tension reduction hypothesis may primarily explain initial drinking decisions rather than choices about continued consumption. These findings advance our mechanistic understanding of how stress influences alcohol-related decision-making and suggest interventions might focus on strengthening competing motivations during high-stress moments, particularly during decisions about initiating drinking episodes.

Purpose: The co-occurrence of cannabis use and internalizing problems, such as depression and anxiety, during emerging adulthood (18-25 years) is well documented, but the directionality is unclear. This study investigates the bidirectional longitudinal relationships between cannabis use (frequency and consequences) and internalizing problems (depressive and anxiety symptoms) among high-risk emerging adults. Methods: Data came from 7 assessment waves collected over a 2-year period among 900 (56% female) high-risk emerging adults participating in two longitudinal cohorts (Ontario, Canada; Tennessee, USA). Latent curve models with structured residuals were used to explore bidirectional between- and within-person relationships between cannabis-related variables and internalizing problems. Results: At baseline, higher cannabis use frequency and consequences were both associated with higher internalizing symptoms. In between-person models, both cannabis-related factors (frequency and consequences) and internalizing symptoms (depressive and anxiety symptoms) decreased across emerging adulthood. In within-person models, bidirectional relationships were observed (partially supporting both symptom-driven and substance-induced pathways), but cannabis consequences, rather than frequency, were most consistently related to subsequently higher internalizing problems (particularly depressive symptoms). These bidirectional relationships were more pronounced among females and those surpassing clinical thresholds for internalizing problems at baseline. Conclusions: This study found evidence of bidirectional relationships between cannabis involvement and internalizing problems across emerging adulthood, although the prevailing direction was from negative cannabis consequences to increases in internalizing. These findings highlight the importance of cannabis intervention in emerging adults, both to reduce consequences and prevent internalizing symptoms, especially targeting females and those with clinically elevated internalizing problems.