Clinical Translation: The final cause analysis of teleological behaviorism has much to offer addiction psychologists in clinical and public health practice

Clinical Translation: The final cause analysis of teleological behaviorism has much to offer addiction psychologists in clinical and public health practice

My colleagues and I (Acuff et al., 2022; Tucker et al., 2023; Vuchinich et al., 2023) provided a perspective on addictive behavior derived from teleological behaviorism (TB; Rachlin 1992; Rachlin et al., 2018). TB makes a crucial distinction between efficient causes and final causes of any particular act (e.g., substance use). Efficient causes are local environmental stimuli or internal psychological or neurobiological events that immediately precede the act. Final causes are temporally extended behavior patterns into which the act fits.

Thinking about efficient causes requires an ever finer grained analysis of the immediate circumstances of the act. Thinking about final causes requires an ever widening analysis of behavior patterns of which the act is a part. Efficient cause analysis is familiar because it dominates psychological, clinical, and neuroscience research, epitomized by research on contemporary mechanisms of behavior change (MOBC) and the brain disease model of addiction. Final cause analysis may be unfamiliar, but has an extensive scientific basis, as our articles detail. Most generally, TB places a client’s substance misuse episodes into the broader pattern of use and, very importantly, into valuable behavior patterns of the client’s life (e.g., intimate relations, family, work, finances). Addictive behaviors are dynamic patterns spread over time that occur within broader dynamic environmental contexts, and final cause analysis focuses directly on these molar patterns.

The research our articles reviewed can be summarized by three points. First, a molar pattern often includes instances when environmental events and behavior do not occur in the temporal sequence required in an efficient cause analysis. But the overall association can be quantitatively strong if examined over long intervals (Baum, 2011). This alleviates the constraint of MOBC applications that require proximal and temporally contiguous sequential associations. Rather, final cause analysis emphasizes measurement of rates of behavioral and environmental events over longish intervals under varied conditions. Our field has measurement tools useful for assessing such environment-behavior co-variation over time, including the Timeline Followback interview and Ecological Momentary Assessment (EMA). Currently, however, EMA data are often used to assess temporally contiguous associations of substance use with psychological variables (e.g., momentary changes in mood, craving, discounting, demand etc.) in service of an efficient cause analysis that supports Just-in-Time interventions that typically target proximal events and behavior. This contrasts with earlier clinical applications wherein individual client TLFB or self-monitoring reports of day-to-day drinking and events were used in an ongoing functional analysis to identify contexts surrounding problem use and ways client behavior may change environmental contexts, distinguish among appropriate and inappropriate use based on consequences of use in a given context, and monitor progress (Sobell et al., 1976). Available measurement technology thus could easily be redeployed in service of a final cause analysis, instead of current emphasis on efficient causes.

Second, discrete acts of addictive behavior are part of an extended/molar behavior pattern most likely to occur when immediate constraints on engaging in the addictive behavior are minimal and few rewarding alternatives are available. Understanding such environment-behavior covariation is vital to characterizing patterns of behavioral allocation involving substance use/misuse among all available and valuable activities. Rarely does a single episode of use rise to the level of severity to qualify for clinical diagnosis and intervention—it is the persistent pattern of use over time. Therefore, a useful re-frame for clinician and client alike is that clients are allocating their molar behavior between a pattern of problem use and a pattern of sober living, not simply between a discrete act to use or not on a single occasion (Rachlin et al., 2018). To focus on the latter and ignore the former is to miss the forest for the trees. A discrete choice between using or engaging in a substance-free activity may favor using in the short run. But a pattern of sober living, if sustained over time, generally has higher value and offers rewards and opportunities in life functioning that reinforce sobriety maintenance—i.e., recovery.

Third, a final cause analysis directly addresses the value of a pattern of substance misuse versus a pattern of engagement in other activities. Extensive literature shows that enriching the environment with rewarding substance-free alternatives reduces substance use in clinical and research populations (Murphy et al., 2022). This is a shared feature of contingency management/reinforcement-based treatments that directly provide the alternative reinforcers and less intensive treatments that provide clients with tools to make contact with alternative reinforcers in the natural environment, such as the Substance-Free Activity Session (Murphy et al., 2022). Moreover, environmental enrichment has been used effectively at the public health level as illustrated by the Icelandic Prevention Model (Kristjansson et al., 2019). Implemented nationwide in Iceland over 20 years, this community-based approach emphasizes long-term intervention and altering social environments at the neighborhood level in ways that reduce the likelihood that young people will initiate and maintain substance use. Based on population survey data collected in local schools, substance use among adolescents in Iceland declined steadily from 1997 to 2014. Contrast this effective enrichment approach with the largely failed U.S. Alcohol Prohibition and War on Drugs, nationwide actions that aimed to reduce substance use and associated negative effects through substance availability restrictions and harsh legal penalties for substance possession and trafficking.

The take-away message is that the final cause analysis of TB has been successfully applied across multiple levels of the socioecological model of health (Vuchinich et al., 2023). Substance misuse and other addictive behavior are multi-determined behavior patterns best understood within broader context, which is where a final cause analysis begins. Efficient cause research on addictive behaviors has certainly identified useful regularities, but we believe it is too constraining to account for molar addictive behavior patterns. Our challenge is to develop better characterizations of relevant contextual features and use them to investigate, understand, and change dynamic individual behavior patterns in context over time. Our field has matured sufficiently to take our research, clinical and public health practice to this broadened level rather than limiting ourselves to studying small temporal slices of the ongoing stream of addictive behavior.

Original Article: Tucker, J. A., Buscemi, J., Murphy, J. G., Reed, D. D., & Vuchinich, R. E. (2023). Addictive behavior as molar behavioral allocation: Distinguishing efficient and final causes in translational research and practice. Psychology of Addictive Behaviors, 37(1), 1–12. https://doi.org/10.1037/adb0000845 (Introduction to the special issue on Addictive Behaviors as Behavioral Allocation)

References

Acuff, S. F., Tucker, J. A., Vuchinich, R. E., & Murphy, J. G. (2022). Addiction is not (only) in the brain: Molar behavioral economic models of etiology and cessation of harmful substance use. In N. Heather, M. Field, A. Moss, & S. Satel (Eds.) on behalf of the Addiction Theory Network, Evaluating the brain disease model of addiction (pp. 459-474). Oxon, U.K.:  Taylor & Francis.

Baum, W. M. (2011). Behaviorism, private events, and the molar view of behavior. The Behavior Analyst, 34(2), 185–200. https://doi.org/10.1007/BF03392249

Kristjansson, A. L., Mann, M. J., Sigfusson, J., Thorisdottir, I. E., Allegrante, J. P., & Sigfusdottir, I. D. (2019). Implementing the Icelandic Model for preventing adolescent substance use. Health Promotion Practice, 21(1), 70–79. https://doi.org/10.1177/1524839919849033

Murphy, J. G., Dennhardt, A. A., & Gex, K. S. (2022). Individual behavioral interventions to incentivize sobriety and enrich the natural environment with appealing alternatives to drinking. In J. A. Tucker & K. Witkiewitz (Eds.), Dynamic pathways to substance use disorder: Meaning and methods (pp. 179-199). Cambridge University Press.

Rachlin, H. (1992). Teleological behaviorism. American Psychologist, 47(11), 1371–1382. https://doi.org/10.1037/0003-066X.47.11.1371

Rachlin, H., Green, L., Vanderveldt, A., & Fisher, E. B. (2018). Behavioral medicine’s roots in behaviorism: Concepts and applications. In E. B. Fisher (Ed.), Principles and concepts of behavioral medicine (pp. 241-275). Springer Science+Business Media LLC.

Sobell, M. B., Sobell, L. C., & Sheahan, D. B. (1976). Functional analysis of drinking problems as an aid in developing individual treatment strategies. Addictive Behaviors, 1(2), 127–132. https://doi.org/10.1016/0306-4603(76)90005-8

Vuchinich, R. E., Tucker, J. A., Acuff, S. F., Reed, D. D., Murphy, J. G., Buscemi, J., & Murphy, J. G. (2023). Matching, behavioral economics, and teleological behaviorism: Final cause analysis of substance use and health behavior. Journal of the Experimental Analysis of Behavior, 119(1), 240- 258. https://doi.org/10.1002/jeab.815