Reinforcer Pathology: Implications for Substance Abuse Intervention

The rate at which individuals discount future rewards (i.e., discounting rate) is strongly associated with their propensity for substance abuse as well as myriad other negative health behaviors. An excessive preference for immediately available rewards suggests a shortened time horizon in which immediate rewards are overvalued and future, potentially negative consequences are undervalued. This review outlines Reinforcer Pathology Theory (i.e., the interaction between excessive preference for immediately available rewards and the overvaluation of a particular commodity that offers brief, intense reinforcement), its neurobiological/behavioral underpinnings, and its implications for treating substance use disorders. In doing so, the current review provides an overview of a variety of ways in which interventions have been used to manipulate aspects of reinforcer pathology in an individual, including narrative theory, framing manipulations, and neuromodulation (e.g., working memory training, TMS) which may serve as promising avenues for the modulation of the temporal window and/or valuation of reinforcers.