Addiction Papers
Week 1
Paper 1: Role of social context in addiction etiology and recovery (Stickland & Acuff, 2023)
Main ideas:
- Who you’re with and how you’re connected powerfully shapes the whole addiction
arc - initiation, escalation, and recovery
- A peer's own drug history moderates the effect:
- Drug-free contexts can buffer or compete with drug use
- Drug-using peers can accelerate use via modeling and the added “reward” of
belonging
Integrates preclinical (animal) and human lab evidence
Initiation (Acquisition):
Preclinical:
- Starting cocaine use: happens faster when a cage-mate is also self-administering, if
the partner is drug-naïve, acquisition slows
- Demonstrates partner-specific social influence
- Social defeat stress (repeated losses to an aggressive rat): speeds acquisition and
later increases drug taking, highlighting stress as a social risk factor
- Social reward: conditioning drugs together with social contact can enhance drug
preference, access to a non-using peer can blunt it
Human laboratory: people drink more and feel more intoxicated
- Drinking with heavy-drinking partners: people “match” or imitate sip timing
- Smoking: exposure to a heavy-smoking confederate increases puffing rates,
non-smoking peers can dampen smoking (esp. in lighter smokers)
- Social stress (Trier Social Stress Test): increases anxiety and can nudge consumption,
though sometimes non-specifically (more of any beverage)
- MDMA: effects feel stronger in a truly social context (another person also on MDMA)
Escalation (Progression)
Preclinical:
- Paired with a using partner: rats escalate cocaine intake
- Paired with a non-using partner, intake is inhibited (even during long “binge-like” access)
- Dominance hierarchies: show sex differences in primates - status and sex / gender can
alter vulnerability and drug reinforcement patterns
Human laboratory and behavioral economics:
- Social context: raises the momentary demand for alcohol or cannabis (higher
willingness to consume / pay in social scenarios)
- Frequent solitary use correlates with heavier weekly consumption and dependence
- Simpson’s paradox: social settings boost event-level risk, while solitary
patterns signal broader severity
1
, Behavioral-economic models (demand intensity, elasticity, alternative reinforcers) help explain
these context effects and guide intervention design
Recovery (cessation, relapse, and supports)
Preclinical choice models: rats often prefer drug-free social access over methamphetamine or
heroin - social contact can function as a potent alternative reinforcer that supports
abstinence
- Does not generalize uniformly: in one paradigm, rats chose alcohol over social reward,
showing drug-class and procedure specificity
- Social stressors or social cues associated with prior use can reinstate drug seeking
after extinction → relapse triggers
Human evidence and treatment mechanisms:
After treatment, people with more non-using and fewer high-risk friends show better
abstinence (even 2 low-risk friends can be impactful)
- The therapeutic alliance (feeling respected, cared for, and collaborated with) is a robust
predictor of engagement
Evidence-based approaches:
- Mutual-help groups (AA, NA): efficacy is supported, key mechanism is reshaping
networks (fewer pro-drinking ties, more pro-abstinence ties) and greater self-efficacy in
high-risk social situations, other mechanisms (coping skills, alternative activities, affect
regulation) also contribute
- Peer Recovery Support Services (PRSS) and recovery coaches: promising for
abstinence, retention, and satisfaction → system navigation, behavior-change
support, harm reduction, and relationship building
- CRAFT (Community Reinforcement Approach and Family Training): trains significant
others to shift home contingencies toward sobriety, consistently gets ~70% of
treatment-refusing individuals into care (far better supported than confrontational
“Johnson Institute” approaches)
- Johnson Method: confront the addict by motivating and encouraging them to
change their lifestyle for the good of not only themselves, but of their family
- Behavioral Couples Therapy (BCT): combines SUD CBT with couples work to reduce
use, teach coping / communication, and use the relationship as an incentive and support
for change
Integrative themes and future directions
Dual nature of social context: social environments can be protective (non-using peers,
supportive ties) or risky (using peers, social stress), and the peer’s drug status is a consistent
moderator across stages
Behavioral-economic framing: context (costs, delays, availability of alternatives like social
reward) helps predict choices to use vs not use → use informed brief interventions that boost
engagement in substance-free, socially rewarding activities
2
Week 1
Paper 1: Role of social context in addiction etiology and recovery (Stickland & Acuff, 2023)
Main ideas:
- Who you’re with and how you’re connected powerfully shapes the whole addiction
arc - initiation, escalation, and recovery
- A peer's own drug history moderates the effect:
- Drug-free contexts can buffer or compete with drug use
- Drug-using peers can accelerate use via modeling and the added “reward” of
belonging
Integrates preclinical (animal) and human lab evidence
Initiation (Acquisition):
Preclinical:
- Starting cocaine use: happens faster when a cage-mate is also self-administering, if
the partner is drug-naïve, acquisition slows
- Demonstrates partner-specific social influence
- Social defeat stress (repeated losses to an aggressive rat): speeds acquisition and
later increases drug taking, highlighting stress as a social risk factor
- Social reward: conditioning drugs together with social contact can enhance drug
preference, access to a non-using peer can blunt it
Human laboratory: people drink more and feel more intoxicated
- Drinking with heavy-drinking partners: people “match” or imitate sip timing
- Smoking: exposure to a heavy-smoking confederate increases puffing rates,
non-smoking peers can dampen smoking (esp. in lighter smokers)
- Social stress (Trier Social Stress Test): increases anxiety and can nudge consumption,
though sometimes non-specifically (more of any beverage)
- MDMA: effects feel stronger in a truly social context (another person also on MDMA)
Escalation (Progression)
Preclinical:
- Paired with a using partner: rats escalate cocaine intake
- Paired with a non-using partner, intake is inhibited (even during long “binge-like” access)
- Dominance hierarchies: show sex differences in primates - status and sex / gender can
alter vulnerability and drug reinforcement patterns
Human laboratory and behavioral economics:
- Social context: raises the momentary demand for alcohol or cannabis (higher
willingness to consume / pay in social scenarios)
- Frequent solitary use correlates with heavier weekly consumption and dependence
- Simpson’s paradox: social settings boost event-level risk, while solitary
patterns signal broader severity
1
, Behavioral-economic models (demand intensity, elasticity, alternative reinforcers) help explain
these context effects and guide intervention design
Recovery (cessation, relapse, and supports)
Preclinical choice models: rats often prefer drug-free social access over methamphetamine or
heroin - social contact can function as a potent alternative reinforcer that supports
abstinence
- Does not generalize uniformly: in one paradigm, rats chose alcohol over social reward,
showing drug-class and procedure specificity
- Social stressors or social cues associated with prior use can reinstate drug seeking
after extinction → relapse triggers
Human evidence and treatment mechanisms:
After treatment, people with more non-using and fewer high-risk friends show better
abstinence (even 2 low-risk friends can be impactful)
- The therapeutic alliance (feeling respected, cared for, and collaborated with) is a robust
predictor of engagement
Evidence-based approaches:
- Mutual-help groups (AA, NA): efficacy is supported, key mechanism is reshaping
networks (fewer pro-drinking ties, more pro-abstinence ties) and greater self-efficacy in
high-risk social situations, other mechanisms (coping skills, alternative activities, affect
regulation) also contribute
- Peer Recovery Support Services (PRSS) and recovery coaches: promising for
abstinence, retention, and satisfaction → system navigation, behavior-change
support, harm reduction, and relationship building
- CRAFT (Community Reinforcement Approach and Family Training): trains significant
others to shift home contingencies toward sobriety, consistently gets ~70% of
treatment-refusing individuals into care (far better supported than confrontational
“Johnson Institute” approaches)
- Johnson Method: confront the addict by motivating and encouraging them to
change their lifestyle for the good of not only themselves, but of their family
- Behavioral Couples Therapy (BCT): combines SUD CBT with couples work to reduce
use, teach coping / communication, and use the relationship as an incentive and support
for change
Integrative themes and future directions
Dual nature of social context: social environments can be protective (non-using peers,
supportive ties) or risky (using peers, social stress), and the peer’s drug status is a consistent
moderator across stages
Behavioral-economic framing: context (costs, delays, availability of alternatives like social
reward) helps predict choices to use vs not use → use informed brief interventions that boost
engagement in substance-free, socially rewarding activities
2
