Peter R. Martin: Historical Vocabulary of Addiction, Vol. II
Reward
According to the current electronic version of the Oxford English Dictionary (OED), the noun reward is a borrowing from the French reward which originates from “the Anglo-Norman reuard, rewarde, Anglo-Norman and Middle French (north-east) reward, Middle French (north-east) rewart, revart, rawarde…, variants of [the noun] regard. In Anglo-Norman, variants of regard with w are used in various senses, frequently with reference to remuneration or recompense, but in…Old French and Middle French such forms are chiefly attested in senses referring to official control and inspection…” Related words include: “post-classical Latin rewardum (jurisdiction or fine of) forest inspection or court…, legal decision, judgement…, reward, payment.” The earlier form of reward as a verb preceded its use as a noun by about two decades.
The first use of the noun reward in the English language was in Dan Michel's Ayenbite of inwyt, or, Remorse of conscience (Laurent 1866). A translation from French by the Benedictine monk Michael of Northgate (flourished 1340) of a treatise on Christian morality, this was originally written in 1279 by Laurentius Gallus, a Dominican friar and confessor to Philip III of France: “Al þet eure þoleden þe holy martires..ne ys bote a beþ ine chald weter to þe reward of þe fornayse.” This meaning of reward is defined in OED as: “Senses relating to regard, consideration, or heed; estimation or worth,” a usage that is now obsolete.
Meanings of reward currently in use include those defined as: “Senses relating to remuneration and recompense.” An early example of this general class of meanings is from The Faerie Queene by Edmund Spenser (1552/1553–1599), the English poet best known for this epic poem and fantastical allegory celebrating the Tudor dynasty and Elizabeth I (Spenser 1931): “He from daunger was releast,..Yet not escaped from the dew reward Of his bad deedes.” The specific definition in OED of this use of reward is: “Recompense or retribution for wrongdoing; punishment, requital; (also) a fair return for such action.” Additionally, reward can mean: “A recompense or return given to (or received by) a person for some service, merit, or favour, or for hardship endured.” This use is exemplified by a quote from History of England by Thomas Babington Macaulay (1800–1859), a British historian and Whig politician (Macaulay 1849): “The clergy had also lost the ascendency which is the natural reward of superior mental cultivation.”
Another commonly used meaning of reward is: “A sum of money offered for information leading to the solving of a crime, the detection or capture of a criminal, recovery of lost or stolen property, etc.” An example of this usage is found in Henry VI by the English playwright, poet and actor William Shakespeare (1564 –1616): “Is Proclamation made, That who finds Edward, Shall haue a high Reward, and he his Life?” And finally, a very modern meaning: “An incentive, such as a free or discounted product or service, offered to a customer in return for repeated patronage of a business. Also occasionally: a credit accrued in return for patronage, which may be redeemed for such an incentive.” This last meaning is exemplified by a quotation from Global Airline (Hanlon 1999): “Airlines whose networks include many routes… on which passengers might seek to redeem rewards in other carriers' schemes.”
The meaning of the noun reward as used in the field of Psychology is probably most relevant to addiction and is defined in OED as: “A recompense given after a particular response which reinforces learning or behaviour; the giving of such a recompense, as a method of behavioural control.” An example of the first use in the English language of this meaning of reward is from Robert M. Yerkes (1876–1956), the American psychologist, ethologist, eugenicist and primatologist in his book The Dancing Mouse (Yerkes 1907): “In connection with the discussion of motives, it is an important fact that forms of reward are far harder to find than forms of punishment.”
In this thoughtful quotation, Yerkes raises the issues of reward and punishment in the motives of an individual, or motivation that serves to produce behavior (Martin 2020b). Motivation is defined in OED as: “The (conscious or unconscious) stimulus for action towards a desired goal, especially as resulting from psychological or social factors; the factors giving purpose or direction to human or animal behaviour…more generally…: the reason a person has for acting in a particular way, a motive.”
Yerkes’ quotation importantly contrasts reward with its opposite member punishment, defined in OED as: “The infliction of an unpleasant stimulus, as pain, deprivation, etc., on an organism as a method of behavioural control, so that unwanted forms of behaviour are suppressed and the desired behaviour pattern is established.” The implication is that the balance of reward and punishment shapes behavior, defined in OED as: “Manner of conducting oneself in the external relations of life; demeanour, deportment, bearing, manners.”
In a simplified sense, reward enhances, whereas punishment diminishes, the likelihood of engaging in a certain behavior under similar circumstances. The complexities of this relationship were initially explored by Edward Thorndike (1874–1949), the American educational psychologist whose learning theories developed from studies in experimental psychology (Thorndike 1931), as later discussed (Dand 1946):
“Thorndike set out to prove that, other things being equal, one right response to a certain situation rewarded by the announcement of ‘right’ strengthens the connexion in question more than one wrong response to the situation punished by the announcement of ‘wrong’ weakens that connexion. This he showed, and other experimenters have agreed with his findings. He made, however, the further assertion that the announcement of ‘wrong’ in his experiment did not weaken the connexion at all, so far as he could see. Rather there is more gain in strength from the occurrence of the response than there is weakening by the attachment of ‘wrong’ to it. Whereas two occurrences of a right response followed by a ‘right’ strengthen the connexion much more than one does, two occurrences of a wrong followed by ‘wrong’ weaken that connexion less than one does.”
The OED definition of reward (as enunciated above) underscores that addiction and learning share fundamental behavioral characteristics and are closely related mechanistically (Martin 2019b, 2021). That reward assists the phenomena associated with learning has long been known as suggested by the following quotation of Gwilym Grindley (1903–1976), a British psychologist, best known for pioneering work in what later became known as operant conditioning (Grindley 1929): “Some experiments on the influence of the amount of food given as a reward on the rate at which young chickens learn.”
In support of the relationship between learning and addiction, it has been stated that learning is the “currency” of addiction (Martin, Weinberg and Bealer 2007) and the constructs that help us understand learning can also shed light on conceptualizing addiction (Kalant, LeBlanc and Gibbins 1971; O’Brien 1975; Kourosh-Arami, Komaki and Gholami 2022). The notion expressed above is that a reward (termed “recompense” in the definition) can be given by an observer to a subject upon the satisfactory performance of a given behavior (“conditioned response”). However, the definition of reward can be interpreted in another manner — namely, an observer need not be designated to judge the subject’s behavior and provide recompense based on performance. Rather, a physiological response occurs in the brain and/or elsewhere in the body of the individual as a consequence of and in close temporal proximity to the performance of a specific behavior and that serves as the reward. There is of course the issue of reward provided at a point in time influencing not only behavior in the moment but resulting in learning. Specifically, learning is associated with changes within the brain that affect the likelihood that a given response at a future time will be based on previous experience.
In the first example indicated above, a reward is administered by an observer after the individual performs an existing element of their behavioral repertoire. The administered reward is intended to encourage the recipient to better and/or more frequently perform the selected behavior. The provision of the reward in this manner has been termed reinforcement (defined in OED as: “The action or an act of establishing or strengthening a particular response to a stimulus or a learnt behaviour through the repetition of a rewarding or unpleasant event [the opposite of reward, often termed punishment] contingent on the response”). The purpose of doing this, of course, is to train/teach the individual, or shape behavior, also termed instrumental or operant conditioning (Martin 2019b). An quotation from the textbook Fundamentals of Social Psychology nicely links reward and reinforcement with motivation (Hartley and Hartley 1952): “Without reinforcement or reward, no connection will be established between response and motivation.”
In the second example, a physiological response is experienced by the performer as a rewarding consequence of a new behavior. As a result of the behavior-induced physiological change that is experienced as rewarding, the behavior in question is likely to be performed again (… and again). Therefore, reward, whether it be delivered by an observer (trainer) or it is the physiological consequences/concomitant of the performance of a behavior (experience), can equally shape behavior via conditioning-related creation of new connections in neural circuits and their progressive strengthening.
The second example better describes what occurs with addiction (Wise 1996; Volkow and Wise 2005). Physiological response(s) become progressively more tightly associated (conditioned) with the pertinent behavior (stimulus) with each occurrence because with repetition the interconnections of relevant neural circuits in the brain (learning) are intensified (Mair, Francoeur, Krell et al. 2022). Thus, the behavior in question may become so powerfully linked within the nervous system with the rewarding physiological response that it is performed almost constantly (Bozarth and Wise 1985), to a degree that it can overwhelm the behavioral repertoire (addiction). Examples of such out-of-control and progressively self-destructive behaviors thus conditioned can include self-administration of abused drugs or behavioral addictions (e.g., gambling). A quotation from the textbook Contemporary Psychology: An Introduction provides an insightful observation expressing the power of even intermittent reward for a gambler, an individual with a behavioral addiction (Hollin 1995): “A player only requires an occasional reward of a payout to reinforce the repeated behaviour of feeding money into the machines.”
Strengthening the linkage of a stimulus with the relevant response as powered by the phenomenon of reward is vitally important to survival of the species. A plethora of terms in which the word reward have been incorporated or to which it has been appended, have been coined to describe aspects of the anatomic substrates and physiological systems of the brain wherein stimuli can trigger and strengthen conditioned behavioral responses (Martin 2019b, 2021). As defined in OED, these terms are: “Designating areas of the brain in or near the hypothalamus which, when stimulated, cause an organism to have sensations of pleasure, as reward cell, reward center, reward system, etc.” Therefore, the notion of reward has become part of the vernacular and central to our understanding of learning theory as well as the pathogenesis of addiction (Olds 1958; Volkow and Morales 2015). These regions of the brain comprise cells integrated within networks of the brain that function in concert to allow interpretation by the organism of their environs so as to be able to navigate a course that allows maintenance of functional integrity (Gardner 2011).
The organism is guided through the challenges of life by the balance of reward and punishment, which determines whether to approach an encountered stimulus or withdraw from it, respectively (Chen 2022). This balance can be disturbed by stress-induced disruption of reward circuits, often associated with various trauma-related mental disorders (Birn, Roeber and Pollak 2017; Birnie, Short, de Carvalho et al. 2023). As a consequence of responses to external/environmental and internal stimuli, a wide range of behaviors may be generated. Such behaviors typically serve to benefit the organism but may also become harmful under certain circumstances.
Highly relevant to any discussion of addiction are those harmful behaviors that reduce the flexibility of an organism to cope with ever present challenges (Wang and Halassa 2022). This typically occurs when rewarding behaviors displace (are repeated over and over, in an out-of-control fashion) healthful behaviors which are intended to maintain the integrity of the organism. Due to their highly rewarding properties, these pathological behaviors may counter evolutionary development of the behavioral patterns the organism can flexibly employ for survival. Therefore, by over-stimulating the brain’s reward circuits, self-administration of drugs of abuse or pathological behaviors have been conceptualized as “hijacking” the brain (Leshner 1997). This construct seems intuitive, compelling and is widely accepted but can be otherwise interpreted (Wakefield 2020).
The essential feature of addictive disorders is the approach by the organism towards harmful elements of the environment, namely drug-seeking behavior or over-involvement in behavioral addictions (Stolerman 1992). Engagement in such behaviors are shaped by an interaction of the associated rewarding and aversive effects of socio-environmental stimuli and discriminative stimuli (Venniro, Marino, Chow et al. 2022). While the former is easily understood, the latter refers to those unique (distinguishable) sensory properties experienced by the individual caused by the pharmacological actions of a drug or from engagement in a behavioral addiction. The balance of reward and punishment that propels drug-seeking behavior or engagement in behavioral addictions are not constant throughout life, but changes during clinical progression of these disorders (Martin, Lovinger and Breese 1995).
Stated otherwise, what may be rewarding or aversive for an individual at initiation of the addictive process are substantially modified by chronic engagement in these behaviors. These transformations occur primarily because addictive disorders modify the nervous system and brain functioning of the affected individual (Koob and Le Moal 2007; Martin, Weinberg and Bealer 2007; Koob and Volkow 2010) but are also affected by changes in their environment over time. Therefore, not only can each of the tripartite factors that underpin addictive processes, namely the host, environment and the agent (the drug or addictive behavior) change, but also their interactions can significantly be altered during the course of the disorder.
Early in the progression of addictive disorders (initiation), the associated pathological behaviors may manifest profound rewarding/reinforcing effects (e.g., euphoria, behavioral activation, novelty, anxiolysis, analgesia) which encourage further engagement in these behaviors. For example, the high that may occur with first use of a drug can be so compelling that an individual continues using, despite the fact that the magnitude of this first experience may never quite be achieved again (Bornstein and Pickard 2020). Along with the rewarding effects of initiation, there are also distinctly aversive (punishment) components of the experiences associated with early engagement (e.g., sedation, blackout, acute withdrawal [hangover], intense anxiety/fear, nausea) which tend to discourage further use or engagement. For example, an automobile accident due to intoxication of an inexperienced drinker, the fear of pregnancy or acquiring sexually transmitted infections during a blackout, or throwing up after drinking beyond one’s limited capacity. Therefore, self-administration of drugs of abuse or engaging in other self-destructive and out-of-control behaviors invoke both rewarding and punishing stimuli/experiences. Subsequent behavior is determined by the vector of these two classes of behavioral consequences, biased by individual proclivities or predispositions.
As mentioned above, chronic involvement in a highly rewarding behavior can change the reward circuits per idem (Martin 2019b, 2021) so that the reason for continued engagement may be quite different from why the individual first engaged in the behavior. For example, the factors that cause these pathological behaviors to be continued, namely reinforcing effects, may now be simply the opportunity to have social interactions with others who engage in the shared behavior and prevention of withdrawal associated distress that occurs if the behavior is stopped. On the other hand, aversive effects of long-term addiction which may provide impetus to discontinue engagement in the pathological behavior, can include organic disease, societal stigma, destruction of one’s relationships and legal problems.
Medical and psychiatric complications of alcohol/drug use disorders or behavioral addictions can also change the reward/punishment vector associated with clinical progression of these disorders (Martin, Weinberg and Bealer 2007). This evolving process can be appreciated with each addictive disorder but is very clearly demonstrated with cigarette smoking as an example. Initially, smoking a cigarette in early adolescence may result in distressing coughing which keeps some from continuing to ever smoke again. If smoking continues, possibly to fit in with one’s peers, over time, distressing consequences are overcome to make the experience of smoking almost totally rewarding and very difficult to stop. However, the rewarding aspects of smoking can change for many on recognition of the toxic effects to health such as shortness of breath or fear of developing heart disease or cancer.
However, stopping these drugs/behaviors when one has been engaging with them repeatedly may be difficult. On discontinuation, a characteristic syndrome of variable severity emerges due to reversal of neuroadaptive changes caused by drug use/behavior and attendant stress responses of the autonomic nervous system (Martin 2019a), which often results in resuming the behavior. Withdrawal may be so distressing that discontinuation of the behavior is impossible without medical detoxification. After detoxification is completed, treatment of addictive disorders must involve restructuring the reward/punishment vector. Historically, when it was thought that addictive behaviors were continued during a lifetime purely for their reward value, punishment was considered the only viable approach to treatment of so deeply ingrained behaviors.
The classical example of how this was accomplished is with punishment of the addictive behavior as can be produced by the medication disulfiram upon ingestion of alcohol by an individual suffering from alcoholism (Hald and Jacobsen 1948; Bahji, Bach, Danilewitz et al. 2022). As it was recognized that reward is modulated by punishment in addictive disorders, psychotherapeutic and social interventions were implemented to replace the dysfunctional behaviors of addiction (Martin 2020a). The focus of these psychosocial therapeutic intercessions is to make recovery more rewarding than the punishment associated with an addictive lifestyle which has become untenable. Such approaches can effectively be complemented with pharmacotherapeutic approaches that address comorbid psychiatric disorders and medical/psychiatric complications of these disorders as well as the addictive disorder per se (Martin, Weinberg and Bealer 2007).
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April 20, 2023