Delay discounting and substance use treatment outcomes: A systematic review focused on treatment outcomes and discounting methodology

Differential discounting of past and future gains and losses in individuals in recovery from substance use disorder

Individuals with substance use disorder (SUD) show consistently higher delay discounting (DD) rates than controls for both future and past outcomes, as well as for gains and losses. However, differences in these DD effects (e.g., tense and sign) among individuals in SUD recovery have yet to be explored. Therefore, the goal of the present study was to (a) investigate differences in discounting of past and future gains and losses among individuals in SUD recovery and (b) examine differences in these DD effects between individuals in different stages of remission (i.e., not in remission, in early remission, or in sustained remission). Our results indicate that individuals in recovery discount past and future gains, but not losses, symmetrically. Additionally, individuals in recovery discount gains more than losses (i.e., sign effect) for the future but not for the past. Finally, those in sustained remission showed significantly lower DD rates than those not in remission, regardless of the DD task. Thus, other discounting tasks might provide a similarly accurate measure of DD and can be employed to assess differences in discounting between those in remission and those not in remission. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Food for thought: The relationship between poor eating habits, delay discounting, and quality of life in substance use recovery

BACKGROUND

Research on poor eating habits among individuals recovering from substance use disorders (SUD) is limited. This study examines the relationship between poor eating habits, delay discounting (DD), quality of life (QOL), and remission status, in addition to examining DD as a mediator of the relationship between poor eating and QOL.

METHODS

Participants (n = 257) in recovery from SUD, completed the Health Behaviors Questionnaire (poor eating was measured using the food domain), a DD task, the World Health Organization QOL questionnaire, demographics, and SUD-related questions. Multivariate linear regression was used to test associations between poor eating and DD, as well as each QOL domain. Mediation analyses were conducted to evaluate the role of DD in the relationship between poor eating and QOL. A binary logistic regression was used to test associations between poor eating and remission status, as well as DD and remission status.

RESULTS

Poor eating habits were significantly associated with higher rates of DD (β = 0.08, p < .001) and lower QOL across psychological (β = -0.88, p < .001, only for those in remission), physical (β = -0.58, p < .001), and environmental (β = -0.75, p < .001) domains. Additionally, DD significantly mediated the relationship between poor eating habits and reduced QOL in these domains (ꞵs < -0.08, ps < 0.003). Poor eating (ꞵ = 0.05, p = .014; OR = 1.05, p = .012) and high DD rates (ꞵ = 0.12, p = .049; OR = 1.12, p = .038) were associated with a lower likelihood of remission from SUD.

CONCLUSIONS

Our findings highlight the integral role of dietary habits in the recovery trajectory of individuals with SUD. The study supports the need for holistic treatment approaches that consider the impacts of nutrition on both psychological and physiological aspects of recovery.

The phenotype of recovery XII: A reinforcer pathology perspective on associations between delay discounting and pain catastrophizing in substance use disorder recovery

BACKGROUND

Substance use disorder (SUD) and pain are highly comorbid conditions and several pain indices (e.g., pain intensity) are associated with an increased risk of relapse. However, the cognitive-emotional experience of pain (i.e., pain catastrophizing) is understudied in SUD recovery. Further, how the association between pain catastrophizing and delay discounting - a posited biomarker of addiction, impacts multidimensional aspects of SUD recovery, including remission and quality of life (QOL), has yet to be examined.

METHODS

Individuals (n = 170) in SUD recovery reporting pain were asked about their chronic pain status, completed the Brief Pain Inventory, the Pain Catastrophizing Scale, an Adjusting Amount Delay Discounting Task, and the World Health Organization QOL-BREF scale. Univariate logistic and linear regressions examined associations between delay discounting and several pain indices with remission and QOL. Mediation analyses were investigated whether pain catastrophizing mediates the relationship between delay discounting and 1) sustained remission and 2) QOL.

RESULTS

Significant negative associations were found between delay discounting (p < .001) and pain catastrophizing (p = .001) with sustained remission. Pain catastrophizing significantly mediated the relationship between delay discounting and physical QOL (p = .044), psychological QOL (p = .009), social (p = .018), and environmental QOL (p = .014). Pain catastrophizing did not mediate the relationship between DD and sustained remission.

CONCLUSION

Individuals with greater DD exhibited greater pain catastrophizing, contributing to poorer QOL in SUD recovery. Our findings support that a Reinforcer Pathology framework is useful to understanding the cognitive-emotional experience of pain within the context of SUD recovery. Interventions that target both delay discounting and maladaptive cognitive and emotional responses to pain may lessen the negative impact of pain on SUD recovery and improve SUD outcomes.

Reward deprivation is associated with elevated alcohol demand in emerging adults

Policies vary substantially in terms of providing sources of psychosocial enrichment. Behavioral economic models of substance use and addiction emphasize that deficits in access to substance-free sources of reward increase substance reinforcing value and risk for addiction. The current study used an alcohol demand curve approach to test the hypothesis that various indices of reward deprivation would be associated with elevated alcohol reinforcing efficacy. We examined associations between alcohol demand indices and several facets of reward deprivation in a sample of young adults (N = 1,331; ages 19-25 years) recruited from the United States and Canada who reported recent binge drinking. Additionally, we created an index of cumulative reward deprivation that integrated the various reward facets and examined its association with alcohol demand intensity and maximum expenditure on alcohol. Our findings indicate that reward deprivation is associated with elevated alcohol demand and provide support for alcohol prevention and intervention approaches that emphasize environmental enrichment.

Delay discounting of rewards and losses, alcohol use, and the influence of socioeconomic factors: A cross-sectional online study in frequent drinkers

BACKGROUND

Delay discounting describes the devaluation of future outcomes over time and is a popular behavioral construct in addiction research. Prior studies show modest yet consistent associations between problematic alcohol use and delayed reward discounting (DRD). However, the potential confounding influence of socioeconomic status (SES, e.g., income and education) is rarely addressed. In this study, we aimed to investigate the robustness of DRD as a predictor of alcohol use after controlling for socioeconomic and demographic variables. Additionally, we aimed to test the association between delayed loss discounting (DLD) and alcohol use in a sufficiently large sample.

METHODS

We collected data from 341 moderate-to-heavy-drinking participants (27.92 ± 21.12 g alcohol/day, 43.48 ± 11.90 years old, 49.9% female, UK residents) in a cross-sectional online study. DRD and DLD were measured using an intertemporal choice task. Questionnaires encompassed alcohol use (AUDIT, weekly alcohol consumption), education and income, subjective measures of past and present socioeconomic status, and impulsivity.

RESULTS

DRD, but not DLD, was significantly associated with AUDIT scores (r = 0.15) and weekly alcohol consumption (r = 0.12). DRD remained a significant yet weak predictor of AUDIT scores when controlling for education and income, but not when controlling for education and age.

CONCLUSIONS

We replicated a small but robust association between alcohol use and DRD, but not DLD. This association appeared to be confounded by education and age, but not by income. We conclude that socioeconomic and demographic variables should systematically be accounted for in future studies investigating DRD and alcohol use.

Recovery from alcohol use disorder: Reinforcer pathology theory, measurement, and methods

Recovery from alcohol use disorder (AUD) is a dynamic process that often entails periods of drinking but has been defined primarily by abstinence. Recently, a broader interpretation of recovery was developed, including meeting the Diagnostic and Statistical Manual of Mental Disorders (DSM) remission criteria and improved psychosocial functioning. This new understanding of recovery has facilitated the development of novel theories and methodologies. This paper reviews a new theoretical perspective of recovery, Reinforcer Pathology, and two novel methodological approaches in light of this broader view of recovery. Using this theoretical framework as a foundation, we propose an alternative perspective to explain the recovery process as it relates to environmental factors and valuation of the future; we suggest that changing the environment in which substances are available (e.g., increasing non-alcohol-related activities) and extending one's temporal window are associated with improved recovery outcomes (e.g., remission and quality of life). In this review, we discuss two novel methodological approaches. The first uses latent profile analysis to show that using a measure of Relative Reinforcement Value of Alcohol-Free Activities is associated with a greater likelihood of belonging to a high functioning/infrequent heavy drinking recovery profile. The second developed an online national sample and used an accelerated longitudinal design to study longer-term recovery of up to 12 years over a 5-year study period. Reinforcer Pathology theory, novel methods, and measures may further our understanding of recovery and begin to address critical questions for future studies. Subsequent randomized clinical trials should examine whether the suggested targets and interventions based on the theoretical model improve recovery outcomes prospectively. Measuring and promoting alcohol-free activity engagement may facilitate improved recovery outcomes, while novel methodologies permit an understanding of returning to use or remission across different recovery durations.

Delay discounting is associated with addiction and mental health measures while controlling for health behaviors and health barriers in a large US sample

Background

Excessive discounting of future rewards [delay discounting (DD)] may be a transdiagnostic process and treatment target underlying behavioral health outcomes, including trauma, depression, anxiety, and problematic substance use. However, multiple health behaviors and barriers are also related to these outcomes, including social media usage, adverse childhood experiences (ACEs), sleep quality, healthcare access, housing status, and exercise. To extend research examining DD as transdiagnostic process, we recruited a large, heterogenous sample to examine the association between DD, problematic substance use, and mental health outcomes while controlling for certain health behaviors and health barriers.

Method

In a cross-sectional online survey of 3992 US residents, we administered validated measures of PTSD, depression, anxiety, and problematic alcohol, stimulant, and opioid use. Using linear or ordinal logistic models, scores for each outcome were regressed onto DD while controlling for demographics, health behaviors, and health barriers.

Results

Including only DD and demographics, DD was associated with each outcome at low effect sizes (ƒ2 = .013, OR range = 1.08-1.16). Except for opioid ASSIST scores, these relationships held when controlling for social media usage, sleep, housing status, healthcare access, ACEs, physical exercise, and demographic variables (ƒ2 = .002, OR range = 1.03-1.12), increasing confidence that DD concurrently and directly relates to four of these five clinical outcomes.

Discussion

These findings support the conceptualization of DD as a transdiagnostic process underlying certain psychopathologies and suggest targeting DD in co-occurring substance use disorder and/or mental health treatments may result in clinically significant outcomes.

Art-delivered episodic future thinking reduces delay discounting: A phase IIa proof-of-concept trial

INTRODUCTION

High rates of delay discounting (DD), or the preference for immediate rewards over delayed rewards, is associated with substance use disorder (SUD). Lower rates of DD predict better treatment outcomes, and thus strategies that reduce DD may support SUD recovery. The process of vividly imagining a future event, known as episodic future thinking (EFT), may be a particularly viable approach to reduce DD. Some limited research has examined delivery of EFT in treatment settings, using verbal prompts that are typical of studies in non-treatment settings. We propose that the creation of visual art represents a unique alignment of the purpose of EFT with an innovative delivery modality in treatment settings.

METHODS

This single arm, proof-of-concept trial evaluated art-delivered EFT (ArtEFT) to reduce DD in a sample of women (N = 39) in a residential SUD treatment center. Participants engaged in a single, 1-h ArtEFT session during which they engaged in EFT and created a visual representation using art materials. The study collected DD measures for hypothetical money ($50 and $1000 magnitude conditions) before and after ArtEFT.

RESULTS

Using area-under-the-curve (AUCord) as the index of DD, the study observed predicted changes following the ArtEFT session. The ANOVA revealed statistically significant main effects of both magnitude [F(1,38) = 11.184, p = .002] and time [F(1. 38) = 4.731, p = .036], with a non-significant interaction [F(1,38) = 3.821, p = .058].

CONCLUSION

This study reveals promising preliminary indicators that art may be an effective modality to deliver EFT, with particular advantages for implementation given the popularity of art programming in SUD treatment programs.