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Hudson JE, Grunevski S, Sebelius J, Yi R. Art-delivered episodic future thinking reduces delay discounting: A phase IIa proof-of-concept trial. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 158:209255. [PMID: 38081541 DOI: 10.1016/j.josat.2023.209255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 10/19/2023] [Accepted: 11/20/2023] [Indexed: 12/17/2023]
Abstract
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.
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Affiliation(s)
- Jennifer E Hudson
- Cofrin Logan Center for Addiction Research and Treatment, University of Kansas, USA
| | | | - John Sebelius
- Cofrin Logan Center for Addiction Research and Treatment, University of Kansas, USA
| | - Richard Yi
- Cofrin Logan Center for Addiction Research and Treatment, University of Kansas, USA; Department of Psychology, University of Kansas, USA.
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Dwyer CL, Tegge AN, Craft WH, Tomlinson DC, Athamneh LN, Bickel WK. The Phenotype of Recovery X: Associations between delay discounting, regulatory flexibility, and remission from substance use disorder. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 155:209122. [PMID: 37451516 PMCID: PMC10787043 DOI: 10.1016/j.josat.2023.209122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/09/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Delay discounting (DD) and self-regulation are important predictors of substance use disorder (SUD) outcomes. Further, regulatory flexibility (RF; i.e., selecting, monitoring, and adapting coping techniques based on contextual demands) is related to psychological resilience. However, studies have yet to examine associations among DD, RF, and remission from SUDs among individuals in recovery. METHODS Individuals (N = 148) in SUD recovery completed the Context Sensitivity Index (CSI), the Flexible Regulation of Emotional Expression (FREE) Scale, and the Perceived Ability to Cope with Trauma (PACT) Scale to assess RF and, an $1000 hypothetical reward Adjusting Amount Delay Discounting Task. The study considered individuals to be in remission from SUD if they did not endorse any SUD DSM-5 symptom other than craving (except tobacco use disorder) in the past three months. The study team used t-tests to examine differences in RF and DD by remission status. Univariate linear regressions were used to examine the relationship between RF and DD. Finally, mediation models examined the dynamic relationship among DD, RF, and remission status. RESULTS Remitted individuals (n = 82) had significantly lower DD (i.e., greater preference for larger, later rewards) rates (p < .001) and higher context sensitivity (p < .001) and coping flexibility (p < .001). The study found significant negative associations between DD and context sensitivity (p = .008), coping flexibility (p = .002), and emotion regulation flexibility (p < .001). Finally, context sensitivity (p = .023) and coping flexibility (p = .009) mediated the relationship between DD and SUD remission. CONCLUSIONS Results suggest that individuals in recovery with broader temporal windows can better identify contextual demands and flexibly cope, contributing to improved SUD recovery outcomes.
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Affiliation(s)
- Candice L Dwyer
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA; Department of Psychology, Virginia Tech, Blacksburg, VA, USA
| | - Allison N Tegge
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA; Department of Statistics, Virginia Tech, Blacksburg, VA, USA
| | - William H Craft
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA; Graduate Program in Translational Biology, Medicine, and Health, Virginia Tech, USA
| | - Devin C Tomlinson
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA; Graduate Program in Translational Biology, Medicine, and Health, Virginia Tech, USA
| | - Liqa N Athamneh
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
| | - Warren K Bickel
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA.
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Jarmolowicz DP, Schneider TD, Strickland JC, Bruce AS, Reed DD, Bruce JM. Reinforcer pathology, probabilistic choice, and medication adherence in patients with multiple sclerosis. J Exp Anal Behav 2023; 119:275-285. [PMID: 36710645 DOI: 10.1002/jeab.830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 04/11/2022] [Accepted: 12/17/2022] [Indexed: 01/31/2023]
Abstract
The reinforcer pathology model posits that core behavioral economic mechanisms, including delay discounting and behavioral economic demand, underlie adverse health decisions and related clinical disorders. Extensions beyond substance use disorder and obesity, however, are limited. Using a reinforcer pathology framework, this study evaluates medical adherence decisions in patients with multiple sclerosis. Participants completed behavioral economic measures, including delay discounting, probability discounting, and a medication purchase task. A medical decision-making task was also used to evaluate how sensitivity to mild side effect risk and efficacy contributed to the likelihood of taking a hypothetical disease-modifying therapy. Less steep delay discounting and more intense (greater) medication demand were independently associated with greater adherence to the medication decision-making procedure. More generally, the pattern of interrelations between the medication-specific and general behavioral economic metrics was consistent with and contributes to the reinforcer pathology model. Additional research is warranted to expand these models to different populations and health behaviors, including those of a positive health orientation (i.e., medication adherence).
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Affiliation(s)
- David P Jarmolowicz
- Department of Applied Behavioral Science, University of Kansas, Lawrence, KS, USA
- Cofrin-Logan Center for Addiction Research and Treatment, University of Kansas, Lawrence, KS, USA
- Healthcare Institute for Innovations in Quality, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Tadd D Schneider
- Department of Applied Behavioral Science, University of Kansas, Lawrence, KS, USA
- Cofrin-Logan Center for Addiction Research and Treatment, University of Kansas, Lawrence, KS, USA
| | - Justin C Strickland
- Behavioral Pharmacology Research Unit, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Amanda S Bruce
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Hospital, Kansas City, MO, USA
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Derek D Reed
- Department of Applied Behavioral Science, University of Kansas, Lawrence, KS, USA
- Cofrin-Logan Center for Addiction Research and Treatment, University of Kansas, Lawrence, KS, USA
| | - Jared M Bruce
- Department(s) of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
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4
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Burk DC, Averbeck BB. Environmental uncertainty and the advantage of impulsive choice strategies. PLoS Comput Biol 2023; 19:e1010873. [PMID: 36716320 PMCID: PMC9910799 DOI: 10.1371/journal.pcbi.1010873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 02/09/2023] [Accepted: 01/15/2023] [Indexed: 02/01/2023] Open
Abstract
Choice impulsivity is characterized by the choice of immediate, smaller reward options over future, larger reward options, and is often thought to be associated with negative life outcomes. However, some environments make future rewards more uncertain, and in these environments impulsive choices can be beneficial. Here we examined the conditions under which impulsive vs. non-impulsive decision strategies would be advantageous. We used Markov Decision Processes (MDPs) to model three common decision-making tasks: Temporal Discounting, Information Sampling, and an Explore-Exploit task. We manipulated environmental variables to create circumstances where future outcomes were relatively uncertain. We then manipulated the discount factor of an MDP agent, which affects the value of immediate versus future rewards, to model impulsive and non-impulsive behavior. This allowed us to examine the performance of impulsive and non-impulsive agents in more or less predictable environments. In Temporal Discounting, we manipulated the transition probability to delayed rewards and found that the agent with the lower discount factor (i.e. the impulsive agent) collected more average reward than the agent with a higher discount factor (the non-impulsive agent) by selecting immediate reward options when the probability of receiving the future reward was low. In the Information Sampling task, we manipulated the amount of information obtained with each sample. When sampling led to small information gains, the impulsive MDP agent collected more average reward than the non-impulsive agent. Third, in the Explore-Exploit task, we manipulated the substitution rate for novel options. When the substitution rate was high, the impulsive agent again performed better than the non-impulsive agent, as it explored the novel options less and instead exploited options with known reward values. The results of these analyses show that impulsivity can be advantageous in environments that are unexpectedly uncertain.
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Affiliation(s)
- Diana C. Burk
- Laboratory of Neuropsychology, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Bruno B. Averbeck
- Laboratory of Neuropsychology, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, United States of America
- * E-mail:
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Belisle J, Paliliunas D, Sickman E, Janota T, Lauer T. Probability Discounting in College Students’ Willingness to Isolate During COVID-19: Implications for Behavior Analysis and Public Health. PSYCHOLOGICAL RECORD 2022; 72:713-725. [PMID: 36092128 PMCID: PMC9444125 DOI: 10.1007/s40732-022-00527-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 11/19/2022]
Abstract
The present study was a preliminary analysis of college students’ willingness to self-isolate and socially isolate during the COVID-19 pandemic analyzed through a probability discounting framework. Researchers developed a pandemic likelihood discounting task where willingness to isolate from others was measured in days as a function of the perceived probability of the escalation of a virus to pandemic levels. Experiment 1 was conducted immediately prior to the World Health Organization (WHO) declaring COVID-19 a pandemic and results showed that participants were more willing to self-isolate when the perceived probability of reaching pandemic levels was high and when there was a guarantee that others in the community would do the same. Experiment 2 was conducted with a subset of participants from Experiment 1 with the same discounting task, and results showed that participants were more willing to self-isolate 2 months following the onset of the pandemic, supporting the view that willingness to isolate from others is a dynamic process. Finally, Experiment 3 evaluated willingness to socially distance and introduced a hypothetical timescale to evaluate common trends with the real-world temporal dynamics observed in Experiments 1 and 2. Results showed similar trends in the data, supporting the use of hypothetical scenarios within probability discounting tasks in future behavior analytic research related to public health.
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Glautier S, Eisenbarth H, Macaskill A. In Search of the Preference Reversal Zone. Exp Psychol 2022; 69:46-59. [PMID: 35579537 DOI: 10.1027/1618-3169/a000542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A preference reversal is observed when a preference for a larger-later (LL) reward over a smaller-sooner (SS) reward reverses as both rewards come closer in time. Preference reversals are common in everyday life and in the laboratory and are often claimed to support hyperbolic delay-discounting models which, in their simplest form, can model reversals with only one free parameter. However, it is not clear if the temporal location of preference reversals can be predicted a priori. Studies testing model predictions have not found support for them, but they overlooked the well-documented effect of reinforcer magnitude on discounting rate. Therefore, we directly tested hyperbolic and exponential model predictions in a pre-registered study by assessing individual discount rates for two reinforcer magnitudes. We then made individualized predictions about pairs of choices between which preference reversals should occur. With 107 participants, we found (1) little evidence that hyperbolic and exponential models could predict the temporal location of preference reversals, (2) some evidence that hyperbolic models had better predictive performance than exponential models, and (3) in contrast to many previous studies, that exponential models generally produced superior fits to the observed data than hyperbolic models.
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Affiliation(s)
| | - Hedwig Eisenbarth
- School of Psychology, Victoria University of Wellington, New Zealand
| | - Anne Macaskill
- School of Psychology, Victoria University of Wellington, New Zealand
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7
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Morris L, O'Callaghan C, Le Heron C. Disordered Decision Making: A Cognitive Framework for Apathy and Impulsivity in Huntington's Disease. Mov Disord 2022; 37:1149-1163. [PMID: 35491758 PMCID: PMC9322688 DOI: 10.1002/mds.29013] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/17/2022] [Accepted: 03/15/2022] [Indexed: 01/12/2023] Open
Abstract
A caregiver's all‐too‐familiar narrative ‐ “He doesn't think through what he does, but mostly he does nothing.” Apathy and impulsivity, debilitating and poorly understood, commonly co‐occur in Huntington's disease (HD). HD is a neurodegenerative disease with manifestations bridging clinical neurology and psychiatry. In addition to movement and cognitive symptoms, neurobehavioral disturbances, particularly apathy and impulsivity, are prevalent features of HD, occurring early in the disease course, often worsening with disease progression, and substantially reducing quality of life. Treatments remain limited, in part because of limited mechanistic understanding of these behavioral disturbances. However, emerging work within the field of decision‐making neuroscience and beyond points to common neurobiological mechanisms underpinning these seemingly disparate problems. These insights bridge the gap between underlying disease pathology and clinical phenotype, offering new treatment strategies, novel behavioral and physiological biomarkers of HD, and deeper understanding of human behavior. In this review, we apply the neurobiological framework of cost‐benefit decision making to the problems of apathy and impulsivity in HD. Through this decision‐making lens, we develop a mechanistic model that elucidates the occurrence of these behavioral disturbances and points to potential treatment strategies and crucial research priorities. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson Movement Disorder Society.
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Affiliation(s)
- Lee‐Anne Morris
- Department of Medicine University of Otago Christchurch New Zealand
- New Zealand Brain Research Institute Christchurch New Zealand
| | - Claire O'Callaghan
- Brain and Mind Centre and School of Medical Sciences, Faculty of Medicine and Health University of Sydney Sydney New South Wales Australia
| | - Campbell Le Heron
- Department of Medicine University of Otago Christchurch New Zealand
- New Zealand Brain Research Institute Christchurch New Zealand
- Department of Neurology Canterbury District Health Board Christchurch New Zealand
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8
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Haynes JM, Odum AL. Testing delay of gratification in rats using a within-session increasing-delay task. J Exp Anal Behav 2022; 118:3-23. [PMID: 35485644 DOI: 10.1002/jeab.767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 02/22/2022] [Accepted: 04/13/2022] [Indexed: 11/07/2022]
Abstract
In delay discounting, preference reversals refer to shifts in preference from a larger-later reward to a smaller-sooner reward. Steep hyperbolic discounting predicts a preference reversal when a smaller-sooner and larger-later reward both become temporally proximal; prior research is consistent with this prediction. Hyperbolic discounting does not predict a preference reversal, however, after an individual chooses a larger-later reward over a smaller-immediate reward; prior research is inconsistent with this prediction. We sought to replicate and extend these findings using a delay of gratification task in rats. The task included a defection response which allowed rats to reverse their preference after choosing a larger-later sucrose reinforcer to instead obtain a smaller-immediate sucrose reinforcer. In Experiment 1, we found that rats would defect on their choice of the larger-later reinforcer, systematically replicating prior research. We also found that experience on the delay of gratification task led to decreases in defection responses. In Experiment 2, we found that prior experience on an intertemporal choice task, with no opportunity to defect, also led to few defection responses on the delay of gratification task. We discuss our findings in the context of whether inhibitory control or temporal learning could be involved in delay of gratification.
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9
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Castillo MI, Frank‐Crawford MA, Liesfeld JE, Doan TM, Newcomb ET, Rooker GW, Borrero JC. Do persons with intellectual and developmental disabilities prefer to save the best for last in an MSWO? A preliminary investigation. BEHAVIORAL INTERVENTIONS 2022. [DOI: 10.1002/bin.1883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Mariana I. Castillo
- Department of Psychology University of Maryland Baltimore County Baltimore Maryland USA
| | - Michelle A. Frank‐Crawford
- Department of Psychology University of Maryland Baltimore County Baltimore Maryland USA
- Behavioral Psychology Department Kennedy Krieger Institute Baltimore Maryland USA
| | | | | | | | - Griffin W. Rooker
- Behavioral Psychology Department Kennedy Krieger Institute Baltimore Maryland USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - John C. Borrero
- Department of Psychology University of Maryland Baltimore County Baltimore Maryland USA
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10
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Athamneh LN, Freitas-Lemos R, Basso JC, Keith DR, King MJ, Bickel WK. The phenotype of recovery VI: The association between life-history strategies, delay discounting, and maladaptive health and financial behaviors among individuals in recovery from alcohol use disorders. Alcohol Res 2022; 46:129-140. [PMID: 35076945 DOI: 10.1111/acer.14747] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 10/13/2021] [Accepted: 11/12/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The life-history theory is a well-established framework that predicts behaviors and explains how and why organisms allocate effort and resources to different life goals. Delay discounting (DD) is associated with risky behaviors and has been suggested as a candidate behavioral marker of addiction. Thus, we investigated the relationship between DD, life-history strategies, and engagement in risky behaviors among individuals in recovery from alcohol use disorder (AUD). METHODS Data from 110 individuals in recovery from addiction from The International Quit & Recovery Registry, an ongoing online registry designed to understand recovery phenotype, were included in the analysis. The association between life-history strategies, DD, engagement in risky behaviors, and remission status were assessed. RESULTS Life-history strategy scores were significantly associated with DD rates and finance, health, and personal development behaviors after controlling for age, sex, race, ethnicity, years of education, marital status, smoking status, and history of other substance use. Remission status was significantly associated with life-history strategy, DD, drug use, fitness, health, and safe driving after controlling for age, sex, race, years of education, marital status, and smoking status. In addition, a mediation analysis using Hayes' methods revealed that the discounting rates partially mediated the association between remission status and life-history strategy scores. CONCLUSIONS Life-history strategies and remission status are both significantly associated with DD and various health and finance behaviors among individuals in recovery from AUD. This finding supports the characterizations of DD as a candidate behavioral marker of addiction that could help differentiate subgroups needing special attention or specific interventions to improve the outcomes of their recovery. Future longitudinal studies are warranted to understand the relationships between changes in life-history strategies, DD, maladaptive health behaviors, and remission status over time.
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Affiliation(s)
- Liqa N Athamneh
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA.,Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA
| | - Roberta Freitas-Lemos
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA.,Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA
| | - Julia C Basso
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA.,Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA
| | - Diana R Keith
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA.,Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA
| | - Michele J King
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA.,Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA
| | - Warren K Bickel
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA.,Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA
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11
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Goodyear K, Miranda R, MacKillop J. Behavioral economic analysis of topiramate pharmacotherapy for alcohol: a placebo-controlled investigation of effects on alcohol reinforcing value and delayed reward discounting. Psychopharmacology (Berl) 2022; 239:153-161. [PMID: 34981180 PMCID: PMC8776590 DOI: 10.1007/s00213-021-06034-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 11/22/2021] [Indexed: 01/07/2023]
Abstract
RATIONALE Pharmacotherapies are an important clinical strategy for treating alcohol use disorder and an understanding of their functional mechanisms can inform optimal use. Behavioral economics provides a translational platform that may advance our understanding of the motivational impacts of pharmacotherapies. OBJECTIVES This secondary analysis study examined the effect of topiramate, a promising pharmacotherapy for treating alcohol use disorder, on two behavioral economic domains, the reinforcing value of alcohol (alcohol demand and alcohol-specific monetary expenditures) and delayed reward discounting (preference for smaller immediate rewards over larger delayed rewards). METHODS A double-blind randomized placebo-controlled study (n = 99) was conducted with non-treatment seeking heavy drinkers, comparing topiramate (target dose of 200 mg/day titrated for 3 weeks and remained at the target dose for 2 weeks) to matched placebo. RESULTS We found that compared to placebo, topiramate reduced the reinforcing value of alcohol, as shown by a reduction in two alcohol demand indices (intensity and Omax), money spent per week on alcohol and an almost a 50% increase in days without expenditures on alcohol from baseline. Directionally consistent patterns were also present for breakpoint and elasticity (ps = .08). No significant effects were found for delayed reward discounting. CONCLUSIONS This study provides evidence that topiramate reduces alcohol's reinforcing value as measured by alcohol demand and alcohol expenditure. More broadly, these findings support the utility of behavioral economics for understanding how medications reduce alcohol use.
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Affiliation(s)
- Kimberly Goodyear
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA.
- Center for Alcohol and Addiction Studies, Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA.
| | - Robert Miranda
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
- Center for Alcohol and Addiction Studies, Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - James MacKillop
- Peter Boris Centre for Addictions Research, McMaster University & St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- Homewood Research Institute, Guelph, ON, Canada
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12
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Lee YJ, Rasmussen EB. Age-related effects in delay discounting for food. Appetite 2022; 168:105783. [PMID: 34743827 DOI: 10.1016/j.appet.2021.105783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 10/04/2021] [Accepted: 10/27/2021] [Indexed: 11/30/2022]
Abstract
Developmental influences of growth, such as hormones and metabolic factors, increase food intake and weight across the lifespan. Delay discounting (DD), a choice procedure that characterizes preferences for immediate rewards, such as food, over larger, more delayed ones may be useful in understanding developmental and metabolic changes in decision making processes related to food intake. The present study examined the relation between age and food DD in a cross-sectional design. Other variables, such as pubertal stage, were examined also as these may influence discounting. Participants (N = 114; 28 children and 86 adult) from a community sample completed measures of food and money delay discounting to determine if age-related variation in discounting tendencies is food-specific or more general. Both measures yield an omnibus discounting value and three additional values for small, medium, and large magnitudes. Analyses first revealed magnitude effects-- smaller magnitudes of both food and money were discounted more steeply than larger magnitudes. Hierarchical regressions indicated subjective hunger predicted steeper food discounting. When subjective hunger was controlled, age, but not puberty, significantly predicted food discounting for omnibus, medium, and large magnitudes of food. In children, food discounting decreased from early childhood to late adolescence. In adults, food discounting increased from early to late adulthood. Neither age, puberty, nor obesity status predicted any measure of monetary discounting. Food discounting, then, appears to change across the lifespan, and therefore, may be appropriate to examine psychological processes that accompany developmental and metabolic changes across the lifespan.
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13
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The phenotype of recovery VII: Delay discounting mediates the relationship between time in recovery and recovery progress. J Subst Abuse Treat 2021; 136:108665. [PMID: 34895955 PMCID: PMC8940660 DOI: 10.1016/j.jsat.2021.108665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/02/2021] [Accepted: 11/10/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Substance use disorders (SUDs) remain challenging maladies to treat in the United States and impose significant societal costs. Despite these challenges, a significant number of individuals endorse being in recovery from SUD. The scientific understanding of SUD recovery has evolved to include not only improvements in substance use but also improvements in personal wellness and psychosocial functioning. The devaluation of future rewards (delay discounting; DD) is broadly associated with SUD inception and outcomes. We sought to investigate the relationship between DD, time in recovery, and recovery progress. METHODS We conducted an online assessment of 127 individuals in recovery from SUD who the study recruited via the International Quit and Recovery Registry (IQRR). The research team obtained measures of recovery progress via the Addiction Recovery Questionnaire (ARQ) and the Treatment Effectiveness Assessment (TEA). Additionally, the study collected measures of DD, time in recovery, and endorsement of abstinence in recovery (i.e., requiring abstinence vs. not). We utilized linear regression to test for associations among these variables and performed a mediation analysis to test the role of DD in mediating the relationship between time in recovery and measures of recovery progress. RESULTS Time in recovery was positively associated with the ARQ (p < .001) and TEA (p < .001). Furthermore, an individual's delay discounting rate mediated the relationship between time in recovery and ARQ/TEA. Of the participants, 66% endorsed recovery requiring total abstinence from alcohol and drugs. Last, through an exhaustive model selection, the study did not find an individual's endorsement of abstinence in recovery to be a primary predictor of recovery progress. CONCLUSIONS This study presents evidence that, for individuals in recovery, the temporal view (i.e., focus on immediate vs. future rewards) is a significant influence on recovery progress. Additionally, an individual's endorsement of abstinence in recovery was not significantly associated with recovery progress, suggesting the importance of a holistic view of SUD recovery. These findings contribute to the understanding of recovery as a multidimensional process and provide further support for DD as a behavioral marker of addiction.
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14
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Stein JS, Madden GJ. Choice bundling, unpacked: Observed and predicted effects on intertemporal choice in an additive model of hyperbolic delay discounting. PLoS One 2021; 16:e0259830. [PMID: 34767599 PMCID: PMC8589209 DOI: 10.1371/journal.pone.0259830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 10/27/2021] [Indexed: 11/18/2022] Open
Abstract
One method known to increase preference for larger, later rewards (LLRs) over smaller, sooner rewards (SSRs) is choice bundling, in which a single choice produces a series of repeating consequences over time. The present study examined whether effects of choice bundling on preference for LLRs: (1) increase with the number of rewards in the bundle (i.e., bundle size); (2) are independent of differences in reward magnitude between conditions; and (3) accord with predictions of an additive model of hyperbolic delay discounting, in which the value of a bundle of rewards can be expressed as the summed discounted value of all rewards in that bundle. Participants (N = 252) completed a choice task to assess valuation of monetary LLRs at bundle sizes of 1 (control), 3, and 9 rewards per choice (ascending/descending order counterbalanced). To control for the magnitude effect, the total reward amounts were held constant across conditions. Choice bundling significantly increased LLR preference (p < .001), with the largest effect observed at the largest bundle size. The descending bundle-size order produced significantly greater LLR preference than the ascending order (p < .05), although order did not significantly interact with bundle size. Difference scores between observed measures and those predicted by an additive model of hyperbolic discounting were small and not significantly different than zero, but were not equivalent to zero. Future research should investigate the clinical utility of choice bundling for reducing the maladaptive health behavior (e.g., substance use) with which delay discounting is associated.
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Affiliation(s)
- Jeffrey S. Stein
- Center for Health Behaviors Research, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, Virginia, United States of America
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, Virginia, United States of America
- * E-mail:
| | - Gregory J. Madden
- Department of Psychology, Utah State University, Logan, Utah, United States of America
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Kangas BD. Examining the effects of psychoactive drugs on complex behavioral processes in laboratory animals. ADVANCES IN PHARMACOLOGY (SAN DIEGO, CALIF.) 2021; 93:243-274. [PMID: 35341568 DOI: 10.1016/bs.apha.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Behavioral pharmacology has been aided significantly by the development of innovative cognitive tasks designed to examine complex behavioral processes in laboratory animals. Performance outcomes under these conditions have provided key metrics of drug action which serve to supplement traditional in vivo assays of physiologic and behavioral effects of psychoactive drugs. This chapter provides a primer of cognitive tasks designed to assay different aspects of complex behavior, including learning, cognitive flexibility, memory, attention, motivation, and impulsivity. Both capstone studies and recent publications are highlighted throughout to illustrate task value for two distinct but often interconnected translational strategies. First, task performance in laboratory animals can be utilized to elucidate how drugs of abuse affect complex behavioral processes. Here, the expectation is that adverse effects on such processes will have predictive relevance to consequences that will be experienced by humans. Second, these same task outcomes can be used to evaluate candidate therapeutics. In this case, the extent to which drug doses with medicinal value perturb task performance can contribute critical information for a more complete safety profile appraisal and advance the process of medications development. Methodological and theoretical considerations are discussed and include an emphasis on determining selectivity in drug action on complex behavioral processes.
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Affiliation(s)
- Brian D Kangas
- Behavioral Biology Program, McLean Hospital, Belmont, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States.
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16
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Trusty WT, Swift JK, Rasmussen EB. A Behavioral Economic Model of Help-Seeking for Depression. Perspect Behav Sci 2021; 44:541-560. [DOI: 10.1007/s40614-021-00308-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 11/28/2022] Open
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Brain responses to drug cues predict craving changes in abstinent heroin users: A preliminary study. Neuroimage 2021; 237:118169. [PMID: 34000396 DOI: 10.1016/j.neuroimage.2021.118169] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/25/2021] [Accepted: 05/12/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Loss of control over drug intake occurring in drug addiction is believed to result from disruption of reward circuits, including reduced responsiveness to natural rewards (e.g., monetary, sex) and heightened responsiveness to drug reward. Yet few studies have assessed reward deficiency and related brain responses in abstinent heroin users with opioid use disorder, and less is known whether the brain responses can predict cue-induced craving changes following by prolonged abstinence. METHOD 31 heroin users (age: 44.13±7.68 years, male: 18 (58%), duration of abstinence: 85.2 ± 52.5 days) were enrolled at a mandatory detoxification center. By employing a cue-reactivity paradigm including three types of cues (drug, sexual, neutral), brain regional activations and circuit-level functional coupling were extracted. Among the 31 heroin users, 15 were followed up longitudinally to assess cue induced craving changes in the ensuing 6 months. RESULTS One way analysis of variance results showed that heroin users have differential brain activations to the three cues (neutral, drug and sexual) in the left dorsolateral prefrontal cortex (DLPFC), insula, orbiotofrontal cortex (OFC) and the bilateral thalamus. Drug cue induced greater activations in left DLPFC, insula and OFC compared to sexual cue. The psychophysiological interactions (PPI) analysis revealed negative couplings of the left DLPFC and the left OFC, bilateral thalamus, putamen in heroin users during drug cue exposure. In the 6-month follow-up study, both drug cue induced activation of the left DLPFC and the functional coupling of the left DLPFC-bilateral thalamus at baseline was correlated with craving reductions, which were not found for sexual cues. CONCLUSION Our preliminary study provided novel evidence for the reward deficiency theory of opioid use disorder. Our findings also have clinical implications, as drug cue induced activation of the left DLPFC and functional coupling of left DLPFC-bilateral thalamus may be potential neuroimaging markers for craving changes during prolonged abstinence. Evidently, the findings in the current preliminary study should be confirmed by large sample size in the future.
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Rodriguez LR, Rasmussen EB, Kyne-Rucker D, Wong M, Martin KS. Delay discounting and obesity in food insecure and food secure women. Health Psychol 2021; 40:242-251. [PMID: 33856831 DOI: 10.1037/hea0001042] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The relation between food insecurity (FI) and delay discounting (DD) and probability discounting (PD) for food and money was tested in women. In addition, discounting was tested as a variable that mediates the relation between obesity and FI. METHOD Women recruited from a community sample (N = 92) completed questionnaires. They completed the food choice questionnaire, the monetary choice questionnaire, measures for food and money probability discounting (which quantify sensitivity to risk aversion), and demographic measures. RESULTS Women with FI had higher rates of obesity and higher food DD compared to food-secure women. However, DD for money or probability discounting for food or money did not significantly differ between FI and food secure groups when controlling for significant covariates. Neither DD or PD significantly mediated the relation between FI and obesity. CONCLUSIONS These results suggest that FI is associated with greater impulsive food choice, but its association with other monetary discounting and probability discounting for food and money appears contingent upon other demographic factors. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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A review of cross-commodity delay discounting research with relevance to addiction. Behav Processes 2021; 186:104339. [PMID: 33545318 DOI: 10.1016/j.beproc.2021.104339] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/01/2020] [Accepted: 01/26/2021] [Indexed: 12/22/2022]
Abstract
Delay discounting (DD) refers to the decrease in the subjective value of a reward as the delay to its receipt increases. As high rates of DD are consistently associated with measures of substance misuse, DD is an important construct in current conceptualizations of addiction. High rates of DD appear to model preference for the immediate rewards provided by substance use, resulting in the interpretation that individuals with substance use disorder are generally unable or unwilling to delay gratification to obtain larger but delayed rewards. This interpretation is largely based on literature implementing binary choice tasks using differing amounts of the same commodity (i.e., single-commodity), in which high rates of DD can result from relative preference for the immediate outcome or relative dispreference for the delayed outcome. We propose that tasks using different commodities (i.e., cross-commodity) for the immediate and delayed outcomes offer potential in disentangling these dissociable and consequentially distinct interpretations. Our review suggests that cross-commodity DD tasks provide unique insights into understanding addiction not captured by single-commodity designs. We conclude that more research implementing cross-commodity DD tasks is needed to better understand the role of intertemporal choice in addiction and recovery.
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Raiha S, Yang G, Wang L, Dai W, Wu H, Meng G, Zhong B, Liu X. Altered Reward Processing System in Internet Gaming Disorder. Front Psychiatry 2020; 11:599141. [PMID: 33343426 PMCID: PMC7746551 DOI: 10.3389/fpsyt.2020.599141] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/10/2020] [Indexed: 11/17/2022] Open
Abstract
Converging evidence indicates that addiction involves impairment in reward processing systems. However, the patterns of dysfunction in different stages of reward processing in internet gaming addiction remain unclear. In previous studies, individuals with internet gaming disorder were found to be impulsive and risk taking, but there is no general consensus on the relation between impulsivity and risk-taking tendencies in these individuals. The current study explored behavioral and electrophysiological responses associated with different stages of reward processing among individuals with internet gaming disorders (IGDs) with a delayed discounting task and simple gambling tasks. Compared to the healthy control (HC) group, the IGD group discounted delays more steeply and made more risky choices, irrespective of the outcome. As for the event-related potential (ERP) results, during the reward anticipation stage, IGDs had the same stimulus-preceding negativity (SPN) for both large and small choices, whereas HCs exhibited a higher SPN in large vs. small choices. During the outcome evaluation stage, IGDs exhibited a blunted feedback-related negativity for losses vs. gains. The results indicate impairment across different stages of reward processing among IGDs. Moreover, we found negative correlation between impulsivity indexed by BIS-11 and reward sensitivity indexed by SPN amplitude during anticipation stage only, indicating different neural mechanisms at different stages of reward processing. The current study helps to elucidate the behavioral and neural mechanisms of reward processing in internet gaming addiction.
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Affiliation(s)
- Syeda Raiha
- Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Guochun Yang
- Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Lingxiao Wang
- Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
- Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China
| | - Weine Dai
- Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Sino-Danish College, University of Chinese Academy of Sciences, Beijing, China
- Sino-Danish Center for Education and Research, Beijing, China
- CFIN and Pet Center, Aarhus University, Aarhus, Denmark
| | - Haiyan Wu
- Centre for Cognitive and Brain Sciences and Department of Psychology, University of Macau, Taipa, Macau
| | - Guangteng Meng
- Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Bowei Zhong
- Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xun Liu
- Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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21
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Tomlinson DC, Tegge AN, Athamneh LN, Bickel WK. The phenotype of recovery IV: Delay discounting predicts perceived stress and a chance locus of control in individuals in recovery from substance use disorders. Addict Behav Rep 2020; 12:100320. [PMID: 33364328 PMCID: PMC7752727 DOI: 10.1016/j.abrep.2020.100320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/09/2020] [Accepted: 11/25/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Understanding individuals who are successful in recovery from substance use disorders will help to inform treatments and preventative measures. Stress has been shown to be associated with both substance use and relapse. Delay discounting is associated with risk of substance use; it is predictive of treatment outcomes and maintained abstinence. Associations between perceived stress, beliefs about locus of control, and delay discounting have yet to be assessed in individuals in recovery from substance use disorder. METHODS Data from 93 individuals in recovery from substance use recruited from the International Quit and Recovery Registry (IQRR) were analyzed. Individuals completed the adjusting amount delay discounting procedure to obtain delay discounting rates. Level of perceived stress was assessed by the Perceived Stress Scale (PSS). An individual's belief about locus of control was assessed using the Internality, Powerful Others and Chance Scale (IPCS). RESULTS Delay discounting was a significant predictor of perceived stress and scores associated with beliefs about a Chance locus of control (i.e., belief that events that occur in an individual's life are because of chance or luck), even after controlling for demographic characteristics. Time in recovery was also predictive of levels of perceived stress; this relationship was mediated by delay discounting. CONCLUSION The present study indicates that delay discounting can predict perception of stress and beliefs about a chance locus of control in individuals in recovery. This information may help understand, identify, and assist individuals whomay need different, new, or more intensive interventions for their substance use disorder.
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Affiliation(s)
- Devin C. Tomlinson
- Fralin Biomedical Research Institute at VTC, Roanoke, VA, USA
- Graduate Program in Translational Biology, Medicine and Health, Virginia Tech, Blacksburg, VA, USA
| | - Allison N. Tegge
- Fralin Biomedical Research Institute at VTC, Roanoke, VA, USA
- Department of Statistics, Virginia Tech, Blacksburg, VA, USA
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22
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Renda CR, Rung JM, Peck S, Madden GJ. Reducing impulsive choice VII: effects of duration of delay-exposure training. Anim Cogn 2020; 24:11-21. [PMID: 32642864 DOI: 10.1007/s10071-020-01412-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/27/2020] [Accepted: 07/03/2020] [Indexed: 02/02/2023]
Abstract
Impulsive choice is related to substance use disorders, obesity, and other behaviors that negatively impact human health. Reducing impulsive choice may prove beneficial in ameliorating these maladaptive behaviors. Preclinical research in rats indicates that one reliable method for producing large and lasting reductions in impulsive choice is delay-exposure (DE) training. In all six of the prior DE-training experiments, rats were given extensive experience (~ 120 training sessions) with a delayed reinforcement contingency. The present experiment evaluated if similar large and lasting reductions in impulsive choice could be achieved with less training. The duration of DE training between groups of male Wistar rats was 0 sessions (training ended after a lever-pressing acquisition criterion was met), 30, 60, or 120 sessions. Comparison groups were given the same durations of training with immediate reinforcement. A post-training assessment of impulsive choice was completed using an increasing-delay procedure. For rats assigned to the 60-session condition, impulsive choice was reassessed at a 120-day follow-up. DE training reduced impulsive choice but, contrary to expectation, reductions in impulsive choice did not increase with DE-training duration (no significant training-duration by group interaction). Importantly, 60 sessions of DE training produced reductions in impulsive choice that were comparable to prior published findings and this effect remained significant at the 120-day follow-up. Procedural elements that may be responsible for the DE-training effect, and how they could be improved in future experiments, are discussed.
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Affiliation(s)
- C Renee Renda
- Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT, 84341, USA.
| | - Jillian M Rung
- Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT, 84341, USA
- Department of Epidemiology, College of Public Health and Health Professions, School of Medicine, University of Florida, Gainesville, USA
| | - Sara Peck
- Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT, 84341, USA
| | - Gregory J Madden
- Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT, 84341, USA
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Ashe ML, Wilson SJ. A brief review of choice bundling: A strategy to reduce delay discounting and bolster self-control. Addict Behav Rep 2020; 11:100262. [PMID: 32467851 PMCID: PMC7244903 DOI: 10.1016/j.abrep.2020.100262] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 02/03/2020] [Accepted: 02/04/2020] [Indexed: 12/15/2022] Open
Abstract
Choice bundling is a behavioral economic strategy designed to reduce excessive delay discounting and bolster self-control. Choice bundling entails aggregating a series of individual, identical intertemporal decisions (e.g., should I smoke today?) into a single choice (e.g., should I smoke this month?). In this brief review, we succinctly summarize delay discounting and how it has been linked to lapses in self-control, using substance use as an exemplar. Next, we describe how choice bundling may theoretically work to counter excess discounting rates. Finally, we review the extant empirical research on choice bundling and offer recommendations for future research.
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Affiliation(s)
- Melinda L. Ashe
- The Pennsylvania State University, Department of Psychology, University Park, PA, USA
| | - Stephen J. Wilson
- The Pennsylvania State University, Department of Psychology, University Park, PA, USA
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24
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Mahoney CT, Cole HE, Gilbar O, Taft CT. The Role of Impulsivity in the Association Between Posttraumatic Stress Disorder Symptom Severity and Substance Use in Male Military Veterans. J Trauma Stress 2020; 33:296-306. [PMID: 32339353 PMCID: PMC7299815 DOI: 10.1002/jts.22508] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 09/24/2019] [Accepted: 09/27/2019] [Indexed: 01/16/2023]
Abstract
High rates of posttraumatic stress disorder (PTSD) and comorbid substance use disorder (SUD) are prevalent in military veterans. However, few studies have investigated impulsivity as a risk factor for engaging in substance use behavior for individuals who are experiencing PTSD symptoms. The present study evaluated impulsivity as a moderator of the association between PTSD symptoms and alcohol/drug use. Male military veterans (N = 106) completed self-report measures of alcohol use behavior, drug use behavior, and impulsivity. Participants also completed a structured diagnostic interview to assess for PTSD. The findings indicated that impulsivity moderated the relation between total PTSD symptoms and alcohol use, B = 0.01, p = .035, along with associations between alcohol use and two of the symptom clusters: PTSD reexperiencing symptoms, B = 0.01, p = .016; and PTSD avoidance/numbing symptoms, B = 0.01, p = .029. Veterans with high levels of impulsivity were at significantly higher risk of engaging in alcohol use than veterans with low-to-average levels. Impulsivity did not potentiate the relation between PTSD hyperarousal symptoms and alcohol use nor did it moderate the association between any of the PTSD variables and drug use. Impulsivity appears to serve as a significant risk factor for alcohol use, but not drug use, for male veterans experiencing PTSD symptoms. Future studies are necessary to replicate and expand upon these findings, particularly to facilitate the development of integrated evidence-based treatments that target both alcohol use and impulsivity within the context of PTSD.
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Affiliation(s)
- Colin T. Mahoney
- National Center for PTSD, Behavioral Science Division, 150 S. Huntington Avenue, Boston, MA, USA, 02130,VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, USA, 02130,Boston University School of Medicine, Department of Psychiatry, 72 E. Concord Street, Boston, MA, USA, 02118
| | - Hannah E. Cole
- National Center for PTSD, Behavioral Science Division, 150 S. Huntington Avenue, Boston, MA, USA, 02130,VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, USA, 02130
| | - Ohad Gilbar
- National Center for PTSD, Behavioral Science Division, 150 S. Huntington Avenue, Boston, MA, USA, 02130,VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, USA, 02130,Boston University School of Medicine, Department of Psychiatry, 72 E. Concord Street, Boston, MA, USA, 02118
| | - Casey T. Taft
- National Center for PTSD, Behavioral Science Division, 150 S. Huntington Avenue, Boston, MA, USA, 02130,VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, USA, 02130,Boston University School of Medicine, Department of Psychiatry, 72 E. Concord Street, Boston, MA, USA, 02118
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25
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Białaszek W, Marcowski P, Cox DJ. Comparison of multiplicative and additive hyperbolic and hyperboloid discounting models in delayed lotteries involving gains and losses. PLoS One 2020; 15:e0233337. [PMID: 32442186 PMCID: PMC7244164 DOI: 10.1371/journal.pone.0233337] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 05/05/2020] [Indexed: 11/18/2022] Open
Abstract
Many day-to-day decisions may involve risky outcomes that occur at some delay after a decision has been made. We refer to such scenarios as delayed lotteries. Despite human choice often involves delayed lotteries, past research has primarily focused on decisions with delayed or risky outcomes. Comparatively, less research has explored how delay and probability interact to influence decisions. Within research on delayed lotteries, rigorous comparisons of models that describe choice from the discounting framework have not been conducted. We performed two experiments to determine how gain or loss outcomes are devalued when delayed and risky. Experiment 1 used delay and probability ranges similar to past research on delayed lotteries. Experiment 2 used individually calibrated delay and probability ranges. Ten discounting models were fit to the data using a genetic algorithm. Candidate models were derived from past research on discounting delayed or probabilistic outcomes. We found that participants' behavior was best described primarily by a three-parameter multiplicative model. Measures based on information criteria pointed to a solution in which only delay and probability were psychophysically scaled. Absolute measures based on residuals pointed to a solution in which amount, delay, and probability are simultaneously scaled. Our research suggests that separate scaling parameters for different discounting factors may not be necessary with delayed lotteries.
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Affiliation(s)
- Wojciech Białaszek
- SWPS University of Social Sciences and Humanities, Warsaw, Poland
- * E-mail:
| | | | - David J. Cox
- JHUSOM Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medicine, Odenton, Maryland United States of America
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Gunawan T, Hachiga Y, Tripoli CS, Silberberg A, Kearns DN. Heroin choice depends on income level and economy type. Psychopharmacology (Berl) 2020; 237:1447-1457. [PMID: 31993695 PMCID: PMC7196508 DOI: 10.1007/s00213-020-05471-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/21/2020] [Indexed: 12/25/2022]
Abstract
RATIONALE In a previous study, investigating choice between heroin and a non-drug alternative in animals and reductions in income (i.e., choices/day) caused the percentage of income spent on heroin to progressively decrease. In contrast, another study found that humans with opioid use disorder spent the majority of their income on heroin even though they had little income. Comparison of these two studies suggests that the seemingly conflicting results could be explained by differences in the underlying economy types of the choice alternatives. OBJECTIVE The present experiment tested the hypothesis that the effect of income changes on choice between heroin and a non-drug alternative depends on economy type. METHODS Rats chose between heroin and saccharin under three income levels. For the Closed group, the choice session was the only opportunity to obtain these reinforcers. For the Heroin Open group and the Saccharin Open group, choice sessions were followed by 3-h periods of unlimited access to heroin or saccharin, respectively. RESULTS As income decreased, the Closed and Heroin Open groups, but not the Saccharin Open group, spent an increasingly greater percentage of income on saccharin than on heroin. The Saccharin Open group, compared to the other groups, spent a greater percentage of income on heroin as income decreased. CONCLUSIONS Results confirm that the effects of income and economy type can interact and this may explain the apparently discrepant results of earlier studies. More generally, findings suggest that situations where heroin choice has little consequence for consumption of non-drug alternatives may promote heroin use.
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Affiliation(s)
- Tommy Gunawan
- Psychology Department, American University, 4400 Massachusetts Ave NW, Washington, DC, 20016, USA
| | - Yosuke Hachiga
- Center for Decision Research, Waseda University, Tokyo, Japan
| | - Christopher S Tripoli
- Psychology Department, American University, 4400 Massachusetts Ave NW, Washington, DC, 20016, USA
| | - Alan Silberberg
- Psychology Department, American University, 4400 Massachusetts Ave NW, Washington, DC, 20016, USA
| | - David N Kearns
- Psychology Department, American University, 4400 Massachusetts Ave NW, Washington, DC, 20016, USA.
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Hlavatá P, Linhartová P, Šumec R, Filip P, Světlák M, Baláž M, Kašpárek T, Bareš M. Behavioral and Neuroanatomical Account of Impulsivity in Parkinson's Disease. Front Neurol 2020; 10:1338. [PMID: 31998210 PMCID: PMC6965152 DOI: 10.3389/fneur.2019.01338] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 12/03/2019] [Indexed: 12/12/2022] Open
Abstract
Impulse control disorder (ICD) is a major non-motor complication of Parkinson's disease (PD) with often devastating consequences for patients' quality of life. In this study, we aimed to characterize the phenotype of impulsivity in PD and its neuroanatomical correlates. Methods: Thirty-seven PD patients (15 patients with ICD, 22 patients without ICD) and 36 healthy controls underwent a neuropsychological battery. The test battery consisted of anxiety and depression scales, self-report measures of impulsivity (Barratt scale and UPPS-P), behavioral measures of impulsive action (Go/No-Go task, Stop signal task) and impulsive choice (Delay discounting, Iowa gambling task), and measures of cognitive abilities (working memory, attention, executive function). Patients and controls underwent structural MRI scanning. Results: Patients with ICD had significantly higher levels of self-reported impulsivity (Barratt scale and Lack of perseverance from UPPS-P) in comparison with healthy controls and non-impulsive PD patients, but they performed similarly in behavioral tasks, except for the Iowa gambling task. In this task, patients with ICD made significantly less risky decisions than patients without ICD and healthy controls. Patients without ICD did not differ from healthy controls in self-reported impulsivity or behavioral measurements. Both patient groups were more anxious and depressive than healthy controls. MRI scanning revealed structural differences in cortical areas related to impulse control in both patient groups. Patients without ICD had lower volumes and cortical thickness of bilateral inferior frontal gyrus. Patients with ICD had higher volumes of right caudal anterior cingulate and rostral middle frontal cortex. Conclusions: Despite the presence of ICD as confirmed by both clinical follow-up and self-reported impulsivity scales and supported by structural differences in various neural nodes related to inhibitory control and reward processing, patients with ICD performed no worse than healthy controls in various behavioral tasks previously hypothesized as robust impulsivity measures. These results call for caution against impetuous interpretation of behavioral tests, since various factors may and will influence the ultimate outcomes, be it the lack of sensitivity in specific, limited ICD subtypes, excessive caution of ICD patients during testing due to previous negative experience rendering simplistic tasks insufficient, or other, as of now unknown aspects, calling for further research.
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Affiliation(s)
- Pavlína Hlavatá
- Department of Psychiatry, Faculty of Medicine, Masaryk University Brno and University Hospital, Brno, Czechia.,Behavioral and Social Neuroscience Research Group, CEITEC-Central European Institute of Technology, Masaryk University, Brno, Czechia
| | - Pavla Linhartová
- Department of Psychiatry, Faculty of Medicine, Masaryk University Brno and University Hospital, Brno, Czechia
| | - Rastislav Šumec
- First Department of Neurology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital, Brno, Czechia
| | - Pavel Filip
- First Department of Neurology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital, Brno, Czechia
| | - Miroslav Světlák
- Faculty of Medicine, Institute of Psychology and Psychosomatics, Masaryk University Brno and University Hospital, Brno, Czechia
| | - Marek Baláž
- First Department of Neurology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital, Brno, Czechia
| | - Tomáš Kašpárek
- Department of Psychiatry, Faculty of Medicine, Masaryk University Brno and University Hospital, Brno, Czechia
| | - Martin Bareš
- First Department of Neurology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital, Brno, Czechia.,Department of Neurology, School of Medicine, University of Minnesota, Minneapolis, MN, United States
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Rung JM, Frye CCJ, DeHart WB, Odum AL. Evaluating the effect of delay spacing on delay discounting: carry-over effects on steepness and the form of the discounting function. J Exp Anal Behav 2019; 112:254-272. [PMID: 31694068 DOI: 10.1002/jeab.556] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 10/12/2019] [Indexed: 11/10/2022]
Abstract
Most delay discounting studies use tasks that arrange delay progressions in which the spacing between consecutive delays becomes progressively larger. To date, little research has examined delay discounting using other progressions. The present study assessed whether the form or steepness of discounting varied across different delay progressions. Human participants completed three discounting tasks with delay progressions that varied in the time between consecutive delays: a standard (increasing duration between delays), linear (equal duration between delays), and an inverse progression (decreasing duration between delays). Steepness of discounting was generally reduced, and remained so, following experience with the inverse progression. Effects of the delay progression on the best fitting equation were order-dependent. Overall the hyperbola model provided better fits, but the exponential model performed better with data from the inverse progression. Regardless, differences in which model fit best were often small. The finding that the best fitting model was dependent, in some cases, on the delay progression suggests that a single quantitative model of discounting may not be applicable to describe discounting across all procedural contexts. Ultimately, changes in steepness of discounting following experience with the inverse progression appeared similar to anchoring effects, whose mechanism will require further study to delineate.
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Jones J, Guest JL, Sullivan PS, Kramer MR, Jenness SM, Sales JM. Concordance between monetary and sexual delay discounting in men who have sex with men. Sex Health 2019; 15:214-222. [PMID: 29212590 DOI: 10.1071/sh17111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 09/15/2017] [Indexed: 11/23/2022]
Abstract
Background Delay discounting has been found to be associated with numerous health-related outcomes, including risky sexual behaviour. To date, it is unclear whether delay discounting measured in different domains is associated within individuals. The goal of this study was to assess the concordance of monetary and sexual delay discounting in men who have sex with men. METHODS Participants completed an online survey, including the Monetary Choice Questionnaire and the Sexual Discounting Task. Linear regression models were used to assess the association between monetary and sexual discount rates. RESULTS Sexual discount rates did not predict monetary discount rates. There was a substantial amount of clustering of sexual discount rates, requiring sexual discounting data to be categorised. CONCLUSIONS Monetary and sexual delay discounting are distinct processes that are not necessarily associated within individuals, and monetary delay discounting is not an appropriate proxy measure for sexual impulsivity. Data from the Sexual Discounting Task are typically rank-transformed for analysis. These data suggest that this might be an invalid method of analysis. Future studies should investigate the distribution of their data to determine if it is appropriate to analyse sexual discounting data as a continuous measure.
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Affiliation(s)
- Jeb Jones
- Department of Epidemiology, Emory University, 1518 Clifton Road, Atlanta, GA 30322
| | - Jodie L Guest
- Department of Epidemiology, Emory University, 1518 Clifton Road, Atlanta, GA 30322
| | - Patrick S Sullivan
- Department of Epidemiology, Emory University, 1518 Clifton Road, Atlanta, GA 30322
| | - Michael R Kramer
- Department of Epidemiology, Emory University, 1518 Clifton Road, Atlanta, GA 30322
| | - Samuel M Jenness
- Department of Epidemiology, Emory University, 1518 Clifton Road, Atlanta, GA 30322
| | - Jessica M Sales
- Department of Behavioral Sciences and Health Education, Emory University, 1518 Clifton Road, Atlanta, GA 30322
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Igaki T, Romanowich P, Yamagishi N. Using Smartphones While Walking is Associated with Delay but Not Social Discounting. PSYCHOLOGICAL RECORD 2019. [DOI: 10.1007/s40732-019-00348-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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31
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Changing Delay Discounting and Impulsive Choice: Implications for Addictions, Prevention, and Human Health. Perspect Behav Sci 2019; 42:397-417. [PMID: 31650104 DOI: 10.1007/s40614-019-00200-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Delay discounting describes the tendency to devalue delayed consequences or future prospects. The degree to which an individual discounts delayed events appears trait-like in that it is stable over time and across functionally similar situations. Steeply discounting delayed rewards is correlated with most substance-use disorders, the severity of these disorders, rates of relapse to drug use, and a host of other maladaptive decisions impacting human health. Longitudinal data suggest steep delay discounting and high levels of impulsive choice are predictive of subsequent drug taking, which suggests (though does not establish) that reducing delay discounting could have a preventive health-promoting effect. Experimental manipulations that produce momentary or long-lasting reductions in delay discounting or impulsive choice are reviewed, and behavioral mechanisms that may underlie these effects are discussed. Shortcomings of each manipulation technique are discussed and areas for future research are identified. While much work remains, it is clear that impulsive decision-making can be reduced, despite its otherwise trait-like qualities. Such findings invite technique refinement, translational research, and hope.
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Athamneh LN, DeHart WB, Pope D, Mellis AM, Snider SE, Kaplan BA, Bickel WK. The phenotype of recovery III: Delay discounting predicts abstinence self-efficacy among individuals in recovery from substance use disorders. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2019; 33:310-317. [PMID: 30896193 DOI: 10.1037/adb0000460] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Abstinence self-efficacy (ASE) and delay discounting predict treatment outcomes and risk of relapse. Associations between delay discounting and ASE among individuals in recovery from substance use have not been investigated. Data from 216 individuals in recovery from substance abuse recruited from The International Quit & Recovery Registry, an ongoing online data collection program used to understand addiction and how people succeed in recovery, were included in the analysis. Discounting rates were assessed using an adjusting-delay task, and ASE was assessed using the Relapse Situation Efficacy Questionnaire (RSEQ). Delay discounting was a significant predictor of ASE, even after controlling for age, gender, race, ethnicity, annual income, education level, marital status, and primary addiction. Context-specific factors of relapse included Negative Affect, Positive Affect, Restrictive Situations (to drug use), Idle Time, Social-Food Situations, Low Arousal, and Craving. A principal component analysis of RSEQ factors in the current sample revealed that self-efficacy scores were primarily unidimensional and not situation specific. The current study expands the generality of delay discounting and indicates that discounting rates predict ASE among individuals in recovery from substance use disorders. This finding supports the recent characterizations of delay discounting as a candidate behavioral marker of addiction and may serve as a basis to better identify and target subgroups that need unique or more intensive interventions to address higher risks of relapse and increase their likelihood of abstinence. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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33
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Phung QH, Snider SE, Tegge AN, Bickel WK. Willing to Work But Not to Wait: Individuals with Greater Alcohol Use Disorder Show Increased Delay Discounting Across Commodities and Less Effort Discounting for Alcohol. Alcohol Clin Exp Res 2019; 43:927-936. [PMID: 30817019 DOI: 10.1111/acer.13996] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 02/20/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Delay discounting refers to the devaluation of a reward given increasing delays to delivery. Similarly, effort discounting refers to the devaluation of a reward given increasing effort required to obtain it. Individuals with substance use disorder show higher rates of delay discounting, exacerbating short-term positive reinforcement at the expense of long-term consequences. This study explores how effort discounting compares to delay discounting behavior among alcohol users as well as how these preferences change between monetary and alcohol rewards. METHODS A total of 100 participants completed an online survey through Amazon Mechanical Turk. Participant alcohol use was evaluated using DSM-5 and the Alcohol Use Disorders Identification Test criteria. All participants completed 4 randomized discounting tasks involving delay or effort discounting, in which the reward was money or alcohol. A follow-up experiment (n = 423) added the alcohol purchase task to assess alcohol valuation. RESULTS Individuals with greater alcohol use disorder (AUD) severity discounted future money and alcohol significantly more than those with less AUD. However, individuals meeting more DSM-5 criteria were only willing to perform more effort for alcohol. The follow-up experiment replicated these findings and demonstrated that individuals with greater AUD also showed an increased valuation of alcohol and alcohol value-mediated effort discounting. CONCLUSIONS These results suggest that individuals with greater AUD were less willing to wait for money or alcohol. While all participants were willing to work for money regardless of AUD severity, individuals with greater AUD showed increased valuation of alcohol drinks and were willing to exert more effort to obtain alcohol. Together, these results paint a picture of individuals with increased AUD as both more impulsive and willing to work to obtain alcohol, contributing to our understanding of decision making among individuals who abuse substances.
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Affiliation(s)
- Quan H Phung
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Sarah E Snider
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia
| | - Allison N Tegge
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia.,Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia.,Department of Statistics, Virginia Tech, Blacksburg, Virginia
| | - Warren K Bickel
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia
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Scholl J, Klein-Flügge M. Understanding psychiatric disorder by capturing ecologically relevant features of learning and decision-making. Behav Brain Res 2018; 355:56-75. [PMID: 28966147 PMCID: PMC6152580 DOI: 10.1016/j.bbr.2017.09.050] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 07/24/2017] [Accepted: 09/27/2017] [Indexed: 01/06/2023]
Abstract
Recent research in cognitive neuroscience has begun to uncover the processes underlying increasingly complex voluntary behaviours, including learning and decision-making. Partly this success has been possible by progressing from simple experimental tasks to paradigms that incorporate more ecological features. More specifically, the premise is that to understand cognitions and brain functions relevant for real life, we need to introduce some of the ecological challenges that we have evolved to solve. This often entails an increase in task complexity, which can be managed by using computational models to help parse complex behaviours into specific component mechanisms. Here we propose that using computational models with tasks that capture ecologically relevant learning and decision-making processes may provide a critical advantage for capturing the mechanisms underlying symptoms of disorders in psychiatry. As a result, it may help develop mechanistic approaches towards diagnosis and treatment. We begin this review by mapping out the basic concepts and models of learning and decision-making. We then move on to consider specific challenges that emerge in realistic environments and describe how they can be captured by tasks. These include changes of context, uncertainty, reflexive/emotional biases, cost-benefit decision-making, and balancing exploration and exploitation. Where appropriate we highlight future or current links to psychiatry. We particularly draw examples from research on clinical depression, a disorder that greatly compromises motivated behaviours in real-life, but where simpler paradigms have yielded mixed results. Finally, we highlight several paradigms that could be used to help provide new insights into the mechanisms of psychiatric disorders.
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Affiliation(s)
- Jacqueline Scholl
- Department of Experimental Psychology, University of Oxford, Tinsley Building, Mansfield Road, Oxford, OX1 3SR, United Kingdom.
| | - Miriam Klein-Flügge
- Department of Experimental Psychology, University of Oxford, Tinsley Building, Mansfield Road, Oxford, OX1 3SR, United Kingdom.
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Rung JM, Madden GJ. Experimental reductions of delay discounting and impulsive choice: A systematic review and meta-analysis. J Exp Psychol Gen 2018; 147:1349-1381. [PMID: 30148386 DOI: 10.1037/xge0000462] [Citation(s) in RCA: 154] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Many behaviors posing significant risks to public health are characterized by repeated decisions to forego better long-term outcomes in the face of immediate temptations. Steeply discounting the value of delayed outcomes often underlies a pattern of impulsive choice. Steep delay discounting is correlated with addictions (e.g., substance abuse, obesity) and behaviors such as seatbelt use and risky sexual activity. As evidence accumulates suggesting steep delay discounting plays a causal role in these maladaptive behaviors, researchers have begun testing methods for reducing discounting. In this first systematic and comprehensive review of this literature, the findings of 92 articles employing different methodologies to reduce discounting are evaluated narratively and meta-analytically. Although most of the methods reviewed produced significant reductions in discounting, they varied in effect sizes. Most methods were ideal for influencing one-off choices (e.g., framing and priming manipulations), although other successful manipulations, such as episodic future thinking, could be incorporated into existing therapies designed to produce longer-lasting changes in decision-making. The largest and longest-lasting effects were produced by learning-based manipulations, although translational research is needed to determine the generality and clinical utility of these methods. Methodological shortcomings in the existing literature and suggestions for ameliorating these issues are discussed. This review reveals a variety of methods with translational potential, which, through continued refinement, may prove effective in reducing impulsive choice and its associated maladaptive decisions that negatively impact quality of life. (PsycINFO Database Record
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36
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A Measure of Delay Discounting Within the Academic Domain. JOURNAL OF BEHAVIORAL DECISION MAKING 2018. [DOI: 10.1002/bdm.2074] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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37
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Koffarnus MN, Kaplan BA. Clinical models of decision making in addiction. Pharmacol Biochem Behav 2018; 164:71-83. [PMID: 28851586 PMCID: PMC5747979 DOI: 10.1016/j.pbb.2017.08.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 08/08/2017] [Accepted: 08/21/2017] [Indexed: 01/25/2023]
Abstract
As research on decision making in addiction accumulates, it is increasingly clear that decision-making processes are dysfunctional in addiction and that this dysfunction may be fundamental to the initiation and maintenance of addictive behavior. How drug-dependent individuals value and choose among drug and nondrug rewards is consistently different from non-dependent individuals. The present review focuses on the assessment of decision-making in addiction. We cover the common behavioral tasks that have shown to be fruitful in decision-making research and highlight analytical and graphical considerations, when available, to facilitate comparisons within and among studies. Delay discounting tasks, drug demand tasks, drug choice tasks, the Iowa Gambling Task, and the Balloon Analogue Risk Task are included.
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Affiliation(s)
- Mikhail N Koffarnus
- Virginia Tech Carilion Research Institute, 2 Riverside Circle, Roanoke, VA 24016, United States.
| | - Brent A Kaplan
- Virginia Tech Carilion Research Institute, 2 Riverside Circle, Roanoke, VA 24016, United States
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38
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Athamneh LN, Stein JS, Quisenberry AJ, Pope D, Bickel WK. The association between parental history and delay discounting among individuals in recovery from addiction. Drug Alcohol Depend 2017; 179:153-158. [PMID: 28780380 PMCID: PMC5599355 DOI: 10.1016/j.drugalcdep.2017.06.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 06/13/2017] [Accepted: 06/16/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Family history of addiction is a risk factor for substance use disorders. Delay discounting (DD) is associated with the risk of substance use and dependence, and is predictive of the likelihood of successful abstinence and treatment outcomes; thus, we investigated the extent to which having parents with addiction (parental history of addiction) and number of addicted parents affect DD among individuals in recovery from addiction. METHODS Data from 177 individuals in recovery from addiction from The International Quit and Recovery Registry (IQRR), an ongoing online data collection program that aims to understand addiction and how people succeed in recovery, were included in the analysis. Participants with no, one, or two parents with addiction were compared on measures of DD using an adjusting-amount task. RESULTS Parental history of addiction was significantly associated with delay discounting. After controlling for age and gender, which were significantly different between groups, participants reporting two biological parents with addiction had significantly higher DD rates compared to those reporting one or no parents with addiction. CONCLUSIONS Participants with two parents with addiction had significantly higher rates of discounting compared to those with no or only one parent with addiction. This information can serve as a foundation to better identify and target important subgroups that need additional or non-traditional intervention strategies to address their larger degree of impulsivity and help maintain abstinence or achieve better treatment outcomes.
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Affiliation(s)
- Liqa N. Athamneh
- Addiction Recovery Research Center, Virginia Tech Carilion Research Institute, 2 Riverside Circle, Roanoke, VA 24016, United States,Graduate Program in Translational Biology, Medicine, and Health, Virginia Tech, 1 Riverside Circle, Roanoke, VA 24016, United States
| | - Jeffrey S. Stein
- Addiction Recovery Research Center, Virginia Tech Carilion Research Institute, 2 Riverside Circle, Roanoke, VA 24016, United States,Graduate Program in Translational Biology, Medicine, and Health, Virginia Tech, 1 Riverside Circle, Roanoke, VA 24016, United States
| | - Amanda J. Quisenberry
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, 1841 Neil Ave., Columbus, OH, 43210, United States
| | - Derek Pope
- Addiction Recovery Research Center, Virginia Tech Carilion Research Institute, 2 Riverside Circle, Roanoke, VA 24016, United States
| | - Warren K. Bickel
- Addiction Recovery Research Center, Virginia Tech Carilion Research Institute, 2 Riverside Circle, Roanoke, VA 24016, United States,Graduate Program in Translational Biology, Medicine, and Health, Virginia Tech, 1 Riverside Circle, Roanoke, VA 24016, United States,Department of Psychology, Virginia Tech, 109 Williams Hall, Blacksburg, VA 24061, United States,Department of Neuroscience, Virginia Tech, 300 Turner Street NW, Blacksburg, VA 24061, United States,Faculty of Health Sciences, Virginia Tech, 1 Riverside Circle, Roanoke, VA 24016, United States,Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, 2 Riverside Circle, Roanoke, VA 24016, United States
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Impulsivity as a mechanism linking child abuse and neglect with substance use in adolescence and adulthood. Dev Psychopathol 2017; 30:417-435. [DOI: 10.1017/s0954579417000943] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AbstractEmerging developmental perspectives suggest that adverse rearing environments promote neurocognitive adaptations that heighten impulsivity and increase vulnerability to risky behavior. Although studies document links between harsh rearing environments and impulsive behavior on substance use, the developmental hypothesis that impulsivity acts as mechanism linking adverse rearing environments to downstream substance use remains to be investigated. The present study investigated the role of impulsivity in linking child abuse and neglect with adult substance use using data from (a) a longitudinal sample of youth (Study 1, N = 9,421) and (b) a cross-sectional sample of adults (Study 2, N = 1,011). In Study 1, the links between child abuse and neglect and young adult smoking and marijuana use were mediated by increases in adolescent impulsivity. In Study 2, indirect links between child abuse and neglect and substance use were evidenced via delayed reward discounting and impulsivity traits. Among impulsivity subcomponents, robust indirect effects connecting childhood experiences to cigarette use emerged for negative urgency. Negative urgency, positive urgency, and sensation seeking mediated the effect of child abuse and neglect on cannabis and alcohol use. Results suggest that child abuse and neglect increases risk for substance use in part, due to effects on impulsivity. Individuals with adverse childhood experiences may benefit from substance use preventive intervention programs that target impulsive behaviors.
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40
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Delay of Gratification and Delay Discounting: A Unifying Feedback Model of Delay-Related Impulsive Behavior. PSYCHOLOGICAL RECORD 2017. [DOI: 10.1007/bf03395520] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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41
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Yi R, King LF, Carter AE, Landes RD, Bickel WK. INTERTEMPORAL DECISION-MAKING FOR A GROUP. PSYCHOLOGICAL RECORD 2017; 60:577-586. [PMID: 25598553 DOI: 10.1007/bf03395733] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Temporal discounting assessments measure the reduction in the subjective value of a reward as a function of the delay to that reward, and are correlated with behavior in social dilemma. Among the solutions proposed for defection in social dilemmas is a single individual making the decisions for the group. The present study examined the influence of group context on temporal discounting. Participants completed temporal discounting procedures when the outcomes affected only the individual and when outcomes affected a group of 10, including the individual. Though no overall difference was observed between the individual and group conditions, sex was found to be a moderating variable: Males discounted significantly more when discounting for the individual, but females discounted significantly more when discounting for the group. These results indicate that sex is an important variable when making intertemporal decisions for a group.
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Affiliation(s)
- Richard Yi
- University of Arkansas for Medical Sciences
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42
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Charlton SR, Gossett BD, Charlton VA. Beyond the Shadow of a Trait: Understanding Discounting Through Item-Level Analysis of Personality Scales. PSYCHOLOGICAL RECORD 2017. [DOI: 10.1007/bf03395778] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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43
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McKerchar TL, Renda CR. Delay and Probability Discounting in Humans: An Overview. PSYCHOLOGICAL RECORD 2017. [DOI: 10.1007/bf03395837] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Amlung M, Vedelago L, Acker J, Balodis I, MacKillop J. Steep delay discounting and addictive behavior: a meta-analysis of continuous associations. Addiction 2017; 112:51-62. [PMID: 27450931 PMCID: PMC5148639 DOI: 10.1111/add.13535] [Citation(s) in RCA: 307] [Impact Index Per Article: 43.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 06/27/2016] [Accepted: 07/15/2016] [Indexed: 12/19/2022]
Abstract
AIMS To synthesize continuous associations between delayed reward discounting (DRD) and both addiction severity and quantity-frequency (QF); to examine moderators of these relationships; and to investigate publication bias. METHODS Meta-analysis of published studies examining continuous associations between DRD and addictive behaviors. Published, peer-reviewed studies on addictive behaviors (alcohol, tobacco, cannabis, stimulants, opiates and gambling) were identified via PubMed, MEDLINE and PsycInfo. Studies were restricted to DRD measures of monetary gains. Random-effects meta-analysis was conducted using Pearson's r as the effect size. Publication bias was evaluated using fail-safe N, Begg-Mazumdar and Egger's tests, meta-regression of publication year and effect size and imputation of missing studies. RESULTS The primary meta-analysis revealed a small magnitude effect size that was highly significant (r = 0.14, P < 10-14 ). Significantly larger effect sizes were observed for studies examining severity compared with QF (P = 0.01), but not between the type of addictive behavior (P = 0.30) or DRD assessment (P = 0.90). Indices of publication bias suggested a modest impact of unpublished findings. CONCLUSIONS Delayed reward discounting is associated robustly with continuous measures of addiction severity and quantity-frequency. This relation is generally robust across type of addictive behavior and delayed reward discounting assessment modality.
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Affiliation(s)
- Michael Amlung
- Peter Boris Centre for Addictions Research, McMaster University/St. Joseph’s Healthcare Hamilton; 100 West 5 St, Hamilton, Ontario, Canada L8N 3K7
| | - Lana Vedelago
- Peter Boris Centre for Addictions Research, McMaster University/St. Joseph’s Healthcare Hamilton; 100 West 5 St, Hamilton, Ontario, Canada L8N 3K7
| | - John Acker
- Center for Integrated Healthcare, Syracuse VA Medical Center; Syracuse, NY 13210 USA
| | - Iris Balodis
- Peter Boris Centre for Addictions Research, McMaster University/St. Joseph’s Healthcare Hamilton; 100 West 5 St, Hamilton, Ontario, Canada L8N 3K7
| | - James MacKillop
- Peter Boris Centre for Addictions Research, McMaster University/St. Joseph’s Healthcare Hamilton; 100 West 5 St, Hamilton, Ontario, Canada L8N 3K7,Homewood Research Institute, Homewood Health Centre; 150 Delhi St, Guelph, Ontario, Canada N1E 6K9
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Hayashi Y, Miller K, Foreman AM, Wirth O. A behavioral economic analysis of texting while driving: Delay discounting processes. ACCIDENT; ANALYSIS AND PREVENTION 2016; 97:132-140. [PMID: 27614547 PMCID: PMC5154926 DOI: 10.1016/j.aap.2016.08.028] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/24/2016] [Accepted: 08/26/2016] [Indexed: 05/09/2023]
Abstract
The purpose of the present study was to examine an impulsive decision-making process underlying texting while driving from a behavioral economic perspective. A sample of 108 college students completed a novel discounting task that presented participants with a hypothetical scenario in which, after receiving a text message while driving, they rated the likelihood of replying to a text message immediately versus waiting to reply for a specific period of time. Participants also completed a delay discounting task in which they made repeated hypothetical choices between obtaining a larger amount of money available after a delay and an equal or lesser amount of money available immediately. The results show that the duration of the delay is a critical variable that strongly determines whether participants choose to wait to reply to a text message, and that the decrease in the likelihood of waiting as a function of delay is best described by a hyperbolic delay discounting function. The results also show that participants who self-reported higher frequency of texting while driving discounted the opportunity to reply to a text message at greater rates, whereas there was no relation between the rates of discounting of hypothetical monetary rewards and the frequency of texting while driving. The results support the conclusion that texting while driving is fundamentally an impulsive choice.
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Affiliation(s)
- Yusuke Hayashi
- Pennsylvania State University, Hazleton, 76 University Drive, Hazleton, PA 18202, USA.
| | - Kimberly Miller
- Pennsylvania State University, Hazleton, 76 University Drive, Hazleton, PA 18202, USA
| | - Anne M Foreman
- National Institute for Occupational Safety and Health, 1095 Willowdale Rd, Morgantown, WV 26505, USA
| | - Oliver Wirth
- National Institute for Occupational Safety and Health, 1095 Willowdale Rd, Morgantown, WV 26505, USA
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47
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Jackson JNS, MacKillop J. Attention-Deficit/Hyperactivity Disorder and Monetary Delay Discounting: A Meta-Analysis of Case-Control Studies. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2016; 1:316-325. [PMID: 27722208 PMCID: PMC5049699 DOI: 10.1016/j.bpsc.2016.01.007] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND A growing number of studies have investigated delay discounting, a behavioral economic index of impulsivity, and its relevance to attention deficit hyperactivity disorder (ADHD), but with mixed findings. The current meta-analysis synthesizes the literature on the relationship between monetary delay discounting and ADHD in studies using case-control designs. Specifically, the objectives were: 1) to characterize the aggregated differences in monetary delay discounting between individuals with ADHD (cases) and controls in studies using categorical case-control designs; 2) to examine potential differences based on sample age (<18 vs. >18), reward outcome (real vs. hypothetical), and prevalence of conduct disorder and oppositional defiant disorder in the sample; and 3) to evaluate potential small-study (publication) bias in the literature. METHODS From 567 candidate articles, 21 independent investigations yielded 25 case-control comparisons (total N=3,913). Random effects meta-analysis was conducted using Cohen's d as the common effect size. Publication bias was evaluated using fail-safe N, Begg-Mazumdar and Egger tests, and metaregression of publication year and effect size. RESULTS Across studies, a statistically significant difference of medium magnitude effect size was present for the case-control comparisons (d=0.43; p < 10-15). No significant differences based on sample age, reward outcome, or comorbid status was detected. Minimal heterogeneity and evidence of publication bias was present. CONCLUSIONS These findings provide robust evidence that delay discounting is significantly elevated among individuals with ADHD compared to controls. Gaps in the literature and the importance of characterizing the neural and genetic bases of this relationship are discussed.
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Affiliation(s)
- Jacob N S Jackson
- Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - James MacKillop
- Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada; Homewood Research Institute, Homewood Health Centre, Guelph, Ontario, Canada
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Abstract
The author presents a selective and integrative overview of cur-rent research examining acute effects of abused drugs on aspects of behavioral control in humans. The review discusses the concept of behavioral control and reviews research models that examine inhibitory influences as a central mechanism of control. Evidence for drug-induced impairment of inhibitory mechanisms is reviewed from current neuroanatomical, neuropharmacological, and behavioral perspectives. Model-based laboratory assessments of behavioral control are described in terms of their application to behavioral pharmacology and evidence for alcohol and psychostimulant effects on basic inhibitory mechanisms is reviewed. Drug effects on inhibitory mechanisms are also discussed in terms of their relevance to higher-order cognitive and behavioral functions, and in relation to impulsive behaviors, such as drug abuse. The review concludes by identifying important drug-related phenomenon (e.g., drug tolerance, cue reactivity) that might also be studied in behavioral control frameworks in future research.
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49
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Vanderveldt A, Oliveira L, Green L. Delay discounting: Pigeon, rat, human--does it matter? JOURNAL OF EXPERIMENTAL PSYCHOLOGY-ANIMAL LEARNING AND COGNITION 2016; 42:141-62. [PMID: 26881899 DOI: 10.1037/xan0000097] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Delay discounting refers to the decrease in subjective value of an outcome as the time to its receipt increases. Across species and situations, animals discount delayed rewards, and their discounting is well-described by a hyperboloid function. The current review begins with a comparison of discounting models and the procedures used to assess delay discounting in nonhuman animals. We next discuss the generality of discounting, reviewing the effects of different variables on the degree of discounting delayed reinforcers by nonhuman animals. Despite the many similarities in discounting observed between human and nonhuman animals, several differences have been proposed (e.g., the magnitude effect; nonhuman animals discount over a matter of seconds whereas humans report willing to wait months, if not years before receiving a reward), raising the possibility of fundamental species differences in intertemporal choice. After evaluating these differences, we discuss delay discounting from an adaptationist perspective. The pervasiveness of discounting across species and situations suggests it is a fundamental process underlying decision making.
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Affiliation(s)
| | - Luís Oliveira
- Department of Psychological and Brain Sciences, Washington University
| | - Leonard Green
- Department of Psychological and Brain Sciences, Washington University
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Stoltman JJ, Woodcock EA, Lister JJ, Lundahl LH, Greenwald MK. Heroin delay discounting: Modulation by pharmacological state, drug-use impulsivity, and intelligence. Exp Clin Psychopharmacol 2015; 23:455-63. [PMID: 26595426 PMCID: PMC4661782 DOI: 10.1037/pha0000054] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Delay discounting (DD) refers to how rapidly an individual devalues goods based on delays to receipt. DD usually is considered a trait variable but can be state dependent, yet few studies have assessed commodity valuation at short, naturalistically relevant time intervals that might enable state-dependent analysis. This study aimed to determine whether drug-use impulsivity and intelligence influence heroin DD at short (ecologically relevant) delays during two pharmacological states (heroin satiation and withdrawal). Out-of-treatment, intensive heroin users (n = 170; 53.5% African American; 66.7% male) provided complete DD data during imagined heroin satiation and withdrawal. Delays were 3, 6, 12, 24, 48, 72, and 96 hours; maximum delayed heroin amount was thirty $10 bags. Indifference points were used to calculate area under the curve (AUC). We also assessed drug-use impulsivity (subscales from the Impulsive Relapse Questionnaire [IRQ]) and estimated intelligence (Shipley IQ) as predictors of DD. Heroin discounting was greater (smaller AUC) during withdrawal than satiation. In regression analyses, lower intelligence and IRQ Capacity for Delay as well as higher IRQ Speed (to return to drug use) predicted greater heroin discounting in the satiation condition. Lower intelligence and higher IRQ Speed predicted greater discounting in the withdrawal condition. Sex, race, substance use variables, and other IRQ subscales were not significantly related to the withdrawal or satiation DD behavior. In summary, heroin discounting was temporally rapid, pharmacologically state dependent, and predicted by drug-use impulsivity and estimated intelligence. These findings highlight a novel and sensitive measure of acute DD that is easy to administer.
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Affiliation(s)
- Jonathan J.K. Stoltman
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI 48201, USA
| | - Eric A. Woodcock
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI 48201, USA
| | - Jamey J. Lister
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI 48201, USA
| | - Leslie H. Lundahl
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI 48201, USA
| | - Mark K. Greenwald
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI 48201, USA,Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI 48201, USA,Corresponding author at: Department of Psychiatry and Behavioral Neurosciences, Tolan Park Medical Building, Suite 2A, 3901 Chrysler Service Drive, Detroit, MI 48201, USA. Tel.: +1 313 993 3965; fax: +1 313 993 1372.
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