The relationship between delay discounting and alcohol dependence in individuals with and without comorbid psychopathology
Alcohol use disorder (AUD) has been associated with greater discounting of delayed monetary rewards, but it is unclear whether this association is primarily related to alcohol consumption or is secondary to the presence of psychiatric comorbidities. It is also unclear if steeper rates of discounting are associated with greater AUD severity.
We sought to determine whether the presence of comorbid psychiatric disorders affected the relationship between AUD and delay discounting. We also examined whether more severe AUD was associated with greater delay discounting.
In this cross-sectional study, 793 adults completed a delay discounting task. Subjects were divided into four groups based on diagnosis: current AUD with psychiatric comorbidities (N = 226), current AUD without psychiatric comorbidities (N = 203), past AUD (N = 69), and healthy controls (N = 295). In those with AUD, we investigated the relationship between delay discounting and alcohol dependence symptom count and recent drinking history. We also compared individuals seeking treatment to non-treatment seeking individuals. Psychiatric comorbidities examined included mood disorders, anxiety disorders, and substance use disorders.
After adjusting for age, sex, income, and education, individuals with current AUD showed significantly higher rates of delay discounting than healthy controls and individuals with a past diagnosis of AUD. The presence of comorbid psychiatric diagnoses was not associated with steeper discounting. Among those with AUD, there was no evidence for a continuous relationship between delay discounting and AUD severity or alcohol consumption. Finally, non-treatment seekers with AUD had steeper delay discounting than treatment seekers.
Individuals with AUD show steeper delay discounting than healthy adults, but the effect is small and there is no added effect from comorbid psychopathology or increased AUD severity. This suggests that steeper delay discounting may have a more limited effect on human alcohol use than previously supposed.
KeywordsAlcoholism Delay discounting Decision making Impulsivity Substance-related disorders Anxiety disorders Depression
We are grateful to Melanie Schwandt for compiling the data set and maintaining the database, and to Michael Kerich and Betsy Davis for maintaining the computer systems used for collecting the delay discounting data. We thank the nursing staff and the research assistants who have helped collect the data, and to all the participants for their time and cooperation. We also thank Alexandria Jensen for assistance with the ordinal logistic regression model.
This study was supported by the NIAAA Division of Intramural Clinical and Biological Research (Z1A AA000466) and a career development award (K99AA024778, PI: Gowin).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- First M, Spitzer RL, Gibbon M, Williams JB (2002) Structured clinical interview for DSM-IV-TR Axis I disorders, research version, patient edition with psychotic Screen (SCID-I/PW/PSY SCREEN). biometrics research, New York state psychiatric institute, New YorkGoogle Scholar
- Griswold MG, Fullman N, Hawley C, Arian N, Zimsen SR, Tymeson HD, Venkateswaran V, Tapp AD, Forouzanfar MH, Salama JS (2018) Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the global burden of disease study 2016. Lancet 392:1015–1035CrossRefGoogle Scholar
- Mazur JE (1987) An adjusting procedure for studying delayed reinforcement. Commons, ML; Mazur, JE; Nevin, JA: 55–73Google Scholar
- NIAAA (2004) NIAAA council approves definition of binge drinking. NIAAA Newslett 3Google Scholar
- Smyth A, Teo KK, Rangarajan S, O'Donnell M, Zhang XH, Rana P, Leong DP, Dagenais G, Seron P, Rosengren A, Schutte AE, Lopez-Jaramillo P, Oguz A, Chifamba J, Diaz R, Lear S, Avezum A, Kumar R, Mohan V, Szuba A, Wei L, Yang W, Jian B, McKee M, Yusuf S, Investigators P (2015) Alcohol consumption and cardiovascular disease, cancer, injury, admission to hospital, and mortality: a prospective cohort study. Lancet 386:1945–1954CrossRefGoogle Scholar
- Sobell LC, Sobell MB (1992) Timeline follow-back Measuring alcohol consumption. Springer, pp 41–72Google Scholar
- Spielberger CD (1983) Manual for the State-Trait Anxiety Inventory STAI (form Y)(" self-evaluation questionnaire")Google Scholar