Delay discounting describes the devaluation of a reinforcer as a function of the delay until its receipt. Although all people discount delayed reinforcers, one consistent finding is that substance-dependent individuals tend to discount delayed reinforcers more rapidly than do healthy controls. Moreover, these higher-than-normal discounting rates have been observed in individuals with other behavioral maladies such as pathological gambling, poor health behavior, and overeating. This suggests that high rates of delay discounting may be a trans-disease process (i.e., a process that occurs across a range of disorders, making findings from one disorder relevant to other disorders). In this paper, we argue that delay discounting is a trans-disease process, undergirded by an imbalance between two competing neurobehavioral decision systems. Implications for our understanding of, and treatment for, this trans-disease process are discussed.

Rationale Although there is considerable interest in how either executive function (EF) or impulsivity relate to addiction, there is little apparent overlap between these research areas. Objectives The present paper aims to determine if components of these two constructs are conceptual antipodes—widely separated on a shared continuum. Methods EFs and impulsivities were compared and contrasted. Specifically, the definitions of the components of EF and impulsivity, the methods used to measure the various components, the populations of drug users that show deficits in these components, and the neural substrates of these components were compared and contrasted. Results Each component of impulsivity had an antipode in EF. EF, however, covered a wider range of phenomena, including compulsivity. Conclusions Impulsivity functions as an antipode of certain components of EF. Recognition of the relationship between EF and impulsivity may inform the scientific inquiry of behavioral problems such as addiction. Other theoretical implications are discussed.

Excessively devaluing delayed reinforcers co-occurs with a wide variety of clinical conditions such as drug dependence, obesity, and excessive gambling. If excessive delay discounting is a trans-disease process that underlies the choice behavior leading to these and other negative health conditions, efforts to change an individual’s discount rate are arguably important. Although discount rate is often regarded as a relatively stable trait, descriptions of interventions and environmental manipulations that successfully alter discount rate have begun to appear in the literature. In this review, we compare published examples of procedures that change discount rate and classify them into categories of procedures, including therapeutic interventions, direct manipulation of the executive decision-making system, framing effects, physiological state effects, and acute drug effects. These changes in discount rate are interpreted from the perspective of the competing neurobehavioral decision systems theory, which describes a combination of neurological and behavioral processes that account for delay discounting. We also suggest future directions that researchers could take to identify the mechanistic processes that allow for changes in discount rate and to test whether the competing neurobehavioral decision systems view of delay discounting is correct.