Excessive discounting of delayed reinforcers as a trans-disease process contributing to addiction and other disease-related vulnerabilities: Emerging evidence

Abstract

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.

Commentary on Brunborg et al. (2012): Future possibilities for investigating gambling and diminished aversive conditioning

“…Of course, their findings will require further replication, ideally with a larger sample of gamblers with varying levels of addictive involvement, but they are consistent with the increasing body of research literature highlighting how conditioning with addictive behaviour involves different dynamics than other forms of learning [6][7][8].…”

Impulsivity as a vulnerability factor for poor addiction treatment outcomes: A review of neurocognitive findings among individuals with substance use disorders

“…The aforementioned notion may also explain why the more complex neurocognitive paradigms of cognitive inhibition of drug-related words, delay discounting and impulsive decision-making -which confront participants with motivationally relevant stimuli (e.g., drug-related cues, monetary rewards or punishments) -are better predictors of abstinence/relapse compared to the more simple paradigms used to index motor disinhibition. Indeed, performance on these tasks can be seen as a relatively straightforward index of the balance between topdown and bottom-up processes (Bickel, Jarmolowicz, Mueller, Koffarnus, & Gatchalian, 2012).…”

News from the NIH: using an experimental medicine approach to facilitate translational research

“…Warren Bickel and colleagues [3] identify one such basic behavioral process called temporal discounting-the devaluation of a reward as a function of the delay until its receipt-and propose that it may be a trans-disease process. The evidence seems to support this proposal, with higher-than-normal temporal discounting rates being associated with a range of problematic health behaviors and conditions, including alcohol and substance abuse, psychiatric disorders, obesity, cognitive decline, and lower rates of recommended cancer screening, preventive dental visits, cholesterol testing, flu vaccination, and safer sexual behavior [4].…”