The behavioral- and neuro-economic process of temporal discounting: A candidate behavioral marker of addiction

Abstract

Addiction science would benefit from the identification of a behavioral marker. A behavioral marker could reflect the projected clinical course of the disorder, function as a surrogate measure of clinical outcome, and/or may be related to biological components that underlie the disorder. In this paper we review relevant literature, made possible with the early and sustained support by NIDA, to determine whether temporal discounting, a neurobehavioral process derived from behavioral economics and further explored through neuroeconomics, may function as a behavioral marker. Our review suggests that temporal discounting 1) identifies individuals who are drug-dependent, 2) identifies those at risk of developing drug dependence, 3) acts as a gauge of addiction severity, 4) correlates with all stages of addiction development, 5) changes with effective treatment, and 6) may be related to the biological and genetic processes that underlie addiction. Thus, initial evidence supports temporal discounting as a candidate behavioral marker. Additional studies will be required in several areas for a more conclusive determination. Confirmation that temporal discounting functions as a behavioral marker for addiction could lead to 1) a screen for new treatments, 2) personalization of prevention and treatment interventions, and 3) the extension of temporal discounting as a behavioral marker for other etiologically similar disorders.

The NIH Science of Behavior Change Program: Transforming the science through a focus on mechanisms of change

“…Measures of these processes have been developed at many levels of analysis and across a diverse set of scientific fields, using techniques such as self-report instruments, field-based approaches (e.g., ecological momentary assessment), and direct assessments of cognitive (e.g., stop-signal task) and behavioral (e.g., temporal discounting tasks) components of self-regulation, as well as indirect measures such as the effect of reappraisal strategies on emotional function (e.g., Bickel, Koffarnus, Moody, & Wilson, 2014; Congdon et al, 2012; Gross & John, 2003). A variety of other-report and observational approaches exist, such as teacher, parent or informant reports of emotional regulatory skills, temperament, and behavior; and behavioral coding from free observation of the family environment, classroom behavior, social interactions, or eating behavior (e.g., Cooper, Balsis, & Oltmanns, 2014; Drake, Belsky, & Fearon, 2014; Lakes, 2013).…”

Effect of Delay on Self-Administration of Remifentanil under a Drug Versus Drug Choice Procedure in Rhesus Monkeys

“…Enhanced discounting might predispose an individual to choose the more immediately available effects of drug taking rather than the delayed benefits of remaining abstinent, such as health, income, and positive social interactions. Individuals who are more sensitive to delay prior to using drugs might be more likely to experiment with drugs; drug use also might enhance discounting and, thus, increase the likelihood of continued drug use (Bickel et al, 2012(Bickel et al, , 2013. Given the continuing public health challenge associated with opioid abuse, particularly prescription opioid abuse (Compton and Volkow, 2006;Manchikanti et al, 2010;Johnston et al, 2013) and the apparent relationship between delay discounting and various aspects of opioid abuse (Madden et al, 1997;Giordano et al, 2002), this study examined the impact of delaying delivery of a large dose of the short-acting m-opioid receptor agonist remifentanil on choice when the alternative is a smaller, immediately available dose of remifentanil.…”

Reward Processing in Motivational and Affective Disorders

“…Temporal discounting has received considerable attention in human behavioral neuroscience, not least because many forms of maladaptive behavior are readily characterized as pursuit of immediate gratification at the expense of reaping greater rewards in the future (Critchfield and Kollins, 2001;Bickel et al, 2007Bickel et al, , 2014aKoffarnus et al, 2013;Story et al, 2014). Indeed, lending validity to the discounting construct, steeper discounting is positively associated with behaviors with potentially harmful long-term consequences such as tobacco smoking (Odum et al, 2002;Epstein et al, 2003;Reynolds et al, 2004;Bickel et al, 2008;MacKillop and Kahler, 2009;Fields et al, 2009a,b;Reynolds and Fields, 2012), alcohol use (Van Oers et al, 1999;Mazas et al, 2000;Petry, 2001;Field et al, 2007;Reynolds et al, 2007;Rossow, 2008;MacKillop and Kahler, 2009;Moore and Cusens, 2010), illicit drug misuse (Kirby et al, 1999;Petry and Casarella, 1999;Kollins, 2003;Petry, 2003;Kirby and Petry, 2004;Washio et al, 2011;Stanger et al, 2012), credit card debt (Meier and Sprenger, 2012) and risky sexual or drug-taking practices (Odum et al, 2000;Dierst-Davies et al, 2011).…”

“…This line of enquiry is not without theoretical justification, for example the broader construct of impulsivity, defined as taking action without forethought or regard for consequences (Moeller et al, 2001), of which discounting is an element, is a defining feature of some psychiatric disorders, for example borderline personality disorder (Moeller et al, 2001;DSM V, 2013) and mania (Swann, 2009). Also, psychiatric disorders are strongly associated with poor health choices, including but not limited to cigarette smoking, and drug and alcohol misuse (Robson and Gray, 2007), which have themselves been associated with steeper discounting (Bickel et al, 2012b(Bickel et al, , 2014aStory et al, 2014). However, in many cases this research, although clearly valuable, appears to have been opportunist.…”

“…Bickel et al (2014aBickel et al ( , 2011a propose a neuropsychological explanation for relationships between low socioeconomic status and unhealthy lifestyle choices, in terms of a dual-systems model of cognition, whereby low socioeconomic status encourages engagement of a more "impulsive" decisionmaking system, putatively mediated by limbic brain structures, over an "executive" decision-making system, mediated by parts of frontal cortex. The authors point to evidence that several neurocognitive abilities including working memory, declarative memory, and cognitive control exhibit socioeconomic gradients (Noble et al, 2007).…”