The phenotype of recovery V: Does delay discounting predict the perceived risk of relapse among individuals in recovery from alcohol and drug use disorders

Abstract

Background Substance use recovery is a dynamic process. Relapse, often part of the recovery process, is a persistent problem for individuals seeking freedom from their harmful substance use and has become a focus of research on the improvement of recovery outcomes. Delay discounting is associated with substance use disorder severity, both its negative outcomes and the propensity to relapse. However, the association between delay discounting and perceived risk of relapse as measured by the Alcohol Warning of Relapse Questionnaire has not previously been examined in a population of individuals in long‐term recovery from substance misuse. Methods In this study, using data collected from the International Quit and Recovery Registry, we investigated the association between delay discounting, self‐reported time in recovery, and perceived risk of relapse. Data from 193 individuals self‐reporting to be in recovery from harmful substance use were included in the study. Results Delay discounting rates were significantly negatively associated with length of recovery (p = 0.036) and positively with perceived risk of relapse (p = 0.027) even after controlling for age, gender, education, marital status, ethnicity, race, primary substance, and length in the registry. Moreover, a mediation analysis using Hayes’ methods revealed that the association between the length of recovery and perceived relapse risk was partially mediated by delay discounting, accounting for 21.2% of the effect. Conclusions Our finding supports previous characterizations of delay discounting as a candidate behavioral marker of substance misuse and may help to identify individuals at higher perceived risk of relapse in an extended recovery population.

The problems with delay discounting: a critical review of current practices and clinical applications

“…alcohol use disorder (AUD) v. depression]. This stands in striking contrast to claims that discounting can and does serve as a 'biomarker' (Kwako, Bickel, & Goldman, 2018) or 'behavioral marker' (Athamneh et al, 2020;Bickel et al, 2012;Bickel, Koffarnus, Moody, & Wilson, 2014;Turner, Athamneh, Basso, & Bickel, 2021) given it wholly fails to be either adequately sensitive or specific to any psychological phenomena to warrant such status. However, in a highly cited review, Bickel et al (2014) come to drastically different conclusions saying 'Our review suggests that temporal discounting (1) identifies individuals who are drugdependent, (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…' (abstract).…”

Neurocognitive Impulsivity in Opiate Users at Different Stages of Abstinence

“…Future studies would benefit from longitudinal designs examining the trajectory of potential changes in delay discounting with increasing periods of abstinence. Such studies may have important practical implications for the treatment and rehabilitation of opiate dependent individuals, due to the high predictive validity of delay discounting in relation to risk of relapse [77] and other significant treatment outcomes [78,79].…”

Rate‐dependent effects of narrative interventions in a longitudinal study of individuals who use alcohol

“…The DD rate reflects an individual's preference for immediate rewards at the expense of greater rewards in the future and quantifies the balance between neural executive and impulsive systems (McClure et al, 2004;McClure & Bickel, 2014). An excessive preference for immediate rewards has been identified in relation to many aspects of AUD, including differentiating dependent individuals from controls (Bobova et al, 2009;Mitchell et al, 2005;Petry, 2001), the severity of use (MacKillop et al, 2010;Vuchinich & Simpson, 1998), polysubstance use (Moallem & Ray, 2012;Moody et al, 2015), relapse risk (Turner et al, 2021), and psychiatric comorbidities (Dom et al, 2006). Concordant findings among other substance classes and across psychopathologies highlight DD as a key undergirding mechanism in substance use disorders (SUDs) and a trans-disease process (Bickel et al, 2012(Bickel et al, , 2019.…”