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Randomized Controlled Trial
. 2009 Oct 1;104(3):197-203.
doi: 10.1016/j.drugalcdep.2009.04.020. Epub 2009 Jun 30.

Delayed reward discounting predicts treatment response for heavy drinkers receiving smoking cessation treatment

James MacKillop  1 , Christopher W Kahler
Affiliations
Randomized Controlled Trial

Delayed reward discounting predicts treatment response for heavy drinkers receiving smoking cessation treatment

James MacKillop et al. Drug Alcohol Depend. .

Abstract

Delayed reward discounting (DRD) is a behavioral economic index of impulsivity that reflects the extent to which an individual devalues a reward based on its delay in time (i.e., preference for smaller immediate rewards relative to larger delayed rewards). Current smokers exhibit greater DRD compared to non-smokers, but also exhibit greater DRD compared to ex-smokers, suggesting that either DRD is inversely associated with successful smoking cessation or that smoking cessation itself reduces DRD. In a sample of treatment-seeking smokers (n=57, 61% male, 85% Caucasian) participating in a randomized controlled smoking cessation trial, the current study prospectively examined DRD for money in general and at three magnitudes in relation to time to the participants' first lapse to smoking. Survival analysis using Cox proportional-hazards regression revealed that DRD predicted days to first lapse (ps<.05-.01) and did so beyond nicotine dependence, sensation-seeking, and income in covariate analyses, with the exception of small magnitude discounting. In addition, dichotomous comparisons revealed significantly more impulsive baseline discounting for individuals who had lapsed by the two-week and eight-week follow-up visits. These findings indicate that high levels of DRD reflect a risk factor for poor smoking cessation treatment response. Interrelationships among the variables assessed and clinical strategies to improve outcomes for smokers who are high in DRD are discussed.

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Figures

Figure 1
Figure 1
Overall survival function of days to first lapse. Days to first lapse is provided on the X-axis, from 0 to 182, and the proportion of individuals who did not lapse is provided on the Y-axis.
Figure 2
Figure 2
Overall discounting curves for individuals who immediately lapsed (zero days abstinent) and individuals who achieved continuous verified abstinence for 182 days. The estimated temporal discounting function (i.e., k) is applied to the mean monetary value ($55) in the measure over a 100 day period.
See this image and copyright information in PMC

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