Contextual decision-making and alcohol use disorder criteria: Delayed reward, delayed loss, and probabilistic reward discounting

Abstract

Objective: Alcohol use disorder (AUD) is an etiologically heterogeneous psychiatric disorder defined by a collection of commonly observed co-occurring symptoms. It is useful to contextualize AUD within theoretical frameworks to identify potential prevention, intervention, and treatment approaches that target personalized mechanisms of behavior change. One theoretical framework, behavioral economics, suggests that AUD is a temporally extended pattern of cost/benefit analyses favoring drinking decisions. The distribution of costs and benefits across choice outcomes is often unequally distributed over time and has different probabilities of receipt, such that delay and probability become critical variables. The present study examines the relations between different forms of economic discounting (delayed reward, delayed cost, and probabilistic reward) and individual symptoms of AUD to inform etiological models.

Method: Participants (N = 732; 41% female, 4.2% Black, 88.1% White, 8% Hispanic) completed an online survey with measures of AUD symptoms and economic discounting. We examined relations between economic discounting and AUD symptoms with zero-order correlations, in separate models (factor models), and in models controlling for an AUD factor (factor-controlled models).

Results: Delayed reward discounting was positively associated with the give up AUD criteria across all three levels of analysis. Probability discounting was associated with social/interpersonal problems across two out of three sets of analyses. Consistent with the broad discounting literature, effect sizes were small (range = -.15 to .13).

Conclusions: These results support the idea that AUD criteria are etiologically distinct, resulting in varying AUD profiles between persons that are differentially associated with behavioral economic discounting. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Figure 1.. Factor and Factor-controlled Structural Regression Models: Relationships between AUD symptom and Delayed Reward Discounting

Note. Conceptual model demonstrating (A) a factor model and (B) an AUD factor-controlled model. (A) Each AUD symptom is regressed onto delay discounting. (B) Each AUD symptom is used to create a latent variable of AUD, and then each symptom is regressed onto delay discounting. Further, delay discounting is regressed onto the AUD latent variable. Age, sex and race paths are not pictured. AUD criterion factors were created and extracted from separate analyses from three items reflecting different levels of severity for each symptom (Boness et al., 2019). Each set of discounting models emulate this figure, replacing delayed reward discounting with probability discounting or delayed loss discounting. For clarity, dashed lines represent relations after controlling for the AUD factor. Larger/Longer = “Alcohol is taken in larger amounts or over longer periods than was intended”; Time spent = “A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects”; Quit/Cut down = “There is a persistent desire or unsuccessful efforts to cut down or control alcohol use”; Craving = “Craving, or a strong desire or urge to use alcohol”; Failure to fulfill = “Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home”; Give up = “Important social, occupational, or recreational activities given up or reduced because of alcohol use”; Hazardous use = “Recurrent alcohol use in situations in which it is physically hazardous”; Physical/Psychological = “Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol”; Tolerance = “Tolerance, as defined by either of the following: (a) a need for markedly increased amounts of alcohol to achieve intoxication or desired effect or (b) a markedly diminished effect with continued use of the same amount of alcohol”; Withdrawal = “Withdrawal, as manifested by either of the following: (a) the characteristic withdrawal syndrome for alcohol or (b) alcohol (or a closely related substance, such as benzodiazepine) is taken to relieve or avoid withdrawal symptoms”; Social/Interpersonal = “Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol”.