Adults Improve Delay Discounting During Treatment. Do Adolescents?

“Delay discounting” is the tendency to place less value on rewards that are delayed in time. Considered one of the many facets of impulsivity, it is a crucial construct in understanding recovery from substance use disorders (SUD).

Many studies show individuals with substance use disorders (SUD) are more likely to discount later rewards than those without SUD, and more recent data show that discounting improves during addiction treatment (i.e., individuals place greater value on the delayed reward at the end of treatment).

The adolescent brain, however, given the imbalance between its better-developed reward circuitry and less well-developed executive functioning systems, may be biologically less able to effectively delay rewards—giving more value to gratification in the here and now while ignoring future consequences.

Yet, the field knows very little about how adolescents and adults in SUD treatment might differ on delay discounting when they enter treatment and whether they might show different response to treatment. Furthermore, the majority of delay discounting studies have been relatively silent on cannabis use disorders which have become increasingly more important to study in the current climate of medicalization and legalization.

Lee, Stanger, and Budney addressed these research gaps by comparing baseline and during-treatment changes in delay discounting among 165 adolescents (mean age 16 years old; 88% male; 60% African American and 38% Caucasian) and 104 adults (mean age 34 years old; 55% male; 50% African American and 48% Caucasian) who met DSM-IV criteria and were in treatment for cannabis use disorder. Of note, participants were drawn from four separate studies – two pilot studies and two randomized trials –but received treatments with similar orientations (cognitive-behavioral and contingency-management as well as motivational enhancement). In this study, participants were asked to make hypothetical choices between less money or less cannabis sooner, relative to $100/$1000 or equivalent amounts of cannabis later.

The authors found that, at treatment intake, adolescents discounted money but not cannabis more so than adults. They also demonstrated greater discounting than adults at intake when the later reward was $1000, but similar levels of discounting when the reward was $100.

Regarding change during treatment, although each group of participants showed improved delay discounting during treatment, adolescents demonstrated less improvement. All participants showed greater improvement in discounting cannabis than money.

IN CONTEXT

This interesting look at life course differences in traits underlying substance use disorder (SUD) and treatment response showed adolescents improve their tendency to overvalue a more immediate, smaller reward, though to a lesser degree than did adults.

Although there are several nuances here, including aggregating participants from four separate studies, this study is an important addition to the adolescent treatment/recovery literature in understanding unique clinical profiles and needs.

LIMITATIONS

One omission appears to be the absence of tasks requiring participants to choose money versus cannabis. This seems especially relevant to recovery in vivo, where in order to maintain abstinence, individuals must choose a less potent immediate reward (compared to cannabis) in support of receiving a larger reward at a later time (e.g., recovery in support of college graduation).

NEXT STEPS

This study supports the importance of intermediate rewards in applying motivational incentives to help adolescents reduce substance use (due to their greater discounting of later rewards than adults). It points to a need for more work on specific interventions targeting delay discounting among this vulnerable cohort. For example, in a recent study, Bickel showed that delay discounting among SUD treatment seeking adults responds to a working memory training task; it would be interesting to see if adolescents showed similar response.

BOTTOM LINE

For individuals & families seeking recovery: Adolescent in general will have a harder time delaying gratification and keeping an eye on rewards that may take time to earn. Adults are likely to increase the way they value the future during treatment, while adolescents may have a more difficult time with this concept. Providing motivational incentives with ongoing monitoring may help adolescents experience enough recovery-related rewards that support shifts in delay discounting and more enduring lifestyle changes.
For scientists: The current study adds to the literature on the importance of a life course treatment/recovery perspective. Future studies may examine whether interventions specifically to improve (i.e., decrease) delay discounting work equally well across age groups and whether adolescents need more or qualitatively different types of interventions to achieve improvements similar to adults.
For policy makers: It is important to consider the unique developmental needs of adolescents in treatment/recovery; adolescent-specific community resources and activities may be needed to support their de-emphasis of future rewards.
For treatment professionals and treatment systems: Adolescents are likely to require even greater emphasis on healthy, rewarding activities than their adult counterparts; they may require greater motivational incentives in contingency management paradigms in order to reduce substance use and achieve remission.

CITATIONS

Lee, D. C., Stanger, C., & Budney, A. J. (2015). Lee, D. C., Stanger, C., & Budney, A. J. (2015, February 2). A Comparison of Delay Discounting in Adolescents and Adults in Treatment for Cannabis Use Disorders. Experimental and Clinical Psychopharmacology. Advance online publication. http://dx.doi.org/10.1037/a0038792