Contextual Decision-Making and Alcohol Use Disorder Criteria: Delayed Reward, Delayed Loss, and Probabilistic Reward Discounting

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. Public Health Significance Statement Alcohol use disorder (AUD) diagnoses, though common, are highly heterogeneous collections of commonly co-occurring symptoms that do not necessarily share common phenotypic variance. Behavioral economics suggests that discounting of losses and rewards across time and over different probabilities may account for some of the variance in specific AUD symptoms. The results of the present study support the notion that AUD diagnosis reflects heterogeneous symptoms and that delayed reward discounting, delayed loss discounting, and probability reward discounting may be useful endophenotypes for three AUD symptoms in particular: giving up, failure to fulfill, and social/interpersonal problems, providing potential treatment targets for these symptoms.