Excessive discounting of delayed reinforcers as a trans-disease process contributing to addiction and other disease-related vulnerabilities: emerging evidence

• Published in: Pharmacology & therapeutics (Oxford) Vol. 134; no. 3; pp. 287 - 297
• Main Authors: Bickel, Warren K, Jarmolowicz, David P, Mueller, E Terry, Koffarnus, Mikhail N, Gatchalian, Kirstin M
• Format: Journal Article
• Language: English
• Published: England 01-06-2012
• Subjects: Decision Making - drug effects; Decision Making - physiology; Gambling - complications; Gambling - psychology; Health Behavior; Humans; Illicit Drugs - pharmacology; Impulsive Behavior - complications; Impulsive Behavior - psychology; Mental Disorders - complications; Mental Disorders - psychology; Neural Pathways - physiopathology; Obesity - complications; Obesity - psychology; Reinforcement, Psychology; Substance-Related Disorders - complications; Substance-Related Disorders - psychology; Time Factors
• ISSN: 0163-7258; 1879-016X
• DOI: 10.1016/j.pharmthera.2012.02.004

Delay discounting describes the devaluation of a reinforcer as a function of the delay until its receipt. Although all people discount delayed reinforcers, one consistent finding is that substance-dependent individuals tend to discount delayed reinforcers more rapidly than do healthy controls. Moreover, these higher-than-normal discounting rates have been observed in individuals with other behavioral maladies such as pathological gambling, poor health behavior, and overeating. This suggests that high rates of delay discounting may be a trans-disease process (i.e., a process that occurs across a range of disorders, making findings from one disorder relevant to other disorders). In this paper, we argue that delay discounting is a trans-disease process, undergirded by an imbalance between two competing neurobehavioral decision systems. Implications for our understanding of, and treatment for, this trans-disease process are discussed.