A new phrase was recently introduced into my vocabulary, and as a therapist, the fact that I was not familiar with it was a bit of a surprise. The phrase is "delay discounting” or “DD.” The definition is the tendency to place less value on rewards that are delayed in time. This is considered one of the many facets of impulsivity, and DD is a crucial component in understanding recovery from substance use disorders (SUD).
According to the Science of Behavior Change from Columbia University Medical Center, one way to measure DD is by using the Kirby Delay-Discounting Task (DDT). This measures temporal discounting, which is the tendency for people to prefer smaller, immediate monetary rewards over larger, delayed rewards. Participants complete a series of 27 questions that each require choosing between a smaller reward now (such as $20 today) over a bigger reward later ($50 in 3 weeks). The tool measures the steepness of the discounting curve which represents a tendency to devalue rewards as they become more remote - in other words, it helps to measure impulse verses self-control. And with both addictions and eating disorders, impulsive behaviors often prevail over self-control, making these types of mental health illnesses very challenging to treat.
The devaluation of future rewards (or delayed discounting) is broadly associated with SUD inception and outcomes. A study by William H. Craft and Warren K. Bickel, sought to determine the relationship between DD and recovery progress. The method was an online assessment of 127 individuals in recovery from substance use which collected measures of DD and time in recovery. The results show an individual's delay discounting rate mediated the relationship between time in recovery. Of these 127 participants, over 66% endorsed recovery requiring total abstinence from alcohol and drugs. The study concluded that for individuals who are in recovery, the temporal view (i.e., focus on immediate vs. future rewards) is a significant influence on the recovery progress. These findings contribute to the understanding of recovery as a multidimensional process and provide further support for DD as a behavioral marker of addiction.
This indicates that rehab programs would benefit their patients by including individual therapy sessions and group therapy sessions around impulse control skills. Patients in rehab must be able to see the benefit of starting their recovery journey for the long term. If they are unable to shift at least part of their focus from “the now” to “the future”, patients will continue to struggle. Rehab can be hard work and extremely difficult without impulse control skills because that difficultly can become too great to overcome forcing patients to leave against medical advice (AMA). Often patients think the early stage of pain and challenges is all there is on the other side of addiction, especially when it comes to drug withdrawal. Skills training around impulse control should really begin at the time of admission to treatment. Patients need psychoeducation concerning their own thought processes to help battle against a natural tendency toward delayed discounting.
Contributed by Preston Goforth, LPC-MHSP, Director of Admissions & Business Development at Focus Treatment Centers. To learn more or schedule an assessment, call or text 423.308.2560.
References: Journal of Substance Abuse Treatment Volume 136, May 2022, 108665
The phenotype of recovery VII: Delay discounting mediates the relationship between time in recovery and recovery progress, Authors: William H Craft, Warren K. Bickel
