Symposia
Addictive Behaviors
Louisa F. Kane, M.S.
Clinical Psychology Doctoral Student
University of North Carolina
Chapel Hill, North Carolina
Paulina Linares Abrego, B.S.
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina
Elizabeth D. Reese, M.A.
Clinical Psychology Doctoral Student
University of North Carolina
Chapel Hill, North Carolina
Katherine L. Benson, B.S.
Clinical Psychology Doctoral Student
University of North Carolina
Chapel Hill, North Carolina
Catherine E. Paquette, MPS, M.A.
Clinical Psychology Doctoral Student
University of North Carolina
Chapel Hill, North Carolina
Stacey B. Daughters, Ph.D.
Professor
University of North Carolina
Chapel Hill, North Carolina
Objective: Delay discounting (DD) is an established correlate of substance use disorder (SUD) and risk factor for poor treatment response. Although evidence indicates that delay discounting improves following treatment engagement and continued abstinence, findings remain mixed. Behavioral activation (BA) treatment aims to increase the valuation of future substance free rewards through the planning and engagement in substance free activities. The current study tested the impact of behavioral activation and substance use on delay discounting over the course of a 1-year recovery period among a sample of low-income Black/African American adults entering treatment for multiple SUDs including cocaine, heroin, cannabis, and alcohol.
Method: 263 adults (94.7% Black/African American, Mage=42.7±11.8, 70.7% male) with a substance use disorder were randomized to receive behavioral activation or a contact time matched control treatment while concurrently receiving residential substance use treatment. Participants self-reported preference for hypothetical immediate or delayed monetary rewards using the Money Choice Questionnaire at pretreatment, posttreatment, and at 3-, 6-, and 12-months post treatment.
Results: The effect of treatment condition and substance use (abstinence, frequency) on delay discounting was tested in a generalized linear mixed model. There was a significant effect of treatment condition over time, with delay discounting deteriorating from pretreatment through 1-year post treatment in the control treatment but not among participants who received behavioral activation (B=.004, SE=.002, 95% CI=.001–.007.). Models testing the impact of comorbid psychopathology and environmental reward did not alter study findings.
Discussion: Behavioral activation prevents the deterioration of delay discounting over time, above and beyond the impact of reengagement in substance use, psychopathology, and environmental reward. Reasons for the protective effect of BA, along with the unexpected deterioration of delay discounting in the control condition will be discussed, with a focus on the impact of concurrent smoking, income, and minority status on the valuation of future rewards.