Delay and Probability Discounting of Sexual and Monetary Outcomes in Individuals with Cocaine Use Disorders and Matched Controls

Abstract

Individuals with cocaine use disorders are disproportionately affected by HIV/AIDS, partly due to higher rates of unprotected sex. Recent research suggests delay discounting of condom use is a factor in sexual HIV risk. Delay discounting is a behavioral economic concept describing how delaying an event reduces that event’s value or impact on behavior. Probability discounting is a related concept describing how the uncertainty of an event decreases its impact on behavior. Individuals with cocaine use disorders (n = 23) and matched non-cocaine-using controls (n = 24) were compared in decision-making tasks involving hypothetical outcomes: delay discounting of condom-protected sex (Sexual Delay Discounting Task), delay discounting of money, the effect of sexually transmitted infection (STI) risk on likelihood of condom use (Sexual Probability Discounting Task), and probability discounting of money. The Cocaine group discounted delayed condom-protected sex (i.e., were more likely to have unprotected sex vs. wait for a condom) significantly more than controls in two of four Sexual Delay Discounting Task partner conditions. The Cocaine group also discounted delayed money (i.e., preferred smaller immediate amounts over larger delayed amounts) significantly more than controls. In the Sexual Probability Discounting Task, both groups showed sensitivity to STI risk, however the groups did not differ. The Cocaine group did not consistently discount probabilistic money more or less than controls. Steeper discounting of delayed, but not probabilistic, sexual outcomes may contribute to greater rates of sexual HIV risk among individuals with cocaine use disorders. Probability discounting of sexual outcomes may contribute to risk of unprotected sex in both groups. Correlations showed sexual and monetary results were unrelated, for both delay and probability discounting. The results highlight the importance of studying specific behavioral processes (e.g., delay and probability discounting) with respect to specific outcomes (e.g., monetary and sexual) to understand decision making in problematic behavior.

Discounting of Condom-Protected Sex as a Measure of High Risk for Sexually Transmitted Infection Among College Students

“…The current study extends earlier research examining delay discounting of condom-protected sex with samples at high-risk for STI contraction and transmission, including individuals with substance use disorders (e.g., Herrmann et al, 2014; Herrmann et al, 2015; Johnson & Bruner, 2012; Johnson et al, 2015) and youth from socioeconomically disadvantaged backgrounds (Dariotis & Johnson, 2015). The present study demonstrates that college students are less likely to use an immediately available condom and less likely to wait to engage in condom-protected sex when partners are viewed as more desirable (i.e., MOST WANT SEX) and less likely to have an STI (i.e., LEAST LIKELY STI).…”

“…The SDDT has shown associations with self-reported risky sex behaviors and high test-retest reliability (Johnson & Bruner, 2012; 2013; Herrmann et al, 2015), and multiple studies have found that users of illicit substances discount condom-protected sex more steeply than healthy controls (Bruner & Johnson, 2012; Herrmann et al, 2014; Herrmann et al, 2015; Johnson, Johnson, Herrmann & Sweeney 2015). Recently, a SDDT study of youth (18–25 years old) recruited from an urban city and surrounding metro area characterized by high STI prevalence rates, crime, and drug use (Dariotis & Johnson, 2015) indicated greater sexual delay discounting for hypothetical partners that they judged as “most want to have sex with” (relative to “least”) and “least likely to have an STI” (relative to “most”), with males showing higher likelihood of engaging in unprotected sex than females when facing no delay but no sex differences in the rate of sexual delay discounting.…”

Alcohol use disorders are associated with increased HIV risk behaviors in cocaine-dependent methadone patients

“…In particular, cocaine-dependent methadone patients who had alcohol use disorders were more likely than those without alcohol use disorders to engage in some of the highest risk HIV sexual risk behaviors (i.e., transactional and anal sex). These results are consistent with findings from previous studies which have shown cocaine-dependence is associated with risky sexual decision-making (Johnson, Johnson, Herrmann, & Sweeney, 2015), and alcohol use increases individuals’ intentions to engage in risky sexual behavior (Johnson et al, 2016; Rehm et al, 2012). …”

Weekly Energy Drink Use Is Positively Associated with Delay Discounting and Risk Behavior in a Nationwide Sample of Young Adults

“…29,[31][32][33] As with monetary delay discounting, individuals with a history of risk behavior (e.g., substance abuse) show steeper delay discounting of condom-protected sex. [31][32][33][34] Collectively, studies that examined monetary and sexual delay discounting outcomes suggest that delay discounting is a fundamental behavioral process related to risk behavior. To our knowledge, however, no studies have investigated the relationship between energy drink use and monetary or sexual delay discounting.…”