Delay Discounting in Gambling Disorder: Implications in Treatment Outcome

Abstract

Impulsive choice, measured by delay discounting (DD) tasks, has been shown in patients with gambling disorders (GD). However, the impact of DD and treatment outcome has been scarcely explored in GD patients. The aims of this study were: (1) to examine the baseline association between DD and clinical variables in GD patients depending on their age and gambling preferences (strategic vs. non-strategic); and (2) to estimate the predictive role of DD on poorer outcomes of cognitive-behavioral therapy (CBT) when considering also the effect of other clinical variables. 133 treatment-seeking male GD patients were evaluated at baseline with a DD task and measures of GD severity, personality traits and psychopathology. Treatment outcome was measured in terms of dropout from CBT and relapses. Results showed baseline associations between DD and GD severity (correlation coefficient R = 0.408 among strategic gamblers and R = 0.279 among mixed gamblers) and between DD and positive/negative urgency (R = 0.330 for the youngest patients, R = 0.244 for middle age, and around R = 0.35 for gamblers who reported preferences for strategic games). Other personality traits such as high harm avoidance and low cooperativeness were also related to DD at baseline (R = 0.606 among strategic gamblers). Regarding treatment outcome, a steeper discount rate predicted a higher risk of relapses in strategic gamblers (odds ratio OR = 3.01) and middle-age ones (OR = 1.59), and a higher risk of dropout in younger gamblers (OR = 1.89), non-strategic gamblers (OR = 1.70) and mixed gamblers (R = 4.74). GD severity mediated the associations between age, DD, personality traits and poor CBT outcome. In conclusion, impulsive choice affects treatment response in individuals with GD and may interfere with it to a significant extent. Considering DD in GD, patients seeking treatment could help control its impact on treatment adherence and relapses.

Features Linked to Treatment Outcomes in Behavioral Addictions and Related Disorders

“…In studies of GD, some authors have found no differences in dropouts when gambling preferences are taken into account [36]. However, other studies have linked delay discounting to dropout in individuals with GD whose preferences are non-strategic or mixed types of gambling [27]. In another study, gambling on machines has been associated with pre-treatment dropout, while sports betting has been linked with dropout during GD treatment [56].…”

“…On the other hand, others noted that younger participants with GD exhibited higher dropout [26,27], and attended fewer treatment sessions before abandoning interventions [27]. Young age has even been considered in different studies as a main predictor of dropout from GD treatment [22,28].…”

“…An association between age and relapse has been described [62]. Some studies suggest that age and relapse have an inverse relationship [62], with younger age linked to relapse in individuals with GD [27].…”

The usefulness of an intervention with a serious video game as a complementary approach to cognitive behavioural therapy in eating disorders: A pilot randomized clinical trial for impulsivity management

“…Impulsivity and emotional instability are broad transdiagnostic constructs that have been described in association with different mental disorders (Amlung et al., 2017; Griffin et al., 2018; Lee et al., 2019; Munguía, Jiménez‐Murcia, et al., 2021) and physical conditions (Jorge et al., 2022; Testa et al., 2021). Impulsivity includes behavioural and cognitive facets characterised by the tendency to act quickly without prior reflection, possibly leading to undesirable consequences (Evenden, 1999) such as harmful or suicidal behaviours (Valenciano‐Mendoza et al., 2021), adverse emotional consequences (e.g., more depression, anxiety; Aldao et al., 2016), as well as poorer treatment adherence (Mallorquí‐Bagué et al., 2021; Mena‐Moreno et al., 2022) and outcomes (Vintró‐Alcaraz et al., 2022).…”

Comparative assessment of psychometric performance on the adjusting amounts versus the 21-item Monetary Choice Delay Discounting tasks among young adult substance users.

“…Greater DD is associated with an array of maladaptive behaviors (Levitt et al, 2023) including substance use (Amlung et al, 2017; Gowin et al, 2019; Strickland et al, 2021; Weinsztok et al, 2021) in both clinical (Baker et al, 2003) and nonclinical populations (Kollins, 2003). Importantly, greater DD has been shown to identify those at risk for developing a SUD as well as drug-use severity (Audrain-McGovern et al, 2009; Bickel et al, 2014; Martínez-Loredo et al, 2018) and predict poorer treatment outcomes and greater relapse risk following initial treatment success (González-Roz et al, 2019; Mena-Moreno et al, 2022; Stanger et al, 2012; Washio et al, 2011; Yoon et al, 2007).…”