Abstract
RationaleAlcohol dependence is characterised by persistent drinking despite health, social and economic costs. Behavioural economics has proposed two explanations for the persistence of alcohol use despite costs. Dependent individuals may (a) ascribe excessively high value to alcohol, such that costs associated with alcohol are exceeded, and/or (b) they may discount (neglect) the costs associated with alcohol.MethodsTo test these predictions, the current study recruited 127 student drinkers who reported varied alcohol use disorder symptom severity in the Alcohol Use Disorders Inventory Test (AUDIT; mean = 11.17, 69% above the hazardous cutoff). Participants made concurrent forced choices between alcohol and food points under conditions that manipulated the magnitude of points (1, 2 or 3) and the delay to receive points (0 or 3 s). Alcohol value was indexed by preferential choice of alcohol versus food points, whereas sensitivity to costs was indexed by the decrease in alcohol choice when food points were of greater magnitude (sensitivity to opportunity costs) and when alcohol points were delayed (sensitivity to delay costs).ResultsPercent choice of alcohol over food varied consistently with the relative magnitude of reward points offered (p < .001) and with time delays imposed on reward points (p < .001). AUDIT scores were associated with greater alcohol versus food choice across all conditions (p = .001). As alcohol use disorder symptom severity increased, the sensitivity of alcohol choice to the relative magnitude of points (p = .29) and time delays (p = .62) remained unchanged, suggesting no differential discounting of opportunity or delay costs imposed on alcohol. In contrasts of AUDIT categories, there was comparable sensitivity to costs across groups defined as low-risk (N = 39), hazardous (n = 57), harmful (n = 20) and possible dependent drinkers (n = 11).ConclusionsAlcohol use disorder symptom severity is associated with greater relative value ascribed to alcohol, but not with greater discounting of opportunity or delay costs imposed on alcohol. Despite limitations of the current study, it may be concluded that cost discounting plays a lesser role in dependence than previously thought.
Highlights
A key diagnostic feature of alcohol dependence is that dependent individuals will continue to drink even when doing so brings about negative health, social and economic consequences (American Psychiatric Association 2013).Behavioural economic theory has proposed two explanations for continued drinking in the face of rising costs in dependent individuals
The current study found that alcohol use disorder symptom severity indexed by the Alcohol Use Disorders Inventory Test (AUDIT) was associated with increased choice of alcohol over chocolate in a concurrent choice procedure
This finding replicates previous studies which have found that alcohol use disorder symptoms are associated with preferential alcohol choice (Hardy and Hogarth 2017; Hardy et al 2017; Hogarth et al 2018) and accords with studies which have found that cocaine dependence symptoms are associated with preferential cocaine choice (Moeller et al 2013; Moeller et al 2009) and that tobacco dependence symptom severity is associated with preferential tobacco choice (Chase et al 2013; Hogarth and Chase 2011)
Summary
Behavioural economic theory has proposed two explanations for continued drinking in the face of rising costs in dependent individuals. More dependent drinkers may ascribe excessively high value to alcohol, such that costs associated with alcohol are exceeded, so drinking persists despite costs (MacKillop 2016). The second possibility is that more dependent drinkers discount (i.e. neglect) the costs associated with drinking in their decision-making, such that drinking persists despite costs (Belin et al 2008; Bickel et al 2014; Mitchell 2003). The purpose of the current study was to test, using a novel concurrent choice procedure, whether alcohol use Psychopharmacology (2018) 235:2257–2266 disorder symptom severity in student drinkers would be associated with greater relative value ascribed to alcohol and/or greater discounting of costs imposed on alcohol
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