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.
Highlights
1.5 million people in the U.S have used cocaine within the past month [1]
Year old youth found increased delay discounting of condom-protected sex to be significantly associated with greater self-reported drug use [33]. These findings suggest that steeper discounting may be related to higher rates of sexual HIV risk in drug-using populations, but it is unknown whether steeper discounting is related to the higher rates of sexual HIV risk behavior observed among individuals who use cocaine
There were no significant differences between the groups with the exception of substance use, self-reported sexual risk behavior, and HIV variables
Summary
1.5 million people in the U.S have used cocaine within the past month [1]. Year old youth found increased delay discounting of condom-protected sex to be significantly associated with greater self-reported drug use [33] These findings suggest that steeper discounting may be related to higher rates of sexual HIV risk in drug-using populations, but it is unknown whether steeper discounting is related to the higher rates of sexual HIV risk behavior observed among individuals who use cocaine. With respect to the influence of probability on sexual outcomes, previous studies using the Sexual Delay Discounting Task showed that a partner’s perceived likelihood of having an STI influenced delay discounting of condom use. We developed the Sexual Probability Discounting Task to quantitatively examine how specified risk of STI contraction resulting from unprotected sex influences condom use. The reliably weak correlations observed in previous studies between delay and probability discounting of monetary rewards prompted us to examine correlations between discounting in the Sexual Delay and Sexual Probability Discounting tasks
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