WHAT PROBLEM DOES THIS STUDY ADDRESS?
Substances with addictive properties often lead to strong, immediate, and reliable effects that are experienced as pleasurable and euphoric, with consequences that are often delayed (e.g., hangovers or withdrawal symptoms) or unreliable and variable (e.g., conflicts with others or driving under the influence [DUI] arrests may not occur after every drinking episode). It is perhaps not surprising that people in general tend to value more immediate rewards than delayed rewards, devaluing or discounting rewards that are further in the future. These effects, known as delayed reward discounting and delayed loss discounting, may, in part, explain why people tend to use drugs. Compared to the general population, people who meet criteria for substance use disorder tend to discount delayed rewards, and costs, more steeply. This means that the preference for immediate reward (“instant gratification”) is enhanced, and the impact of delayed consequences is lessened. However, less is known about delayed discounting rates among people in recovery. Improved (i.e., lower) discounting rates may be a marker of recovery progress while still-elevated discounting rates may impede recovery progress. The present study investigated differences in delayed reward discounting and delayed loss discounting among individuals in recovery.
HOW WAS THIS STUDY CONDUCTED?
The current study was a naturalistic, cross-sectional survey that was completed by 130 people in December 2023 who met lifetime history for a substance use disorder, self-reported being in recovery from substance use disorder, and who were enrolled in the International Quit & Recovery Registry. Participants completed measures about symptoms of substance use disorder in addition to four hypothetical delayed discounting tasks for both past and future gains and losses. In a typical delayed reward discounting task, participants make a series of selections between smaller amounts of money available now or larger amounts of money available at a distant time in the past or future. In a typical delayed loss discounting task, participants make a series of selections between losing smaller amounts of money now or losing larger amounts of money at a distant time in the past or future. The researchers used these selections to compute an index representing degree of delayed reward discounting for future gains, degree of delayed reward discounting for past gains, degree of delayed loss discounting for future gains, and degree of delayed loss discounting for past gains. The authors compared participants across three remission categories: Not in remission (2+ symptoms for any substance), early remission (no symptoms on any substance except craving for 3 months), or sustained remission (no symptoms on any substance except craving for 12 months).
WHAT DID THIS STUDY FIND?
Of the 130 people who completed the study, 83 were not in remission (64%), 14 were in early remission (11%), and 33 were in sustained remission (25%). Those not in remission tended to be younger than those in early or sustained remission; otherwise, the groups were similar in racial makeup, education, and income levels.
Across all participants, losses were discounted more in the past task than in the future task, indicating that they were more likely to prefer larger, but distant losses when those losses were in the past compared to the future. There were no differences in discounting rates for past and future gains. Future gains were discounted to a greater degree than future losses, meaning that the sample demonstrated a tendency to prefer immediate future rewards over larger, delayed future rewards, but were more likely to prefer immediate future losses to delayed future losses. For all discounting tasks, those in sustained remission demonstrated lower discounting rates, meaning that they tended more than the other groups to prefer delayed rewards to immediate rewards, and immediate costs to delayed costs, in both past and future discounting tasks. There were no differences between those not in remission and those in early remission.
WHAT ARE THE IMPLICATIONS OF THE STUDY FINDINGS?
These results suggest that sustained remission is associated with lower levels of discounting both gains and losses. This means that people in sustained remission, relative to those not in remission or in early remission, appear to be more willing to wait for rewards that are larger, but perhaps further away instead of more immediate rewards, and that they are willing to take the hit of more immediate losses if it means avoiding delayed losses that are larger in nature. This is important because recovery is often marked by significant immediate challenges that accompany rebuilding one’s life in multiple domains, including social, occupational, financial, spiritual, and relational areas. However, with substantial effort, recovery may lead to significant rewards that might be delayed but that outweigh the more immediate reward of substance use. However, that said, because the data are cross-sectional, it is unclear whether people’s discounting rates tend to change as they accrue time in recovery (i.e., due to learning and associated brain changes), or whether people with lower discounting rates are simply more likely to sustain recovery for at least 1 year without return to use, to begin with. More longitudinal research is needed to determine if discounting rates change over time with remission and, if so, what drives this change. Regardless, given that many of the strongest costs might occur earlier in recovery, and the greatest rewards are delayed, people in early recovery nevertheless may be more likely to discount both delays and losses, and therefore are likely to need additional support to maintain recovery.
BOTTOM LINE
Longer time in recovery is associated with a willingness to wait for delayed rewards, and a tolerance for immediate losses over delayed, but larger, losses. These findings might be considered emblematic of recovery progress, in a broad sense, given that substance use is typically associated with immediate rewards and delayed costs (although this is dynamic as the relative intensity of rewards to costs favors the latter as addiction progresses), whereas many elements of recovery require engagement with immediate costs for delayed rewards.
- For individuals and families seeking recovery: If you are early in your recovery journey, you may notice a tendency to prefer things that feel good in the immediate, or to delay something that is uncomfortable. This is a normal human tendency that is likely amplified during this early recovery period and may make it more difficult for you to succeed in some of your recovery goals. Consider finding ways to make progress toward being comfortable with more delayed rewards, like finding an accountability partner that you can trust, or using mindfulness, or prayer, or self-affirmations or distraction.
- For treatment professionals and treatment systems: If you are treating individuals who use substances or who are in early remission, they may have a more difficult time working towards delayed rewards, and they may prefer to defer costs. This is normal, and it may be important to maintain a spirit of patience and support. It may be helpful also to consider helping patients break goals down into more manageable steps that are paired with smaller, more immediate rewards. Providing rewards for people when they do something difficult may help counteract the tendency to defer costs.
- For scientists: Although this study provides some preliminary evidence for an association between time in remission and discounting rates, the lack of a longitudinal study design prevents clear conclusions from being drawn about cause and effect. These results might be due to the fact that discounting rates are stable, and those with higher rates of discounting generally are less likely to sustain remission for a full year. Alternatively, the results may be due to improvements in discounting that occur as a function of continuous time in remission from substance use disorder – this could come from learning skills to be more patient and/or neurophysiological repair and recalibration that occurs when substances are no longer present or much less present. Future studies should use longitudinal designs to untangle what is cause and what is effect.
- For policy makers: People in recovery are often at a disadvantage, in part because of what this study shows: that a natural human tendency to prefer immediate rewards, and to defer costs, is amplified in people who meet criteria for substance use disorder or who are in early remission. Policies that protect against these tendencies – e.g., reimbursing for contingency management which provides rewards in response to recovery-related behaviors like negative toxicology screens – might increases people abilities to seek and sustain remission long term.
CITATIONS
Fontes, R. M., Bovo, A. C. L., Freitas-Lemos, R., & Bickel, W. K. (2025). Differential discounting of past and future gains and losses in individuals in recovery from substance use disorder. Experimental and Clinical Psychopharmacology, 33(3), 291-299. doi: 10.1037/pha0000769.
