Delay Discounting, Treatment Motivation and Treatment Retention Among Substance-Dependent Individuals Attending an in Inpatient Detoxification Program

• We examine the relationship between delay discounting and treatment retention.
• We explore the mediating role of treatment motivation in this relationship.
• Delay discounting predicts poorer treatment retention.
• Part of this effect may be explained by lower treatment readiness.
• Implications of findings for recovery-oriented services are being discussed.

BackgroundRecent studies consistently indicate high rates of delay discounting in drug users, which refers to a strong tendency to devaluate delayed rewards. Many addiction treatment programs however, place high demands on the ability to postpone immediate gratification. Therefore, these programs may be particularly challenging for drug users who are disproportionally oriented towards the present, potentially leading to a drop in their treatment involvement. Still, few studies to date have looked at whether delay discounting in drug users is associated with poorer treatment motivation or shorter treatment retention (i.e., the length of stay in treatment).MethodIn the current study, we examined whether delay discounting, as measured shortly following treatment entry, was predictive of poor treatment retention among 84 substance-dependent individuals (SDI) attending an inpatient detoxification program. In addition, we examined whether motivation for treatment would act as a mediator of this relationship.ResultsDelay discounting was predictive of shorter treatment retention and higher odds of dropping out of treatment prematurely. The effects of delay discounting on treatment retention were partially mediated by a subcomponent of treatment motivation, i.e., treatment readiness.ConclusionThe propensity to more steeply discount delayed rewards in drug users has the potential to become a clinically relevant behavioral marker, alerting clinicians that these clients may exhibit lower treatment readiness and are more likely to drop out of treatment prematurely. Targeting delay discounting or increasing treatment readiness in drug users with a low tolerance for delay-of-gratification may help to improve treatment retention among these individuals.