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Review
. 2015 Sep 1:6:1104.
doi: 10.3389/fpsyg.2015.01104. eCollection 2015.

Impulsive delayed reward discounting as a genetically-influenced target for drug abuse prevention: a critical evaluation

Joshua C Gray  1 , James MacKillop  2
Affiliations
Review

Impulsive delayed reward discounting as a genetically-influenced target for drug abuse prevention: a critical evaluation

Joshua C Gray et al. Front Psychol. .

Abstract

This review evaluates the viability of delayed reward discounting (DRD), an index of how much an individual devalues a future reward based on its delay in time, for genetically-informed drug abuse prevention. A review of the literature suggests that impulsive DRD is robustly associated with drug addiction and meets most of the criteria for being an endophenotype, albeit with mixed findings for specific molecular genetic influences. Several modes of experimental manipulation have been demonstrated to reduce DRD acutely. These include behavioral strategies, such as mindfulness, reward bundling, and episodic future thinking; pharmacological interventions, including noradrenergic agonists, adrenergic agonists, and multiple monoamine agonists; and neuromodulatory interventions, such as transcranial magnetic stimulation and transcranial direct current stimulation. However, the generalization of these interventions to positive clinical outcomes remains unclear and no studies to date have examined interventions on DRD in the context of prevention. Collectively, these findings suggest it would be premature to target DRD for genetically-informed prevention. Indeed, given the evidence of environmental contributions to impulsive DRD, whether genetically-informed secondary prevention would ever be warranted is debatable. Progress in identifying polymorphisms associated with DRD profiles could further clarify the underlying biological systems for pharmacological and neuromodulatory interventions, and, as a qualitatively different risk factor from existing prevention programs, impulsive DRD is worthy of investigation at a more general level as a novel and promising drug abuse prevention target.

Keywords: addiction; behavior economics; behavioral economics; delayed reward discounting; drug abuse; intertemporal choice; substance use disorders.

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Figures

FIGURE 1
FIGURE 1
Prototypic hyperbolic delayed reward discounting curves reflecting the discounted subjective value of $100 delayed from 1 day to 1 year The curves reflect the points at which the smaller immediate reward is equal in value to the $100 delayed reward. For example, at a delay of 100 days, $100 has lost ∼50% of its nominal value for the low impulsivity profile and ∼90% of its nominal value for the high impulsivity profile. Figure from MacKillop (2013).
FIGURE 2
FIGURE 2
A framework for considering developing genetically-informed prevention and treatment. General theoretical framework for an endophenotype approach to addiction genetics, integrating endophenotype-specific treatment approaches (Ray et al., 2010) (A). Specific model of delayed reward discounting (DRD) as an endophenotype of genetic risk for addiction liability (B). Numbers 1–4 reflect the necessary components to establish DRD as a viable genetically-influenced prevention target for drug abuse: (1) a robust relationship between DRD and drug abuse; (2) genetic loci that are reliably associated with delay discounting; (3) possession of risk alleles for DRD risk that are responsible for drug abuse risk; (4) efficacious strategies for reducing impulsive DRD.
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