共病精神病理学个体中，延迟折扣与酒精依赖之间的关系。
The relationship between delay discounting and alcohol dependence in individuals with and without comorbid psychopathology.
机构信息
Department of Radiology, University of Colorado School of Medicine, Denver, CO, USA.
Section on Human Psychopharmacology, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, 10 Center Drive, Building 10, Room 2-2352, Bethesda, MD, 20892-1540, USA.
出版信息
Psychopharmacology (Berl). 2019 Feb;236(2):775-785. doi: 10.1007/s00213-018-5113-3. Epub 2018 Nov 19.
RATIONALE
Alcohol use disorder (AUD) has been associated with greater discounting of delayed monetary rewards, but it is unclear whether this association is primarily related to alcohol consumption or is secondary to the presence of psychiatric comorbidities. It is also unclear if steeper rates of discounting are associated with greater AUD severity.
OBJECTIVE
We sought to determine whether the presence of comorbid psychiatric disorders affected the relationship between AUD and delay discounting. We also examined whether more severe AUD was associated with greater delay discounting.
METHODS
In this cross-sectional study, 793 adults completed a delay discounting task. Subjects were divided into four groups based on diagnosis: current AUD with psychiatric comorbidities (N = 226), current AUD without psychiatric comorbidities (N = 203), past AUD (N = 69), and healthy controls (N = 295). In those with AUD, we investigated the relationship between delay discounting and alcohol dependence symptom count and recent drinking history. We also compared individuals seeking treatment to non-treatment seeking individuals. Psychiatric comorbidities examined included mood disorders, anxiety disorders, and substance use disorders.
RESULTS
After adjusting for age, sex, income, and education, individuals with current AUD showed significantly higher rates of delay discounting than healthy controls and individuals with a past diagnosis of AUD. The presence of comorbid psychiatric diagnoses was not associated with steeper discounting. Among those with AUD, there was no evidence for a continuous relationship between delay discounting and AUD severity or alcohol consumption. Finally, non-treatment seekers with AUD had steeper delay discounting than treatment seekers.
CONCLUSIONS
Individuals with AUD show steeper delay discounting than healthy adults, but the effect is small and there is no added effect from comorbid psychopathology or increased AUD severity. This suggests that steeper delay discounting may have a more limited effect on human alcohol use than previously supposed.
背景
酒精使用障碍（AUD）与延迟货币奖励的折扣程度增加有关，但尚不清楚这种关联主要与饮酒有关，还是与精神共病的存在有关。此外，折扣率的陡峭程度是否与 AUD 严重程度增加有关也不清楚。
目的
我们旨在确定精神共病是否会影响 AUD 与延迟折扣之间的关系。我们还检查了更严重的 AUD 是否与更大的延迟折扣有关。
方法
在这项横断面研究中，793 名成年人完成了延迟折扣任务。根据诊断将受试者分为四组：有精神共病的当前 AUD（N=226）、无精神共病的当前 AUD（N=203）、过去 AUD（N=69）和健康对照组（N=295）。在 AUD 患者中，我们研究了延迟折扣与酒精依赖症状计数和近期饮酒史之间的关系。我们还比较了寻求治疗的个体和非治疗寻求的个体。检查的精神共病包括心境障碍、焦虑障碍和物质使用障碍。
结果
在调整年龄、性别、收入和教育程度后，当前 AUD 患者的延迟折扣率明显高于健康对照组和过去 AUD 患者。共病精神诊断的存在与折扣率的陡峭程度无关。在 AUD 患者中，没有证据表明延迟折扣与 AUD 严重程度或饮酒之间存在连续关系。最后，有 AUD 的非治疗寻求者的延迟折扣率高于治疗寻求者。
结论
AUD 患者的延迟折扣率高于健康成年人，但影响较小，且共病精神病理学或 AUD 严重程度增加没有额外影响。这表明，与之前的假设相比，延迟折扣率对人类饮酒的影响可能更为有限。
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