Delay discounting rates: a strong prognostic indicator of smoking relapse

Christine E Sheffer, Darren R Christensen, Reid Landes, Larry P Carter, Lisa Jackson, Warren K Bickel, Christine E Sheffer, Darren R Christensen, Reid Landes, Larry P Carter, Lisa Jackson, Warren K Bickel

Abstract

Background: Recent evidence suggests that several dimensions of impulsivity and locus of control are likely to be significant prognostic indicators of relapse.

Method: One-hundred and thirty-one treatment seeking smokers were enrolled in six weeks of multi-component cognitive-behavioral therapy with eight weeks of nicotine replacement therapy.

Analysis: Cox proportional hazard regressions were used to model days to relapse with each of the following: delay discounting of $100, delay discounting of $1000, six subscales of the Barratt Impulsiveness Scale (BIS), Rotter's Locus of Control (RLOC), Fagerstrom's Test for Nicotine Dependence (FTND), and the Perceived Stress Scale (PSS). Hazard ratios for a one standard deviation increase were estimated with 95% confidence intervals for each explanatory variable. Likelihood ratios were used to examine the level of association with days to relapse for different combinations of the explanatory variables while accounting for nicotine dependence and stress level.

Results: These analyses found that the $100 delay discounting rate had the strongest association with days to relapse. Further, when discounting rates were combined with the FTND and PSS, the associations remained significant. When the other measures were combined with the FTND and PSS, their associations with relapse non-significant.

Conclusions: These findings indicate that delay discounting is independently associated with relapse and adds to what is already accounted for by nicotine dependence and stress level. They also signify that delay discounting is a productive new target for enhancing treatment for tobacco dependence. Consequently, adding an intervention designed to decrease discounting rates to a comprehensive treatment for tobacco dependence has the potential to decrease relapse rates.

Keywords: Delay discounting rates; Impulsivity; Smoking cessation; Tobacco dependence.

Copyright © 2014 Elsevier Ltd. All rights reserved.

Figures

Figure 1
Figure 1
Hazard ratios for a one standard deviation increase for each measure/explanatory variable plotted with 95% confidence intervals (CIs). CIs that do not cover the center line (i.e., hazard ration = 1) are significant at the .05 level. Discounting = Delay discounting measures; BIS = Barratt Impulsiveness Scale-11; LOC=Rotter’s Locus of Control; PSS = Perceived Stress Scale; FTND= Fagerstrom Test for Nicotine Dependence; $100= delay discounting of $100; Mean = Mean value of delay discounting of $100 and $1000; $1000 = delay discounting of $1000; CI = Cognitive Instability; SC= Self-control; MI= Motor Impulsivity; MO = Motor; NI=Non-planning Impulsivity; AI=Attentional Impulsivity.
Figure 2
Figure 2
Standardized regression coefficient estimates for one standard deviation increase for each measure/explanatory variable plotted with 95% confidence intervals (CIs) for a difference from the coefficient for delay discounting of $100. CIs not covering the center line are significantly different from the coefficient for delay discounting of $100 (p<.05 discounting="Delay" measures bis="Barratt" impulsiveness scale-11 loc="Rotter’s" locus of control pss="Perceived" stress scale ftnd="Fagerstrom" test for nicotine dependence delay mean="Mean" value and ci="Cognitive" instability sc="Self-control;" mi="Motor" impulsivity mo="Motor;" ni="Non-planning" ai="Attentional" impulsivity.>

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