A Descriptive Analysis of Preference for and Delay Discounting of Community Reinforcers in Substance Use Treatment

Abstract

The community reinforcement approach (CRA) to substance use treatment involves providing individuals who use substances access to community and leisure activities. The delivery format of CRA and availability of community activities varies across treatment centers. Twelve community and leisure activities described as commonly incorporated into CRA were identified through a survey of clinicians and practitioners at substance use clinics and treatment centers. In a subsequent survey, people who engage in substance use self-reported their preference for each of these activities via two different methods: rating and ranking. The most frequently highly rated activities across participants included hiking and reading and the lowest rated activity across participants was attending a social club. In contrast, activities with family and friends and attending self-help groups were most highly ranked across participants whereas reading was ranked lowest across participants. Correspondence between rating and ranking of community reinforcers in individuals who use substances generally showed high variability. Delay discounting (DD) of the highest and lowest ranked community reinforcer was in turn assessed to determine if more highly preferred activities were discounted less than non-preferred activities. Discounting of the highest and lowest ranked activities on the 5-trial adjusting delay discounting task was similar, and these commodities were discounted more than hypothetical monetary rewards on an abbreviated monetary choice questionnaire (MCQ). Although further research is needed, utilization of preference assessments and subsequent DD of preferred stimuli could be a means to identify activities that may function as reinforcers in CRA to maintain abstinence in people who use substances.