Persistence outperforms delay discounting in predicting drinking severity in healthy adults

Background: Alcohol misuse ranks among the leading causes of preventable death worldwide. Therefore, discovering measures that can predict hazardous drinking and vulnerability to alcohol use disorder is of critical importance. The delay discounting paradigm – which assesses relative preference for smaller, sooner rewards over larger, later rewards – has frequently been used as a proxy for impulsivity in substance use disorders. Delay discounting, however, does not capture how long a person is willing to wait for delayed rewards when arrival time is uncertain. In contrast, a recently developed persistence task measures how long a person is willing to wait for a delayed reward of uncertain timing before giving up. We hypothesized that performance in the persistence task would be associated with drinking severity in healthy adults, and that this task may even outperform delay discounting as a predictor of drinking severity. Methods: A delay discounting task, a persistence task, and the Alcohol Use DisordersIdentification Test (AUDIT) were administered to 241 healthy adults (n = 213 included in finalanalyses). Data were pooled from four laboratory studies. Zero-inflated Poisson regressionmodels were used to assess the association between delay discounting rate and AUDIT scores,and between persistence and AUDIT scores. Results: We found that persistence under temporal uncertainty, but not delay discounting, wasassociated with the severity of alcohol consumption among drinkers. Specifically, compared tolow-risk drinkers, hazardous drinkers were less willing to wait for delayed rewards when delayswere unknown. Neither measure predicted whether or not someone endorsed drinking at all. Conclusions: These findings suggest that persistence, but not delay discounting, may be animportant predictor of drinking severity. A lower willingness to persist for delayed rewardsunder temporal uncertainty may be a risk factor for the development of alcohol use disorder.