Diagnostic validity of alcohol demand and monetary delay discounting in relation to alcohol use disorder

BACKGROUND: A reinforcer pathology approach to alcohol use disorder (AUD) proposes that high alcohol reinforcing value (high alcohol demand) and overvaluation of immediate rewards (high discounting of future rewards) are critical determinants of problematic drinking. Applied to clinical settings, these indicators have not been examined as potential assessments for use in clinical practice. Toward that end, the current study examined whether reinforcer pathology indicators accurately classify individuals with AUD from recreational drinkers without AUD at levels that would meet clinical accuracy benchmarks. METHODS: In a case-control sample of 267 Canadian adults (180 meeting DSM-5 criteria for AUD), receiver operating characteristic (ROC) curves were constructed using reinforcer pathology indicators from an alcohol purchase task and a monetary delay discounting tasks. RESULTS: Analysis of the ROC curves revealed that three alcohol demand indices from the alcohol purchase task [i.e. Intensity (observed consumption when free), Omax (observed maximum expenditure), and α (a derived index of price-sensitivity)] significantly differed by groups and met established clinical benchmarks for diagnostic differentiation. While delay discounting significantly differed between groups, it did not meet benchmarks as a clinical differentiator. CONCLUSIONS: This study provides evidence that behavioral economic measures of alcohol valuation accurately diagnostically discriminate individuals with AUD from recreational drinkers. Future work should consider utilizing other behavioral economic indices and validating these results in more diverse populations.