Substance use disorder severity is associated with sensitivity to effort-related decision-making constraints

Rationale: Several studies have reported associations between substance use and effort-related decision making, or the degree to which effort expenditure impacts the choice between lower and higher value rewards. However, previous research has not explored effort-related decision making in populations with severe substance use disorder.

Objectives: Investigate the association between effort-related decision-making and substance use disorder severity.

Methods: Adults with substance use disorders (n = 106) enrolled in intensive outpatient treatment completed clinician administered diagnostic interviews and the effort expenditure for rewards task (EEfRT). General linear mixed methods tested the interactive effect of substance use disorder severity and trial-level probability and value on the likelihood of selecting a high-effort choice.

Results: There was a significant interaction between SUD severity and both reward value and reward probability on high-effort choice. The strength of the association between both reward value and probability on high-effort choice significantly increased with SUD severity.

Conclusions: These results support theories of reward sensitivity and behavioral economics and highlight an emerging risk factor that may serve as a useful target for treatment.