A Serial Mediation Analysis of Delay Discounting and Remission in Substance Use Disorders Recovery

Understanding the mechanisms that support or undermine substance use disorders (SUDs) recovery is essential. We examine the direct and indirect associations between delay discounting and three-month remission among individuals in recovery from SUDs.

Participants (N = 316) from the International Quit & Recovery Registry completed demographics, measures of distress tolerance, craving, and delay discounting. Remission from SUDs was defined as no DSM-5 SUD symptoms except craving in the past three months. Zero-order correlations were utilized to investigate associations among the core study variables. Serial multiple mediation models were estimated, with delay discounting as the predictor, distress tolerance followed by craving as the mediators, and the three-month remission as the outcome.

Delay discounting was significantly associated with three-month remission, with lower discounting associated with a greater likelihood of remission. Delay discounting indirectly predicted three-month remission via two significant mediating pathways: distress tolerance followed by craving accounted for 20.5%, and craving alone accounted for 51.9% of the overall effect. The total mediating effect was 77.1%. These findings suggest that the delay discounting-three-month remission link is partially and serially explained by distress tolerance followed by craving.

Addressing both distress tolerance and craving, particularly for individuals exhibiting elevated delay discounting, may be significant for promoting long-term recovery.