Context-dependent asymmetries in intertemporal decision-making: a comparative study of substance use disorder and control groups

This study investigated context-dependent intertemporal decision-making patterns in substance use disorder (SUD) through a comprehensive experimental paradigm examining both gain and loss contexts. Using mixed-effects analysis of 26,144 decisions from 186 participants (100 SUD, 86 controls), we found significant group differences in context-dependent choice patterns (OR = 0.39, p <.001). The SUD group showed enhanced preference for delayed losses (lnk = 4.67 vs. 4.81, p <.001) but only marginally stronger immediate reward preference (lnk = 4.40 vs. 4.37, p =.089). While temporal processing remained intact across groups (OR = 0.98, p =.785), magnitude sensitivity varied significantly by context, particularly in loss scenarios. These findings challenge traditional views of uniformly impaired decision-making in SUD and suggest the need for context-aware intervention strategies that leverage preserved temporal processing abilities.