Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
Alcohol Clin Exp Res. 2017 Oct;41(10):1794-1807. doi: 10.1111/acer.13481. Epub 2017 Sep 25.
Impulsive decision making relates to problematic substance use. Specifically, altered delay discounting (DD) has been suggested as a behavioral marker for addiction, while other relevant facets of choice impulsivity such as probability discounting (PD) or loss aversion are clearly understudied.
Two studies were performed collecting behavioral data on choice impulsivity with a value-based decision-making battery providing estimates of DD, PD for gains and losses, and loss aversion. Study (1): In a sample of 198 male 18-year-old social drinkers, we analyzed impulsive choice behavior and its association with alcohol consumption and self-report measures of substance use-related personality traits on a cross-sectional level. Additionally, the predictive value of baseline choice behavior for the trajectories of alcohol consumption over a 12-month follow-up period was evaluated. Study (2): Behavioral data on choice impulsivity were collected for 114 detoxified patients with alcohol use disorder (AUD) and 98 control participants. We analyzed group differences at baseline and assessed the predictive value of choice impulsivity for relapse to heavy alcohol use in patients during a follow-up period of 48 weeks.
Study (1): Only DD was associated with baseline alcohol use, but no measure of choice impulsivity predicted the drinking trajectories over the following 12 months. Study (2): Compared to the control group, AUD patients showed higher DD, lower risk aversion regarding probabilistic gains, lower risk seeking regarding probabilistic losses, and lower loss aversion facing mixed prospects. Further, shallow discounting of probabilistic losses at baseline was predictive for relapse in patients.
All 4 domains of impulsive decision making were considerably altered in AUD patients though mostly not related to alcohol use in young adult social drinkers. This suggests that these facets of impulsive behavior may develop as consequences of chronic alcohol consumption. Furthermore, discounting of probabilistic losses might prove valuable in identifying patients vulnerable for relapse.
冲动决策与问题性物质使用有关。具体而言，改变的延迟折扣（DD）被认为是成瘾的行为标志物，而其他相关选择冲动的方面，如概率折扣（PD）或损失厌恶，显然研究不足。
进行了两项研究，使用基于价值的决策测试收集了选择冲动的行为数据，该测试提供了 DD、得失的 PD 和损失厌恶的估计值。研究 1：在 198 名 18 岁的男性社交饮酒者样本中，我们分析了冲动选择行为及其与酒精消费和物质使用相关人格特质的自我报告测量之间的关系，在横断面水平上。此外，还评估了基线选择行为对 12 个月随访期间酒精消费轨迹的预测价值。研究 2：对 114 名酒精使用障碍（AUD）患者和 98 名对照参与者进行了选择冲动的行为数据收集。我们分析了基线的组间差异，并评估了选择冲动对患者在 48 周随访期间复饮的预测价值。
研究 1：只有 DD 与基线酒精使用有关，但没有任何选择冲动的测量指标预测了接下来 12 个月的饮酒轨迹。研究 2：与对照组相比，AUD 患者的 DD 更高，对概率收益的风险规避更低，对概率损失的风险寻求更低，以及对混合前景的损失厌恶更低。此外，基线时概率损失的浅折扣预测了患者的复发。
尽管冲动决策的所有 4 个领域在 AUD 患者中都发生了相当大的改变，但在年轻成年社交饮酒者中，这些领域与酒精使用大多没有关系。这表明这些冲动行为方面可能是由于慢性酒精消费而发展的。此外，概率损失的折扣可能证明在识别易复发的患者方面具有价值。
