Section on Human Psychopharmacology, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA.
Section on Human Psychopharmacology, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA.
Pharmacol Biochem Behav. 2018 Jan;164:118-124. doi: 10.1016/j.pbb.2017.09.007. Epub 2017 Sep 18.
Poor decision-making is a central feature of all substance use disorders (SUD), but substances vary in the legal and health consequences associated with their use. For example, while the negative health consequences associated with cigarette smoking are often years away, the consequences of heroin abuse can be fatal in mere hours. It remains unclear if users of these substances show decision-making patterns that differ with the relative riskiness of their drug of choice. To address this question, we reviewed studies that compared decision-making of individuals using different substances. We focused on studies assessing two of the most commonly investigated decision-making processes-delay discounting and risk taking-and specifically focused on decision-making that involved selection between options for hypothetical monetary rewards. For delay discounting, we reviewed studies that assessed decisions regarding delayed or immediate monetary rewards, and for risk-taking we reviewed studies using the Iowa Gambling Task. Studies directly comparing different SUD groups were limited in number and tended to compare alcohol or cocaine users to other substance users. Overall, these studies do not support the hypothesis that decision-making differed by drug of choice. Major limitations in the literature include failing to account for comorbid substance use and a lack of prospective longitudinal studies. Due to these limitations, conclusions should be considered provisional. Nonetheless, current findings suggest that these two facets of decision-making are similar across drugs of abuse.
决策能力差是所有物质使用障碍（SUD）的核心特征，但不同物质的使用与其相关的法律和健康后果也有所不同。例如，虽然吸烟带来的负面健康后果往往要多年后才会显现，但滥用海洛因的后果在短短几个小时内就可能致命。目前尚不清楚这些物质的使用者是否表现出与他们选择的药物相对风险程度不同的决策模式。为了解决这个问题，我们回顾了比较不同物质使用者决策的研究。我们重点关注评估两种最常被研究的决策过程——延迟折扣和冒险行为的研究，并特别关注涉及对假设货币奖励选项进行选择的决策。对于延迟折扣，我们回顾了评估关于延迟或即时货币奖励的决策的研究，对于冒险行为，我们回顾了使用爱荷华赌博任务的研究。直接比较不同 SUD 群体的研究数量有限，而且往往将酒精或可卡因使用者与其他物质使用者进行比较。总体而言，这些研究并不支持决策因药物选择而异的假设。文献中的主要局限性包括没有考虑共病物质使用以及缺乏前瞻性纵向研究。由于这些局限性，结论应被视为暂定的。尽管如此，目前的研究结果表明，这两个决策方面在滥用药物中是相似的。
