Lake Marilyn T, Shoptaw Steven, Ipser Jonathan C, Takada Sae, van Nunen Lara J, Lipinska Gosia, Stein Dan J, London Edythe D
Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
Department of Psychology, University of Cape Town, Cape Town, South Africa.
Front Psychiatry. 2020 Feb 18;11:22. doi: 10.3389/fpsyt.2020.00022. eCollection 2020.
Individuals with substance use disorders exhibit maladaptive decision-making on the Iowa Gambling Task (IGT), which involves selecting from card decks differing in the magnitudes of rewards, and the frequency and magnitude of losses. We investigated whether baseline IGT performance could predict responses to contingency management (CM) by treatment-seeking individuals with methamphetamine use disorder (MA Use Disorder) in Cape Town, South Africa.
Twenty-nine individuals with MA Use Disorder underwent an 8-week, escalating reinforcement, voucher-based CM treatment in a study on the suitability of CM therapy for the South African context. Along with 20 healthy control participants, they performed a computerized version of the IGT before starting CM treatment. Seventeen participants maintained abstinence from methamphetamine throughout the trial (full responders), and 12 had an incomplete response (partial responders). Performance on the IGT was scored for magnitude effect (selection of large immediate rewards with high long-term loss) and for frequency effect (preference for frequent rewards and avoidance of frequent losses). Group differences were investigated using linear mixed-effect modeling.
Partial responders made more selections from decks providing large, immediate rewards and long-term losses than healthy controls [ = 0.038, = -0.77 (-1.09: -0.44)]. Full responders showed a greater, nonsignificant preference for frequent rewards and aversion to frequent losses than partial responders [ = 0.054, = -0.63 (-0.95: -0.29)].
A predilection for choices based on the size and immediacy of reward may reflect a cognitive strategy that works against CM. Pretesting with a decision-making task, such as the IGT, may help in matching cognitive therapies to clients with MA Use Disorder.
患有物质使用障碍的个体在爱荷华赌博任务（IGT）中表现出适应不良的决策，该任务涉及从奖励大小、损失频率和损失大小不同的牌组中进行选择。我们调查了基线IGT表现是否可以预测南非开普敦寻求治疗的甲基苯丙胺使用障碍（MA使用障碍）个体对权变管理（CM）的反应。
29名患有MA使用障碍的个体在一项关于CM疗法在南非适用性的研究中接受了为期8周的强化、基于代金券的CM治疗。与20名健康对照参与者一起，他们在开始CM治疗前进行了计算机化的IGT。17名参与者在整个试验中保持甲基苯丙胺戒断（完全反应者），12名参与者反应不完全（部分反应者）。对IGT的表现进行评分，包括大小效应（选择具有高长期损失的大即时奖励）和频率效应（偏好频繁奖励并避免频繁损失）。使用线性混合效应模型研究组间差异。
部分反应者从提供大即时奖励和长期损失的牌组中做出的选择比健康对照者更多[P = 0.038，β = -0.77（-1.09：-0.44）]。完全反应者比部分反应者对频繁奖励表现出更大但不显著的偏好，对频繁损失表现出厌恶[P = 0.054，β = -0.63（-0.95：-0.29）]。
基于奖励大小和即时性的选择偏好可能反映了一种不利于CM的认知策略。使用决策任务（如IGT）进行预测试可能有助于将认知疗法与患有MA使用障碍的客户相匹配。
