Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai, 200030, China.
Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China.
Psychopharmacology (Berl). 2020 Jul;237(7):1893-1908. doi: 10.1007/s00213-020-05506-y. Epub 2020 May 4.
This review aims to identify whether risky decision-making is increased in substance users, and the impact of substance type, polysubstance use status, abstinence period, and treatment status on risky decision-making.
A literature search with no date restrictions was conducted to identify case-control studies or cross-sectional studies that used behavioral tasks to measure risky decision-making in substance users. A random-effects model was performed. GRADE criteria was used to assess the quality of evidence.
52 studies were enrolled. The result showed that the difference in risky decision-making performance between user groups and control groups was significant (SMD = - 0.590; 95%CI = - 0.849 to - 0.330; p < 0.001; I = 93.4%; P < 0.001). Subgroup analysis showed that users in the subgroups of alcohol (p < 0.001), tobacco (p < 0.01), cocaine (p < 0.001), opioid (p < 0.001), mixed group (p < 0.01), adult users (p < 0.001), small sample size (p < 0.001), large sample size (p < 0.01), low education (p < 0.001), high education (p < 0.001), short-abstinence period (p < 0.001), long-abstinence period (p < 0.001), without current polysubstance dependence (p < 0.001), and with treatment (p < 0.001) had increased risky decision-making when compared to the controls. On the other hand, elderly substance users with short-abstinence period showed increased risky decision-making. Moreover, current treatment status and polysubstance use may not influence the level of decision-making in substance users.
The results show that substance use is associated with impaired risky decision-making, indicating that interventions targeting risky decision-making in substance users should be developed for relapse prevention and rehabilitation.
本综述旨在确定物质使用者是否存在风险决策增加的情况，以及物质类型、多物质使用状况、戒断期和治疗状况对风险决策的影响。
对无日期限制的文献进行检索，以确定使用行为任务来测量物质使用者风险决策的病例对照研究或横断面研究。采用随机效应模型。使用 GRADE 标准评估证据质量。
纳入了 52 项研究。结果表明，使用者组和对照组之间的风险决策表现存在显著差异（SMD=-0.590；95%CI=-0.849 至-0.330；p<0.001；I=93.4%；P<0.001）。亚组分析显示，酒精（p<0.001）、烟草（p<0.01）、可卡因（p<0.001）、阿片类药物（p<0.001）、混合组（p<0.01）、成年使用者（p<0.001）、小样本量（p<0.001）、大样本量（p<0.01）、低教育程度（p<0.001）、高教育程度（p<0.001）、短戒断期（p<0.001）、长戒断期（p<0.001）、当前无多物质依赖（p<0.001）和接受治疗（p<0.001）的使用者组与对照组相比，风险决策能力增加。另一方面，短期戒断期的老年物质使用者表现出增加的风险决策能力。此外，当前的治疗状况和多物质使用可能不会影响物质使用者的决策水平。
结果表明，物质使用与受损的风险决策有关，这表明应针对物质使用者的风险决策制定干预措施，以预防复发和康复。
